Tennessee Gov. Bill Haslam says his letter this week to Health and Human Services Secretary Kathleen Sebelius on the terms of a possible Medicaid expansion in Tennessee means ongoing talks between his administration and Sebelius’ office will continue.
Haslam gave a conditional “no” to such an expansion in March, which was followed by the discussions on terms Haslam has said are necessary because of Tennessee’s unique situation.
Expansion of Medicaid coverage opens Jan. 1. For Tennessee that would mean $1.4 billion to cover 140,000 Tennesseans who are currently uninsured.
The federal government would pay 100 percent of the cost for the first three years and 90 percent for three years after that.
“We do not see a path forward in the current environment that will allow us to extend coverage to the Medicaid Expansion population,” Haslam wrote in his Dec. 9 letter to Sebelius.
In Memphis Tuesday, Dec. 10, for the annual Greater Memphis Chamber luncheon, Haslam said the expansion “addressed covering more people but it didn’t address better outcomes and controlling the cost.”
TennCare, which is Tennessee’s version of Medicaid, will take up 80 percent of the state’s new growth dollars in revenue in this year’s budget, according to Haslam. And Haslam has cited the state’s experience with growing the rolls of TennCare only to have to make the painful decision to pare the roles during the administration of his predecessor, Phil Bredesen.
Haslam’s letter this week to Washington was an appeal to one side of a volatile political combination.
“The difficulty in this for me is to see if I can come up with something the legislature can approve and that HHS will approve,” he said. “Those two bodies have a fairly different view of how health care should work.”
Lt. Gov. and Senate Speaker Ron Ramsey has said several times that he thinks Haslam’s pursuit of an agreement is a waste of time.
State Sen. Brian Kelsey of Memphis told Sebelius during her November visit to Memphis that Tennesseans are not interested in a Medicaid expansion.
The opposition among legislators in his own party is important because Haslam has promised that any terms for a Medicaid expansion that he might negotiate with Washington will go to the legislature for approval.
And Republicans in each chamber have a super majority.
Haslam has said some of the opposition within his own party is a reaction to the Affordable Care Act, which Haslam has distinguished from an expansion of TennCare.
“I think we need to get past some of the current form of looking at it. … I don’t think it was passed in the right way,” he said of the act. “That being said, what we have to do is deal with where we are. My pledge is, I’m not going to propose something to the legislature until I think it provides better cost control and the possibility of better health outcomes for Tennesseans.”
Meanwhile, Haslam’s letter is taking criticism from the other side of the aisle in the legislature for being an attempt to pay private insurance providers.
House Democratic Minority Leader Craig Fitzhugh called the letter “simply the latest in a series of farces.”
“It’s more of the same hand-wringing, ducking and dodging we’ve come to expect from this administration, all in an attempt to absolve themselves of the worst moral and mathematical failure in a generation – denying health care to 330,000 working Tennesseans,” Fitzhugh said. “Expanding Medicaid in Tennessee is not an impossible task, but Gov. Haslam is doing everything he can to make it one.”
House Democratic Caucus Chairman Mike Turner accused Haslam of “seeking to offer lower quality care to fewer people and still collect all the money allocated in the Medicaid expansion,” which Turner said is something Sebelius doesn’t have the power to authorize.