After winning approval in a House committee, legislation to prohibit Tennessee insurance companies from participating in health care exchanges set under the Affordable Care Act has failed in the Senate.
The bill (SB666) got only one vote in the Senate Commerce Committee — that of the sponsor, Sen. Dolores Gresham, R-Somerville — after critical commentary from insurance company representatives and state officials. Gov. Bill Haslam said after the House vote that he opposes the bill.
The measure earlier won 6-2 approval in a House panel where sponsor Rep. Vance Dennis, R-Savannah, said it would exploit “the Achilles’ heel of Obamacare.” Since states control insurance companies, sponsors argued legislators can block the federal law by prohibiting state-licensed insurance firms from participating in the program.
Critics said that the result would likely be authorization from the federal government for out-of-state companies to sell insurance within Tennessee instead.
The two Democratic senators on the Commerce Committee voted against the bill. All Republicans on the panel — except Gresham — either abstained or were not present when the vote was taken.
Tennessee insurance companies would be prohibited from participating in the state’s federal health care exchange that will provide federally-subsidized medical insurance under a bill approved Wednesday by a House subcommittee.
Rep. Vance Dennis, R-Savannah, said he had found “the Achilles heel of Obamacare” with his bill (HB476) and, once Tennessee approves it, other states are likely to follow and doom the federal health care program.
“With this bill, I bring you the opportunity for your children and grandchildren and my children and grandchildren to save billions and billions of dollars of money being borrowed against them by the federal government,” said Dennis.
The “Achilles heel,” Dennis said, is that the federal law still allows states to control insurance companies. Thus, by declaring a state’s insurance companies cannot use the health care exchanges set up under Obamacare, the law can be negated, he said.
Dennis also contended that Obamacare would take business away from state insurance agencies writing policies for private insurance that is not subsidized by Obamacare.
By Eric Schelzig, Associated Press
NASHVILLE, Tenn. — Tennessee won’t participate in a partnership with the federal government in establishing a health insurance exchange, Gov. Bill Haslam announced Friday.
The Republican governor said in a letter to U.S. Health and Human Resources Secretary Kathleen Sebelius that the partnership model doesn’t address his concerns over what he called “aggressive federal timelines, a lack of true flexibility for states, and misguided federal policies.”
Exchanges are online markets required under President Barack Obama’s health care law where consumers will be able to buy individual private policies and apply for government subsidies to help pay their premiums.
Haslam noted that he had the same complaints when he rejected a state-based exchange in December. His deadline decision means Tennesseans will participate in an exchange completely run by the federal government.
About 982,000 people lack health insurance in Tennessee. The state projects that about 300,000 people will participate in the exchange, through some estimates put that number as high as 600,000.
NASHVILLE, Tenn. (AP) — A new Vanderbilt University poll shows a strong preference among Tennesseans for a state-run health insurance exchange over one run by the federal government.
The poll of 829 registered voters released Wednesday showed 53 percent favor the state-run exchange, while 33 percent prefer the federal approach.
The results contrast with Republican Gov. Bill Haslam’s decision earlier this week not to pursue a state-run exchange. Vanderbilt officials said the governor was not aware of the poll results before Wednesday’s release.
Haslam’s office did not immediately return a message seeking comment.
Meanwhile, a pending decision over whether to expand Medicaid was much more evenly divided among poll respondents: 47 percent said they support an expansion, while 46 oppose it.
Haslam has said he will decide the Medicaid issue sometime in the spring.
UPDATE: Here’s a quote from Haslam’s press secretary, David Smith, on the healthcare exchange finding: “The governor weighed all of the information and made a business decision. He understood throughout the process that there were strong opinions on both sides of the issue but removed politics from his decision making.”
— Note: Here’s the Vanderbilt news release on the poll:
NASHVILLE, Tenn. – A new poll from Vanderbilt University shows that Tennessee voters prefer that the state run the online health care exchange required by the federal Affordable Health Care Act, with Republicans more adamant about the issue than voters as a whole.
