Expand Medicaid, Tennessee. It's a matter of life and death

Expand Medicaid, Tennessee. It's a matter of life and death

March 8th, 2014 in Opinion Times

Erlanger CEO Kevin Spiegel

Photo by Doug Strickland/Times Free Press.

It's time for Tennessee to stop playing partisan games with the Affordable Care Act because our red-state lawmakers don't like the president and the party he represents.

The games have gone far beyond rhetoric and they're hurting Tennesseans and our hospitals -- especially Erlanger, which treats the lion's share of Chattanooga's uninsured charity patients.

Many of those charity patients would have insurance if Tennessee Gov. Bill Haslam had expanded Medicaid under the ACA and accepted the 100 percent federal payment for it.

Instead, Erlanger's charity care amounts to more than $92 million this year -- up from $86 million, thanks largely to a perfect storm of health care funding changes and the state's failure to act.

The Affordable Care Act, derogatorily dubbed Obamacare by the GOP, would have gone a long way toward solving Erlanger's charity care deficit. Erlanger Health System CEO Kevin Spiegel said Tennessee foregoing the expansion means Erlanger is losing out on $35 million a year that would have been paid by insurance for people who now receive charity care.

Additionally the hospital lost out on $1.2 million in special payments the ACA cut because the law assumed states would expand Medicaid. When a U.S. Supreme Court ruling left decisions about expansion up to states, most Republican governors, including Haslam, balked.

Erlanger also lost another $1.2 million when the state canceled TennCare's CoverKids (because CoverKids did not meet ACA standards and our red-state officials opted not to upgrade the coverage). All those losses added a double whammy to the fact that Erlanger already was suffering from a four-year-long loss of $8.5 million in state disproportionate share payments intended to help defray charity care costs.

Make no mistake: Tennessee didn't refuse ACA to save itself money. In fact, expanding Medicaid under Obamacare would have paid the tab for that expansion. The federal health law provides 100 percent funding for the first three years of Medicaid expansion and 90 percent thereafter. That's tax money we've already sent to Washington, and now it's going to other states (like neighboring Kentucky and Arkansas) and hospitals where governors weren't covering GOP election bets.

"You can't just sit there and blame Obamacare for the next four years and watch all of the money leave Tennessee," Spiegel said Thursday. "At some point, it's not about red and blue, it's about green."

But Haslam and other state GOPers face re-election this year, and although GOP wins are virtually certain, they continue to play the hard-right conservative line to trash the president and Democrats at every turn.

Haslam began his grandstand act a year ago, saying he would not seek Medicaid expansion and instead would work to get federal approval for what he calls his "Tennessee Plan." He said his plan would make the expansion affordable over the long haul by allowing the state to charge recipients higher co-pays than allowed under federal rules.

Haslam, however, never submitted a formal plan to U.S. Health and Human Services Secretary Kathleen Sebelius. Last month, he tried to dump responsibility for a plan in her lap, telling the department to come up with something he can accept.

Apparently his fellow Republicans didn't trust that he would continue to tow the nonsensical, no-Obamacare line -- and, in fact, he probably won't. He can't be that illogical. Not with 54 Tennessee hospitals at risk of major cuts or closures without the expansion. Spiegel says doctor and hospital groups plan a major push after the election to persuade action.

But it already may be too late. On Thursday, the state Senate passed a bill that requires Haslam to obtain legislative approval on any deal he may cut with the Obama administration on expanding Medicaid. The House passed a similar bill last month. The effect is to tie Haslam's hands. Yes, he could veto the joint bill, but then a super majority could override his veto. Check and checkmate.

This is partisan politics at its reddest.

There's an old saying that applies here: Don't cut off your nose to spite your face. Tennessee has clearly done that.

Gov. Haslam can stop the bleeding -- if he acts right now.