NASHVILLE -- Tennessee will be able to carry out requirements of the federal Affordable Care Act if the U.S. Supreme Court upholds the controversial law and should President Barack Obama be re-elected, Republican Gov. Bill Haslam said.
But the governor, who opposes the law, is keeping his fingers crossed the high court will strike down the law in a decision expected to be released today.
"Obviously I'm hoping that they do, because I think it saves the state money long term, and that will make things easier," Haslam told reporters this week.
Justices could uphold or strike down the entire law or major provisions like the individual mandate that requires most Americans to maintain a minimum level of private or, if they qualify, obtain government-sponsored health insurance coverage.
Another provision requires state Medicaid programs to expand and cover far more poor adults.
A University of Memphis study released earlier this year estimates that some 558,000 residents would get health insurance through the individual mandate or through a required expansion of the state's Medicaid program, TennCare, if the law is left intact.
According to 2010 U.S. Census Bureau estimates, about 930,000 people or 15 percent of Tennesseans don't have individual, employer-sponsored or government-sponsored health insurance coverage.
"We're hoping that it will be upheld," said Brad Palmertree, spokesman for the advocacy group Tennessee Health Care Campaign. Hundreds of thousands of people without coverage would soon see health benefits, he noted.
An estimated 1.6 million Georgians, or almost one in five people in the state, don't have coverage, Census Bureau figures show.
Haslam said Tennessee officials have continued to take steps toward establishing the health care "exchange" or market which is required by Democrat Obama's initiative.
Haslam's fellow Republicans in the Legislature this year balked at giving the go-ahead to the exchange, which will offer qualified health plans and cost-sharing assistance to people within certain income levels.
Republican state House and Senate leaders said they preferred to await the Supreme Court decision and, should the law or major portions be upheld, await the outcome of presidential and congressional elections in hopes of political change and the law's repeal.
States must notify federal officials by Nov. 16 on whether they intend to create their own exchange or let the federal government do it.
But Haslam said TennCare Director Darin Gordon told him that if the law is upheld, Tennessee wouldn't have to begin implementing the exchange until January, giving the GOP-led Legislature time to act.
"So if it's upheld, if the election [result] stays the same in November," the governor said. "If Obama wins the election, we don't think we would have to make any decision that would involve the legislature, which is when they'll be back in session."
"I think we've played this right, in the sense of being ready either way it goes," Haslam said.
The law also requires states expand their Medicaid programs and cover far more poor adults.
At this point, the TennCare Bureau estimates between 200,000 to 300,000 new enrollees could join the program, said agency spokeswoman Kelly Gunderson.
The additional costs are now projected at "$300 million plus," she said.
States like Georgia are battling the Medicaid provision in court and the Supreme Court is expected to rule on that along with the individual mandate.
"From the state-level perspective, the Medicaid expansion is the scariest provision in the law," said Georgia Gov. Nathan Deal spokesman Brian Robinson in an email.
He said Georgia officials anticipate 620,172 new enrollees in Medicaid as soon as the law takes effect Jan. 1, 2014.
"By 2013, that number will have risen to 694,325," he added. "Each one of those new enrollees comes with a price tag to the state."
Over the course of 10 years that would cost Georgia some $4.5 billion -- "money we don't have," Robinson said.
Haslam acknowledged more Tennesseans would get health coverage, but he, too, continues to worry about costs.
He said the state's prescription drug costs have started soaring late last year. The governor thinks "that was providers starting to take into accounts what we are going to do when we have to cover more people."
"I just think there are a lot of inherent costs in the new Health Care Act that [are] only just now beginning to show up and will accelerate," Haslam said. "Again, my concern is we didn't fix health care costs, which is the issue, we just expanded who was covered."
The Tennessee Health Care Campaign's Palmertree said the federal government will initially pay 100 percent of the cost for new enrollees brought into TennCare by the law's expansion requirements.
"It actually doesn't cost the state anything up front," Palmertree said.
Over the course of a decade, that will phase down to 90 percent, still a pretty big percentage with Tennessee picking up just 10 percent, Palmertree said.
But the state will continue to provide about a third of the costs for those coming onto the program who are eligible under existing poverty standards, the so-called "woodwork effect," he noted.
In an open letter to Obama posted on the Internet website Real Clear Politics on Tuesday, Deal told the president "we here in Georgia have strong opinions about this law. No matter how the court rules on its constitutionality, we believe that it is bad for Georgia, bad for businesses in Georgia, bad for the health care system and bad for the country.
"The fact of the matter is that Obamacare is not only a federal power grab but also an unfunded mandate," Deal added.