NASHVILLE - The Republican Senate approved a previously passed House bill that directs the Lee administration to seek a waiver of federal Medicaid rules that would restructure federal financing for much of the state's TennCare program for the poor.
House Bill 1280 passed 24-5 despite the last-minute plea from a dozen national patient groups including the The American Cancer Society, American Heart Association and American Lung Association.
In their letter to the governor, dated Monday, the groups warn that turning federal Medicaid support of TennCare from an entitlement into a "block grant" program "will jeopardize Medicaid enrollees' access to care, and our organizations strongly urge you to oppose the proposal."
In their letter, the national patient groups say "our patients in Tennessee and around the country need to have continuous access to quality and affordable health care."
"Changing federal Medicaid funding for TennCare to a block grant amount jeopardizes their access to treatment and, in turn, their health," the coalition stated. "Our organizations ask you to protect patients and reject HB 1280/SB1428 and any other efforts to change the funding structure of the Medicaid program that could jeopardize patients' access to care."
They warn that "a block grant could drastically increase the costs to Tennessee to implement its Medicaid program. Block granting TennCare would not take into account any changes in the demographics of the state (such as the rising numbers of older adults or of individuals with disabilities) or periodic economic downturns in state finances."
That could make Tennessee fund a higher portion of Medicaid expenditures, the groups warn.
"Absent these additional state funds, the state would be forced to drastically reduce eligibility or benefits covered by the program, jeopardizing access to coverage for patients with serious and chronic illnesses and their ability to receive the treatments and services they need to manage their conditions and stay healthy."
Many of the groups signing the letter represent major disease issues.
Other groups signing the letter to Lee are the American Lung Association, Cystic Fibrosis Foundation, Epilepsy Foundation, Hemophilia Federation of American Leukemia & Lymphoma Society, March of Dimes, National Multiple Sclerosis Foundation, National Organization for Rare Disorders, National Psoriasis Foundation and Susan G. Komen.
An apparently irritated Sen. Paul Bailey, R-Sparta, the bill's sponsor, sought to brush aside concerns, saying the Senate version has been substantially amended a number of times.
The bill seeks federal permission to convert federal funding into a "block grant" for TennCare, the state version of the federal Medicaid program that now covers some 1.25 million low-income pregnant women, children, the disabled and seniors.
Under a block grant, the state would receive a set, annual amount regardless of what Tennessee spends. Trump's administration is encouraging states to come forward with such plans but Tennessee Republicans are angling to become the first, arguing it will let them manage the program more efficiently.
Currently, federal spending for states' jointly funded Medicaid programs matches whatever the state spends. The federal government now pays 65.87 percent or $7.5 billion of the Tennessee program's total $12 billion cost.
Under Medicaid's current funding mechanism, if a state's spending goes up, matching federal dollars rise too. Advocates say that allows Medicaid funding to grow with inflation, deal with economic downturns that drive up enrollment and cover health care crises such as an epidemic.
Advocates say that allows Medicaid funding to grow with inflation, deal with economic downturns that drive up enrollment and cover health care crises such as an epidemic.
Republican supporters of the bill say it would free the state of many federal Medicaid rules and allow officials to innovate, run the program less expensively and even allow some other people into the program.
Senate Republicans said they have added provisions allowing for a set federal rate per enrollees, annual inflation adjustments and allowances for economic downturns.
Bailey sought to reassure critics, including a few nervous Republicans, that Tennesseans won't be put in jeopardy.
"This legislation does not seek to reduce any current funding, nor does it seek to reduce services for anyone," Bailey said. "It simply addresses the financing mechanism for the TennCare funding."
He said he has worked with TennCare officials to ensure there are safeguards in place. And Bailey promised that TennCare's nursing home care programs, as well as the pharmacy program and funding for the disabled, are excluded.
Senate Minority Leader Jeff Yarbro, D-Nashville, remained skeptical.
"I have a problem understanding why we would want to be a guinea pig for the states on this kind of program," Yarbro said, adding there's a "reason" why the Trump administration is trying to push the program on states.
It's to "ensure" federal funding growth slows, Yarbro said. And alluding to critics' accusations that Republicans are pressing the bill as a political excuse for not expanding Medicaid under the federal Affordable Care Act, Yarbro said the block grant approach on covering more people is "unnecessary when we know what the real answer is."
Senate Democratic Caucus Chair Raumesh Akbari of Memphis said federal officials are interested primarily in cutting their expenses. Calling a waiver request a "very serious step," Akbari said "it is putting us on a dangerous pathway."
But Bailey said Senate Republicans have had similar concerns and "we've taken those into consideration" by removing nursing home care, pharmacy programs and other areas from the proposed waiver.
He said the bill also has a required "maintenance of effort provision," ensuring federal support would never be decreased, and that it would actually increase.
The bill now goes back to the House.
Contact Andy Sher at asher@timesfreepress.com or 615-255-0550. Follow on Twitter @AndySher1.