Tennessee Democrats continue to prod Gov. Bill Haslam to convene another legislative special session so they can once again take a crack at passing the twice-defeated Medicaid expansion proposal known as “Insure Tennessee.”
State Democratic Party chairwoman Mary Mancini and House Minority Leader Craig Fitzhugh, as well as several other Democratic lawmakers, held a press conference Wednesday in which they derided the Republican supermajority for obstructing the Haslam administration’s Affordable Care Act-related initiative.
“In the last session, we had all 26 of our caucus members ready to vote for this,” said Fitzhugh. “That meant only 24 out of 73 (Republicans) would be needed to put this over the top in the House.”
Legislation needs 50 votes to pass the House. In the Senate, where Republicans outnumber Democrats 28-5, a bill must garner 17 votes to win approval. Several GOP senators are in fact on record in support of Insure Tennessee, but a number of key supermajority caucus leaders and committee chairs oppose it.
None of the Senate Democrats took part in the morning press conference at Legislative Plaza, although Memphis Rep. G.A. Hardaway said that wasn’t in any way a sign of lackluster support for the governor’s plan among their thin ranks, but rather “merely logistics.”
Mancini, who formerly headed the liberal activist group Tennessee Citizen Action and was a runner-up Davidson County state Senate primary candidate last August prior to taking the TNDP reins in January, cast Republicans as more focused on “their personal political future” than providing “access to affordable health care” to lower-income Tennesseans. Up to 300,000 or more people are predicted to become eligible for taxpayer-subsidized medical insurance and government-financed doctor visits, hospital stays and drug prescriptions under the Haslam plan.
“Democrats are concerned with the future of all Tennesseans, which is why we are the ones that worked with the governor to create Insure Tennessee, to give access to affordable health care to 280,000 hardworking Tennesseans,” said Mancini.
Mancini also criticized state legislative opponents of Insure Tennessee for aligning themselves with Republican politicians at the federal level against President Barack Obama’s signature health reform initiative. The Patient Protection and Affordable Care Act, signed into law five years ago, passed without any support from Republicans in Washington, who were the minority party in both chambers of Congress at the time.
“Why are Republicans more concerned with what (U.S. House Speaker) John Boehner and (U.S. Senate Majority Leader) Mitch McConnell want? We know that they have been playing politics with this issue, with the issue of health care, for years,” said Mancini. “They have put everything in its path to stop it, and now the Tennessee Republicans are falling in lockstep with them.”
In the event that another special session is launched, Fitzhugh offered that Democrats are quite willing to educate skeptical House GOP legislators on the merits of the Republican governor’s Medicaid expansion plan.
“We as a caucus are trying to answer every question that our colleagues on the other side of the aisle put forth in their opposition to Insure Tennessee,” said Fitzhugh. “We believe we have answered those, and stand ready to answer them at a special session, or even before a special session.”
Even while, in the Democrats’ view, Insure Tennessee is “not the best program in the world,” Fitzhugh said, the proposal does enjoy “a hundred percent support from our caucus.”
“It’s not a political issue. It is a moral and a mathematical issue for Tennessee,” the Ripley lawmaker said. He suggested a prime time to convene a special session will be in wake of the United States Supreme Court’s opinion on taxpayer subsidization of Obamacare’s federally run health insurance exchanges, which is expected to come down next month.
Gov. Haslam has expressed disappointment that Insure Tennessee didn’t get more traction in the Legislature, where it failed on lopsided Senate committee votes in a February special session and then again during the regular session in March. The House never actually took a formal vote on the measure, even though it was sponsored during the special session by Majority Leader Gerald McCormick, R-Chattanooga.
Haslam told reporters earlier this month that he gets “a little frustrated” with Republican lawmakers who keep expressing anxiety over the potential costs of his handcrafted Medicaid expansion plan.
Insure Tennessee is designed to secure billions of dollars in Obamacare funding and leave responsibility for funding the state’s share of the program to Tennessee hospitals, which stand to directly benefit from the transfusion of federal cash. Gov. Haslam maintains it “won’t cost Tennessee a dime,” although a “fiscal note” was attached to the legislation.
But the governor’s also aware hostility to the Affordable Care Act is deeply held among GOP lawmakers, and not just in Tennessee.
“We knew from the very beginning that was going to be hard,” the governor told said during a May 15 press conference. “And if you look anywhere there is a Republican legislature around the country, it hadn’t passed. So it is not like we are in a unique situation in the state of Tennessee.”
“Obviously, we need to do something to help change the impression of the Legislature,” Haslam continued. “We’re going to continue to have those discussions and look to see are there things that we can do in the program, that Washington will let us do, that we can change.”
Haslam said he hopes legislators’ constituents will make it known they support Medicaid expansion, and in turn lawmakers will warm to it. That was a sentiment reiterated Wednesday by the ranking House Democrat, who also touted a recent poll from Vanderbilt suggesting Tennesseans by a 2-1 margin want expanded health care options for the poor. If members of the General Assembly who’ve opposed Haslam’s plan “start hearing from their constituents, I think that’s what will change their minds,” said Fitzhugh.
Lt. Gov. Ramsey, R-Blountville, who serves as speaker of the Tennessee Senate, has said he doesn’t anticipate the GOP-dominated Legislature approving any kind of Medicaid expansion until the country has a new president — whom he hopes is a Republican — and likely then only if the state is granted federal permission to overhaul TennCare top to bottom.
Haslam said that while he understands and appreciates Ramsey’s perspective, there’s really no guarantee that a future president, even a fellow Republican, will grant Tennessee any Medicaid reform deal more attractive than what the governor says he’s already negotiated with the Obama administration.
“The thing to think about there is, and Lt. Gov. Ramsey and I have had these conversations, is No. 1, we have a new president, it still depends on what happens in Congress if the law is going to get changed,” said Haslam. “We have had Republican presidents before who could have given us block grants and haven’t. So it is not like that is a brand new idea. We have tried that for years in the state of Tennessee.”
Republicans want a lump-sum chunk of federal no-strings-attached funding to underwrite TennCare, so the state can run the health-care-for-the-poor program as it sees fit.
The governor suggested such an overhaul would in fact likely approximate the Medicaid “waiver” his administration developed over the last two years to access Obamacare funding. It includes patient co-pays and coverage premiums and “market-based” incentives to encourage healthier lifestyles and shrewder use of the health system by those signed up for government-funded medical coverage.
“If we got a block grant, it would be really similar to Insure Tennessee — not exactly, we would do more, I want to be really clear, we would do more if we got a block grant,” said Haslam. “But if we got a block grant, it would look relatively similar to what we are talking about.”