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Johnson Succeeds Bonnyman at TN Justice Center

NASHVILLE, Tenn. (AP) — Michele Johnson has been named the new executive director of a Nashville group that supports greater access to Medicaid.
Johnson will succeed Gordon Bonnyman at the Tennessee Justice Center at the end of the year.
Bonnyman and Johnson co-founded the organization 17 years ago to advocate for Tennessee’s vulnerable population, particularly those struggling to find access to health care.
Johnson is nationally known for her legal work with children who have special health care needs.

Memories of TennCare Cuts Linger In Medicaid Expansion Debate

By Erik Schelzig, Associated Press
NASHVILLE, Tenn. — Proponents of expanding Medicaid in Tennessee say the financial support from Washington is a deal too good to pass up — federal funding for 100 percent of the expansion costs for three years and at least a 90 percent match after that.
But Tennessee is approaching the carrot warily partly because of its experience as a pioneer in expanding Medicaid to cover the uninsured back in the 1990s. Federal funding for that expansion was cut after the White House and governorship changed hands.
The ballooning expenses for TennCare, Tennessee’s expanded Medicaid program, strained state finances and set off incendiary fights over taxes that reshaped the state’s political landscape.
That history is one reason Gov. Bill Haslam is among the last Republican governors to decide whether to expand Medicaid. He has said he will make his recommendation by the end of the month — though he acknowledges that it’s far from certain that lawmakers will approve his choice.
“A lot of people say the governor should never propose something that he or she can’t pass, but I haven’t thought of that,” Haslam told reporters at his most recent public appearance last week. “We haven’t made the call, but if we decide to do it, obviously there’s a lot of selling to do.”
TennCare was authorized in 1994 by the Clinton administration after its national health care reform proposal died in Congress. The Tennessee plan was meant to be a new model for expanded Medicaid programs, where it was up to doctors to determine what care was necessary. The hope was that treating problems earlier would improve overall health and prevent costly trips to the emergency room.
But in practice, few limits on prescription drugs, duration of hospital days, or office and home visits quickly led to escalating costs. And federal guidelines on eligibility created a situation where insurers were able to easily pass off people with chronic health problems to the state-run program.
TennCare soon ran into cost overruns and management turmoil, with 10 directors running the program in its first 10 years of existence. The budget-busting nature of the program was cited by supporters of a failed effort to implement a state income tax in Tennessee, which helped accelerate Democratic losses in Legislature that have left the party with little voice in state government.
An outside study in 2003 found that 15 percent of TennCare enrollees represented 75 percent of the costs.
The first term of then-Gov. Phil Bredesen, a Democrat, was marked by his 2005 decision to cut 170,000 adults from the TennCare rolls and reduce benefits to thousands more. It was an acknowledgment that the state had given up on expanding Medicaid and would revert toward the traditional approach of covering only poor women and children.
It’s not lost on political observers that Bredesen’s Republican successor could end up adding back an estimated 140,000 uninsured Tennesseans. It would be a counterintuitive turn of events given each party’s traditional stances toward Medicaid.
Some TennCare advocates’ argue the state could add the uninsured for the duration of the 100 percent coverage and remove them from the rolls later if the price tag is deemed too high. Haslam is dismissive of that notion.
“I’m not sure those folks appreciated the difficulty of cutting back the rolls last time,” Haslam said. “I don’t think you can just easily walk away at that point.”
State Rep. Craig Fitzhugh, D-Ripley and a former longtime chairman of the House Finance Committee, said the state’s experience with TennCare should encourage officials to embrace Medicaid expansion instead of scaring them away.
“Remember when you got turned down by an insurance company, you just had to present a letter and you got full Cadillac coverage,” he said. “And that’s a thing of the past.”
“If, as some fear, the federal government pulls the plug and we have to shrink it back down, we’ve got experience with that,” he said.
The most persuasive argument made to the Republican supermajorities in the state Legislature has been that rejecting the Medicaid expansion would hurt hospitals — especially those in rural areas — and likely cause some of them to close.
But Senate Speaker Ron Ramsey, R-Blountville, said he doesn’t trust the federal government to keep up its end of the bargain.
“I would almost lay odds that they will not keep their promise of funding,” he said. “And what are our options then? Either to raise taxes on the people of state of the Tennessee, or remove people from the rolls.
“I’ve been through that once, and that’s not fun,” he said.
Gordon Bonnyman, executive director of the Tennessee Justice Center, a group that supports greater access to Medicaid, said the state’s experience under the new federal health care law would be different than it was when it was seeking waivers for the TennCare program.
“A state in a waiver context basically goes to the feds and says, ‘Mother, may I?'” Bonnyman said. “Which is very different from the statutory guarantees under the Affordable Care Act.”
For Joyce Cotter of Nashville, Medicaid expansion could allow her to attend to several medical conditions that have gone untreated since she was cut form TennCare for a second time in 2010.
“If they would expand it even for the three years, that would give me a chance to have myself check for my heart, my (lung) and my leg problems that I’ve got,” she said. “I have a lot of health issues, and they’re not being taken care of.”

