After two years, we'll know if Gov. Bill Haslam's Insure Tennessee pilot plan is truly a new way forward in health care coverage or simply another pass-through program of federal funds that results in little or no reform toward the same end.
What's clear is the Tennessee governor has tried to create a system to cover state residents who don't have access to health insurance or have limited options and do it in a way that does not increase taxes, does not increase the state budget, uses market-based options and calls on the personal responsibility of those who sign up to make better choices.
The idea, Haslam said in a meeting with Times Free Press editors and writers, is to cover "the most vulnerable" because "it's morally the right thing to do." Fiscally, he said, it's also the right thing to do if the program is set up right.
Some of those details are still being worked out, but the governor said the U.S Department of Health and Human Services (HHS) "has given us a verbal agreement."
The plan, pleasing big-government Democrats, will provide care to those who would have been covered had the state simply expanded Medicaid two years ago, but will add no new taxes, no budget increase, market options and personal responsibility, pleasing small-government Republicans.
Haslam did not apologize -- and had no need to -- for taking his time to craft a plan for the state that must be sanctioned by both the liberal federal government and the conservative state government.
"Finding something that would be approved is difficult," he said. The first step, he said, was asking to have an alternative blessed by the people who designed the Affordable Care Act system in the first place.
Fortunately, Haslam said, HHS Secretary Sylvia Burwell has been open to conversation on the state's options.
"I think I have her on speed-dial," he said.
Next, in a special session likely to be called in January, Haslam must convince the General Assembly, both houses of which by law must sign off on any plan between the governor and the federal government.
How difficult might that approval be?
"Very," he said tongue in cheek, adding that while he expects passage he would have to convince Republican members "why this is not Obamacare" and that it is a true, market-based plan.
In essence, Haslam said he would tell the legislature, if the federal money for health care were to have come in a block grant to the state, "we would do it like this."
What the governor seemed most excited about, and what could be revolutionary if it is successful, is the plan's shifting of the delivery model and payment of health care from fee-for-service to outcome based.
Its Healthy Incentives Plan offers financial incentives for providers to extend high-quality, efficient care in order to reduce costs and improve health outcomes. In turn, it creates participant incentives -- getting a flu shot, an annual physical or not using the emergency room for routine care, for example -- that align with the provider incentives, ultimately controlling costs across the board.
A positive pilot program, according to Haslam, would spur a similar delivery model for TennCare, the state's Medicaid managed health care program for low-income children, pregnant women, elderly or disabled people, and could begin aligning provider and patient outcomes across the country.
That, he said, is "my hope."
Meanwhile, the Volunteer Plan offers vouchers that could be used to pay for premiums and other out-of-pocket expenses incurred in a participant's employer-sponsored health care plan, Haslam said.
The carrot-or-the-stick part of that plan, he said, is that employees will want to move up in their company, earn more money and therefore be able to afford the cost of their employer-sponsored plan.
Unlike in other states, and contributing to the plan's soundness, Haslam said, is the Tennessee Hospital Association's willingness -- at its suggestion -- to cover any additional costs to Tennessee other than the federal dollars. In the long run, controlled costs will help hospitals, help cover more people and offer better health outcomes, he said.
The governor's plan, obviously, won't please everybody but will offer health care to an expected 200,000 Tennesseans, uses conservative principles to deliver it and has the opportunity to create true reform in the nation's health care system.
It's worth at least a two-year try.