Two Tennessee Republican lawmakers are hoping to expand health care coverage to hundreds of thousands of working poor, while Democrats are trying to turn back the state's modified "block grant" program with the help of the new Biden administration.
Legislative Democrats sent a letter to President Joe Biden Monday asking him to rescind the "block grant" waiver approved in the final days of the Trump administration.
Meanwhile, Rep. Sam Whitson, a Franklin Republican, and Sen. Richard Briggs, a Knoxville Republican, have filed legislation they could use to initiate state insurance coverage for those caught between TennCare and expensive private health insurance plans.
"What this would do is target the working poor, those who are at 138% of the poverty level who cannot afford the premiums, who are working. They make too much to qualify for the block grant services, but the cost of premiums is so high it really puts them in a pickle," Whitson said this week.
He hopes such a plan could help rural hospitals as well, since Tennessee has lost at least 13 to closure or major cutbacks since the Affordable Care Act took effect and the Legislature refused to expand Medicaid.
The retired U.S. Army colonel said he has talked to several House members in search of a "conservative approach" that wouldn't hurt the state financially but would give people the opportunity to obtain insurance coverage by paying part of the premiums and copayments, in addition to some "personal responsibility."
Whitson noted the plan would not be connected to the Affordable Care Act and most likely would require a waiver from the U.S. Centers for Medicare and Medicaid Services.
He wants the state to be able to tap into $1.4 billion annually through the federal government, but he also wants to make sure it can draw support from the administration of Gov. Bill Lee and Republican leadership in the Legislature.
Republicans balked at former Gov. Bill Haslam's Insure Tennessee proposal six years ago, saying it would bring Obamacare to the state and put too much of a financial burden on Tennessee's budget. They continue to remind Democratic lawmakers seeking to expand Medicaid to some 300,000 people caught between TennCare and the Affordable Care Act that former Democratic Gov. Phil Bredesen had to remove more than 200,000 people from the TennCare rolls in 2008 because the state was hemorrhaging money.
Since Republicans killed Insure Tennessee, Democrats have kept up the mantra to expand Medicaid and bring that $1.4 billion annually to the state to serve those caught in a coverage gap.
They continued the argument two weeks ago when the Republican-controlled Legislature passed resolutions to adopt a modified "block grant" agreement with the federal government that would cap the amount of money Tennessee receives each year for TennCare but allow it to tap into annual savings to provide more services to some 1.5 million enrollees.
Democrats warned that the incoming Biden administration could rescind the agreement, which was reached just 12 days before President Donald Trump left office, then approved in two days by the Legislature. The minority party sent a letter to the new president last week asking him to stop the block grant waiver.
Rep. Vincent Dixie, chairman of the House Democratic Caucus, said he believes the chances are good the Biden administration will reject the agreement with Tennessee. He points out health care is one of Biden's priorities, especially since he was vice president when the Affordable Care Act took effect.
"I believe he's going to take this very serious. Plus, by being the first of its kind in the United States, they're going to really take a close look at it," said Dixie, a Nashville Democrat.
In recent years, TennCare inadvertently kicked people off the rolls because of problems with a re-enrollment "glitch" in the program, Dixie pointed out.
"The waiver allows for reducing the population of the 1.4 million Tennesseans eligible for Medicaid if there are problems re-registering beneficiaries. It also hands near-total oversight of the funds to TennCare, which has a history of dysfunction and unnecessary barriers to enrollment," the letter states.
They contend Gov. Bill Lee and Republican leaders have shown they are "unable to handle the responsibility of being given more control over federal dollars. In addition to refusing to expand Medicaid for nearly a decade, our state government allowed a $732 million surplus of [Temporary Assistance for Needy Families] funds to accumulate, rather than spend that money on what it was intended for – helping families in need."
Dixie contends the state isn't using the TANF money for its intended purpose, continuing a trend under the Lee administration. He's not sure the state is going to put the money back into programs to help needy families and those seeking help.
The state is using about $35 million from the Temporary Assistance for Needy Families fund to pay for its recently approved literacy initiative.
Gov. Bill Lee said last week his administration had contacted the Biden administration, which indicated it would be talking about the modified "block grant."
Republicans are preferring to call the agreement a "shared savings" plan, and they point out TennCare will be able to use about $6 billion in funds built up over the decades by efficient Medicaid spending.
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