Tag Archives: expansion

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.”

Medicaid Expansion: Arkansas Plan Eyed; Shelby Mayor Backs It

Gov. Bill Haslam’s health policy specialists are probing into what Arkansas is doing with respect to increasing Medicaid coverage as part of federal Affordable Care Act reform initiatives, according to TNReport.
During a press conference last week in Nashville, Tennessee’s Republican chief executive said his administration is “learning some things” from policies being pursued under Obamacare by Arkansas Gov. Mike Beebe, a Democrat.
Beebe appears to have secured approval from the Obama administration to funnel federal dollars earmarked for Medicaid expansions into private insurance for those eligible. According to the Washington Post’s “Wonkblog” today, other states considering such an approach are Florida, Ohio, Louisiana and Maine and perhaps even Texas.
…Republicans in the Tennessee Legislature are divided between those who want to inoculate Tennessee against Obamacare to the greatest extent possible, and those who’re inclined to defer to Gov. Haslam to prescribe policy treatments that best suit the state’s unique conditions.
“Nobody likes the idea of just a sort of blanket Obamacare expansion, but that’s not what the governor is looking at,” said Mark Norris, the Tennessee Senate majority leader. “He’s real curious about what is happening in Arkansas, with their initiative to use Medicaid dollars for private insurance.”
Norris said he doesn’t anticipate Haslam making any decisions that could potentially put state government over a financial barrel. “He’s doing his due diligence. He’s doing what a good governor ought to do,” said the Republican from Collierville.
Norris added, “I have enough respect for the separation of powers and the three branches of government, and this particular governor, to wait and let him reach his own decision before we jump in and try to preempt something that he may never do anyway.”


And from the Commercial Appeal:
Shelby County’s Mayor Mark Luttrell has encouraged Gov. Bill Haslam to pursue expansion of Tennessee’s Medicaid program, saying in a letter that the benefits of extending health coverage to 60,000 to 80,000 additional low-income Shelby County residents outweigh the concerns.
The mayor, like Haslam a Republican, also said the impacts of not participating in the Medicaid expansion authorized by President Obama’s Affordable Care Act “would be damaging to The Med, if not devastating.”

Haslam Flags Medicaid Expansion Legislation

NASHVILLE, Tenn. (AP) — Gov. Bill Haslam’s administration has served written notice that it opposes a freshman Republican lawmaker’s bill to block Medicaid expansion under President Barack Obama’s health care overhaul.
Leslie Hafner, the governor’s legislative director, wrote in a Monday letter to Rep. Jeremy Durham of Franklin that the administration opposes the bill on philosophical grounds.
Haslam spokesman David Smith said the governor has sent a similar letter to Democratic sponsors of a bill encouraging the state to participate in an expansion of Medicaid.
The governor has said he plans to make a recommendation to Legislature about whether to pursue an expansion by the end of the month.
The U.S. Supreme Court has left a decision on Medicaid expansion up to the states, though the federal government will pick up most of the cost.

TN Employers Could Face Tax Penalties Without Medicaid Expansion

Tennessee companies employing 50 or more lower-paid workers are staring at paying up to $90 million collectively in annual tax penalties if the state rejects expanding TennCare, according to a national tax preparation firm’s findings reported by the Chattanooga TFP.
Jackson Hewitt Tax Service’s estimate comes in a new report shedding light into a little-discussed provision in President Barack Obama’s Affordable Care Act. The report outlines the tax consequences for some employers with full-time employees in states that forgo expanding Medicaid after the U.S. Supreme Court ruled last year that doing so is voluntary instead of mandatory. Medicaid is operated as TennCare in Tennessee.
Republican Gov. Bill Haslam told reporters Wednesday that employer liability, which the tax preparation company estimated at $59 million to $89 million annually, is part of his calculus as he weighs whether to extend TennCare coverage to an estimated 181,700 Tennesseans.
“It’s a complex decision,” Haslam told reporters. “You have the impact on the state, impact on people who would be potentially insured, impact on businesses, impact on hospitals.”

Rally Against TN Medicaid Expansion Draws 100

A small throng of protesters gathered at War Memorial Plaza on Sunday in a rally organized by conservative activists, including tea party members, to oppose extending TennCare to tens of thousands of Tennessee families, reports The Tennessean. They claimed that an expansion would undermine small government values and inflate the national debt.
On a bright and breezy day, about 100 demonstrators carried handwritten signs suggesting that their anger stretched beyond the issue of TennCare expansion with messages like “entitlement programs create more dependency and harm.” Many of the speakers blasted President Barack Obama’s health care overhaul as an instance of the federal government overstepping its constitutional powers.
“There are always well-intended groups suggesting that we abandon our principles contrary to sound conservative judgment,” said Rep. Jeremy Durham, R-Franklin, who filed a measure in the House to bar the state from expanding TennCare. “That’s the exact mindset that got our country into the dire fiscal straits we face today.”
U.S. Rep. Scott DesJarlais spoke in broad terms about how Obamacare represents “the socialization of our health care system.” Asked by reporters after he spoke about his position on TennCare expansion, he said he opposes it. “To look at history and say, ‘let’s double down on a failed policy’ doesn’t make a lot of sense.”


