By Scott Robertson
Before the Tennessee General Assembly gets down to regular business this year, it will have already debated what is likely to be one of the most contentious issues it will face. Governor Bill Haslam has called a special session during which no other issues may be discussed in order to vote his Insure Tennessee plan up or down. That session is slated to begin at 4 p.m., Feb.2.
What is Insure Tennessee? In a nutshell, it’s Haslam’s way of accepting Medicaid expansion dollars the federal government is returning to states as part of the Affordable Care Act. Many states took those dollars a year ago on the federal government’s terms, but Haslam declined for the first year, choosing instead to take the time to create a Tennessee-specific plan that is acceptable to the Obama administration while allowing for greater use of the private insurance marketplace.
“Whether we pass (Insure Tennessee) or we don’t pass it, our decision has the potential of setting healthcare policy in this state for at least the next two generations,” says Matthew Hill, seventh district state representative.
During the last session of the Tennessee General Assembly, legislators passed a law giving themselves veto power over any Tennessee plan. So, on Feb. 2, legislators will begin discussing whether or not to approve Insure Tennessee.
Lt. Gov. Ron Ramsey has been working with the governor on the plan and says he expects a close vote. “The pros are that we’re already sending money to Washington – Tennessee taxpayer dollars – that we aren’t getting back, and this would bring those dollars back to Tennessee so we can use them in a fashion that we deem proper in Tennessee. That’s what we are doing with this. The other side is that this is a political animal, and we’re dealing with an Obama administration that hasn’t exactly had a good record of doing what they say they’re going to do or of running anything well.
“Those states that took the dollars immediately out of the gate were really kind of idiots to be honest with you,” Ramsey says. “They’re stuck with an old broken system and you see states like Tennessee coming up with innovative ways to spend the same money.”
The key for the Tennessee plan to succeed, Ramsey says, is to limit the state’s exposure if the Obama administration fails to live up to its side of the bargain. “It’s not by accident that this plan addresses many of the problems that a lot of people have with Medicaid expansion before the debate even gets started. With the proper safeguards I think we can do the Insure Tennessee, but again there are a lot of details that need to be worked out between now and Feb. 2.
“I’ve talked with the governor about these things,” Ramsey says. “We’ve talked about how the federal government may tell you they’re going to do something, but will they really? We’ve talked about Indiana, Arkansas and other places where they tried a few things that didn’t work out exactly like they thought. So we need to make sure we have these outs, that if they say they’re going to do ‘x’ but don’t do it, then we’re out of the deal.”
Hill describes his own approach to the issue of whether to vote for Insure Tennessee as, “cautious.”
On one hand, Hill says, “I am very concerned that we ought to help people who have jobs and are working and are productive members of society. I also think that as one of the state representatives representing Washington County, I owe it to Governor Haslam to be very deliberate and very judicious with his proposal – not just because he is the governor, but because he really has spent a lot of time, about a year-and-a-half, working with the federal government, negotiating to get this waiver out. So really everyone in the legislature owes it to the governor to keep an open mind and take a look at the details.”
On the other hand, however, Hill says, “I am cautious because I remember back in 2005 when the rolls were expanded, 91 cents of every new dollar that came into the state went into TennCare and Governor Bredesen had to take tens of thousands of people off the rolls to keep from bankrupting the state. I remember going to town hall meetings and meeting people who were being disenrolled from TennCare who literally had to choose between their groceries and insulin. I don’t ever want to get back to anything remotely close to that ever again.”
In addition, Hill says the transitory nature of the agreement gives him cause for concern. It only addresses the next two years, when the federal government is committed to covering 100 percent of the cost. After that, the costs begin shifting to the states. “So let’s say we go to a Tennessean who has a job and a spouse and a family and we say, ‘Here’s some healthcare coverage, but remember there’s a really good chance it’s going to go away in two years.’ Do you think they heard the last part of what we said about it probably going away, or do you think they just heard, ‘Here, have some healthcare coverage’?”
Hill says he’s still at the point of reading the materials provided by the Haslam administration and making a list of questions.
“I think it is a very good idea that we address this in special session,” Hill says. “It forces us – the house, the senate and the executive branch, to focus entirely on this matter. That’s good because this really is so very important.”