NASHVILLE — Advocates and opponents of expanding Medicaid are eagerly awaiting Republican Gov. Bill Haslam’s decision on whether Tennessee will participate in a key facet of President Barack Obama’s health care overhaul.
Lawmakers are expected to formally invite Haslam to address a joint session of the General Assembly about potential Medicaid decision Wednesday morning.
Haslam canceled his weekly breakfast with legislative leaders, and his press office advised reporters to attend the House floor session at 9:30 a.m. CDT. While Haslam’s office would not confirm that he was planning to speak, the Republican governor has said he plans to announce his decision before the end of the week.
The governor hasn’t indicated whether he’ll recommend expanding TennCare, the state’s Medicaid program. The federal government would pay the entire cost for the first three years and at least 90 percent thereafter.
While Republican governors have been highly critical of so-called “Obamacare,” a number of them are reevaluating their opposition to accepting federal dollars to expand health care coverage to the poor as they review the budget implications and face pressure from hospitals that treat the uninsured. Republicans also are proposing alternatives that would cover fewer people than Obama’s plan, guarantee less financial help or rely more on private insurers.
“This is an incredibly complex issue,” Haslam told reporters earlier this week. “Every day I learn something new about the law, about its impact on Tennessee, about its impact on local governments, about its impact on businesses.”
An expansion would be estimated to cover roughly 140,000 uninsured Tennesseans and bring in $1.4 billion in federal money in the first year. The hospital industry has called expansion crucial to boosting jobs in that sector, and has warned that declining the money could cause some rural hospitals to go out of business.
“I’m hopeful, I really am,” said House Democratic Caucus Chairman Mike Turner of Nashville. “I’m concerned, but I’m hoping he’s bold and does the right thing.”
“This affects more than just the uninsured,” he said. “This affects the working county hospitals, people of all walks of life.”
The prospects of getting the Republican supermajority to agree to an expansion of Obama’s signature law could prove daunting.
“The politics of it are difficult,” Haslam told reporters earlier this week. “And we’ve recognized that from the very beginning.”
Haslam said his administration was working to the “last minute” to work through the various scenarios with the federal government.
“Ultimately, we have to be convinced it’s the right thing for Tennessee and we’re not taking on a lot of added burden that’s going to cost us down the road,” Haslam said.
A study commissioned by the AARP estimates that the state’s participation in Medicaid expansion would result in $9.4 billion in direct federal funding through 2019, while the state’s share would be about $315 million.
The report says federal money would result in additional production of goods and services valued at $17.6 billion and wages, salaries and benefits worth $7.9 billion. The study calculates there would be a nearly $30 return for every state dollar spent on expanding Medicaid.
But skeptics have cited the state’s 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 and ballooning expenses set off incendiary fights over taxes that reshaped the state’s political landscape.
Haslam’s predecessor, Democrat Phil Bredesen, in 2005 cut 170,000 adults from the TennCare rolls and reduced 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.
Haslam has said he has been poring over the deals struck by other Republican governors who have decided to pursue Medicaid expansion and that he would want maximum flexibility for Tennessee under an expansion.
Committees in Florida’s Republican-led Legislature have rejected a Medicaid expansion for roughly 1 million of the state’s poorest residents, even though it is backed by GOP Gov. Rick Scott. Now a Republican state senator is pursuing an alternative that would use federal funds to provide vouchers for low-income residents to buy private policies.
Republican Ohio Gov. John Kasich also has been in discussions with the Obama administration about providing subsidized insurance instead of full Medicaid coverage for more adults. Republican governors in Texas, Nebraska and Indiana want the federal government to award Medicaid money as block grants to states.
Haslam vowed not to be swayed by political considerations, though his previous decisions not to pursue either a state-run health insurance exchange or a joint one with the federal government hewed closely to the ideological preferences of Republicans in the Legislature.
“You’re elected to try to make the hard decisions on the big issues,” Haslam said. “And there’s no question that health care is as big an issue facing Tennessee and the country as there is.”