Signs Point to Soon-to-be-bold Bill on Medicaid Expansion

Politico discovered Bill Haslam last week, declaring in a flattering profile piece that he is “the most important Republican governor you’ve never heard of,” a prospective candidate for national office and “at the very least a model for national Republicans groping around for ideas that appeal to the middle class.”
At the same time, the national online political magazine was also running an article about the great divide among Republican governors over Medicaid expansion. The “ideological purists are big-name Southern governors who have all said ‘hell no’ to major pieces of the law, even turning down free federal cash to expand Medicaid in their states,” the article says. Haslam, not being a big-name governor and only recently discovered by Politico, is not mentioned.
He’s also not mentioned among the “more pragmatic governors” who have said yes to Medicaid expansion, risking the wrath of their party’s right wing for doing something that can be construed as embracing the despised Affordable Care Act, otherwise known as “Obamacare.”
But it’s a pretty safe bet that he will be joining the more pragmatic governors after going through a few more motions to soften the ensuring confrontation with the Legislature’s ideological purists as much as possible.

Already, our governor has rejected setting up a state-operated health insurance exchange or going into partnership with the federal government. This pleased the purists, and Haslam also keeps these folks in mind by always declaring how much he really dislikes Obamacare.
Haslam blamed the exchange decision, in large part, on the Obama administration’s inability to answer questions and grant flexibility. But talks are continuing on Medicaid expansion and, one may reasonably expect, the governor will at one point be able to say he’s got some answers and some flexibility.
At that point, giving thousands of Tennesseans health care insurance at no cost to the state — for three years, anyway — arguably becomes at the very least the pragmatic thing to do and maybe even a no-brainer.
After all, the newly covered Tennesseans benefit, the state’s economy benefits, the state’s health care industry benefits and already-insured citizens probably won’t see their premiums go up as much.
The loser is the federal treasury, already running at a deficit. But if the money doesn’t go to cover Tennesseans, it will be spent in other states.
Even Florida Gov. Rick Scott, an ideological purist and big-name Obamacare-basher, reached that conclusion last week. Haslam is still officially undecided.
As the Politico profile accurately points out, Haslam has a real distaste for confrontation. So it is to be expected that he will take some time to ease the confrontation and soften the inevitable outcry from a Legislature where bills have been filed to pre-empt the forthcoming Haslam decision and simply say no to Medicaid expansion.
A couple of weeks ago, one of the Haslam pre-emption bills was scheduled for a committee vote, only to be unscheduled after some back-room talking.
Senate Speaker Ron Ramsey apparently did some of that talking. Texas Gov. Rick Perry, whom Ramsey backed for the Republican presidential nomination, has said no to Medicaid expansion. Ramsey says he’s strongly inclined to do the same but is willing to wait and listen.
If the new Bold Bill goes for expansion — no, let’s say when he does, as long as we’re speculating — there will be a vote in the Legislature. Haslam will be able to count on the minority Democrats but needs a substantial bloc of Republicans to back him as well.
Just maybe there was a sign of things to come on that front as well last week. A Republican bill setting the stage for Tennessee state government to take over federal health care programs failed in a House committee on a tie vote. Four Republicans joined with all five Democrats on the panel in voting against the bill — on which, of course, the old and not-so-bold Haslam had no position.
Last session, the same legislation made it all the way through the House and Senate with uniform Republican support, only to fail because some were absent from the House floor at the final vote.
Maybe the please-don’t-call-me-moderate Republicans of the General Assembly are getting ready to stand with soon-to-be-Bold Bill.

Note: This was written for Sunday’s News-Sentinel, and also appears there.

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