For more reporting on the rally, see Andy Sher, and WPLN.

Miscellaneous TN News and Opinion Links

The Chattanooga Times-Free Press has an update on the Georgia Legislature’s push to tap into Tennessee River water. Seems the bill has stalled in the Senate after passing the House and there’s talk of a new approach – take water from Georgia streams that flow into the Tennessee instead.
In his weekly column, Robert Houk reports “a troubling feeling of déjà vu whenever I read about the exploits of the Tennessee General Assembly. Maybe it’s the fact our legislators grapple with many of the same bills year after year.”
The Jackson Sun has a long analysis article that says 54 rural hospitals in the state could be closed without Medicaid expansion. A Boliver hospital is the focus.
About 100 people showed up at Progressive Baptist Church in Nashville for an hourlong “town hall meeting” organized by AhealthyTN.org, a coalition of community volunteers formed about six months ago to support Medicaid expansion, according to The Tennessean.
The Chattanooga Free Press editorializes against a U.S. Postal Service rule that has lead to hundreds of new children’s books – purchased by taxpayers through the Governor’s Books From Birth Foundation” – being “tossed in the garbage every month.”
From a Frank Daniels’ opinion piece on the proposed judicial selection amendment to the state constitution: It is a sham the way the Tennessee Plan works. We should either correctly amend the state constitution, which, despite any opinion from the attorney general (who is appointed by the very judges whose status is in constitutional question), SJR 0002 does not do, or we should return to the what the framers of Tennessee’s constitution stipulated: that qualified voters should elect judges.
Never tire of reading about wine in grocery stores? The Johnson City Press today has an article quoting Northeast Tennessee liquor store owners and supermarket operators under the headline, “All Eyes Are on Wine Measure.”
Otis Sanford says “a rare case of reasonableness has seeped into the minds of a couple of lawmakers. Sen. Bill Ketron, R-Murfreesboro, and Rep. Susan Lynn, R-Lebanon, are co-sponsoring a bill that would allow the use of a student ID issued by state colleges and universities for voting in Tennessee.”

Haslam: At Least 20 People Would Be a Better President Than Me

Despite recent press suggesting Gov. Bill Haslam should be on the list of presidential contenders, the governor said there is “zero” truth to rumors he would consider a bid, reports Andrea Zelinski.
“There’s about 20 people who would be better at it, no, more than that,” Haslam told reporters after addressing small business groups like the National Federation of Independent Business Tuesday morning at the Downtown Hilton. “There’s at least 20 people who’d be better than me.”
When asked directly whether there were truth to the rumors he would consider running for president, he said, “there’s zero.”
Haslam also told reporters he plans to decide whether to expand Tennessee’s Medicaid program by the end of the month and added that he is likely to sign legislation that would allow legally storing guns in locked vehicles parked in lots.

TN Hospital Association Poll: 60 Percent Favor Medicaid Expansion

The Tennessee Hospital Association released a poll showing a majority of residents want expansion, reports WPLN.
Nearly 60 percent of respondents to the hospital association’s poll said the state should accept federal dollars to expand it’s health insurance program for the poor as envisioned in the Affordable Care Act.
THA president Craig Becker says he’s also seen a softening among state lawmakers.
“We started with many of our legislators back in the summertime with basically a ‘hell no.’ Now we’ve moved ourselves much closer I think where they’re willing to be open to hear what we have to say.”
Becker claims some rural facilities could close. Because of cuts, he says hospitals need the hundreds of thousands of paying customers Medicaid expansion would provide.
Democrats are also now pushing for an up or down vote. They say they’re tired of waiting for Governor Bill Haslam to make a decision


Note: News release below.

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Democrats Call for Vote on Medicaid Expansion

News release from House-Senate Democratic Caucus
NASHVILLE – House and Senate Democrats pushed in a Tuesday press conference for a full debate and an up or down vote on a bill to allow Tennessee to expand Medicaid.
“Unfortunately, this General Assembly has been in session for more than a month now, and we’ve spent most of our time on trivial matters,” House Democratic Leader Craig Fitzhugh said. “Whether we expand Medicaid affects the lives and livelihoods of hundreds of thousands of Tennesseans and has profound implications for our states budget.
“It’s time for us to do what the people sent us here to do and tackle the elephant in the room.”
Gov. Bill Haslam, Lt. Gov. Ron Ramsey and Speaker Beth Harwell have remained open to Medicaid expansion, and Republican legislation to block expansion was taken off notice in the House and Senate.
“Accepting federal funds to expand Medicaid will create thousands of new jobs and create millions in new revenues for state government,” Senate Democratic Caucus Chairman Lowe Finney said. “If we don’t expand, Tennessee businesses will face millions in new taxes.
“This should not be a partisan issue. This is about jobs and people.”

Note: The Fitzhugh/Finney bill on Medicaid expansion is HB290/SB604.

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.

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