VOL. 132 | NO. 69 | Thursday, April 6, 2017
View From the Hill
GOP Happy to ‘Wait and See’ on Medicaid
By Sam Stockard
Republicans say ho, Democrats say go. In the wake of Trumpcare’s congressional crash, states such as Kansas and North Carolina are joining the majority of the nation in expanding Medicaid rolls.
With Speaker Paul Ryan saying the Affordable Care Act, aka Obamacare, is the law of the land for the “foreseeable” future, they’re following the other 31 states that are already receiving federal funds to expand, according to reports.
But Tennessee is likely to stick to its political stripes and sit on the sidelines.
Republican House Speaker Beth Harwell says it’s up to Gov. Bill Haslam to go back to the feds and renegotiate. She even says she believes, after talking to the governor, some “wiggle room” could be open to persuade the federal government to allow Tennessee to adjust its Medicaid or TennCare financial qualification, which sounds vaguely like expansion.
But asked if she thinks Medicaid needs to be expanded in Tennessee, with House Democrats pushing legislation to enable the governor to seek a waiver for expansion, she adds, “I don’t think there’s the political will to do that in this legislative session.”
Considering Republicans outnumber Democrats 64-25 in the House and 28-5 in the Senate, look for Republicans to get their way, regardless of what the governor does.
Lt. Gov. Randy McNally is holding out hope Congress will make block grants of Medicaid money the state can put into its TennCare program, which, incidentally, is budgeted to expand by $214 million in fiscal 2018 to cover more people.
Asked if Tennessee would follow states such as Kansas, not exactly a hotbed of liberalism, McNally says, “I think we’re still in our same position. We want to wait and see more where the federal government’s headed.”
But wouldn’t the governor’s Insure Tennessee program, which is estimated by some to pull down about a billion dollars a year, put the state in a better position by covering about 290,000 people caught in a gap?
“No,” McNally says. “Each year we’re faced with difficulty in funding the current TennCare/Medicaid program. We’ve experienced a lot of growth since the Affordable Care Act. We’ve also run into other problems with that act such as some parts of the state, after this year, there won’t be insurance available.”
Make no mistake, in some regions, providers are dropping out of the individual coverage market because, they say, they can’t afford to cover the people. Some of that took place even though the state allowed major premium increases, and McNally predicts Humana will leave the market, following BlueCross BlueShield.
“It’s fraught with problems, and I’d like to see the federal government try to straighten out the issues that it faces,” McNally points out.
State exchanges “have gone belly up” for the most part, he notes, because the program was underfunded, with expenditures exceeding revenue in the latter part of its first 10-year cycle.
As for Insure Tennessee, an alternative the governor proposed at the Legislature’s request after it refused to expand Medicaid when Obamacare passed in 2010, McNally says he doesn’t think the state can afford it.
“Particularly if the underlying program craters,” adds Senate Majority Leader Mark Norris, who helps McNally count the state’s beans.
The Collierville Republican, who is considering a gubernatorial run, is clearly not in favor of Medicaid expansion, which he, too, considers an expensive proposition the state can’t afford to fund annually. Norris also points out the state’s insurance and revenue commissioner has testified about instability in the individual coverage market linked with the Affordable Care Act.
“So there’s real risk involved, even though this is a component of the overall program. If it goes under, it takes everything with it,” Norris adds.
“And arguably, it leaves us and our constituents holding the bag, so it’s better to hold and see what happens right now, I think.”
Gov. Haslam says he’s like most Americans and has no idea what will happen next in Washington, though he predicts Congress will move on to other matters.
The second-term Republican governor says he’ll work with TennCare to get the best deal it can with the Trump administration. His office didn’t comment on Harwell’s contention about “wiggle room” to adjust TennCare qualifications.
He sees no connection between the push to repeal and replace Obamacare and marketplace uncertainty, preferring to say the problem is caused by a bad mix of users, one in which the people who wound up getting coverage were costlier than insurers could handle.
But at least he acknowledges the shortage of coverage for the individual marketplace is a “primary concern.”
