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Haslam says no to Medicaid expansion — for now

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NASHVILLE — Tennessee Gov. Bill Haslam on Wednesday rejected an expansion of TennCare, the state’s Medicaid program . . . at least for now.

Addressing a rare joint session of the state General Assembly, the Republican governor said that he would instead pursue a private option to expand insurance to the state’s uninsured.

Haslam’s long-awaited decision would have faced a tough sell in the Republican-controlled legislature even if he had supported expansion of TennCare under terms of the federal health care reform legislation, commonly dubbed Obamacare.

The federal legislation called for states expanding Medicaid programs to make 138 percent of the poverty level eligible for coverage. The feds would cover most of the cost for a finite period of time. That assurance was not enough to satisfy many of the state’s GOP lawmakers, who said that the cost to the state would be too much. A ruling by the U.S. Supreme Court last year shot down mandatory Medicaid expansion by the states, making compliance optional.

According to the Associated Press, rejecting Medicaid expansion will leave 140,000 Tennesseans without free coverage to which they would have otherwise been eligible. Nationwide, some eight million are expected to enroll in Medicaid programs next year due to the expansion.

State Sen. Ken Yager, R-Harriman, one of the legislators who had expressed a reluctance to support an expansion of Medicaid in Tennessee due to the costs associated with it, said that 30 percent of the population in Scott County is currently eligible for TennCare.

Rejection of Medicaid expansion in Tennessee is not a surprise. In addition to the governor’s mansion, Republicans carry a two-thirds majority in the state legislature. When Obamacare passed Congress in 2010, it did so without a single Republican vote.

Haslam, who has been critical of the costs associated with various elements of Obamacare, said he wants to pursue a state plan that will use federal dollars that would have otherwise helped the state pay for Medicaid expansion, to help the state’s uninsured purchase private insurance plans.

“I believe Tennessee can also be a model for what true health care reform looks like,” Haslam told lawmakers assembled at Wednesday’s joint session.

That plan, which is not dissimilar to a pursuit recently announced by Arkansas, would require approval from the federal government, though there is no indication of whether the Department of Health & Human Services might sign off on it.

Haslam, who said he has not received assurances he needs from the federal government to insure that Medicaid expansion can happen without substantial cost to Tennessee, said that eligibility for the state plan he envisions would be based on the same guidelines as Obamacare’s Medicaid guidelines — 138 percent of the poverty level. He added that it would require copays from residents who could afford to pay them, among other stipulations.

Similar state programs seeking federal vouchers for health care coverage rather than outright Medicaid expansion are being considered in Ohio and Florida, which — like Tennessee — have Republican governors.

Haslam’s announcement was met with praise from Republicans and criticism from Democrats.

The sharpest rebuke came from the Tennessee Justice Center, a low-income advocacy group, which said the announcement would “mean that many of our neighbors will live sicker and that some will die sooner.”

But Haslam’s plan also has plenty of support. Lt. Gov. Ron Ramsey, a Republican from East Tennessee, said, “Without bold reform of the Medicaid program tailored to Tennessee’s unique situation, there can be no compromise on this issue.”

Ramsey echoed Haslam’s remarks that the federal government has not been forthcoming with assurances sought by the state, and added that the governor’s plan is “what true health care reform looks like.”

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