When your health insurance premium goes up this year—and it will—you can thank Gov. Bill Haslam and his Republican majority in the Legislature. But you can take comfort in the fact that they showed President Obama who's boss by rejecting over $1 billion in federal funds.
I guess we get to pay for their thrills.
Two things have happened: The feds have offered 100 percent funding for three years to expand Medicaid (TennCare in Tennessee) to cover more people. At the same time they have cut the federal funds that normally go to hospitals that take a disproportionate share of poor people without insurance.
Tennessee Hospitals will not get the extra Medicaid money, but now they will lose the funds they already get to pay for indigent patients. Hospitals have to have revenue to survive. So where will they get it? They will get it from the patients who do have health insurance. It's called cost shifting. It has happened for a very long time, but now it will get worse.
Haslam did not have the votes to get the Republicans to approve his expansion of TennCare. He might have been able to find enough Republicans to vote with the Democrats to pass it in the House, but it was unlikely in the Senate. But if he had gone to the mat, he could have explained the issue, explained to the public the importance of the stakes and paraded local hospital administrators through their delegation offices. Even if the measure were defeated, he would have forced the fight and made legislators go on record. Then they could explain to the folks back home why they forced their local hospital to close.
Haslam's "third way" idea, called the Tennessee Plan, asks the Obama administration to allow a Republican governor to rewrite the rules. Good luck with that. Rather than just announce he wouldn't take the money, which would have allowed the Democrats to scream and walk out in protest, Haslam muddied up the issue. The Republicans are happy because they stopped that awful Obama from making them take the money.
The plan asks the feds to give the state the money and let the state then purchase private insurance for the working poor. Other than diverting TennCare money from hospitals to increase insurance company profits, it seems a distinction without a difference.
The best possible outcome is for Haslam to wait until session is over and the legislators go home. If his Tennessee Plan is rejected, then he needs to approve the Medicaid expansion by executive order. There is a prevailing opinion that the Legislature has to approve a budget that includes authorization for expanding Medicaid (TennCare). But do they really?
There is an argument to be made that while the Legislature can vote to forbid participation in the expansion of Medicaid, there is no requirement that they vote to participate.
The TennCare program exists. It does not require legislation to be created. Should there be any state expense involved in implementing the program, the governor can shift money around to accomplish it. Governors have been doing it since Lamar Alexander.
Enrollment needs to start in October and will be entrained by the opening of session next year.
There is the possibility that Lt. Gov. Ron Ramsey and House Speaker Beth Harwell could call a special session at some point and try and pass legislation to forbid the program. But it isn't likely to happen.
I completely understand legislators upset with continuing federal deficits. I also question the health-care mess being created by Obamacare if it ever gets fully implemented. I sympathize with the attitude of just wanting it to go away.
But Medicaid (TennCare) already exists. If Tennessee doesn't take the money, it will not reduce the deficit. It will just go to another state.
Haslam needs to do what needs to be done and he needs to bypass legislators who are more concerned with making a statement against Obamacare than the health and well-being of state hospitals and the working poor.