Still, the governor says it’s too early to consider calling a special session to deal with health-care insurance and Medicaid.
“I just think the reality is that health care and changing health care is a lot more difficult than it looks. It’s a huge part of our economy. It affects every American, and when you make a change like that, there are going to be people who aren’t going to like whatever the change is,” Haslam points out.
“It’s a lot easier to say we’re going to end it than to say here’s what we’re going to replace it with.”
But while people on both sides of the political aisle say the Affordable Care Act needs tweaking, nobody capable of pulling the strings appears to be doing it, including most Republicans, probably because they like the things it requires, such as coverage of pre-existing illnesses, maternity care, hospital treatments, allowances for children up to age 26 on parents’ plans.
Democrats are much closer to going all the way, at least in Tennessee, though a lot of people agree the individual mandate, with its tax penalty, might have pushed people out of the market instead of attracting them.
‘What are we waitin’ for?’
For those who’ve forgotten, those are the words of Mick (Burgess Meredith), Rocky’s trainer, who, more or less, told him to put his rear in gear and knock out Apollo Creed.
They also could sum up the position of legislative Democrats, who backed Insure Tennessee two years ago and have been trying roundabout ways since then to revive it.
The latest effort is a measure by House Minority Leader Craig Fitzhugh, also weighing a gubernatorial bid, allowing the governor to negotiate with President Trump and federal Health and Human Services to implement Insure Tennessee, or the state’s 3-Star Healthy proposal by Speaker Harwell and give anywhere from 250,000 to 400,000 people the ability to obtain health-care coverage.
Fitzhugh, a Ripley Democrat from West Tennessee, points out the state recently hit the $3 billion mark for funds forfeited by not opting for Insure Tennessee under the Affordable Care Act.
The demise of the American Health Care Act gives the state an opportunity to help the working-class people who are priced out of the health care market, Fitzhugh adds.
“All we’re trying to do is give our governor, our state, the ability to do what the majority of people in this state want us to do,” Fitzhugh says.
He doesn’t wear a toboggan like Mick, but state Sen. Jeff Yarbro, who chairs the Senate Minority Caucus, also wonders what the Legislature is waiting for.
After two U.S. Supreme Court decisions, a year’s worth of negotiations with the Feds for Insure Tennessee approval, a failed special session, the 3-Star Healthy initiative – which would do roughly the same thing as Insure Tennessee – a presidential election, a new president and now a defunct Republican plan, he’s had enough.
“How long are we gonna wait and how much are we gonna make the citizens of Tennessee pay for that waiting,” Yarbro says. “Because it’s shortsighted and, frankly, cruel to the 200,000 people who should be covered by Medicaid.”
Even worse, he adds, the state’s failure to expand pushes the price of everyone else’s insurance higher because companies have to charge more for healthy people to pay for those in poor health. Of course, even healthy people get sick, have shoulder and knee operations or, worse, get cancer.
When the Commerce and Insurance commissioner warned of the shaky system last summer, Yarbro and state Rep. John Ray Clemmons called for immediate legislative action.
Hardly anyone budged.
Now that Obamacare will remain in effect – courtesy of an odd concoction of congressional Democrats and ultra-conservative Freedom Caucus Republicans – Fitzhugh calls this opportunity to expand Medicaid “manna from heaven.”
“I’ve said that it’s the biggest moral failure we’ve had in the 23 years I’ve been here. If we turn this part down right now and don’t take advantage of that, it will be double the worst moral failure we’ve ever had. It would just be exacerbating that,” Fitzhugh says.
As for the Republicans’ plan to wait, he gets a little exasperated. “Waaait? People are dying. They’re literally dying. There’s evidence that people die every day because they don’t have health care that this expansion could give them. It’s that simple.
“And if you’re not dead, you’re getting sick.”
More than likely, rural hospitals, which are increasingly at risk for closing, and those whose insurance is in danger of being canceled would agree: What are we waitin’ for?
Sam Stockard can be reached at firstname.lastname@example.org.