Opposite Approaches to Medicaid Expansion


Opposite Approaches to Medicaid Expansion

By Scott Robertson, Managing Editor

Sometimes you have to side with somebody on the other team. I have been criticized by some of my fellow Republicans for going against the party line in print. “Say what you want behind closed doors,” has been the admonition, “but don’t disagree with the family in public.” And that would be fine if this were a family, or even a business. But when I go against my party in print, it’s because I believe the party is on the wrong side of an issue that affects the community I live in, and I believe that the best interest of my community is more important than the public face of the party.

 That will never change the fact that I am a staunch Second Amendment guy or that I believe that in most cases that government works best at the local level and worst at the federal level. I believe in religious freedom and all that goes with it, and I think the business community is generally made up of the smartest people in most any room. So if you call me a RINO, I have some choice words for you.

 But sometimes I have to admit that the party line is not correct 100 percent of the time. We are not infallible just because we aren’t Democrats (we’re just less fallible).

 For instance, I think it’s insane for the Tennessee State Legislature and the Virginia House of Delegates to consider declining federal Medicaid expansion dollars.

 Let’s “Ben Franklin” it. What are the pros and cons of taking the dollars?

 On the plus side, local hospitals that are already facing declining revenues thanks to Medicare reimbursement cuts and rapidly rising numbers of unpaid bills from high-deductible plan patients, won’t have to cut services, cut jobs or close their doors entirely. Rural patients won’t have to drive an hour or more to get services they can currently get in their own communities.

 On the minus side, after three years, the federal coverage of the cost of Medicaid expansion drops from 100 percent to 90 percent, and no one knows where the costs will go from there. Also, the cost of expanding Medicaid drives up the federal deficit.

 I’ve talked with the governors of both states about this, and I have gone from supporting the Tennessee governor’s approach to supporting the Virginia governor’s approach.

 Tennessee’s Bill Haslam earned my respect a year ago when he declined the federal money under the terms set forth in Obamacare. He wanted a more capitalist approach, under which the federal dollars would come to Tennessee, but would be distributed in such a way that Tennessee Medicaid (TennCare) patients would purchase healthcare coverage through the marketplace.

 Yet as the months have passed, no progress was ever apparent. The new year came and went. The federal government started handing out dollars to other states. The Tennessee Plan still failed to materialize.

 Finally, the governor met with Health and Human Services Secretary Kathleen Sebelius last month during a trip to Washington for a governors’ conference. He said he asked the secretary for a counter-proposal to his plan. I think the governor wanted us to see this as a sign of progress.

 In fact, it raises the question of whether Haslam was bailing on the issue. He has washed his hands of tough questions before, letting bills move across his desk without his signature. I have now heard members of both parties suggest that the governor merely let the clock run out, turning responsibility for progress over to Washington in the short term while letting the state legislature give itself the power to take the decision out of his hands permanently.

 That’s the problem with us moderates. We often come up with bold plans, but don’t seem to have the wherewithal to take hard, decisive, timely action to put them into effect. I really believe Haslam missed the boat on a chance to be a visionary, effective governor who could have single-handedly turned the tide in the healthcare debate. I think he blew it, for himself and for the state.

 Having said that, it’s always dangerous to predict the future (in this space just last week I failed to foresee Virginia’s governor stepping in to save “The Falls”). And who knows, there’s always the possibility that someone will ride in on a white horse with a sensible, politically palatable compromise. Tennessee, especially Nashville, Knoxville and the Tri-Cities, has many great healthcare industry minds. I’d love to see it happen.

 But while all this dawdling is going on, money that could help Tennessee and Virginia is going to other states.

Virginia Governor Terry McAuliffe is demanding a budget from the General Assembly by July 1 with a Medicaid expansion package included. The House of Delegates is seeking a delay to that, up to one year.

 I asked Wellmont’s CEO this week if she could guarantee her hospitals in Virginia and Tennessee won’t close if they don’t get Medicaid expansion funds for a year. She said, “No. I can’t guarantee anything.”

 McAuliffe put it like this. “First off, nobody’s raising new taxes for this. The taxes have already been raised. This is money that we’ve already shipped over the Potomac Ocean to Washington. They’re just giving it back. We lose $5.2 million a day of money that you have already paid into the system that is now going to another state.

 “Think of it in these terms,” McAuliffe added. “This is like going to the gas station. You pay 18 cents in federal gas tax on every gallon. You have no option. You pay it. But then this is like calling the Federal Department of Transportation and saying, ‘We don’t want our federal highway money. Send it to Massachusetts or California or New York. We’re afraid we’ll grow the debt if we take this highway money.’ It’s the same thing.”

 Now, I do maintain a healthy distrust of the idea that the federal government will not slough more and more and more of the cost of this expansion onto the states as time goes by. The federal government invented the unfunded mandate.

 But in the first three years, the federal government has committed to paying 100 percent. So why not write a bill that accepts the money for the first three years, and then deal with it year-to-year after that? Why not accept the money now, at 100 cents per dollar, to get our least healthy citizens healthier, which will positively affect all our healthcare costs? In the meantime, we can save up for the future when separating from Medicaid expansion makes more sense.

 There’s so much wrong with Obamacare to start with that it’s idiotic to make it worse just to take a partisan stand. Obamacare won’t go away just because we take political positions that lead to the closing of hospitals, the loss of healthcare jobs, and drastic cuts in services in Tennessee and Virginia.


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