From insurance co-pays to the reliability of the federal government, local lawmakers had plenty of ground they wanted Gov. Bill Haslam to cover Wednesday during an hourlong meeting in Chattanooga about his proposed Insure Tennessee plan.
Legislators peppered the governor with questions, and some struck a skeptical tone. But Haslam expected as much, he said after the meeting.
"Health care, first of all, is a complex subject. And because it's tied in some people's minds to Obamacare it becomes very politically contentious," he said. But, he argued, the plan is "an opportunity for Tennesseans who don't have health care coverage to have that at no cost to state government."
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Chattanooga was just one stop on the governor's statewide tour to meet with lawmakers before the General Assembly convenes next week in a special session to debate the plan.
Insure Tennessee aims to use federal Medicaid dollars to pay for what Haslam calls a "market-based" program that could provide coverage for an estimated 280,000 people. Haslam said Wednesday it's too early to predict whether he has the votes to pass the bill. He said he would announce a Senate sponsor this week.
Publicly, many lawmakers have been slow to support the plan. While House Majority Leader Gerald McCormick, R-Chattanooga, has already said he will help carry the bill, he, too, had questions as the group gathered at the downtown clinic of Cherokee Health Systems.
Cherokee's clinics serve more than 64,000 patients annually, including more than 21,000 who are uninsured, officials said. Currently only children, pregnant mothers and the disabled can get TennCare, the state's Medicaid program.
The Affordable Care Act allows states to cover thousands more, with federal dollars footing most of the bill. Advocates for expanding TennCare say Tennessee taxpayers' money is being used to expand Medicaid in other states, while Tennessee's refusal to expand the program here hurts its own working poor and its hospitals.
Sen. Todd Gardenhire, R-Chattanooga, said he had a problem with how hospitals, like Erlanger Health System, received taxpayer money to provide uncompensated care, and yet still turned large profits.
"Why do these companies need more money?" he asked.
Haslam said other Tennessee hospitals are struggling, and added that "this isn't about the hospitals" but about "individuals right now who don't have coverage."
Senate Speaker Pro Tempore Bo Watson, R-Hixson, asked for more details about how co-pays and vouchers would work, and said he was concerned an influx of new Medicaid patients and a limited number of doctors might create a bottleneck.
Rep. Ron Travis, R-Dayton, said he attended "pro" and "con" meetings about the bill, but important details -- like whether the state would be on the hook to keep the program even if it failed -- remained unclear.
"Will the federal government say, 'You bought into it, you must continue it?'" Travis asked.
Haslam said a Tuesday opinion from the state's attorney general and a letter this week from federal officials -- along with the Supreme Court's 2012 ruling -- assure him the state can opt out anytime.
"There are some things to be concerned about. That, I feel like, is not one of them," Haslam said. "I feel like some people have played that up."
Conservative groups like the Koch brothers-backed Americans for Prosperity and the Beacon Center have financed a blizzard of radio ads and direct mailers criticizing the plan. Haslam referenced such critics and the argument the plan creates more debt, saying that unaddressed health care costs are driving state and national debt.
"Long-term, we think the plan will actually take down health care costs," he said.
After attending the meeting, Mark West, president of the Chattanooga Tea Party, said the governor's "premise is flawed," and that the program still relies on taxpayer dollars -- even if they're federal rather than state.
"Is the government the right entity to be doing more and more to provide health care, when there are funding shortfalls in every other program they have?" he asked. "Is this the government's business?"
Grass-roots groups will protest the plan in Nashville next week, he said.
Around the same time Haslam was talking with lawmakers here, top administrative officials met at the state Capitol with at least 45 legislators to give new details and field questions.
Reaction was mixed among Republicans, who hold supermajorities in the House and Senate and are key to whether Haslam can proceed with his waiver.
Rep. Tim Wirgau, R-Buchanan, thanked fellow Republican Haslam for presenting a plan.
"I know a lot of representatives and senators are sitting here on pins and needles," he said. "They don't want to touch this because it's like Kryptonite to Superman."
But, Wirgau said, "From the rural side, my side, I see hospitals that are hurting and people who are hurting. I hope this will finally put to bed this political pingpong ball that we're bouncing back and forth."
However, Rep. Andy Holt, R-Dresden, said: "I'll tell you what I see. I see a plan that will create more dependency. And I think we as a country are moving in that direction. I see if we pass this waiver, we'll be the No. 1 subsidized state in the United States. I'm pretty uncomfortable with that."
Contact staff writer Kate Belz at kbelz@timesfresspress.com or 423-757-6673. Contact staff writer Andy Sher at 615-255-0550.