Tennessee is now one small step from being a very large step further from accepting funds from the federal government for expanding Medicaid.
A proposal requiring Gov. Bill Haslam to secure the General Assembly’s blessing before signing the state up to start offering taxpayer-financed health coverage to a larger share of poor and low-income Tennesseans looks to have cleared its last legislative hurdle.
The sponsors of the legislation are Rep. Jeremy Durham and Sen. Brian Kelsey, both Republicans and committed foes of the Obama administration’s signature health reform law, the Patient Protection and Affordable Care Act. They’ve worried that Haslam — or some future holder of the state’s highest office — might try to slip a Medicaid expansion funding initiative through the General Assembly by enmeshing it in a sweeping budget proposal, and that lawmakers opposed to it might have difficulty rooting it out or be faced with having to choose whether to vote against an entire state spending package or risk looking like they tacitly support a key pillar of Obamacare.
It’s not too surprising House Bill 937 passed, given that most Republicans in both chambers of the GOP-dominated Legislature support the idea of resisting the Affordable Care Act. Signed into law four years ago this month by President Obama, the ACA passed the United States Congress without a single Republican vote.
But HB937’s final passage in the Tennessee Senate Thursday didn’t come off without a little parliamentary intrigue and some rhetorical provocations to propel it along the way to the governor’s desk. And that wasn’t altogether unexpected, either. Among the numerically marginalized ranks of legislative Democrats, there probably isn’t a more openly loathed piece of legislation in the General Assembly this year.
Senate Minority Leader Jim Kyle, D-Memphis, had sought to make putting the finishing touches on the measure as politically awkward as possible for Republicans — even at the cost of offering up a constitutionally suspect amendment, which could technically put him in violation of his oath of office if he did so willfully and knowingly.
He denied that was the case, though — or, for that matter, even that he was trying to sabotage HB937.
During the March 6 Senate floor debate on the Medicaid expansion legislation, Kyle successfully argued for the attachment of an auxiliary provision to the bill prohibiting lawmakers from collecting expenses or their standard $173 a day per-diem paycheck in the event that a special session is called later this spring or summer to discuss any potential deals Haslam has negotiated with the Obama administration. Because lawmakers are scheduled to finish up their regular business by the end of next month, no Medicaid expansion plan could take effect until at least January of next year unless the Legislature convenes specifically to address the matter at some point over the intervening eight months.
In that event, Kyle argued, lawmakers don’t really deserve to cash checks for any additional pay or travel and lodging reimbursement in order to come back and decide something that they could, if they so chose, just as easily determine now, or at least before the regular session ends for the year.
That line of reasoning resonated with most of the Senate’s Republicans.
Typically the past few years under GOP legislative dominance, amendments offered by Democratic opponents of a bill with broad Republican support are summarily shot down — as were a number of others in both chambers on HB937. But Kyle’s no-per-diem amendment passed on a bipartisan 23-7 vote — and, in fact, over the objections of the sponsor, Sen. Kelsey, who argued that any compensation issues could be discussed when and if the need for a special session arises.
Among the 18 Republicans voting for the Kyle amendment were the chamber’s ranking GOP officers, Lt. Gov. Ron Ramsey, Majority Leader Mark Norris, Caucus Chairman Bill Ketron and Speaker Pro Tem Bo Watson. The only minority-party caucus member voting against the no-compensation amendment was Nashville Democrat Thelma Harper.
The amended bill, with the payment elimination stipulation attached, ultimately passed 23-6. None of the chamber’s Democrats voted for it and none of the Republicans against it — although Steven Dickerson, R-Nashville, abstained.
On March 17 it was again taken up in the House, where some lawmakers of both parties indicated they had no problem foregoing paychecks to come back to Nashville for the purpose of discussing Medicaid expansion. Others, though, like Democrats Joe Towns of Memphis and Joe Armstrong of Knoxville, argued that withholding expense reimbursements from legislators would impose an unfair financial burden on those who live far away from the Capitol — and could even hamper efforts to gain the quorums necessary to conduct legislative business.
Rep. Durham, the Republican sponsor from Franklin, had indicated prior to discussion of the Kyle amendment that he didn’t really care one way or the other if the no-compensation language was on his bill. He shrugged off questions and complaints put to him by Towns and Armstrong, suggesting they take their concerns to the amendment’s source, the Senate’s ranking Democrat.
Durham changed his tune though when John Ragan, a Republican from Oak Ridge, challenged the state-constitutionality of the Kyle amendment. Ragan cited a section of Tennessee’s governing document declaring that while “compensation and expenses” for lawmakers “may from time to time be reduced or increased” by members of the body, in fact “no increase or decrease in the amount thereof shall take effect until the next general election.”
