NASHVILLE -- Gov. Bill Haslam says he doesn't know how many of Tennessee's low-income workers will sign up for health coverage under his proposed Medicaid-funded "Volunteer Plan."
"Nobody's done this before," Haslam said in interviews with the Times Free Press about his Insure Tennessee proposal, a major part of which is built on the Volunteer Plan. The idea is for workers to use federally funded vouchers to participate in employers' health plans.
But Haslam, a Republican, thinks the "market-driven" idea should prove attractive to the working poor as well as their bosses.
The employee/employer voucher component surprised some businesses and business groups, that are interested in more details.
Haslam said he sees the program being voluntary for employers.
"I don't think we can force [employers] to be required to accept it," Haslam said, but added he thinks employers would welcome it.
"I'm not certain why the business would say we're OK with you paying for it, but we're not OK with taking your money and a voucher, which is what it would be," Haslam said. "From their standpoint it would actually tie their employee to them a little more."
According to the administration's calculations, the working poor are a substantial number of the estimated 200,000 low-income people who could qualify for Haslam's proposed Medicaid expansion under the federal Affordable Care Act.
President Barack Obama's health care law extends Medicaid eligibility to people earning up to 138 percent of the federal poverty -- $16,100 for a single person and $27,300 for a family of three.
"We know that over half are working now," the governor said. "... The arguments for doing it [offering vouchers] are that your employer's plan is accepted more places than Medicaid is."
Employer plans also generally provide better benefits, Haslam said.
Right now, many workers earning $8 or $9 an hour can't afford health coverage offered by their employers, Haslam said. The vouchers would pay for premiums, copays and other out-of-pocket costs.
But many workers envision moving up the pay ladder over time. The Volunteer Plan, Haslam said, offers them an easier way of getting coverage with employers now, and they won't later have to switch from TennCare to an employer's plan as their incomes rise and they are no longer eligible for government assistance.
The newly formed Coalition for a Healthy Tennessee, comprising about 80 business, health care, civic and advocacy groups, supports the plan and has said it will put on a series of events to promote it. Participants include the Tennessee Business Roundtable, several local chambers of commerce, Chattanooga-based BlueCross BlueShield of Tennessee and the Tennessee Hospital Association.
"We fully support the Governor's plan to expand Medicaid and appreciate his hard work in negotiating a plan that makes sense for Tennessee," Sybil Topel, spokeswoman for the Chattanooga Area Chamber of Commerce, said in a statement. "We hope the legislature approves it during the special session."
But other business groups are more wary of Haslam's plan.
NFIB, which represents 8,000 independent businesses in Tennessee, said it wants more details about Haslam's Insure Tennessee proposal before it will offer any support.
Two years ago when NFIB surveyed its members on whether Medicaid should be expanded, 78 percent opposed the idea, compared with just 10 percent of employers who said they liked the idea.
"Gov. Haslam's Insure Tennessee proposal must be thoroughly vetted and understood, not just for obvious positive aspects but also for potential threats to the long-term welfare of our state and our country," said Jim Brown, president of the NFIB in Tennessee. "We're eager to learn more details so we can engage the small-business community at the grassroots level."
The second part of Insure Tennessee includes a second option for the newly eligible Medicaid population called the Healthy Incentives Plan. It's a reworking of TennCare, the state's existing Medicaid program.
People with incomes above 100 percent of the poverty level would be responsible for paying modest premiums and copays under the Healthy Incentives program. The plan includes incentives for healthy behaviors such as quitting smoking and having annual screening tests.
And everyone, including people earning below 100 percent of the poverty level, would pay modest copays on drugs.
Haslam worked on the two-pronged plan for nearly 18 months and thinks it can pass muster with the feds and the GOP-led Legislature. The Medicaid expansion went into effect Jan. 1, 2014, but Haslam and a number of other Republican governors refused to participate.
He has mentioned calling a special session, possibly in February. Republican lawmakers say at first blush Haslam's proposals sound good but they're awaiting more details.
The governor said the state will have counselors in place to advise workers on which plan -- the voucher program or the Healthy Incentives Plan -- is best suited to their needs.
Dr. Wendy Long, TennCare's chief medical officer, said counselors could help workers weigh differences in benefits between the two parts of the plan.
"That's part of what the options counseling will focus on -- helping a person see, 'Here's the difference between what I can get from my employer's plan and what I can get through Medicaid.'"
Long said there will be certain requirements on employers' insurance plans that participate in the Volunteer Plan vouchers. For example, the employer contribution to the insurance coverage will have to cover at least 60 percent of the cost, she said.
As for whether the voucher is assigned to the insurance carrier or the worker, Long said, "Those details have yet to be worked out."
Haslam pointed out that TennCare currently covers the disabled, pregnant women, young children and their caretakers.
"Really," he said, "a whole new population" would be coming in.
Staff writer Dave Flessner contributed to this report.
Contact staff writer Andy Sher at email@example.com or 615-255-0550.
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