That sentiment reflected by the Vanderbilt Poll conflicts with the actions of Republican Gov. Bill Haslam. He informed the U.S. Department of Health and Human Services Dec. 10 that Tennessee is declining to create and run the exchange, an online marketplace where state residents can shop for health coverage. That means the federal government will step in and do it.
“If a health care exchange must be created, the voters of Tennessee place more trust in the state than the federal government to do it,” said John Geer, Gertrude Conaway Vanderbilt Professor of Political Science and co-director of the Center for the Study of Democratic Institutions at Vanderbilt. “And Republicans are even more trusting of the state to run the health care exchange than Democrats. That may be a surprise to some, but it makes sense since Republicans have long had more faith in state governments than Democrats.”
Chris Carroll rounds up comments from the state’s congressmen on Gov. Bill Haslam’s decision to let the federal government run a healthcare exchange in Tennessee. Guess what? Republicans think that’s just fine; Democrats don’t. On Monday, a (U.S. Rep. Scott) DesJarlais Twitter message thanked Haslam for rejecting a state-run exchange, implicitly applauding the decision to yield administrative power to a Washington-based federal agency with 64,000 employees.
DesJarlais’ office declined to comment, but in a Tennessean op-ed, he claimed a state-run exchange would be “a logistical nightmare.”
Feelings are similar in the Senate. A former governor and onetime education secretary for President George H.W. Bush, U.S. Sen. Lamar Alexander, R-Tenn., has pushed for states to set their own standards for schools, teachers and students.
In a 2011 New York Times piece critical of “the Washington-imposed” No Child Left Behind Act, Alexander wrote: “Washington can’t create good jobs, and Washington can’t create good schools.”
On Tuesday the Maryville Republican took another approach when asked about the Affordable Care Act.
“Given the number of unanswered questions about federal control of a state exchange and state tax dollars, it certainly is a reasonable decision,” Alexander said of Haslam’s choice to cede authority.
Similarly, U.S. Rep. Chuck Fleischmann, R-Tenn., often slams “Obamacare” as an overreach. At one debate, he said “the federal government took over one-sixth of our economy in a bill that was not even read.”
But Tuesday the congressman refused to apply that criticism to Haslam’s decision to let the federal government implement a statewide insurance market.
“Rep. Fleischmann makes no secret of his principled opposition to Obamacare,” spokesman Alek Vey said. “However, decisions about how to implement Obamacare in Tennessee are made at the state level by the governor and the Legislature.”
Democrats pounced on what they see as hypocrisy and sabotage against President Obama.
“It is obvious politics played a substantial part in the governor’s decision,” U.S. Rep. Steve Cohen, D-Tenn., said in a statement. “Governor Haslam has surrendered the chance to establish an exchange program tailored to Tennessee’s specific needs.”
Gov. Bill Haslam said Tuesday his decision against state operation of a healthcare exchange will not make much difference in the extent of state control over the handling mandated medical insurance in Tennessee.
Asked in a Fox News interview whether he had problems “ceding a lot of control” to the federal government, Haslam replied, “I have a lot of problems with that.
“But the decision on the exchange really wasn’t going to make a big difference there one way or the other,” he said. “Our fear, once we got into it, was that the basic exchange didn’t give us a lot more flexibility or latitude than running it with them would or letting them run it would.”
Under the federal Affordable Care Act, states have option of running a healthcare exchange themselves, operating one in partnership with the federal government or leaving all operations to the federal government. Haslam announced Monday that he has decided to leave operation of the insurance clearinghouse to the federal government.
Here’s some comments emailed to media on Gov. Bill Haslam’s decision to reject a state-operated Health Care Exchange. News release from House Democratic Caucus:
NASHVILLE, Tenn. – Governor Bill Haslam announced today that Tennessee would not be setting up a state-based health exchange as called for under the Affordable Care Act. His decision will result in the federal government taking over responsibility for creating a health insurance marketplace for Tennessee consumers and small businesses.
