Haslam's approach short-sighted

Haslam's approach short-sighted

April 7th, 2013 in Opinion Times

Bill Haslam

Photo by Associated Press /Times Free Press.

Gov. Haslam's rejection of the federal offer to cover all the cost of expanding TennCare/Medicaid for three years, and 90 percent thereafter, is widely reported to leave at least 180,000 poor Tennessee workers uninsured. These are workers, and families, whose incomes range from 100-to-138 percent of the federal poverty: They simply can't afford insurance. This is needlessly cruel -- a fact made more poignant by estimates that the number that might be covered, if the governor cared to advance health care for the working poor, could be double that figure.

Studies by the Urban Institute and Families USA, a national health care advocacy organization, suggests the number of non-elderly Tennesseans (those below the Medicare-eligible age of 65) who could be brought into TennCare under the expansion is far higher than Haslam acknowledges.

The Urban Institute estimates 363,000 presently uninsured Tennesseeans could be covered under the offered Medicaid expansion. That figure, to be sure, includes a significant number of people who are already eligible for TennCare, but have not enrolled. Families USA, using 2010-11 surveys, reported the potential un-enrolled population eligible for TennCare under the proposed expansion at 547,476.

These estimates of the uninsured poor are much closer to the findings cited in a BlueCross BlueShield research paper on the impact of the Affordable Care Act, more commonly known as Obamacare. The BCBS report found that a quarter of Tennessee's population (currently 6.45 million by 2012 Census data) had incomes that fell below the Medicaid expansion threshold.

In any case, it seems apparent that TennCare's current 1.2 million enrollment could easily bump over the 1.5 million level if the state made a concerted effort to enroll as many eligible citizens as possible in TennCare.

Contrary to what Gov. Haslam and the Legislature's anti-Obamacare Republicans think, expanding TennCare would provide broad economic benefits that lawmakers fail consider or to value. They apparently still seem think that the hidden cost of leaving people uninsured doesn't harm the economy, and has no impact on already strapped middle-class families.

They are wrong. The hidden cost of care for indigents and the uninsured, regardless of their income is huge. That's because indigent care is commonly provided in the most expensive setting, an emergency room; and because other costs for uninsured families commonly become unrecoverable debt. The bulk of these costs is shifted directly on to the premiums paid by the insured and their employers.

These shifted costs are higher than the cost for preventive care for the poor under Medicaid, and for the cost of the insurance subsidies that will soon be available for other working families under the state insurance exchanges that are scheduled to open in January under Obamacare. These exchanges will offer flat-rate quality insurance to the uninsured under federal comprehensive care guidelines.

Within the next eight months, the ACA will focus more on health care funding for both Medicaid and uninsured middle-class workers and families with incomes up to four times the federal poverty level. A family of four with an income of up to $94,200 will receive a wage-adjusted federal subsidy designed to make quality health insurance affordable for all Americans.

In Hamilton County, Families USA estimates, 29,760 workers and families will receive wage-adjusted subsidies and tax credits designed to make quality health insurance affordable. The lower a family's income, the higher the subsidy or tax credit.

Nearly 17,000 of these Hamilton County families have incomes from two-to-four times the federal poverty level. An estimated 12,770 have incomes of less than two times the federal poverty level.

State lawmakers cannot deny the benefits of the exchanges to those with incomes above the 138 percent poverty level. But by rejecting the Medicaid expansion, they can continue to deny insurance under TennCare for those trapped in the limbo land of the 100-to-138 percent of poverty gap -- a group that would have been included under Medicaid had the U.S. Supreme Court not ruled that states had the right to limit Medicaid.

If Gov. Haslam and the Legislature's Republican majority continue to resist the Medicaid expansion, they will hurt needy Tennesseans. They will forfeit the state's share of federal funds for Medicaid. And they will cause the closing of hospitals that will soon lose funding for indigent care as ACA funds go to other states to expand Medicaid. This would be the result of studied idiocy. State leaders should open their eyes, and change course now.