Getting Insure Tennessee plan through legislature poses 'real test' for Haslam

Republican Gov. Bill Haslam presides over a meeting at the Jackson-Madison County General Hospital in Jackson, Tenn., about his proposal to extend health coverage to 200,000 low-income Tennesseans, on Jan. 21, 2015.
Republican Gov. Bill Haslam presides over a meeting at the Jackson-Madison County General Hospital in Jackson, Tenn., about his proposal to extend health coverage to 200,000 low-income Tennesseans, on Jan. 21, 2015.
photo Republican Gov. Bill Haslam presides over a meeting at the Jackson-Madison County General Hospital in Jackson, Tenn., about his proposal to extend health coverage to 200,000 low-income Tennesseans, on Jan. 21, 2015.

NASHVILLE -- Gov. Bill Haslam faces what may be the biggest test of his political career this week as he attempts to persuade fellow Republicans in the GOP-dominated General Assembly to approve his proposed Insure Tennessee plan.

Right now, the vote looks to be a squeaker in the special session that starts Monday.

And it's unclear which way lawmakers will squeak as they consider what Haslam calls his "market-driven" plan to use federal Medicaid dollars to offer health insurance coverage to 280,000 low-income Tennesseans under President Barack Obama's 2010 Affordable Care Act.

"I think it's very close right now," House Majority Leader Gerald McCormick, R-Chattanooga, said Friday in an interview.

However, McCormick, who is sponsoring the resolution enabling Haslam to proceed, said "the momentum has picked up" as the governor, administration officials and allies including hospitals and other business over the last two weeks began a full-court press.

But House Republican Caucus Leader Glen Casada of Franklin, who opposes the plan, doesn't think the votes for passage are there. The resolution, released Saturday, could die in any of the six committees -- three House and three Senate -- expected to hear it.

"My gut feeling is it's less than 50 percent chance of passing, today" in the House, Casada said after listening to Haslam's arguments in Murfreesboro last week, one of eight public meetings he held across the state to sell his plan.

"Right now, if I was betting your money, I'd bet no," he said.

There's been talk in legislative corridors that some Republicans may seek to adjourn the special session right after it's gaveled to order. Haslam is scheduled to address lawmakers Monday night.

Casada said he would "vehemently" oppose such a move.

"The governor needs to present," he said, adding, "I think it's just one or two members" who are talking about adjourning without considering the governor's proposal.

Haslam told reporters Friday he knows what he's up against.

"It's no secret that a lot of people in Tennessee, on anything they think is Obamacare, they're going to be very nervous about," Haslam said. "But I honestly think this is very different. This is not Medicaid as we've known it. And it's my job to make this case."

effectiveness test

Dr. Bruce Oppenheimer, a Vanderbilt University political science professor, said the issue is whether Haslam can get enough Republicans to support his plan, "even if they're kicking and screaming."

"I think this is a real test for him," Oppenheimer said. "This will be in some ways ... a benchmark against which he gets charted. I think this is something that for better or worse people will remember, in terms of, is he effective or isn't he?"

The governor has stressed that his two-pronged, two-year pilot project allows Tennessee to innovate and introduce market "tension" into the new enrollees' choices. One part of the plan provides vouchers allowing lower income workers to join employers' health plans.

The other portion workers more like traditional Medicaid, known as TennCare here. It would introduce modest premiums and co-pays for those above the federal poverty level. Along with the administration's plan to move health care charges from a fee-for-service mode to an outcomes-based model, Haslam says it can bend the "cost curve" on exploding health care costs.

Many Republicans say they are keeping open minds, but others are asking questions. One is whether the state could get out of the program at any time, as Haslam promises. A legal opinion from the state attorney general says it can.

Others have questioned funding. The federal government will pay 100 percent of costs through 2016. The state then begins picking up a share, with a ceiling set at 10 percent by 2020.

Tennessee hospitals have promised to pay the state's share by raising the rate of an existing 4.52 percent assessment on hospitals' net profits. In the first full year of implementation, the state would see a federal infusion of $1.42 billion, with $35.56 million required from the state.

Any number of Republicans say they don't trust Obama and say congressional Republicans could torpedo the assessment. Haslam has sought to reassure them he can and will pull the plug if that happens or the program fails to work.

Politics and ambitions

Haslam has said he needs the backing of all 26 Democrats in the 99-member House and all five Democrats in the 33-member Senate. He's got most of the, but two to three Democrats in conservative rural areas are said to be wary of going along with a plan that could put them in hot water with voters come election time.

The resolution needs 50 votes to pass in the House and 17 in the Senate.

And many Republicans worry about GOP primary challenges. The Tennessee chapter of Americans for Prosperity, backed by the billionaire conservative Koch brothers, is running radio ads denouncing the plan. One ad attacked House Assistant Majority Leader Kevin Brooks, R-Cleveland, who said he has yet to decide but simply told colleagues to keep an open mind until they arrive in Nashville.

Meanwhile, the Haslam-aligned Coalition for a Healthy Tennessee, comprising of businesses, hospitals and advocacy groups, has jumped in with its own ads.

An extra complication is the potential gubernatorial or other ambitions of some Republican lawmakers, including House Speaker Harwell of Nashville, Senate Majority Leader Mark Norris of Collierville, Sen. Mark Green of Clarksville and Sen. Brian Kelsey of Germantown.

Harwell, a close Haslam ally, has remained noncommital. While top administration officials briefed 45 legislators and fielded questions last week, the speaker sat silently in a chair as Speaker Pro Tem Curtis Johnson, R-Clarksville, presided over the meeting.

Asked by a Times Free Press reporter afterwards whether she would support the proposal, Harwell said, "I've got to hear another side now. I've got to get going," and darted off.

Norris refused to sponsor the authorizing resolution. And as Senate Judiciary Committee chairman, Kelsey held a hearing questioning the attorney general's legal opinion. That drew fire from Sen. Doug Overbey, R-Maryville, whom Haslam later said will carry the resolution.

The key fight in the House is expected to come in the Insurance and Banking Committee. Should the bill come out of that committee -- and that's not certain -- the momentum is expected to help it survive the health and finance committees.

It also could help in the Senate. Republican Caucus Chairman Bill Ketron of Murfreesboro said last week that when the Legislature convened Jan. 13, he saw only eight Republican Senate votes for the plan.

But Ketron emphasized a lot has happened as Haslam has traveled the state.

Republican Senate Speaker Ron Ramsey of Blountville has been open to Insure Tennessee, but it's unclear whether he would try to exert his considerable powers to pass it.

"It will be a hard sell for one reason and one reason only -- there's a couple of terms that are toxic in politics right now and one of those is Obamacare," Ramsey told Johnson City television station WJHL reported Friday. "This is not Obamacare."

Contact staff writer Andy Sher at asher@timesfrepress.com or 615-255-0550.

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