By Lucas Johnson, Associated Press
NASHVILLE, Tenn. — Faith leaders from across Tennessee gathered at the Capitol on Monday to speak out for the poor, while the governor and lawmakers consider initiatives affecting health insurance and welfare benefits.
About 15 clergy delivered 133 baskets of loaves and paper fish to the offices of each legislator and Republican Gov. Bill Haslam, urging them to accept $1.4 billion in Medicaid money if the federal government doesn’t approve an alternate plan for Medicaid expansion in Tennessee.
The clergy said the loaves and fish symbolized the story of Jesus feeding the multitude, and that the money could provide thousands with health insurance.
“We’re here today … to send a message to Gov. Haslam that if the government does not accept his alternate plan for health care here in Tennessee, then we really want him to accept the Medicaid expansion dollars,” said Kathy Chambers, one of the organizers of Clergy for Justice, a grassroots advocacy group for equality.
“We want him to take the resources and be able to multiply it like in the miracle of the loaves and fish, and be able to help Tennesseans who need health insurance desperately.”
Haslam later told reporters that he understands the group’s concern for “the least of these,” but that he also must be financially responsible.
Scott McNutt’s latest Snark Bite chews on Gov. Bill Haslam’s rejection of Medicaid expansion as opening new opportunities. An excerpt: Haslam’s refusal of the federal authorities’ offer of Medicaid expansion funds under the federal Patient Protection and Affordable Care Act was prompted by the Department of Health and Human Services’ unwillingness to accede to his demands not to have to do certain chores to receive the allowance, “even after I cried and stomped my feet,” he said. He added that Tennessee’s conservative GOP supermajority was no help in his battle over the money, because “they’re too scary to even talk to about it.”
“If Lt. Gov. Ron Ramsey even looks at me crosswise, I feel my knees begin to buckle,” he said, explaining that, because his spine is missing, staying upright was a challenge anyway.
Haslam developed his idea of turning Tennessee into a zombie factory after Ramsey and House Speaker Beth Harwell told him that refusing additional Medicaid dollars would demonstrate the marvels of a free market economy and force several Tennessee hospitals to close, leaving needy populations without health care access.
“With Tennessee’s alarming incidence of chronic killer ailments like diabetes, heart disease, cancer and obesity, these closures could balloon the state’s death rate, which made the zombie idea a no-brainer,” Haslam said. “For the fee of one voodoo priest, we can churn out thousands of walking-corpses-for-hire.”
According to Haslam, the new state law prohibiting local governments from requiring contractors to pay workers a “living wage” also means “more Tennessee workers making a nonliving wage, which means they’ll have more opportunities to become the living dead.”
Tennesseans should view adversities like scant wages, illness and lack of insurance as opportunities for pursuing a career in zombiism, the governor counseled.
“Even if you’re jobless and on death’s door, you can still find employment as a zombie, because the undead are in high demand right now,” the Knoxville native said.
— Note: In case you missed it — as I did last week — see also McNutt’s bite into the Muslim sink mop matter.
NASHVILLE, Tenn. (AP) — Gov. Bill Haslam said Tuesday that his ongoing pursuit of a special deal for Medicaid expansion in Tennessee is no “fool’s errand” and that an arrangement could still be struck at any time.
The Republican governor said he remains in negotiations with the federal government over his proposal to use $1.4 billion in Medicaid money available under the federal health care overhaul to pay for private coverage for uninsured Tennesseans.
“This wasn’t just a ‘I’ll throw this up as a way to get out of it,'” Haslam told reporters. “I always thought this was a real possibility. But I’m also not ignorant of the fact that what we’re trying to do is not the easiest thing in the world. ”
Haslam said he has been in discussions with health care providers about ways to decrease coverage costs to the point where the savings would defray the increased costs to the state once the federal government stops paying the entire cost of Medicaid expansion after the first three years.
The failure to reach a deal earlier caused Haslam to exclude the Medicaid expansion money from his budget proposal this year. That decision was met with glee by Republicans in the state, who are largely hostile to President Barack Obama’s signature health care law.
But Haslam said that call wasn’t the end of the story.
