There is good news and Christmas cheer for Tennesseans.
Gov. Bill Haslam and his administration have negotiated a Tennessee version of Medicaid expansion under the Affordable Care Act that will help Tennessee's working poor and uninsured people while also using Tennessee-paid federal taxes to pay for that care -- meaning that it will not cost the state any additional money, the governor said here Tuesday. Now he just has to sell it to the Tennessee General Assembly.
The obvious question is why didn't he and Tennessee do this two years ago, as most states did, and cash in last year on the ACA's guarantee of paying fully for the expansion for the first three years and 90 percent of the expansion's cost for the future.
The obvious answer can be summed up in two words. Republican politics. Neither Haslam nor the GOP-controlled General Assembly could see a balanced bottom line if it was brought about by Obamacare and a Democrat president. So Tennessee's leadership dug in its collective heels and left 200,000 Tennesseans without access to affordable health care while spending state money to plug holes that would have been filled -- even overfilled -- with the gains of our federal tax dollars to offer our own people better health care.
What was the bottom line for Tennessee to nurse that Republicans-will-never-play-nice-with-Democrats nonsense?
A cool $20.8 billion.
Refusing to acknowledge and play along with the ACA would over 10 years cost Tennessee $20.8 billion, according to a September report by McClatchy Newspapers and the Urban Institute. The state-by-state found that in Tennessee, expanding Medicaid to align with the ACA would have cost an estimated $1.7 billion over 10 years. Instead, just saying no to "Obamacare" would mean Tennessee leaves $22.5 billion in lost federal funding on the table, while simultaneously costing Tennessee hospitals about $7.7 billion in lost hospital reimbursements.
What part of spending $1.7 billion to gain $22.5 billion took two years to figure out?
Well, Gov. Haslam has figured it out. To be fair, he probably would have signed on in the first year, but the Tennessee General Assembly -- whipped by tea party fever -- passed a law prohibiting the governor to opt in without the General Assembly's approval.
But now the ACA has proven to be a success, in spite of all that spurning. A University of Tennessee Center for Business and Economic Research study found the number of uninsured people in the Volunteer State has shrunk by nearly a quarter in the first year since the ACA health insurance marketplace launched. Meanwhile, President Barack Obama is coasting to the last years of his presidency and the GOP's new control in Congress means Republicans have to put up or shut up in governing.
Coupled with gaining $22.5 billion to spend $1.7 billion, convincing Tennessee lawmakers to expand Medicaid should be easy. Just don't call it Obamacare.
Of course, Haslam is nobody's dummy. So this week he's making the rounds of newsrooms in the state and unwrapping his "health-coverage alternative." It is "a two-year pilot program" that Haslam is calling "Insure Tennessee." Like other ACA programs in some other states, it has more than one "voucher" (subsidy) choice, and it borrows from some other state expansion programs an attempt to "reward healthy behaviors" and "incentivize choosing preventive and routine care" instead of overusing emergency rooms. But details aren't yet available, the governor acknowledges.
Even Tennessee Republican and Senate Speaker Ron Ramsey is finally getting the bottom line. But he, too, puts a decidedly GOP spin on it: "Gov. Haslam has negotiated a deal which returns tax dollars back to Tennessee while using conservative principles to bring health insurance to more Tennesseans," Ramsey says.
Whatever. Call it the ACA, call it Obamacare, call it Insure Tennessee, call it Haslamcare, call it Finallycare -- just get it passed. Save our dollars. Save some health.