Ragan called Kyle’s amendment “unconstitutional, on its face.” Rep. Durham quickly then moved to dump the no-compensation language. The bill was kicked back up to the Senate, where the matter was taken up Thursday, and Kyle had this to say: “I have, during my 31 years, from time to time done some sneaky things on some bills to try to harm bills that I thought were not appropriate. This was not the case on this matter.”
He added later, though, “If I could damage this bill, I would.”
Kyle, who is running for judge in Shelby County this year, also said he’s concluded there’s “no reason to believe that it is unconstitutional” for the General Assembly to adopt a proposal keeping lawmakers from getting per diem or expenses during a Medicaid-expansion special session.
Kelsey, who chairs the Senate Judiciary Committee, argued otherwise, saying three Tennessee Supreme Court rulings and an attorney general opinion have concluded that compensation and expense reimbursement arrangements can’t be altered in the midst of a legislative session cycle. Kelsey speculated that Kyle’s true intentions were to insert a constitutional flaw into the law that would potentially render it null and void upon challenge. He accused Kyle and others who’ve attempted along the way to amend and alter what he, Kelsey, calls the “Stop Obamacare Act,” of scheming to use whatever procedural tricks or political maneuvers they can conceive of to derail the bill or in some way grease the skids for Medicaid expansion.
“They’ve been messing with this bill since Day 1 because they want Obamacare in Tennessee. And we do not want Obamacare in Tennessee,” said Kelsey.
With 22 Republicans voting for tabling the Kyle amendment, and five Democrats voting against, the no-compensation provision was stripped from the bill. But not before Kyle got off a parting shot warning that anyone voting to do away with the amendment is “voting yourself per-diem compensation in a special session that you have voted to create, to do something that does not need to be done.”
“That is what the record will reflect and that is what your constituents will see — that you required yourself to receive compensation,” Kyle said.
Several senators present for other votes that day didn’t participate in the vote to remove Kyle’s amendment from HB937, including Republicans Mark Norris of Collierville, Rusty Crowe of Johnson City, Becky Duncan Massey of Knoxville, Jim Summerville of Dickson and Democrat Thelma Harper of Nashville.
The governor has indicated he doesn’t oppose House Bill 937 and isn’t expected to veto it. But for the past year Haslam has assured lawmakers he plans to keep them looped-in to Medicaid negotiations with the Obama administration.
Depending on who’s doing the estimating, the Affordable Care Act’s Medicaid expansion plan would cover anywhere from well under 200,000 low-income Tennesseans who lack coverage to more than 500,000. A report from The Associated Press on U.S. Health and Human Services Secretary Kathleen Sebelius visiting Nashville this week indicated that the Obama administration puts the number at 520,000 — and that she said Tennessee is losing $6.2 million a day in federal funds by not expanding Medicaid. The Medicaid eligibility numbers Sebelius cited appear close to three times what the Haslam administration figures, according to AP.
An estimate from The Pew Charitable Trusts published in January suggested 307,000 Tennesseans would be eligible for government-funded coverage under the Affordable Care Act’s Medicaid expansion.
Washington has pledged that federally collected taxes will pay for most, though not all, the costs of expanding Medicaid eligibility. The Obama administration has promised Tennessee a total of about $2.1 billion through 2022.
However, Haslam has said he doesn’t want to simply start signing more people up to TennCare, which underwent a difficult period of eligibility contraction and coverage retraction a few years ago. The governor has said he’d prefer to develop a “Tennessee plan” that controls costs and encourages patient responsibility — something unique to the Volunteer State that’s at this time outside the ACA’s existing framework. The AP story on Sebelius noted that she and the governor did not meet when she was in town Thursday.
According to the Kaiser Foundation, 19 states have rejected Medicaid expansion or are “not moving forward at this time.” Twenty-six states and the District of Columbia have accepted expansion and 5 states are presently debating it.
Tennessee House Democrats on Thursday commemorated the one-year anniversary of Haslam’s announcement that Tennessee wouldn’t be taking the Medicaid expansion offer under the Obama administration’s terms by urging the governor to do whatever is necessary to get the ball rolling to grab that federal payout.
“We need real leadership today that will provide solutions, not more excuses,” Knoxville Rep. Armstrong said in a press release. “To the 161,000 Tennesseans who are too poor to buy health insurance on the exchange, but would be eligible for coverage under Medicaid expansion, it is time to call Governor Haslam and tell him to do his job and expand Medicaid now.”