Gov. Bill Haslam assured reporters Wednesday he hasn’t given up on the prospect of the state accepting federal funding to expand taxpayer-financed health coverage for lower income Tennesseans.
Speaking during a press conference at Lipscomb University in Nashville, the Republican governor stressed, as he has before, that his administration faces a daunting political challenge in fashioning a Medicaid-expansion policy acceptable both to the Obama administration and the GOP-run Tennessee General Assembly.
“Getting something passed — even if it is something that we get approved with (the U.S. Department of Health and Human Services), and it’s something that we think is good for Tennessee — will not be an easy sell at all,” said Haslam. “That is why we are working so hard in Washington to get something that can sell here.”
Last month the governor signed a bill passed by the Legislature that requires him to win approval from lawmakers for any deal he strikes enabling the state to tap into hundreds of millions of federal dollars to enlarge the pool of Tennesseans eligible for Medicaid.
Under the terms of the Patient Protection and Affordable Care Act, Washington is promising to cover the cost through 2016 of expanding Medicaid eligibility to people earning up to 138 percent of the federal poverty line. After that, the states would be required to start picking up a portion of the tab, about 10 percent of the costs by 2020 and afterward.
Many in the Tennessee General Assembly’s Republican supermajority are committed foes of Obamacare, and they — including the House and Senate sponsors of the measure requiring express legislative approval of future Medicaid expansions — have indicated they’ll oppose attempts to facilitate Affordable Care Act implementation at every opportunity.
By the same token, Haslam said he’s still uninterested in Medicaid expansion unless Washington agrees to grant the state latitude to construct the program so as to prevent runaway spending.
“We know providing additional health care coverage for folks is a positive,” Haslam said. “The question is, what is the financial impact for the state. And I have to be convinced that we can come up with something both in terms of controlling provider costs and in terms of making sure that there are incentives for really, truly good outcomes — that we can accomplish both of those things in Tennessee.”
Therein lies the rub, the governor said. “There are people who don’t understand both sides of that,” he said. Haslam said he hears both from those who ask, “Why wouldn’t Washington give you exactly what you want?”, and others wondering, “Why wouldn’t the Legislature approve it?”
“My job is to get both done. And as you can see, it is not easy,” said Haslam.
When he was asked by a reporter if he thinks he’ll have a better relationship with President Obama’s new pick to serve as HHS secretary, Sylvia Mathews Burwell, the governor chafed a bit.
Haslam denied that communications between he and Kathleen Sebelius, who resigned her post as the department’s chief last month, were unproductive. “I think that it is not fair to say that I don’t have a good relationship with Secretary Sebelius, because we talked frequently,” said Haslam.
Still, nothing in the way of a Medicaid agreement between the state and federal government ever materialized after Haslam announced in March 2013 that he was rejecting expansion of the program in lieu of management-flexibility concessions by the Obama administration.
Haslam was asked Wednesday if it is realistic to expect a breakthrough anytime soon, given the past delays and existing political roadblocks. “I literally wouldn’t be wasting my time on it if I didn’t think it was,” he responded.
Democrats in the Legislature are hoping so. They spent a lot of time this past session excoriating GOP lawmakers and the governor for the impasse. But with their anemic numbers in both the House and Senate, they could do little more than make speeches expressing their discontentment.
In an interview last week, House Minority Leader Craig Fitzhugh, D-Ripley, said he’s spoken with members of Haslam’s administration who indicate “they are hopeful” that the change in leadership at HHS might jumpstart Medicaid expansion talks. He said the state is losing anywhere from $2 million to more than $6 million a day in federal money.
“There is a need for some degree of urgency here that nobody seems to have,” Fitzhugh said. “I think the governor is convinced he can’t get the votes in the Legislature, and as long as he is convinced of that, he is not prone to give it a try.”
Fitzhugh said rural and smaller-community hospitals are at risk of closure because the state is refusing to expand Medicaid.
Haslam said “there are several reasons, Medicaid being one” for the recent announcement that the Haywood Park hospital in West Tennessee is closing.