Fiddling While Hospitals Burn: Haslam's Futile Dallying with Rewriting Medicaid Program Starts Closing Hospitals

They announced the closing of a hospital in Brownsville, Tenn. last week.

Tennessee has refused, thus far, to accept $1.25 billion in federal Medicaid funds.

These things are not unrelated.

The Tennessee Hospital Association has predicted that Brownsville’s hospital will not be the only rural hospital to close as financially strapped centers are treating the working poor who are not getting expanded Medicaid and cannot afford insurance. And the feds have cut back on appropriations to hospitals because the hospitals are supposed to be getting an infusion of money from expanded Medicaid. Except in Tennessee, they aren’t.

The hospital in Brownsville is owned by the parent company of Knoxville’s Tennova Healthcare. It will be reduced to a clinic and patients will be sent to Jackson for hospital care.

Gov. Bill Haslam is continuing to “negotiate” with the feds, arguing that they should let him rewrite the Medicaid law and create something new in Tennessee. He has made this pitch to two Health and Human Services secretaries thus far, to no avail.

The latest rebuff comes after the feds launched a blistering report on the state’s inability to even operate the system we have. People that are supposed to be getting existing Medicaid (TennCare) coverage aren’t getting it. So we can’t operate a program that has been around for decades, but Haslam wants the feds to trust him to set up a new program? How’s that gonna work for ya?

I must admit a sense of déjà vu. I doubt many of you recall the details of the TennCare fiascoes of the Sundquist administration. But figuring prominently in the mess was the failure to get computer software to work—the state spent millions and had costly overruns trying to computerize the TennCare system.

The failure to bring a state computer on line is being blamed for the current problems identified in the feds’ criticism.

Instead of quietly expanding Medicaid (TennCare) when the program came on line, like Republican Gov. John Kasich of Ohio, Haslam fiddled around. He came up with the idea that he could design something better. He delayed, knowing all the while that the conservative Republicans in the Legislature were foaming at the mouth about “Obamacare.”

He knew at the end the 2013 session of the Legislature that a conservative majority of his party were lining up against expansion. Even after the Legislature went home he continued to push his half-hearted Tennessee Plan.

So the Legislature came back this year and—afraid that the governor would develop a spine—they passed legislation that now requires them to vote approval of any Medicaid expansion.

If they had to pass a law giving them approval, then it means they didn’t have to approve it in the previous years when Haslam could have just expanded the existing Medicaid (TennCare) program.

Yes, the legislators would have cried foul. They might have even sued. But so what? In the meantime, Tennessee hospitals would have begun to receive that $1.25 billion lost thus far.

I can imagine former Gov. Ned McWherter doing just that. He implemented TennCare without the Legislature saying boo. I can imagine former Gov. Phil Bredesen doing it. He cut the TennCare rolls without asking for legislative approval.

But, no, I guess we can’t imagine Haslam taking bold action on anything.

You would think that failing rural hospitals would prompt some of this year’s legislative candidates to raise the issue. But they haven’t, because they get more mileage foaming at the mouth about Obamacare.

This won’t be the first election when low-income people voted against their own interest. I do admire people who vote on principle rather than narrow self-interest. Vote to uphold the Constitution, to protect our rights, vote your views on abortion or gun rights or balancing the budget. But should you really vote for a legislative candidate who is, at least metaphorically, standing in front of your local hospital and saying he is helping close it cause we all hate Obama?

But then where are the candidates in rural Tennessee who are stepping out to argue that we are stupid to turn down the billions of dollars that will be going to other states because we didn’t take them?