Governor takes pains to differentiate the plan from Obamacare during Johnson City stop
By Scott Robertson
Before the Tennessee General Assembly went into special session Monday to debate Governor Bill Haslam’s Insure Tennessee proposal, the governor spent time in Johnson City last week promoting the plan. Insure Tennessee faces an uphill battle in Nashville because several state legislators have promised to oppose any expansion of Medicaid in Tennessee funded by the Affordable Care Act, or Obamacare.
The funding for Haslam’s Insure Tennessee plan is available to the state through the ACA, and the population covered – those who make up to 138 percent of the federal poverty level – is the same covered by traditional Medicaid expansion. Haslam’s plan differs from the Obamacare initiatives in several ways, however, said Haslam during his visit to the Johnson City Community Health Center.
“People ask me, ‘Isn’t this Obamacare?’” Haslam said. “No, this is the first step toward what Republicans would do if we had the control of healthcare. As Republicans, I feel we owe an answer to the question, ‘If you don’t like Obamacare, what would you do instead?’ I think we would start with something like this and maybe a little bit more.”
Tennesseans are being unfairly taxed at present, Haslam said, because their tax dollars are flowing to states that have already signed onto Medicaid expansion or worked their own state-specific alternative plans with the federal government. “Right now, Tennesseans are paying tax for this and those dollars are being used in other states that have covered this population. So a lot of what we’re trying to do with Insure Tennessee is to bring back to the state money that Tennesseans are paying now.”
Some state legislators have suggested it is irresponsible to accept funds from a program that could increase the federal deficit. Haslam suggested that approach is short-sighted, particularly considering the innovative cost-reduction elements he said his plan includes.
“It will never cost the state of Tennessee a dime,”Haslam promised. “We worked hard to design it that way. The federal government will pay just over a billion dollars in the first year. And I understand that we should all be concerned about the federal deficit. But we should also be concerned about rising healthcare costs. They are what are driving the rise in the federal deficit. The things we’re doing can bend that cost curve that’s currently growing at a rate none of us can afford. What we’re doing in Tennessee is taking the first steps in solving a bigger long-term national issue.”
Insure Tennessee offers two plans. The first, called the Volunteer Plan, would offer vouchers to the working poor who need assistance paying for the coverage sponsored by their employers. “That is not something they (the federal government) have in their plan,” Haslam said.
The second, known as the Healthy Incentives Plan, includes premiums and copays. Should an individual fail to pay these for more than 60 days, he or she could be disenrolled from the plan entirely, something that cannot happen under Medicaid expansion as strictly proscribed by the ACA. The plan offers low-income patients the chance to earn credits for healthy living choices targeted at lowering their own healthcare costs. “We think that when patients have ‘skin in the game,’ so to speak, they are far more likely to make healthy choices and be good participants in their own healthcare,” Haslam said.
State Senator Rusty Crowe asked whether the credits earned for healthy living could be used for anything. “It can go toward copays and premiums,” Haslam replied. “That’s all it can go toward.”
The governor also addressed concerns raised by some legislators that the state would be stuck in an eternal agreement with the federal government that places unfunded mandates on Tennessee if the ACA should be altered. “I’m not a big fan of a lot of things with the federal government,” Haslam said. “But they have never in their history not paid what they owed in Medicaid.”
Currently the ACA guarantees the state will not pay anything for the next two years, after which time the federal match will shrink, but the Tennessee Hospital Association has committed to covering the difference. Haslam said the state already has a law on the books that would prevent the hospitals from passing the cost back to patients.
“I understand some legislators are worried that this might somehow cost the state money, or that the feds might try to change the rules on us mid-game,” Haslam said. “We have now a Supreme Court ruling, an Attorney General’s opinion and a letter from the secretary of HHS in Washington saying, ‘If in any case the state decides it does not wish to cover a certain population, we can no longer cover them. Those three things together, that’s pretty clear direction.”
There has been speculation that the House Insurance and Banking Committee will kill the legislation before it can come to a vote in the full State House. That committee has 20 members, eight of whom co-sponsored legislation in the last session that would have prohibited any form of Medicaid expansion.
Haslam said legislators must realize that a vote for Insure Tennessee is different than a vote for Obamacare. “I think the people of Tennessee understand the difference. Being able to communicate that to legislators is really key. I think the people of Tennessee really want this to be talked about. We’ve been working on it for the better part of two years, and I think it would be a shame if it were to not be fully vetted. The people of Tennessee want this to happen and ultimately I think the legislators will listen to the people who elect them.”