“I’m disappointed to see the Governor pandering to the far right of his party rather than doing what is best for the people of Tennessee,” said Leader Craig Fitzhugh. “I would hate to know that I had a 70 percent approval rating statewide, and couldn’t get my own party to support my initiatives.”
State-based exchanges have enjoyed bi-partisan support historically. Former Sen. Majority Leader Bill Frist (R-TN) wrote in an op-ed recently that it would be “best for Tennessee to develop its own exchange because exchanges are an innovative, market-driven strategy, which foster competition, choice, cost-savings and quality among insurers.”
“It is disappointing that our Governor found it too difficult to do what 23 other states have begun to do – implement their own health insurance exchange,” said Caucus Chairman Mike Turner. “In the end, if Governor Haslam was unable to convince his party to reject partisan politics and do the right thing, perhaps it was best for him to allow the federal government to begin setting up an exchange for him.”
While Governor Haslam’s decision to leave health care exchanges to the federal government takes this issue off the table, Democrats will continue to push for Tennessee to participate in the federally funded Medicaid expansion that would cover an additional 330,000 souls.
“While the Governor is able to fall back on the federal government to handle these health care exchanges, he won’t be able to shirk the responsibility for participating in the Medicaid expansion,” said Leader Fitzhugh. “If we don’t participate in the new Medicaid program, we’ll be leaving $10.5 billion in federal dollars on the table. Punting on this issue would hurt Tennessee businesses, working families, and rural hospitals.”
Gov, Bill Haslam said today he has decided against the establishment of a state-operated health care exchange and will allow the federal government to oversee the clearing house for insuring Tennesseans.
Haslam said he would have preferred for several reasons to set up a state-run exchange but, “I’m sad to say and sorry to say, we won’t.” He said the federal government has been so unclear about the rules that it is not practical.
“More and more I’m convinced they are making this up as they go,” Haslam told a Nashville Rotary Club audience. “It’s scary, quite frankly.”
Haslam said 800 pages of proposed regulations — as part of the Affordable Care Act — have been received from the federal government since the Nov. 6 election and those are draft proposals subject to change.
While he knows some would say he is making a politically based decision, but that isn’t the case, he said.
“If it was a political decision, we would have made it months ago,” he said. “The politics have always been pretty clear on this.”
Several Republican legislators have declared they would oppose Haslam if he tried to set up such a state-run exchange in Tennessee. The governor acknowledged that getting legislative approval for a state exchange “would have been an uphill battle,” but said that was not the deciding factor.
Haslam said it’s possible that the state could revisit the issue in another year or two.
“When we’re convinced they have their ducks in a row, then we’ll take a look at it,” he said, adding that federal officials as recently as Friday had declined to answer state questions about how things would function with a state-run exchange.
“The face they couldn’t or wouldn’t was really bothersome,” Haslam said.
— Note: Text of the letter Haslam sent Health and Human Services Secretary Kathleen Sebelius announcing his decision is below.
Chas Sisk has a piece on signs of division in Tennessee Republican ranks. An excerpt with some of his examples: A task force appointed by Haslam to come up with a plan for school voucher legislation wound up kicking the can down the road, as members could not agree about what limits should be placed on the measure in an environment where proponents think they can do almost anything.
Haslam and Lt. Gov. Ron Ramsey also have expressed public differences over guns-in-trunks legislation, an issue that has divided Republicans in recent years.
And on Wednesday, several Republican lawmakers joined in a rally at the state Capitol to oppose setting up a state-run health insurance exchange. Haslam — who emerged from this year’s legislative session with sky-high approval ratings, even winning over a majority of Democrats — has said he has not decided whether to go forward with an exchange. But state Sen. Bill Ketron, one of the top Republicans in the Senate, claimed a mandate to oppose state involvement.
“We spoke out loud and clear against Obamacare, and we elected supermajorities in both houses,” he told the crowd, some of whom brought along signs calling for Haslam to be fired. “We are a bold state of red who is making it clear where we stand.”
