Haslam not sure on next steps after Insure Tennessee plan crushed in committee

Republican Gov. Bill Haslam speaks to reporters at the state Capitol in Nashville on Wednesday, Feb. 4., 2015, after the GOP-controlled Legislature defeated his Insure Tennessee proposal to extend health coverage to 280,000 low-income Tennesseans.
Republican Gov. Bill Haslam speaks to reporters at the state Capitol in Nashville on Wednesday, Feb. 4., 2015, after the GOP-controlled Legislature defeated his Insure Tennessee proposal to extend health coverage to 280,000 low-income Tennesseans.

Ultimately, the absence of a clear, written agreement between the federal government and the State of Tennessee made passage impossible.

NASHVILLE -- After watching fellow Republicans kill his proposal to extend health insurance coverage to 280,000 low-income Tennesseans in a special session, a frustrated Gov. Bill Haslam said Wednesday the need is still there but he sees no immediate way forward.

Haslam said while he is "open to the idea" of presenting his Insure Tennessee in the regular legislative session that resumes Monday, he emphasized, "We're not going to do that unless we have some encouragement of a path.

What people are saying about Insure Tennessee:

"While stopping the expansion of Medicaid under Obamacare was a necessary first step, it is still our responsibility as Tennesseans to find affordable health care solutions for our most vulnerable neighbors." - Justin Owen, CEO of The Beacon Center "For more than two years, hospitals in this state have advocated and worked hard to find a way to provide health care coverage for the uninsured of Tennessee. We are disappointed. I think the governor was very careful in his consideration to protect the state budget along with a large number of Tennessee citizens who have health problems. The lawmakers have a difficult job, trying to balance the needs of citizens against the cost to the state. But this seemed straightforward to me. It was not going to cost the citizens of Tennessee anything, and it dooms many citizens to being higher risk. It will cost us more in the long run." - Dr. Gene Huffstutter, president, Chattanooga-Hamilton County Medical Society "Unfortunately, seven members of the Senate Health Committee decided that this plan did not benefit the public health of our state. This decision was made after two days of compelling testimony that reinforced how Insure Tennessee would improve the lives of hardworking Tennesseans and how the plan would strengthen communities, support hospitals and make Tennessee a better place to live. Ultimately, seven legislators made a decision that prevented the full General Assembly from having the opportunity to debate this extremely important issue." - Craig Becker, president, Tennessee Hospital Association "We couldn't have done this without our grass-roots activists showing up to hold their legislators accountable. This is truly a victory for the Tennessee taxpayers. We commend the senators voting to defeat this measure and other legislators who led the fight. Thank you for listening to your constituents and voting to stop Obamacare's Medicaid expansion in Tennessee." - Andrew Ogles, Tennessee state director, Americans for Prosperity "Clearly Gov. Haslam was wrong when he told President Obama to trust Republicans to care for 'the least of these,' because Sen. [Todd] Gardenhire is willing to leave over a quarter of a million Tennesseans without health care. It's clear that he puts politics before the people of his district." - Terry Lee, chairman, the Hamilton County Democratic Party "Tennesseans will die and hospitals will close as a result of our cruel state Legislature. Rarely in state history have we seen such a devastating lack of leadership." - U.S. Rep. Jim Cooper, D-Tenn.

"I don't know what the next step looks like. It's not in my nature to give up," Haslam said. "To me it feels wrong to say, 'We've got a big problem but we tried and we're not going to do anything else about it.'"

Haslam said he believes he got as much leeway from the U.S. Health and Human Services Secretary as federal law allows.

His comments came after his plan to use federal Medicaid dollars to provide coverage and control costs crashed and burned in a partisan 7-4 vote in the Senate's special Health Committee. It came on the special session's third day.

All seven "no" votes came from Republicans, and included three area lawmakers: Republican Sens. Todd Gardenhire of Chattanooga, Mike Bell of Riceville and Janice Bowling of Tullahoma.

Following the Senate's action, House Majority Leader Gerald McCormick, R-Chattanooga, withdrew that chamber's version of the resolution first from the Insurance and Banking Committee and later from the House, and both the House and Senate adjourned.

Earlier, Republican House Speaker Beth Harwell said not enough GOP lawmakers were willing to join with the House's 26 Democrats to pass the governor's plan.

It was the first major defeat on a signature initiative for Haslam, who began his second term in January, a politically volatile issue he'd spent 21 months trying to solve.

The governor's answer was what he called a conservative, "market-driven" twist to make the insurance available with funding from President Barack Obama's 2010 Affordable Care Act, known as Obamacare.

But it still proved ideological poison to many of his own party and generated fears among Republican lawmakers that even a hint of support for Obamacare could come back to haunt them in their next primary elections.

