It's time for a bold move by Gov. Bill Haslam to put the health of Tennesseans ahead of politics.
The governor announced nearly a year ago he would not seek the Affordable Care Act's Medicaid expansion, an option the Supreme Court gave the states when it ruled in 2012 on the constitutionality of what has become known as Obamacare.
Haslam said he, instead, would seek federal approval for what he call his "Tennessee Plan," which he said would be financially better for the state in the long run. However, he has never submitted a formal plan to U.S. Health and Human Services Secretary Kathleen Sebelius and suggested last month the HHS come up with a plan he can accept.
It's understandable why the governor would not seek the Medicaid expansion and its possibly untenable cost just a few years down the road when the federal government, under the law, begins to pay less and less to the states. And there's the seemingly daily changes President Obama makes to the general law. As Forrest Gump once said, "You never know what you are going to get."
But Erlanger Health Systems Chief Executive Officer Kevin Spiegel and many others believe Haslam will wait until after the November election to move forward on whatever plan he may submit or craft with the help of HHS.
"People are playing hands-off until the election," Spiegel said in an editorial board meeting with Times Free Press reporters and editors Thursday.
The thought, according to the hospital executive, is that Republicans must not show fealty toward anything that has to do with Obamacare, lest it expose a rift in the state party.
Haslam, though, has little if anything to lose. He's cruising to an almost certain re-election in November. The balance of power in the state's Congressional delegation is unlikely to change. And the makeup of the state legislature should still be firmly in GOP hands after the election.
So the governor should prioritize the "Tennessee Plan," which would allow the state to use federal funds to "buy" the Medicaid expansion population's way onto the federal health insurance exchanges in which Americans can buy coverage with subsidies based on income.
The Republican-dominated state legislature, which is in the process of passing a law to say it will have buy-in on anything Haslam does on the matter, should be prodding him -- or working with him -- to do this, although only weeks remain in this year's legislative session.
Perhaps Tennessee's plan would work somewhat like the one in Arkansas, which uses the Medicaid money to buy private insurance for about 250,000 eligible low-income residents. That state's governor, Mike Beebe, albeit a Democrat, signed the legislation on April 23, 2013, and it was approved by the federal government last September.
Other states such as Iowa and Michigan, both with Republican governors, have crafted their own plans and received federal approval. Still other states have found or are seeking waivers to go their own way with the funds.
While other deep South states such as Georgia, Alabama, Mississippi and North Carolina have flatly turned down Medicaid expansion, Haslam can and should press ahead for a plan that would assist some 180,000 low-income, mostly working adults in Tennessee.
The need is becoming critical, especially at hospitals such as Erlanger, which have had special federal funds withdrawn in the Obamacare assumption all states would expand Medicaid.
Earlier this week, hospital executives announced they were freezing paid time off for 4,000 employees from now through July, a decision Spiegel admitted was "a terrible thing we did" but one for which the alternative was laying off a quarter of its employees. He also said the hospital had taken nearly $14 million in state, federal and insurance cuts this year and was likely to see its uncompensated care rise to $92 million in 2014.
It's the perfect storm for one of Chattanooga's largest employers, which this year also has prudently phased out its traditional, defined-benefit pension plan in favor of 401(k)-like accounts, changed how its paid leave is structured and approved, and has increased what retirees pay toward their health insurance in order to right its ship.
"No one has moved faster or quicker than Erlanger has done," Spiegel said.
And yet, the hospital continues to hemorrhage red ink.
Gov. Haslam, for Erlanger -- which stands to gain some $35 million with whatever plan is crafted -- and hospitals in similar straits, for those Tennesseans you believe should have health care, don't wait to act.