“Some folks will say, well, ‘You’re off on this quest that really is a fool’s errand because there’s no way you’ll work this out,'” Haslam said. “My argument would be this really is a once-in-a-lifetime chance to do this, and shame on us if we don’t take this chance to do it.”
Haslam said sticking points have included a federal requirement for private plans to cover 100 percent of the benefits that would be available to Medicaid recipients, including transportation. Tennessee also wants to require greater co-pays for things like emergency room visits for routing health problems or failing to choose available generic drugs.
The governor said he spoke with U.S. Health and Human Services Secretary Kathleen Sebelius over the weekend. Haslam suggested that an arrangement could still be struck.
“I don’t know if we can work this out in a day, a month or a year,” he said. “I don’t really know.”
But Haslam has pledged that he would seek legislative approval for any change in course on Medicaid expansion, which would be a tough sell to the Republican supermajorities in both chambers — especially as leaders hope to adjourn for the year before the end of the month.
Republican Gov. Bill Haslam has gotten some of the “clarity” he wants from the Obama administration on his plan to use federal Medicaid dollars to provide insurance for an estimated 181,000 low-income Tennesseans, reports Andy Sher. He probably won’t like some of what they’re telling him.
That’s because the guidance, issued Friday, says no to several provisions Haslam included in the “Tennessee Plan” he unveiled Wednesday to state lawmakers.
…Reached by phone, TennCare spokeswoman Kelly Gunderson said no one could comment on the guidance issued by the federal Centers for Medicare and Medicaid Services.
Under those guidelines, Tennessee could indeed do just what Haslam wants: Use new Medicaid dollars to enroll people earning up to 138 percent of the federal poverty level in insurance exchanges.
But that’s only if states make the program optional for the Medicaid-eligible population. Beneficiaries “must be able to choose an alternative to private insurance to receive Medicaid benefits,” CMS says.
To get the flexibility wants and put new beneficiaries into the exchange, Haslam would have to obtain a federal waiver of Medicaid requirements. That can take considerable time.
Haslam also wants new beneficiaries to have the same benefits and co-payments as other enrollees in the exchange’s private insurance plans.
But CMS says states would have to make “arrangements” with the exchange’s insurers for “wrap around benefits,” that is, extra benefits required under traditional Medicaid rules.
That includes things like providing transport to and from a doctor’s office, experts said.
Traditional Medicaid co-payments also appear to be required. TennCare Director Darin Gordon said for Medicaid enrollees in the exchange to pay the same co-payments as others, the cost would be 6 percent of the premium.
Gordon Bonnyman, an attorney and Medicaid expert with the Tennessee Justice Center, said it’s “always been pretty clear that some of things on their list would not be legally permissible.”
But, he added, “The good news is that the core of the plan can go forward which is using Medicaid matching money” to pay for premiums in the exchange.
Nothing in the guidelines prevents Haslam from moving ahead with a major component of his plan, reforming payments to health providers.
From Chas Sisk:
When Gov. Bill Haslam strode into the chamber for a joint session of the state legislature Wednesday morning, few in the room knew how he planned to resolve perhaps the biggest dilemma he has faced since being sworn into office in 2011.
More than halfway through his speech, many still weren’t sure.
As the governor darted and bobbed through the arguments over whether to expand TennCare, Democrats shifted anxiously in their chairs. They had planned to walk out of the chamber if Haslam announced he would reject expansion and the federal money that went with it.
Republicans sat back with arms folded, seemingly unimpressed with his arguments. Some failed to applaud when the governor at last delivered the verdict they’d hoped for.
By announcing he would not add more of the poor to TennCare — but would continue bargaining with federal officials — Haslam managed to defuse, at least for now, a controversy that could have blown up in his face.
As he has many times before, Haslam emerged unscathed — largely by finding ways to avoid confrontation. Such searches for a middle path have served him well, helping to push his approval rating over 60 percent and producing a string of legislative victories.
This year, Haslam has emerged unscathed from the fight between business groups and the National Rifle Association over whether Tennesseans should be able to leave handguns in their parked vehicles. The bill he signed into law this month appeared to mollify both sides, in part because it left unclear whether companies could fire employees for violating no-gun policies.
