Much about the way forward on health care reform is unclear.
The information state leaders need to know from Washington to make critical decisions about the state’s substantial role in the changes now at our doorstep and those following closely haven’t been as forthcoming as they should have been. That was a large part of the reason Tennessee Gov. Bill Haslam opted not to form a state exchange to provide health care insurance.
And it was cited again as Haslam rejected an expansion of Medicaid in Tennessee that would have been fully funded by the federal government for the first three years. We sense that this is an evolving process with many more critical decisions to come as Americans use the system and change some theories into realities while discarding others.
As that happens the debate will likely continue about whether Haslam should have attempted to mold a state exchange to meet the needs of Tennessee or left it at the doorstep of federal regulators operating a broader exchange. But we also believe there is little doubt about the basic need for the state of Tennessee to participate in an expansion of Medicaid.
The way we see it, either a “yes” or “no” on Medicaid expansion could have come with the continued pursuit of the “third option” Haslam advocates for – federal funding to leverage toward allowing the previously uninsured to buy private health care insurance.
A “yes” would have allowed perhaps 60,000 to 80,000 in Shelby County who are now uninsured to have TennCare coverage. And in the three years that the expansion is fully funded by Washington, Haslam and the Health and Human Services bureaucrats he tried to work with would have that time to work on the middle ground.
It’s been done before with the state’s historic and initially hurried move to TennCare during the McWherter administration. The road to TennCare was strewn with the same differences between state and federal leaders that Haslam bemoaned as he rejected the Medicaid expansion. And there were even more differences once TennCare was established with federal waivers up for uncertain renewals at several points.
Haslam’s concerns about what happens in that expansion of Medicaid beyond the first three years are undeniably valid. But his third option raises numerous issues in pursuit of basic principles that also need time to be examined and discussed. Three years is the kind of timeframe to work through those questions. The here-and-now stakes of Haslam’s decision in this community are to be found in a group of 60,000 to 80,000 people in Shelby County, most eligible for a Medicaid expansion.
Without it their care is delayed and uncompensated. Both of those factors are recurring themes in the fortunes of the safety net hospital not just for this city but for this region. We don’t have to wonder about what will happen. We know what has happened.