Make 'em Vote: Haslam Should Make Legislators Get on the Record on Medicaid Expansion

Let's be charitable and assume that Gov. Bill Haslam is not proposing an expansion of Medicaid because he thinks the super majority Republican Legislature won't approve it—they hate Obamacare as well as poor people too shiftless to pay their hospital bills on their minimum wage salary.

Besides, the legislators have insurance paid for by the taxpayers.

So the governor has dithered, trying to find a third way out of the box. Neither proposing what he knows is right or being honest about rejecting an estimated $6 billion injected into the state's medical infrastructure over the next five years.

It has become apparent that the governor is continuing his usual practice of avoiding confrontation. But there are times when you are in a position of leadership and people, well, expect you to lead.

And the governor doesn't need to take the rap alone for turning down the money. He needs to get legislators on the record as well.

An expansion of Medicaid (TennCare), paid 100 percent by the federal government for the next three years, will prevent the closing of some rural hospitals. It will preserve thousands of jobs in the state's medical community. It will save lives. It will allow at least 160,000 of the working poor's hospital bills to be paid rather than being cost-shifted onto people who do have insurance. The governor knows all this, but he still hesitates to take the expansion to the Legislature.

So the conservative Republicans in the Legislature can posture and tell like-minded constituents that they oppose Obamacare. But they don't have to pay a price. They don't have to vote to refuse a billion dollars in health care this year for the working poor. They don't have to explain to the voters back home that they voted to close the community hospital. They are getting a free ride.

It is an election year. If legislators had to vote to kill their local hospital, or deny care to people who work at low-wage jobs, you might be surprised at the number of them who will hold their nose and vote for the Medicaid expansion.

But we won't know that because the governor won't make them vote on it.

A leader might be able to galvanize his party members to support him on a crucial vote, if Haslam were that kind of leader. A Ned McWherter or a Phil Bredesen. You won't find anybody in the current Legislature who is afraid of voting against the governor. They do it with impunity. They know that he is not constitutionally capable of punishing them for defying his wishes.

But sometimes a leader needs to do the right thing even with only a long shot at success. He needs to do what's right and force the members of his party to do the right thing or suffer the consequences. It doesn't matter if Haslam knows what the right thing might be; if he won't step up and force the issue then he is clearly in the camp of the short-sighted posturers who will put politics above the welfare of thousands of fellow citizens.

Haslam can talk about his pipe dream of rewriting federal health care regulations, but if he doesn't bring Medicaid expansion to a vote, make no mistake about it: He is firmly in the camp of those who will deny insurance coverage for a huge portion of the population, imperil hospitals, and risk wrecking the precarious health care system in Tennessee.

Haslam has no fear in taking this position. Given his money and his support from the business community, there is little likelihood that he will have a credible opponent for his re-election. He will suffer no political consequence for not fighting for the working poor in Tennessee.

But he should realize that while he may not face political consequences for his decision, he will face the judgment of history. He will, sometime in his second term, start thinking about his legacy. The failure to even try and provide insurance coverage for a large portion of the state population will be a permanent stain.

Failure is a better option than not even trying.