NASHVILLE - Gov. Bill Haslam said Thursday he wants to decide during this legislative session if the state should expand Medicaid to an estimated 181,000 low-income Tennesseans under the federal Affordable Care Act.
"Any decision we make, I promise you, we're going to get the Legislature to approve," the Republican governor said after speaking at a Tennessee Press Association and The Associated Press luncheon. "We'd love to decide that prior to their leaving. It just makes it neater."
Haslam had said he would like to wait until later in the year to decide, but there's already a move afoot in the GOP-dominated Legislature to bar the state from expanding its Medicaid program, known as TennCare.
The hospital industry and advocates for the poor, meanwhile, are urging the governor to go along with the expansion.
Earlier Thursday, Republican Senate Speaker Ron Ramsey told reporters that Sen. Brian Kelsey, R-Collierville, has agreed to go slow on his bill to bar any TennCare expansion.
Ramsey said he told Kelsey the governor needs time to explore the pros and cons and decide whether an expansion makes sense.
Ramsey and Haslam have indicated the Obama administration is making overtures about granting states more flexibility in managing Medicaid through copays in things like emergency room care.
"Let's don't preclude a good discussion and thoughtful process to decide what the right thing is for the state," he said.
Still, the speaker said he's not convinced the expansion is a good idea because of federal budget problems.
Uncle Sam will pay the entire cost for the first three years, scaling back to 90 percent after 2019. The first 51/2 years would cost the state about $200 million, according to the TennCare Bureau.
But a federal budget squeeze could make it impossible to keep the 90 percent promise, Ramsey and Kelsey fear.
Kelsey called the promise a "false assumption" given past federal actions including a Medicaid funding cut in 1981. He recalled how Gov. Phil Bredesen slashed TennCare rolls in the mid-1990s when costs proved unsustainable.
"You know the federal government will have to cut its subsidy," he said.
Voice for patients
Gordon Bonnyman, executive director of the Tennessee Justice Center, told publishers, editors and reporters at the TPA-AP event expanding TennCare would save lives and provide financial security to "hundreds of thousands of working families."
The expansion would provide coverage for families whose incomes are up to 138 percent of the federal poverty level -- $15,415 a year or less for a single person, or $31,809 for a family of four.
Moreover, said Bonnyman, an attorney and health care expert, a University of Minnesota study found that 90,000 direct jobs would be created.
Bonnyman said low-income people with illnesses like cancer would welcome even three years of coverage paid entirely by the federal government.
"The folks that I'm close to would say, 'I need help right now,'" Bonnyman said.
Tennessee hospital officials said the national hospital industry struck a deal with President Barack Obama to give up special federal payments in exchange for the Medicaid expansion.
With neither, many hospitals will lose money and some could fail, industry officials say.
Tennessee Hospital Association President Craig Becker said state hospitals will lose about $4.3 billion over 10 years in cuts to special payments. Other cuts by Congress bring the projected losses to $5.6 billion.
Undeterred, Kelsey said, "My job is not to bail out the special-interest hospital lobby. My job is to represent Tennessee taxpayers. I represent Tennessee taxpayers. I do not represent Tennessee hospitals."