Possible TennCare Expansion Still Work in Progress

By Bill Dries


The Tennessee lieutenant governor says it is a waste of time. The Memphis representative in U.S. Congress says it is overdue.

Tennessee Gov. Bill Haslam is still negotiating with the White House on a possible $1.4 billion expansion of Medicaid in Tennessee that could cover 140,000 uninsured Tennesseans under TennCare, the state’s version of Medicaid.

Even if he reaches an accord with the Obama administration, Haslam has committed to taking any deal to the Tennessee legislature for approval as he runs a gauntlet of criticism from both opponents and proponents of an expansion fully funded by Washington in its first three years and 90 percent federally funded in the following three years.

“Obviously I think it’s still worth working on or we would have thrown in the towel before,” Haslam said recently at an appearance in Memphis.

Meanwhile, opponents of the Medicaid expansion have taken their opposition to other levels.

That was the message Tennessee Sen. Brian Kelsey was delivering as he gave Health and Human Services Secretary Kathleen Sebelius a copy of the book “Web Sites for Dummies” when she visited Memphis this month.

Kelsey told Sebelius he didn’t want her “designing an expansion program for us.”

“I only had two seconds to convey that message to her,” Kelsey said later. “So I thought the book would be a creative way to ensure she remembered the message.”

U.S. Rep. Steve Cohen, upon returning back to the Memphis district after the October government shutdown had ended, evaluated the meaning of the shutdown inside the Washington Beltway. But he spent more time urging Haslam to take the next step in the health care reform debate in Tennessee and expand TennCare.

“I think it’s a fiscal and a moral crime that Tennessee hasn’t expanded,” said Cohen, who is a former Tennessee senator with plenty of thoughts about the current make-up of the chamber, which like the House has a Republican super majority.

“It’s my understanding that the state Senate … is his Waterloo,” Cohen added. “He knows it’s the right thing to do economically and morally. Nobody thinks the Senate would vote for it.”

Cohen spoke about a month after Lt. Gov. and Speaker of the Senate Ron Ramsey said that based on the rollout of the Affordable Care Act, he thought Haslam’s effort was “wasting his time.”

Haslam has insisted any final decision on the TennCare expansion is separate from his decision not to set up a state exchange for health care insurance but instead rely on the federal exchange.

“There are hospitals across this state, many of them in rural communities that are going to struggle if not close under the health care law without (Medicaid) expansion, and that’s not something to take lightly,” Haslam told the Tennessee legislature in January during his annual state of the state address.

“Most of us in this room don’t like the Affordable Care Act, but the decision to expand Medicaid isn’t as basic as saying, ‘No Obamacare, no expansion.’”

In March, Haslam told a joint session of the House and Senate that he was exploring a “third option” and saying “no” to the Medicaid expansion for now.

Haslam acknowledged this month that getting approval from the Tennessee legislature on an agreement that federal officials also agree to is “a thin needle to thread.”

“We haven’t sent a formal proposal because what I told Secretary Sebelius is, ‘We are not going to waste your time or ours until we know that we have something that we think there is a real chance that they will accept and that we can get passed in the legislature in Nashville,’” Haslam said this month. “So far, I haven’t been able to come up with a plan that will do both of those.”

Haslam, who is running for re-election next year, has time. He has said for some time that he doesn’t think an agreement is likely this year. Ramsey has said he would like to see the state wait two years before giving the option a final “no.”

In Nashville this week, Haslam began budget hearings that are the first public step in putting together his third state budget since taking office in 2011.

In the hour-long tiers of public discussions, TennCare in general comes up Monday afternoon, Nov. 18, and the discussions will be watched closely by both sides of the question for what Haslam has to say.