NASHVILLE — Gov. Bill Haslam said today he still doesn't know how a U.S. House Republican plan that seeks to replace the Affordable Care Act or Obamacare will ultimately impact Tennessee.
The nonpartisan Congressional Budget Office's report on the House proposal projects the bill, which has already cleared two House committees, would boost the number of uninsured Americans by 14 million next year, with a total of 24 million impacted over the next decade.
But it includes no state-by-state breakdowns.
"Some of that depends on obviously what the final bill looks like," Haslam, a Republican, told reporters. "The key thing, as I keep saying, for us is I think it's moving toward something where we'll get some per capita grant, a per person amount for folks in Medicaid."
Haslam added: "We're willing to do that, but will we have some additional flexibility in the program? The initial bill that I saw did not have all that much additional flexibility. So that's our primary concern."
Tennesseans who are on the federal health care exchanges — where they currently receive federally subsidized premium assistance based on their income — would be affected.
And states' Medicaid programs, operated in Tennessee as TennCare, would be impacted, as well. It covers an estimated 1.3 million low- income women, children, disabled and some elderly persons.
Medicaid, which is jointly funded by states and the federal government, is currently an open-ended entitlement program, meaning the federal government provides matching funds based on enrollment and costs. But that would change under the House bill's plan to turn Medi-caid into a block grant program with set amounts.
"The challenge for us as a state is if there's, say, a new drug that comes out that we weren't covering previously, say like the Hep C drug that came out that's $95,000 per regimen," Haslam said. "That would all be new expenses and built on the base you have.
"That's the reason we feel like we need more flexibility to be prepared for something like [that]," Haslam continued. "Obviously in an economic downturn you're going to have more people come on Medicaid. That's why we feel like we need the flexibly in that new environment."
Unlike many states, Tennessee did not expand Medicaid under the Affordable Care Act. Haslam tried but fellow Republicans in the Tennessee General Assembly rebuffed him.
Alluding to the health care exchange intended for persons whose incomes are above the poverty level, Craig Becker, executive director of the Tennessee Hospital Association, warned last week that state-based hospitals believe "a significant number of the roughly 230,000 Tennesseans currently covered could lose their coverage because of an inability to pay for insurance due to significantly reduced federal subsidies."
Contact staff writer Andy Sher at email@example.com or 615-255-0550. Follow him on Twitter @AndySher1.
This story was updated March 14 at 11:20 p.m.