TN Trinity: Loud in Attacking ‘Obamacare,’ Silent on Medicaid Expansion

While joining other Republicans in attacking “Obamacare,” the Commercial Appeal notes that Tennessee’s GOP leadership trinity — Gov. Bill Haslam, Lt. Gov. Ron Ramsey and House Speaker Beth Harwell — maintains silence on whether the state should a key provision by expanding Medicaid eligibility.
Although Tennessee’s governor has said he opposed the Affordable Care Act and took heat for using the term “Obamacare,” the politically charged nickname for the law on his official taxpayer-funded website, he hasn’t signaled whether he would block an expansion of TennCare, the state’s Medicaid program.
Immediately after the Supreme Court ruling, Haslam issued a statement calling the court’s language on Medicaid “unanticipated” and “significant,” but he said “it would be premature to know the exact ramifications” on the state. As of Friday, the governor’s office had nothing to add on the issue, according to a spokesman.
Lt. Gov. Ron Ramsey, an outspoken East Tennessee conservative, has called the Affordable Care Act “insidious” and has vowed, like many Republicans, to help Mitt Romney get elected president in November so he can repeal the law. Ramsey, however, has not publicly opposed the expansion of TennCare.
Tennessee House Speaker Beth Harwell’s latest public statement on the Affordable Care Act last week indicated she, too, would need time to study the impacts of the court’s decision on Medicaid expansion.
“Over the coming months we will carefully study how this law impacts our state and what needs to be done,” Harwell said in a statement.
Under the Affordable Care Act, the federal government agrees to pick up the entire tab from 2014 to 2016 for expanding TennCare. It’s an offer that could be worth $11 billion from the federal government and could cover some 200,000 now-uninsured Tennesseans. But to get the money, the state would have to spend an estimated $716 million to $1.5 billion over five years, based on Congressional Budget Office projections.
All of these figures can change depending on who wins the White House in November. They can also change if political or economic winds shift in the future and the Affordable Care Act is changed, which could leave states with expanded Medicaid rolls but without the promised federal funds to cover them.
But if the Affordable Care Act is implemented as-is, it could bring 3,480 jobs, with $160.8 million in new wages and a total of $451.3 million of new money to Shelby County in 2014, according to a 2011 study by researchers from the University of Memphis. The newly insured would generate 145,194 more medical visits here in 2014 bringing more work to hospitals, doctors’ offices and health care providers, the study said.
Gordon Bonnyman, executive director of the Tennessee Justice Center, said the state doesn’t really have any choice but to expand TennCare. Should the state fail to expand the program, Tennesseans will, in effect, see their federal taxes used to subsidize expanded Medicaid programs in other states, he said.
Because the federal government matches state spending on Medicaid programs, expanding TennCare is a way to get more federal money. That’s why, for example, the state’s hospitals voluntarily agreed to pay an “enhanced coverage fee” to the state in the last few years to help draw those funds.
“Without the Medicaid expansion, hospitals will have neither the financial ability, nor the political will, to continue paying the assessment,” Bonnyman said. “Without the hospital assessment, the resulting loss of federal funds would have a devastating impact across state government and local governments.”

Supreme Decision Brings Renewed Call for Health Care Compact

Several Republican state lawmakers plan to renew their push next year for a multistate “health care compact” that, if approved by Congress, could lead to Tennessee taking over most federal health programs, including Medicare, operating in the Volunteer State.
More from Action Andy Sher:
Citing this week’s U.S. Supreme Court decision upholding the federal health care law, the lawmakers said the time is ripe for the bill, which failed on the last day of this year’s legislative session.
“I hope we can pass the Health Care Compact next year in Tennessee, and I look forward to working with Rep. [Linda] Elam, Rep. [Mark] Pody and other conservative lawmakers who hope to lower health care costs and raise quality in an efficient and constitutional manner,” Sen. Mae Beavers, R-Mount Juliet, said in a news release.
Republicans began pushing the bill in 2010 as a way to get out of President Barack Obama’s Affordable Care Act. It would require permission from Congress to do. Proponents said a state-based solution was preferable to a federal system that was already unwieldy.
The bill would authorize Tennessee to join a health care compact for states interested in crafting their own health care policies, which would supersede federal law.
Each state would receive a federal block grant covering programs such as Medicaid, the jointly funded state and federal health program for the poor. Tennessee’s Medicaid program is called TennCare.
…Senate Majority Leader Mark Norris, R-Collierville, raised the compact issue this week as he attacked the Supreme Court decision, which upheld an individual mandate requiring Americans to obtain private or employer-based insurance or, if eligible, a government-sponsored program.
“Perhaps next year our efforts to enact the Health Care Compact will finally succeed,” Norris said.
The court ruled as unconstitutional a provision requiring states to participate in a major expansion of Medicaid programs like TennCare. But it allowed the expansion to proceed, giving states the choice of whether to participate.
Republican Gov. Bill Haslam, who is still sorting through the implications of Thursday’s Supreme Court decision, wasn’t so sure creating the compact is the right idea. He has supported federal block grants for Medicaid.
“I don’t know that we have both the means or the ambition to take over all federal health care in the state,” Haslam said Friday. “I think there would be some cost concerns.”
Gordon Bonnyman with the Tennessee Justice Center, which advocates for the poor on health care among other issues, predicted the compact will never pass.
He said all it would take is one solid ad by Democrats, “saying, ‘Yo, Medicare beneficiaries, do you want to be enrolled in TennCare and have TennCare govern your health care?’ You can imagine the reaction. That’s what that compact would be.”
The legislative financial analysis of the bill was “very clear” that the measure would give Tennessee control over Medicare, Bonnyman said. Republicans should be wary about upsetting Medicare beneficiaries, who include the middle class and the wealthy, he said.
“It [bill] is the only thing that could restore a pulse to the Tennessee Democratic Party — and not only restore its pulse but get it up on its feet prancing around,” he quipped
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