Tag Archives: expansion

McCormick backs Haslam on Medicaid expansion

House Majority Leader Gerald McCormick has become the highest-ranking Republican legislator to declare support for Republican Gov. Bill Haslam’s modified Medicaid expansion plan.

From the Tennessean:

“It’s a government program and we’re expanding it. And as Republicans, we don’t like to expand government programs period,” McCormick said Tuesday afternoon.

“But then you go back to the common-sense part of this … really the only practical way to provide these services in another way is to expand the Medicaid program.”

…McCormick said he thinks members of the House want to hear details about the plan before they vote. Asked if the votes are there to pass the plan in the House, McCormick said, “no, not yet.”

Typically the majority leaders in both chambers sponsor or “carry” the governor’s legislation when they are all the same party. McCormick said, “You’d like to have some more motherhood and apple pie and easier legislation to carry” but that traditional role ultimately helped him make up his mind.

“That puts me in a position of really either having a very public break with the governor or carrying the legislation. Sometimes you just man up and carry the legislation, even if you have some disagreements with it,” McCormick said.

Late Tuesday, (Senate Majority Leader Mark) Norris said he is still reviewing the plan.

AP story on Haslam’s special session call (with links to relevant documents)

By Erik Schelzig, Associated Press
NASHVILLE, Tenn. — Republican Gov. Bill Haslam on Thursday issued a call for a special legislative session to take up his proposal to offer medical coverage to more than 200,000 low-income Tennesseans.

The governor’s proclamation calls for the special session to begin Feb. 2, and legislative leaders expect it to take about a week. The proposal dubbed “Insure Tennessee” is billed as a two-year pilot program using federal funds available under President Barack Obama’s health care law.

But Haslam stresses that his proposal is different than a straight expansion of Medicaid, as it would include what he calls a market-based approach that includes incentives for healthier living. According to the summary of his proposal released Thursday, the aim is “to shift health care spending toward paying for value rather than paying for volume.”

Still, the governor has acknowledged that the proposal will be a tough sell in the GOP-controlled Legislature, and that he will likely need the votes of all Democrats to give it a chance. Democrats hold 26 of 99 seats in the House and five of 33 seats in the Senate.

Senate Speaker Ron Ramsey, R-Blountville, told reporters Thursday morning that he was surprised the governor expected to rely on Democrats so heavily.

“I’m not depending on Democrats to pull the weight on this,” Ramsey said. “If we want to pass it or not pass it, it should be up to the 28 Republicans to decide that.”

House Speaker Beth Harwell, R-Nashville, said she was less concerned about working in concert with Democrats on the measure.

“I actually think it’s good when we have bipartisan efforts, and I think the public agrees with that,” she said. “I do agree with the governor that we’re going to need every Democrat vote.”

Ramsey said he had not yet seen enough of the full proposal to raise any specific concerns, but he said lingering mistrust of the Obama administration will be a major factor.

“The only thing that bothers any of us is that we’re negotiating with the Obama administration,” Ramsey said. “I want to see it in writing, where we are, what escape clauses do we have if promises aren’t kept.”

Note: The governor’s proclamation calling the special session — very limited — is HERE. The waiver request document is HERE. The governor’s news release HERE.

Haslam calls special legislative session on ‘Insure Tennessee’ to begin Feb. 2

News release from the governor’s office:
NASHVILLE – Tennessee Gov. Bill Haslam today issued a proclamation convening an “extraordinary session” of the 109th General Assembly to consider “Insure Tennessee,” a two year pilot program to provide health care coverage to Tennesseans who do not currently have access to health insurance or have limited options. The program is designed to reward healthy behaviors, promote personal responsibility and incentivize preventative care and healthy choices.

The proclamation calls for the special session to begin Monday, Feb. 2 at 4 p.m. CST for the legislature to consider a joint resolution authorizing the governor to implement Insure Tennessee. The governor is scheduled to address the General Assembly at 6 p.m. CST that evening.

“There are few challenges facing us today as great as those presented by our broken health care system,” Haslam said. “The Insure Tennessee plan is a conservative approach that introduces market principles to Medicaid, provides health care coverage to more Tennesseans at no additional cost to taxpayers, and leverages a payment reform initiative that is working to control health care costs and improve the quality of care. I believe this plan is a critical first step to fundamentally changing health care in Tennessee.”

In December the governor was joined by representatives from a coalition of business, health care and civic organizations when he announced his Insure Tennessee plan.

The plan does not create any new taxes nor adds any state cost to the budget. The hospital industry has committed that it will cover any additional cost to the state, and the program will automatically terminate in the event that either federal funding or support from the hospitals is modified in any way.

The plan would provide coverage to more than 200,000 uninsured Tennesseans earning less than 138 percent of the federal poverty level, valued at slightly over $16,000 a year for an individual and $27,000 for a family of three.

Five key areas of the governor’s plan include: a fiscally sound and sustainable program; providing two new private market choices for Tennesseans; shifting the delivery model and payment of health care in Tennessee from fee-for-service to outcomes based; incentivizing Tennesseans to be more engaged and to take more personal responsibility in their health; and preparing participants for eventual transition to commercial health coverage.