What's next

Haslam says fight will continue

How they voted:

Against Insure Tennessee: Mike Bell (R), Janice Bowling (R), Todd Gardenhire (R), Frank Nicely (R), Brian Kelsey (R), Kerry Roberts (R), and Rusty Crowe (R) For Insure Tennessee: Richard Briggs (R), Becky Massey (R), Ed Jackson (R), and Jeff Yarbro (D).

photo Republican Gov. Bill Haslam addresses state lawmakers at the state Capitol in Nashville on Feb. 2, 2015.
photo David Jones of Lawrenceburg, Tenn., and other opponents of Gov. Bill Haslam's Insure Tennessee proposal watch a committee hearing on a television in the legislative office complex in Nashville, Tenn., on Tuesday, Feb. 3, 2015. Haslam has said the program would cover 280,000 low-income Tennesseans using money available under President Barack Obama's health care law. (AP Photo/Erik Schelzig)
photo Governor Bill Haslam answers questions from legislators about his Insure Tennessee plan which could expand Medicare to thousands of people in the state. Governor Haslam spoke while visiting the Cherokee Health Systems office in downtown Chattanooga on Wednesday, January 28, 2015.
photo Republican Gov. Bill Haslam is greeted by lawmakers as he leeaves the House chamber in Nashville in this Feb. 2, 2015, file photo.
photo Republican Gov. Bill Haslam addresses state lawmakers at the state Capitol in Nashville on Monday, Feb. 2, 2015.
photo Republican Gov. Bill Haslam is greeted by lawmakers as he enters the House chamber in Nashville, Tenn., on Monday, Feb. 2, 2015. Haslam spoke to a joint assembly of the General Assembly to promote his Insure Tennessee proposal to extend health coverage to 280,000 low-income residents.

House Minority Leader Craig Fitzhugh, D-Ripley, charged that the Senate "let seven people decide for 6 1/2 million people that 300,000 people wouldn't receive health insurance. That's not the way it's supposed to work. I don't care who's running the railroad."

The cost of coverage would have been paid by the federal government through 2016. After that, the state would start sharing the cost, capped at 10 percent by 2020. Tennessee hospitals had pledged $74 million to cover the state's share. The federal government would have provided $2.8 billion.

But GOP opponents raised objections, ranging from the impact on the federal deficit to how Haslam's two-pronged plan to use vouchers to enable workers to join their employers' health plans would work. Another component would have placed many enrollees into a retooled version of TennCare, the state's Medicaid program, with premiums and co-pays and a heavy dose of promoting personal responsibility with incentives.

Other Republican concerns were that the Obama administration couldn't be trusted.

In a statement, Republican Senate Speaker Ron Ramsey said that "ultimately, the absence of a clear, written agreement between the federal government and the state of Tennessee made passage impossible."

Tennessee Hospital Association President Craig Becker said hospitals are "extremely disappointed" by the resolution's failure.

He said hospitals "remain hopeful that members of the General Assembly will continue to consider ways for Tennessee to provide coverage to the hundreds of thousands of uninsured in our state who have no option for coverage."

McCormick, who was carrying the resolution in the House, told reporters he was "disappointed" but added, "I think we had a good fair and open debate. Everyone got to hear from the witnesses and interested parties."

He also defended the committee system as necessary to the functioning of the Legislature, adding, "If we'd gone to a committee of the whole, I think we could have passed the bill. I think we also would have had a very big problem running the state in the years ahead."

Gardenhire said his problem was "strictly fiscal in nature."

"State government on Medicaid itself has grown so rapidly. The population has increased 20 percent. Medicaid itself has increased 200 percent. There's something out of whack there," Gardenhire said.

He said he "respectfully" disagrees with Haslam that the cost-control measures would work.

Bowling was thought to be a potential swing vote. But she said she dug hard into the issue and still had concerns. She said she knows her local hospital officials are worried - hospitals say some rural facilities face ruin and closure without the federal money.

"I do feel like this was not the long-term solution, and the more I studied it the more questions I had," Bowling said. "Back in the district they call it a pig in a poke, and there were still some aspects to that."

She cited the testimony last week from a Vanderbilt University law professor, a critic of Obamacare, who said lawmakers should ask for a clear promise from federal officials that the state could jettison the program at any point. Haslam and Tennessee Attorney General Herbert Slatery had repeatedly said they already had such a commitment.

Bell, who helped lead opposition in committee, said it wasn't a single thing that triggered his opposition.

"It was a number of things. Everything from it being a bad waiver to increasing the federal debt [to whether] the requirements in the volunteer program can be enforced," he said.

Bell said he would be "shocked" if Haslam tried for approval again this year. "Because I think he put a lot of capital into this and as you saw, the vote was 7-4."

During the committee hearing, members heard from nurse practitioner Cathy Hill-McKinney of Troy, Tenn., who described herself as a conservative Republican. She described what it means not to have insurance, saying hospital emergency room treatment cannot solve the problem.

She cited two cases, one involving a woman who couldn't afford treatment for a condition that Hill-McKinney is convinced led to the woman's death with pancreatic cancer.

"I wish you would at least give it a shot," she told Senate committee members. "We've got an opportunity to do something good."

Rep. JoAnne Favors, D-Chattanooga, said she was "very disheartened" by what happened. "I had expected to have a lot more support than what was there. I did not realize it would be seven people making that decision."

She said she is hoping "this won't be the end."

Favors said she expects Republicans will face retribution from voters and added, "I certainly hope that they do."

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

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