Haslam’s Plan Faces Bumps

Senator Mark Norris posted this story on his facebook page. It’s from the Tennessean. Norris commented, “The governor proposes, but the legislature disposes.”

The issue is Medicaid expansion, something Senator Kelsey, who will speak at our Midtown Republican Club meeting tonight, knows a lot about. We’ll want his input.

Here’s the story:

Gov. Bill Haslam will have to manage the politics of Medicaid expansion a lot better than he has so far if he’s going to get Tennessee in line for millions of dollars in health coverage for some of its most vulnerable citizens.

On Thursday, for the second time since the Affordable Care Act went into effect, Haslam promised a plan for Tennessee.

The first time was in March 2013, when he christened his forthcoming effort the “Tennessee Plan.” But he never followed through on the promise, and there’s still no plan to speak of.

On Thursday, in a briefing with reporters after an event downtown (Nashville), the governor said he hoped to have a plan to present to the federal government sometime this fall. He didn’t explicitly say it would include expanding Medicaid, but that was the question he had been asked. He did say he’d have to get whatever he came up with through the legislature.

That was the first sign that this wasn’t a big “Eureka!” moment for the governor. The second came on Friday and Saturday, after Republican lawmakers weighed in. Sen. Majority Leader Mark Norris, R-Collierville, said the governor didn’t seem very serious about his plan because he hadn’t been talking to members of the General Assembly at all.

In separate emails sent Friday and Saturday, in what sounded a lot like a walk-back, Haslam spokesman Dave Smith used identical language to describe the governor’s intentions. His words suggested the administration doesn’t want its “plan” to be seen as an expansion.

“The governor has said Tennessee is not expanding the current Medicaid program,” Smith said in both emails. “This is an ongoing conversation about leveraging available federal dollars to cover more working Tennesseans to control costs and improve health outcomes.”

That’s a mushy way of saying “hold on just a minute.” But if there’s a difference between “leveraging federal dollars” and bringing more of them to Tennessee, it probably needs to be explained.

The upshot of all of this is that we’d better wait to see what Haslam actually proposes. That goes for the 162,000 uninsured Tennesseans who stand to benefit and for the hospitals that take care of them.

As a purely political matter, Haslam should have pushed this through when it first became available — before the botched enrollment process made health care reform a political albatross. Now the politics are a lot harder.

But that leaves Tennessee in the position of turning its back on a lot of money. Calculations vary, but it’s upwards of $2.5 million a day. The Obama-friendly states of California, Connecticut, Minnesota, New Jersey and Washington have been on board since 2010, as has the District of Columbia. On Thursday, Pennsylvania became the 27th state in the nation to sign on.

Is the moral of this story going to be that if you want health insurance you probably ought to live in a blue state? Maybe so.

But Haslam has a political problem. It almost doesn’t matter what he thinks should happen.

Being the fiscally conscious governor that he is, he probably wants to take the money. And Tennessee hospitals really want the money. But Republicans in the legislature are going to take more convincing to sign off on something so clearly connected to the president. This year they passed a law essentially giving them the final say on expansion.

It sounded as if they meant it.

That points to one of two outcomes. The governor could come up with a “plan” that looks good enough to Republicans to persuade them to ignore the Obamacare label. The challenge down that road is that he would have to get the Obama administration to like it, too.

His only other choice is to somehow convince the legislature that expanding Medicaid is the right thing to do.

Check that. Leveraging federal dollars.

Writer Scott Stroud sure managed to pepper this story with bias and snark, didn’t he? To him, we are losing $2.5 million a day. Since this money comes from the taxpayer it’s not like it’s a pot at the end of a rainbow Tennesseans decided to reject. It comes from our pockets, not “Obama’s stash.” That $2.5 million comes from us.

Stroud’s suggestion then is that blue states are better than our red one, implying that Republicans don’t care about health issues. We, of course do, just not as Obama envisions it. Besides, we are red for a reason. It’s the will of the people here so maybe the reporter is the one who should move.

As for fiscal soundness, it’s not a good deal to get a hamburger for free today but then to pay three times the going price as the federal government removes the free coupon and sticks us with the bill.

Thank God most of our legislators put a stop on the expansion.

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