Sometimes when numbers don't add up, the reason is just error. Sometimes when one plus one isn't two, the reason is more insidious.
In the case of Tennessee's continuing rejection of the federal offer to cover all the cost of expanding TennCare/Medicaid for three years and 90 percent of it thereafter, the bottom line -- throwing away free money -- seems simply to be partisan obstructionism.
This week, Tennessee Gov. Bill Haslam and his TennCare chief Darin Gordon said they reviewed the final federal rules on the Medicaid expansion, a part of President Barack Obama's Affordable Care Act, and they still aren't happy with it.
Why? Because their "early read" indicates it doesn't provide the "flexibility" the governor wants on "cost-sharing for enrollees."
Translation: Haslam has a "Tennessee plan" in which he wants to use the additional federal money intended for the Medicaid expansion to buy these adults' way onto the federal health care exchanges where the uninsured can purchase private insurance.
What difference can it make whether these 180,000-plus poor and uninsured Tennessee workers are added to TennCare or the so-called federal health care exchanges? Both are subsidized insurance managed by private insurance companies. One is under the state umbrella and one is under a federal umbrella, but both are paid for largely with federal tax money managed by states.
The difference for Haslam may be a real effort toward compromise -- or it may just be a cover. He knows his fellow Republicans in the GOP-led state legislature will balk at accepting Obamacare money for the Medicaid expansion.
Other Tennessee leaders in Congress, Sen. Lamar Alexander and Sen. Bob Corker, both dismissed the final Obamacare rules, too. Rather than work toward compromise, they called on the president to permanently delay the implementation of the entire health care law, not just delay the implementation of the employer mandate, as was announced by the Obama Administration last week.
The partisan baloney is not just hurting those poor people who have no insurance and therefore very poor health care -- people whose incomes range up to 138 percent of the federal poverty level. The spiteful gridlock also hurts everyone else and the country.
The hidden cost of care for the uninsured, regardless of their income, is enormous. 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 rest of us -- the insured and their employers.
These shifted costs are higher than the price for preventive care for the poor under Medicaid, and higher than the cost of the insurance subsidies that will soon be available for other working families under the insurance exchanges.
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 under the Affordable Care Act.
If Haslam and the Legislature's Republican majority continue to resist the Medicaid expansion, they will hurt all Tennesseans.
Those uninsured people will not miraculously cease to be sick or injured. They will still go to emergency rooms all over the state. Many Tennessee hospitals, especially rural ones, also will suffer, and some may close because federal reimbursements to hospitals nationwide are cut. In most states that won't matter, because more insured people means more hospital bills paid.
There's more fallout: In rural areas, hospitals are major employers, and where a hospital closes, it will be hard to make up for those lost jobs: What companies would think about locating in a place with no nearby emergency care?
Without opting into the Affordable Care Act's Medicaid expansion, Tennessee will not have the benefit of additional federal dollars or more insured people to pay hospital bills -- all because the Tennessee General Assembly -- and perhaps the governor -- chose not to compromise on an already sweet deal.
Who's the loser? Not Obama. The Patient Protection and Affordable Care Act is law. The loser will be Tennessee if we forfeit the benefit of extra federal dollars and better health care for all Tennesseans.