Tennessee Gov. Bill Haslam could have decided Wednesday to make the sensible and humane decision to accept federal funding under the Affordable Care Act to expand Medcaid/TennCare to approximately 180,000 uninsured working-poor Tennesseans. Allowing these people, who earn between 100 percent and 138 percent of the national poverty level, access to Medicaid would not have added any new costs to the state for at least the next three years, and then the state would only have to pay a 10 percent match to keep the expansion intact.
But Gov. Haslam didn't make that decision.
Haslam punted instead for a vague middle ground that may let Tennessee receive the federal money to pay for private insurance policies for some of these spurned Tennesseans -- if he and more reasonable Republican legislators can find enough caveats to make his game to grab the money still seem like a poke in the eye against one of the core goals of Obamacare toward universal care.
The need to accept the Medicaid expansion arises from the ruling by the U.S. Supreme Court on the health care reform act. It had been written to allow a federal mandate to require states to raise the ceiling for Medicaid -- two-thirds of which is federally funded -- from 100 percent of the federal poverty level, to 138 percent. State insurance exchanges were designed to accept uninsured Americans with incomes above that level. But the high court voided the Medicaid expansion mandate, making it an option for state governments -- and leaving a hole of coverage for Americans just above the poverty level.
Haslam's decision was, of course, at least partly driven by extreme pressure from the Legislature's most myopic, callous and bitter opponents of health care reform. Left to his better senses, he might well have accepted an expanded Medicaid program, as eight more independent Republican governors have done. But with a raft of irrational Obamacare haters in the state's Legislature slinging their propagandist version the health reform act, he wilted.
His fallback position -- a tentative (and as yet unapproved) proposal to the federal Health and Human Services Department for a waiver to channel some of the Medicaid-purposed money into private insurance for the targeted population -- is not original, to be sure. Nor does it match the reach and benefits of the ACA offer.
It was initiated in Arkansas, and it's being considered by some other Republican governors despite their legislatures' opposition. These governors realize the serious personal, financial and health-care industry losses their states will suffer if they fail to accept new federal dollars for Medicaid expansion.
They aren't quite willing to sit on their hands while other states scoop up the funding to improve their residents' well-being. But they remain afraid to fully embrace the economic benefits of a healthier population and the efficiencies the ACA will drive both in Medicaid and in the insurance companies that will come into their ACA-mandated insurance exchanges next January.
Haslam's spin on his position had him excoriating Obamacare in the beginning of his announcement Wednesday, and then spouting as his own and praising potential reform efficiencies that already are embraced in the ACA playbook and among progressive insurers, like Tennessee's BlueCross BlueShield.
For example, he touted the chance under his "private insured care" option to coordinate reform efforts with health care providers to revise the standard health-care fee-for-service system in favor of "true payment reform" geared toward quality outcomes for patients. That, of course, is just one of the ACA goals aimed at creating new models of health care and best-practice procedures.
Haslam's decision and the contingent agreements on which he framed it are deeply troubling. Tennessee Hospital Association leaders and other industry experts predict that without the state's official expansion of Medicaid, health care will suffer across the state, and many hospitals, both in rural and urban areas, may be forced to close for lack of insured patients and their ability to pay for care. That's because the ACA will take some current federal funding away from hospitals in order to provide expanded Medicaid and thus more insured patients.
State business leaders and Chamber of Commerce officials, insurers and health care providers, faith groups and community advocates, have joined in warning state and legislative lawmakers of the dire consequences both to people in need of care, and to the state's health care infrastructure, over failure by the governor and Legislature to accept a federally funded expansion of Medicaid.
It's never too late to reverse gear and correct a mistake. Haslam and the Legislature shouldn't make citizens and health care in Tennessee suffer over a partisan divide. They should change course, and approve the expansion of Medicaid.