Similarly, Haslam has not had to repeat last year’s veto of a measure punishing Vanderbilt University for its nondiscrimination policy. Instead, he has been able to wait out the debate until the bill sank under an attorney general’s opinion it would not hold up in court.
…”The way for a governor to remain popular in Tennessee is to govern from the political center,” said Ken Blake, a journalism professor at Middle Tennessee State University and director of that school’s poll. “It seems to be working well so far for Haslam.”
…If Democrats were robbed of a dramatic confrontation, so were some of the GOP lawmakers to Haslam’s right a few hours later, when debate was finally taken up on a measure that would have barred him from expanding TennCare.
A committee quickly amended Senate Bill 804 to give Haslam the flexibility he sought to negotiate with federal officials. The House version was pushed back to next year’s calendar.
By day’s end, Haslam had sidestepped two showdowns on one of the few issues that could have hurt him deeply.
Senate Speaker Ron Ramsey and House Speaker Beth Harwell acknowledged Thursday that some Tennessee hospitals may face closure as fellow Republican Gov. Bill Haslam delays a decision on whether to expand the state’s Medicaid program under the federal health care overhaul, according to the Chattanooga TFP But the leaders, who back Haslam’s decision to continue negotiating with the Obama administration, say that’s life in the free market.
Ramsey, R-Blountville, said he’s heard the warnings from the Tennessee Hospital Association, but he still thinks “there’s a little bit of ‘the sky is falling’ out there with them when it really wasn’t.”
Still, he acknowledged, “obviously this is going to hurt. In some cases there may be hospitals that have to close — but look, if you want to operate in a free market, things like that happen. But I think overall they will figure out a way to cut this.”
Harwell, R-Nashville, told reporters earlier that some of her rural members have already been concerned about the fate of hospitals.
“There are some rural hospitals that will be hurt; there’s no doubt about that. But the health care industry is a changing industry and those that can’t keep up, they just simply can’t,” she said. “I’m sorry that that might happen, but again, if it was a little exaggerated, we’ll find out in the next six months.”
Hospitals have been counting on the expansion of people in the state’s Medicaid program, TennCare, through the federal Affordable Care Act to help offset special federal payments for people with no coverage at all.
From the House and Senate Democratic Caucuses:
NASHVILLE, Tenn. – Gov. Bill Halsam promised a decision on expanding Medicaid today, but instead delivered a “no” dressed up as a year of delayed action and indecision.
“We expected clarity today on Medicaid, but all we got was confusion,” Senate Democratic Caucus Chairman Sen. Lowe Finney said. “Our rural hospitals and the uninsured will be the ones to suffer.”
The governor gave a definitive “no” on expanding Medicaid. He instead pitched a so-called “Tennessee plan,” but it’s unclear whether the plan will work. Meanwhile, federal payments to hospitals for uncompensated care will end Jan. 1.
“This is a time when the people of Tennessee need clear, precise and bold leadership, and Governor Haslam offered none of that today,” House Democratic Caucus Chairman Mike Turner said. “It’s a failure of our moral obligation to protect the health and welfare of the most vulnerable among us. It’s a failure that will be paid with the lives of the working poor in our state – this is quite simply shameful.”
According to the Tennessee Hospital Association, the projected statewide job loss without the Medicaid expansion will be 90,000 jobs. In addition, they estimate that there will be an economic loss to the state of nearly $13 billion.
“I truly believed that the governor was going to use this opportunity to show real leadership,” House Democratic Leader Craig Fitzhugh said. “Instead we’ve seen more of the hand-wringing and delayed action that we’ve become accustomed to. Lives will be lost while we wait for a real decision.”
Hospital administrators, health care advocates, chambers of commerce, mayors of cities both big and small, and many others have implored the governor over the past year to expand Medicaid.
“The governor made this decision in a vacuum without consulting leaders from either party,” Senate Democratic Leader Jim Kyle said. “We’ve heard from a broad coalition of groups who will suffer if we don’t expand Medicaid, and apparently their concerns fell on deaf ears.
“It matters who governs.”
