Bill HaslamTennessee Gov. Bill Haslam could have decided Wednesday to make the sensible and humane decision to accept federal funding under the Affordable Care Act to expand Medcaid/TennCare to approximately 180,000 uninsured working-poor Tennesseans. Allowing these people, who earn between 100 percent and 138 percent of the national poverty level, access to Medicaid would not have added any new costs to the state for at least the next three years, and then the state would only have to pay a 10 percent match to keep the expansion intact.
But Gov. Haslam didn’t make that decision.
Haslam punted instead for a vague middle ground that may let Tennessee receive the federal money to pay for private insurance policies for some of these spurned Tennesseans — if he and more reasonable Republican legislators can find enough caveats to make his game to grab the money still seem like a poke in the eye against one of the core goals of Obamacare toward universal care.
The need to accept the Medicaid expansion arises from the ruling by the U.S. Supreme Court on the health care reform act. It had been written to allow a federal mandate to require states to raise the ceiling for Medicaid — two-thirds of which is federally funded — from 100 percent of the federal poverty level, to 138 percent. State insurance exchanges were designed to accept uninsured Americans with incomes above that level. But the high court voided the Medicaid expansion mandate, making it an option for state governments — and leaving a hole of coverage for Americans just above the poverty level.
Haslam’s decision was, of course, at least partly driven by extreme pressure from the Legislature’s most myopic, callous and bitter opponents of health care reform. Left to his better senses, he might well have accepted an expanded Medicaid program, as eight more independent Republican governors have done. But with a raft of irrational Obamacare haters in the state’s Legislature slinging their propagandist version the health reform act, he wilted.