…Shortly after Thanksgiving, House Republicans agreed to nominate House Speaker Beth Harwell for a second term. The GOP caucus also punished one of the few voices of dissent to emerge by voting to strip state Rep. Judd Matheny, who publicly flirted last fall with the idea of challenging Harwell for the speakership, of his position as speaker pro tempore.
But even the smallest fractures within the caucus could be exploited. On Thursday, House Minority Leader Craig Fitzhugh called on Haslam to consider vetoing any measure that would allow guns in the parking lots of colleges and universities, a reference to the governor’s differences with Ramsey over gun legislation.
…At Wednesday’s rally at the state Capitol, several conservative activists declared that the November election gave Tennessee Republicans a mandate to dig in their heels.
“We’re the majority,” radio host Steve Gill told the crowd. “Our no should mean more than their yes.”
Gill and several other speakers linked the dispute over health care exchanges to the battle at the state Capitol over an income tax in the early 2000s.
— Columnist Gail Kerr, meanwhile, weighs in on one of the sources of GOP disagreement, advising Haslam to choose pragmatism over politics in the health care exchange debate. But here’s the sticky wicket: Republicans loathe the Affordable Care Act, known as Obamacare. Haslam will have to get the legislature to pass whichever choice he makes, and if he opts to let the state run the program, that will not be easy. Lawmakers do not want to look as if they are endorsing Obamacare (and they wouldn’t be — they’d be following the law).
Add to the mix 250 tea party protesters who gathered last week at War Memorial Plaza with their wacky triangle hats and their tired signs. They don’t get it: The fight over the Affordable Care Act is over. The law passed. The U.S. Supreme Court upheld it. Barack Obama was re-elected president, and this is his signature program. Staging a protest that you still don’t like it is akin to believing the tooth fairy is real
…Haslam told Republicans last week that he’s determined to find the “right answer” by Friday, and not let politics enter into the decision.
“The easy political answer is just to say no, we’re not doing a state-based exchange because it’s the easiest answer,” he said.
Haslam knows, and the GOP-dominated legislature needs to admit, the easy answer is not always the right answer. This is one of those times.
Georgina Vines talks with freshmen legislators about their orientation sessions…. and one who made a trip to Washington for an ALEC meeting, too. “It’s not government civics.”
That’s how newly-elected state Rep. Roger Kane, a Knoxville Republican, described orientation and GOP caucus sessions that he’s attended in Nashville to get ready for when the General Assembly begins meeting in January. The Legislature will have a large freshman class with 22 new House members and six new senators.
Representing the new 89th District in Northwest Knox County, Kane said the GOP caucus session in particular was not something he remembered studying. The vote was done by a secret ballot.
“I thought it would be more of a voice thing,” he said.
….Orientation covered everything from security to offices. A tour of the newly-renovated Capitol was given. Presentations were made by the Tennessee State Collaborative on Reforming Education.
“They want us to be prepared so in January everything is not overwhelming and new,” he said.
Democrat Gloria Johnson, elected to represent the 13th District, also attended the sessions.
“As I am still teaching, I haven’t had the time I would like to get familiar with things there, so the day was definitely beneficial for me,” she said.
The Nashville meetings were Nov. 26-27,and then Kane went to Washington, D.C., on Nov. 28-30 to attend a conference of the American Legislative Exchange Council. ALEC paid the transportation and expenses at the Grand Hyatt of freshmen legislators, Kane said.
He was the only newly-elected lawmaker from East Tennessee to attend the ALEC program, he said. Johnson did not attend, saying she chose instead to meet with constituents in her district.
…Kane said the group acknowledged it had taken some missteps and planned to focus in areas where it feels it’s the strongest. Its website said ALEC works on the principles of free markets and limited government.
“I’m being inquisitive and figuring out what these groups do for me, how I can be a part of it or not be a part of it,” Kane said.