NASHVILLE, Tenn. (AP) — Here is the full text Gov. Bill Haslam’s prepared remarks to the Tennessee General Assembly on Wednesday, when he announced the state won’t expand Medicaid as part of the federal health care overhaul.
I appreciate the opportunity to speak this morning. I’m well aware this is an extremely busy time, and I’m grateful for the opportunity to come before you today. It is the first time I’ve asked to do this outside of the State of the State, but I asked for this opportunity because.
There is no more important issue, or more complex issue facing our country and our state today than healthcare, and I wanted to update you about where we are regarding Medicaid expansion.
This may look like a simple decision. On one side, people think how could we not accept federal money to expand Medicaid to cover more Tennesseans and on the other, why in the world would we accept funds tied to ObamaCare knowing the federal government can’t pay for it? But it isn’t that easy.
Gov. Bill Haslam told the General Assembly today that he is rejecting an expansion of Medicaid for now because the federal government has not agreed to some aspects of a “Tennessee plan” that involves using federal money to buy private insurance.
“A pure expansion of medicaid, expanding a broken system, doesn’t work,” said Haslam, contending he wants to use federal money to buy private insurance akin to the approach being tried in Arkansas. That would mean more people with health insurance without expanding the number on TennCare, the state’s system for Medicaid, he said.
But the federal Department of Health and Human Services has insisted on conditions for implementing the proposal that are unacceptable, Haslam said, and for now he will not recommend expansion in Tennessee.
“Our budget will not include language to accept the federal funds,” he said.
The statement brought applause from many Republicans assembled to hear his address, which left the door open for a change if federal officials change their position.
Haslam had earlier rejected establishment of a state-operated health care exchange in Tennessee, leaving the federal government to operate the clearinghouse between insurance companies offering policies and customers.
A broad array of interest groups have been urging the governor to accept expansion, ranging from the Tennessee Health Care Coalition, which advocates for low-income and disabled persons, to the the Tennessee Hospital Association and the Tennessee Chamber of Commerce and Industry,
The Legislature’s Fiscal Review Committee staff estimates that expansion would make 144,500 Tennesseans newly eligible for TennCare in the first year and bring about $1 billion in federal funds into the state.
Legislation that would block any expansion of Medicaid in the state had been scheduled for hearings later today in the Senate Commerce Committee and the House Insurance and Banking Subcommittee.
Haslam said that, if federal officials would go along with his plans, Tennessee can be “a model for what true health care reform looks like; reform that will take significant steps to save the state and the nation from the unsustainable path we are on now.”
The governor said his plan would take on “the critical issue of aligning incentives among users, payers and providers of health care.”
As described in a news release from the governor’s office, the Haslam “Tennessee Plan” would:
— Leverage available federal dollars to purchase private health insurance for Tennesseans up to 138 percent of the federal poverty level who don’t have access to health insurance, which would translate to 175,000 more insured Tennesseans;
— Allow co-pays for those who can afford to pay something;
— Include a definitive circuit-breaker or sunset of the plan that could only be renewed with the General Assembly’s approval;
— And reform the payment structure for providers so they are compensated for health outcomes, not just based on services performed.
— And reform the payment structure for providers so they are compensated for health outcomes, not just based on services performed.
By Erik Schelzig, Associated Press
NASHVILLE, Tenn. — Republican Gov. Bill Haslam will address a joint session of the Tennessee General Assembly on Wednesday about his decision on whether to expand Medicaid to cover more uninsured people under the federal health care overhaul, according to a person familiar with the plans.
Lawmakers plan to authorize the gathering during regular floor sessions Wednesday morning, the official told The Associated Press on the condition of anonymity because the joint assembly hadn’t yet been publicly announced.
The governor’s office did not immediately return messages seeking comment, though Haslam’s spokesman recommended reporters attend the House floor session at 9:30 a.m. CDT.
Haslam hasn’t indicated whether he’ll recommend expanding TennCare, the state’s Medicaid program, with the federal government paying the entire cost for the first three years and at least 90 percent thereafter.
“This is an incredibly complex issue,” Haslam told reporters earlier this week. “Every day I learn something new about the law, about its impact on Tennessee, about its impact on local governments, about its impact on businesses.”