House Speaker Beth Harwell and Senate Speaker Ron Ramsey both said Tuesday they are inclined to oppose Medicaid expansion, though not flatly ruling out the possibility as Gov. Bill Haslam studies the issue and contemplates making a decision sometime next year.
With Haslam’s decision Monday to leave operation of a healthcare exchange in Tennessee to the federal government, battle lines are now being formed on whether or not to expand Medicaid, operated as TennCare in Tennessee, as envisioned by the federal Affordable Care Act, also known as Obamacare.
Haslam said rejection of a state-operated healthcare exchange should not be seen as an indication he will reject Medicaid expansion.
“I’ve tried from the very beginning to separate the two because they are very different issues,” said Haslam.
The governor also said he has no hard timeline for making a decision, which could come after the Legislature ends its 2013 session – probably in late April or early May. The federal law calls for expanded Medicaid to begin on Jan. 1, 2014.
But the first bill officially filed for the 2013 session, labeled Senate Bill 1, would preempt the governor by enacting a state law that prohibits Medicaid expansion. Sen. Brian Kelsey, R-Germantown, who sponsored the measure, said Tuesday he is undecided whether to push for prompt action early in the coming session.
Democratic leaders said they strongly support expansion because it would provide medical insurance for thousands of Tennesseans who now have none – estimates range from 180,000 to 330,000 – and perhaps save 20 or more hospitals, primarily in rural areas, from closing as they lose federal funding for charity care under a separate provision of Obamacare.
Most Republicans seem to oppose expansion — though some interviewed Tuesday said they were undecided, including House Majority Leader Gerald McCormick and Knoxville’s Rep. Steve Hall.
Harwell and Ramsey said they lean against expansion, but are willing to listen to arguments in support of the idea and want to hear what Haslam eventually decides.
“I don’t think we’re going to go that way (to expand Medicaid),” said Harwell. “I think it would leave our state vulnerable after they (the federal government) run out of money.”
“On the surface, I’d have to say it’s a bad idea,” said Ramsey. “It’s a whole lot like the state exchange issue – who will pay for it, for how long, and how would it work?”
Rep. Ryan Haynes, R-Knoxville, said he is opposed but willing to listen to contrary arguments. On the other hand, Sens. Mike Bell of Riceville and Stacey Campfield of Knoxville, along with House Republican Caucus Chairman Glen Casada of College Grove, said Wednesday they are opposed
“It’s not going to happen,” predicted Campfield, who described expansion as “Obama trying to have the states’ help in bankrupting the federal government.”
House Minority Leader Craig Fitzhugh, D-Ripley, and Senate Democratic Caucus Chairman Lowe Finney of Jackson both said in interviews that they believe Republicans are predisposed to block expansion because of a general dislike for Obamacare, but hopeful some GOP minds can be changed as they learn more about the situation.
“If the governor doesn’t have the votes for exchanges, expanding Medicaid doesn’t stand a chance,” said Finney.
Fitzhugh said the “right-wing wind” is pushing Republicans against expansion, but he is hopeful that the Democrats’ “cry in the wilderness” will be heard if debate continues for an extended time and Republicans pay attention to facts on how expansion will help the state’s economy through the health care industry.
U.S. Health and Human Services Secretary Kathleen Sebelius, meanwhile, has made two recent statements that could impact the decision-making process for states.
First, Sebelius has indicated, according to a Los Angeles Times story Tuesday, that states refusing to open enrollment to all those eligible under the law will not get full federal funding. The move would block state considerations from a partial expansion, as some have suggested is an option.
On the other hand, Sebelius’ department has also indicated that states choosing to expand Medicaid rolls could also reverse their decision in later years.