The Tennessee House of Representatives has approved a bill requiring the governor to seek approval from the state Legislature before agreeing to any Medicaid expansion deal with the federal government.
The vote on House Bill 937 was 69-24, with Republicans voting for it and most Democrats opposed.
The bill’s primary sponsor, Jeremy Durham, R-Franklin, has argued that lawmakers deserve a chance to inspect — and, if they so choose, reject — any proposal to enlarge government-financed health coverage for low income Tennesseans as called for in the Affordable Care Act.
A companion measure is awaiting a floor vote in the state Senate. The upper-chamber sponsor, Brian Kelsey, R-Germantown, said after Monday’s House action that he plans to bring his bill to a vote next week. Kelsey has dubbed his proposal the “Stop Obamacare Act.”
Under the ACA, the federal government has promised that until 2016 it will fully fund increasing Medicaid coverage to adults who make 138 percent of the federal poverty level. After that, states will have to start kicking in funds of their own each year. In 2020 and afterward states will have to pick up 10 percent of the Medicaid costs.
House Democrats, whose numbers are too thin to thwart initiatives with broad GOP support, tried unsuccessfully to add a number of amendments to HB937. One of those failed provisions would’ve allowed the state to sign on to Medicaid expansion immediately — but only up until 2016, while the costs are fully covered by federal taxpayers.
Minority Leader Craig Fitzhugh, D-Ripley, said Medicaid expansion “is in fact a financial boon for our state.”
“It will bring in, over the first three years, about five billion — with a ‘b’ — federal dollars,” he said. “It will create 18,000 new jobs. It will save our state money, including $1.6 billion saved in the cost of uncompensated care that we have to spend now.”
Democrats argue that Republican foot-dragging and obstructionism on Medicaid expansion approval is costing Tennessee “an average of $2.5 million a day, or $137,500,000 to date.”
Republicans tend to respond that the federal government is in no fiscal position to be promising immense new spending programs. They also argue that down the road, when the state has to start picking up a share of Medicaid expansion costs — however seemingly modest in the scheme of things — it will either force a tax increase on Tennesseans or siphon resources from other budget areas, like education and transportation infrastructure spending.
Republican Gov. Bill Haslam, who’s indicated he is amenable to getting the Legislature’s blessing on a Medicaid expansion deal, has said he is not interested in simply inviting more people to sign up for TennCare. During an address before a joint session of the General Assembly last spring, Haslam said the ACA “doesn’t address the real issues of health care reform — users and payers not being aligned, and users and providers not being in alignment.”
The governor’s refrain since then has been that he and his health policy advisers are working to develop a unique “Tennessee Plan” that controls health care costs — one that’s acceptable both to the Obama administration and the Republican-dominated Tennessee Legislature, where opposition to the Affordable Care Act runs deep.
Democrats complained Monday that forcing Haslam to get the Legislature’s permission to ink a deal with the Obama administration on Medicaid expansion likely ensures that no agreement would take effect until at least 2015, given that the General Assembly will probably adjourn for the year in about two months.
“This is unprecedented, what we are about to do,” Democratic Caucus Chairman Mike Turner said during debate on HB937. “We’re about to tell the governor of the state of Tennessee that we don’t trust him. We’ve not done that since probably 1977, when we swore Lamar Alexander in early because we didn’t trust (Gov. Ray Blanton) to not let some prisoners out early. But we’ve never tried to tie a governor’s hands. I just can’t believe this.”
Turner added, “I trust Gov. Haslam. I think he’ll do the right thing. It’s a sad day when we start thinking we can’t trust our governor to do what’s right.”
Earlier Monday, prior to the House voting on the Medicaid expansion authorization bill, the Knoxville News Sentinel reported that Haslam has asked U.S. Health and Human Services Secretary Kathleen Sebelius to provide some guidance on “a proposal that will work” from the federal government’s perspective.
While they’d spent much of Monday night’s debate on HB937 defending Haslam’s executive policymaking judgment, Democrats were none too pleased that he looks to be punting to the feds on a Medicaid deal.
“Governor Haslam appears to have repeatedly misled the public into believing there is a plan to expand Medicaid, but in reality, one does not exist,” Rep. Mike Stewart of Nashville said in a House Democratic Caucus press release. “Now, after a year of dragging his feet, we find out today that he has asked Secretary Sebelius to come up with a ‘Tennessee plan’ for him. The dereliction of duty by the Governor on this has been astounding. Hundreds of thousands of Tennesseans have been waiting on health care; instead, all they’ve received from Governor Haslam is more excuses.”
Initially, when Obamacare was signed into law, the states were mandated to expand Medicaid. However, the U.S. Supreme Court later ruled that the president and Congress overstepped their constitutional authority, and that the ACA’s Medicaid expansion provisions cannot be implemented where state governments don’t agree to the terms.
While Haslam has generally tried to avoid appearing driven by partisanship on the issue of Affordable Care Act implementation, he has blamed much of the opposition to Obamacare — only 25 states have signed up for Medicaid expansion — on the president’s administration and the Democratic U.S. Congress that initiated “a massive new entitlement plan for the country that was passed without one bipartisan vote, without ever asking governors how they thought the plan should work.”
“As a result, you have something that is not working well,” Haslam told TNReport back in December. “If they had done the policy the right way — gotten true input from both sides of the aisle and gone to governors, who are going to be responsible for implementing this and for paying for part of it — I guarantee you that you would have a better result.”