The amendment to the state’s existing waiver is being made available today for a 30-day public comment period.

Note: Text of the waiver request is available by clicking this link: Insure Tennessee – Waiver Amendment

Text of the proclamation calling the special session — it’s very limited — is available by clicking on this link: proclamation

Haslam acknowledges he’ll need every Democrat’s vote on Medicaid expansion

By Erik Schelzig, Associated Press
NASHVILLE, Tenn. — Republican Gov. Bill Haslam said Wednesday that he expects to need the votes of every Democrat in the Tennessee General Assembly to give his Medicaid proposal a chance of passage.

Haslam told reporters after a groundbreaking ceremony for Bridgestone’s new downtown Nashville headquarters that he expected to release full details of his proposal dubbed Insure Tennessee by Thursday.

The governor said he is well aware of grumbling among many in the GOP-controlled Legislature that they haven’t been given more details about the proposal to cover more than 200,000 low-income Tennesseans since it was first announced last month. But Haslam said his administration has been working to convert an oral agreement with federal officials into a written waiver proposal.

“Obviously, we’re hurrying as much as we can to get the waiver finished, we want to make certain the waiver is right,” he said. “Hopefully within 24 hours everybody will actually have the waiver and an executive summary on their desk.”

House Minority Leader Craig Fitzhugh says Democrats are “favorably postured” to get behind Haslam’s proposal, but they also awaiting more details about the deal. Democrats hold 26 of 99 seats in the House, and five of 33 seats in the Senate.

“This is the first time he’s ever come forward and said he’s counting on Democrats, but that’s a good sign,” Fitzhugh said. “We’ve often said we want to work together on issues, and this is a huge issue for Tennesseans and we are going to do everything we can to make the process work.”

Haslam laughed when asked whether he confident that most lawmakers would get behind his proposal.

“No, everybody does not feel like they’re on board,” he said. “We knew up front that this would be a controversial proposal, and I think it’s up to us to make the case as to why this is the right thing to do for Tennessee.”
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Haslam, TennCare Chief Unhappy With Latest Fed Medicaid Rules

Gov. Bill Haslam and his TennCare chief aren’t happy with the final federal rules on Medicaid expansion, saying they don’t provide the flexibility the governor wants on cost-sharing for enrollees, according to Andy Sher.
The “early read” on the 606-page set of rules, released July 5 by the federal Centers for Medicare and Medicaid Services, are “not encouraging,” but Tennessee is “still having discussions,” Haslam told reporters this week.
Haslam, a Republican, doesn’t want to expand the state’s version of TennCare, as envisioned in President Barack Obama’s Affordable Care Act, to additional low-income residents.
But instead of flatly refusing to participate, he wants to use the additional federal money intended for the Medicaid expansion to buy these adults’ way onto the federal health care exchanges where the uninsured can purchase private insurance.
The governor said he still holds out hope that federal officials will accept his “Tennessee Plan” that includes higher cost-sharing for people under 100 percent of the federal poverty level than the new rules allow.
“It’s awfully early to get down,” he said.
TennCare Director Darin Gordon said the state still is sorting through the rules. But he noted “some of the early takeaways” are the added flexibility on cost-sharing Tennessee is seeking isn’t there.
The Haslam administration was looking for more flexibility in “nominal” charges on care that officials hope to use to shape enrollees’ use of services and lifestyle choices.
“What they did was basically finalize what they put out in January,” Gordon said. “If you’re trying to read between the lines, it doesn’t seem to indicate they are interested in being flexible beyond what they set out in the Jan. 22 rule. This is a final rule.”
Still, Gordon said Tennessee and several other states interested in the same approach “will have some discussions” with federal officials
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Governor Gets 4,500-Signature Petition Urging Medicaid Expansion

A group that advocates expanding TennCare to more of the state’s poor delivered a petition and stated its case to an aide to Gov. Bill Haslam on Wednesday, reports The Tennessean.
A coalition that includes the Tennessee Nurses Association, Tennessee League of Women Voters, Tennessee Health Care Campaign and the Tennessee Justice Center said it has gathered more than 4,500 signatures for an online petition calling on Haslam to offer TennCare services to everyone making 138 percent of the federal poverty level or less.
The cost would be paid in full by the federal government through 2016 and in large measure until at least 2020.
Haslam put off a decision on TennCare expansion in March, saying he wanted to continue negotiating with the federal government for a plan that would let the state offer private insurance to new enrollees. He has said he expects to know whether those negotiations will pay off by the end of summer.
Don Johnson, Haslam’s assistant director for constituent services, accepted the petition on the governor’s behalf and met with several advocates. They argued that expanding TennCare would help those who currently do not have coverage as well as rural hospitals that face service cuts or closure.


Note: News release below.

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Haslam, Oregon Governor Co-Chair NGA Health Care Task Force

Gov. Bill Haslam has been named co-chair of a National Governors Association task force on “health care sustainability” with Oregon Gov. John Kitzhaber, a Democrat.
Haslam has rejected Medicaid expansion under the federal Affordable Care Act, also known as “Obama- care,” while Oregon was among the first states to accept Medicaid expansion.
But Haslam is still negotiating with federal officials about possibly accepting expansion, if they go along with his notion of using federal money — more than $1 billion in Tennessee’s case — to buy commercial insurance policies. He says recent talks have been “encouraging: and expects a final result by the end of the summer.
Oregon, meanwhile, is operating its Medicaid program under a federal waiver that includes a departure from fee-for-service payments to health care providers in favor of what are called “outcome-based” payments. That is also part of Haslam’s expansion proposal, which he calls the “Tennessee plan.”
An NGA news release says the task force will review and report on “developing innovative Medicaid programs” and declares that governors “must retain flexibility to implement these measures.”
The news release has quotes from both Haslam and Kitzhaber.
“Right now states are looking to change how they do business in order to more effectively serve their constituents,” Kitzhaber said. “This task force will help states sit down together to figure out what’s working and what isn’t and identify how the federal government can best support these efforts.”
“Governors are working in their states to find ways to cut costs when it comes to health care,” Haslam said. “It is our responsibility to examine every possible option in an effort to make sure promising new initiatives can be fully utilized.”

Haslam To Decide Medicaid Expansion by ‘End of Summer’

Gov. Bill Haslam said Friday that he expects to know by the end of the summer whether a deal can be reached with federal officials over TennCare expansion. The Tennessean says this is the first time he has suggested a timetable for a final decision on the issue.
“It’s not a question of lack of dialogue,” Haslam told reporters after a Memorial Day commemoration on War Memorial Plaza. “I think if we haven’t made real progress by this summer, it’ll show that we’re not going to.”
… Haslam said state officials continue to negotiate toward a compromise. He named Marilyn Tavenner, administrator of the Centers for Medicare and Medicaid Services, as one of the officials they have met.
“Marilyn actually lived in Nashville for awhile, understands Tennessee very well,” he said “We’ve had very frank conversations with her that have given me a lot of encouragement.”

Note: More details in the Commercial Appeal, HERE.

Vanderbilt Poll: More Tennesseans Support Medicaid Expansion (but not ‘Obamacare’)

A growing majority of Tennesseans support expansion of Medicaid within the state though most at the same time have an unfavorable impression of the federal law that authorizes expansion, according to a Vanderbilt University poll released Tuesday.
About 63 percent of the state’s registered voters have a favorable opinion of Gov. Bill Haslam, who has tentatively rejected Medicaid expansion. That’s down five points from six months ago, though Vanderbilt pollsters said the decline is “statistically insignificant” given the poll’s four point margin of error.
The survey of 813 registered voters, taken May 6-13, found solid approval for the state’s two U.S. Senators, Lamar Alexander and Bob Corker, while a more narrow 51 percent said they like the Tennessee General Assembly with its Republican “supermajority.”
Opinions were mixed on whether state sales tax collection for internet sales should be enforced. When asked if online sales taxes was bad idea, 55 percent agreed with 38 saying it was a good idea. But when the question was framed as to whether it’s fair for in-state retailers to collect the taxes while out-of-state retailers do not, the result was a 47-47 percent tie.

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In TN, Medicaid Will Cover Low-income Immigrants, But Not Citizens

Republican Gov. Bill Haslam’s refusal so far to expand Medicaid under federal health reform could mean that Tennessee’s poorest residents won’t have access to health coverage in 2014 but some lawful immigrants will, according to the Chattanooga TFP.
That’s because legal immigrants with incomes below 100 percent of the poverty level — $11,170 for a single person or $23,050 for a family of four — will be eligible for federal subsidies to buy private coverage through health insurance exchanges.
American citizens with the same income levels, however, can’t participate in the exchange because the law envisioned those with incomes up to 138 percent of the poverty level would be covered through the Medicaid expansion.
The politically ticklish contrast came about as a result of last year’s U.S. Supreme Court ruling on the 2010 Affordable Care Act.
The act aims to provide coverage to millions of lower-income people in two ways. One is to mandate that most people have health insurance and to help those who can’t afford it by subsidizing purchase of private coverage on new state health insurance exchanges. People with incomes up to 400 percent of the federal poverty level could get subsidies.
The other is by expanding state Medicaid programs, which now cover mostly low-income pregnant mothers, children and some disabled people, to everyone whose income is up to 138 percent of the federal poverty level.
The court upheld the law but made Medicaid expansion optional rather than mandatory for states. Georgia, Alabama and many other Republican-led states have ruled out the expansion.
The prospect that legal immigrants, such as workers and refugees, will be insured but not the state’s poorest residents is “quite an irony,” said Ron Pollack, executive director of the Washington-based health advocacy group Families USA.
He said Arizona’s Republican governor, Jan Brewer, cited that fact among others when she recommended her state expand Medicaid.
Matt Salo, executive director of the National Association of Medicaid Directors, said the Supreme Court ruling sets up a political dilemma.
“If you’re a state that doesn’t do the expansion, there will be two groups of people below 100 percent of the poverty level: citizens, who will likely get nothing, [and] legal immigrants, who get fully subsidized coverage in the exchange. … That’s not going to sit well with folks.”