‘Intractable Pain Act’ Repeal Goes to Guv

Both chambers of the Tennessee General Assembly have voted to do away with the state’s “Intractable Pain Act,” which has been in existence for 14 years.

On Monday the House of Representatives voted 93-0 to eliminate a provision in the law — dubbed the “Pain Patient’s Bill of Rights” — granting people “the option to choose opiate medications to relieve severe chronic intractable pain without first having to submit to an invasive medical procedure.”

There was no discussion on the repeal bill, which is sponsored by Rep. Ryan Williams, R-Cookeville. Last month the Senate approved the repeal as well – one of the first bills to pass the upper chamber this year.

Sponsor Janice Bowling of Tullahoma said the 2001 “Pain Patient’s Bill of Rights” was partly responsible for Tennessee becoming known as one of the states along the “Hillbilly Heroin Trail.” She said that the Act negatively impacted the criminal justice system and state’s economy and has resulted in babies being born with addictive drugs in their system.

Under the statute the Legislature is seeking to repeal, doctors who refused to prescribe effective pain medication are required to inform patients of others who will. Advocates of eliminating that mandate say it has compounded the problems of pain-pill abuse and “doctor shopping” in Tennessee.

In August 2014, the Department of Mental Health & Substance Abuse Services issued a press release indicating as of July 2012 pills had replaced alcohol as Tennessee’s favorite drug to abuse.

There are those, though, who don’t necessarily believe making pain medications harder to obtain legally is going to put much of a dent in the overall problem of addiction.

Dr. Sanjay Gupta, a neurosurgeon who is CNN’s chief medical correspondent, has noted that when pills are unavailable to pain medication addicts, they frequently turn to heroin, which is often cheaper.

And in Tennessee, the state’s top public safety officials have recently fretted about a surge in heroin use across the state.

In November and December of last year, during a series of budget hearings for the next fiscal year, both Tennessee Bureau of Investigation Dir. Mark Gwyn, and Department of Safety & Homeland Security Commissioner Bill Gibbons, informed Gov. Bill Haslam that heroin was on the rise.

The news website Vox.com recently noted a rise in heroin overdoses, and suggested drug-abusing populations are being driven from pills to heroin as pills become harder to obtain, as well as by a generational shift in drug culture.

The bill now goes to Haslam’s desk awaiting his signature.

Contact Alex Harris at alex@tnreport.com.

TennCare Cuts Running into Resistance

Questions and criticisms surrounding a proposed reduction in the Bureau of TennCare’s mental health services has prompted Gov. Bill Haslam to reconsider the cut.

At a Senate budget hearing Monday, however, the TennCare officials continued to make their case for the reduction.

TennCare’s proposed budget is $10.3 billion. Of that, $3.3 billion is a state appropriation. The governor is proposing a $400 million budget reduction to the agency.

The budget proposal cuts $10.5 million from state dollars for providing outpatient care for the mentally ill. When coupled with lost federal matching dollars, the budget reduction is about $30 million.

Maryville Republican Doug Overbey, chairman of the Senate Ethics Committee, questioned TennCare officials about cutting millions from a line item that represents “2 to 3 percent” of the total budget.

Darrin Gordon, TennCare’s director responded that the structure for the agency’s reduction is because of their need to cut “a half-of-a-billion dollars,” and decisions about “what are areas that we can be tighter on, where are things we could do some things differently. This is on that list.”

Gordon added part of the problem was a “great variation in the system” as to who uses the program, how it’s used and for how long. Audits have uncovered “some things that do not fit the federal definition of case management,” he said.

The proposed reforms “are policy driven” to ensure “taxpayer funded benefits” are only being used when “appropriate,” according to emailed information from Kelly Gunderson, the Health Care Finance Administration communications director.

Individuals already receiving “Level 2” care and meeting “certain criteria” will “automatically receive the three months of services,” after which they will be evaluated to determine if continued case management is needed. The agency is also offering a 10 percent rate increase for behavioral health outpatient services, “to help promote the transition to a different treatment model,” according to the email.

“Continued case management without a discharge plan creates an unhealthy dependence and is contrary to good management of limited resources,” Gunderson’s email said.

Community behavioral care providers from across the state — including Centerstone in Middle Tennessee and Frontier Health in Northeast Tennessee — have called the cuts shortsighted.

Teresa Kidd, the chief executive officer of Frontier, told the Johnson City Press in February, those suffering from mental illness could have long periods of stability, followed by relapse and need for care. Those with poor mental health also have self-destructive tendencies that could lead them to hospitalization or encounters with law enforcement officials — something avoidable with case management, she said. Data from Frontier indicates that 65 percent of patients leave case management within three years.

Ben Middleton, the chief operating officer for Centerstone, made similar points to the Tennessean earlier this month. “Without tending to their issues, they could not only be a harm to themselves but to others,” he said,

Dave Smith, Gov. Bill Haslam’s spokesman, said via email, due to feedback received from around the state, “the governor wants to take a closer look” to ensure “that these services are being provided in the most efficient and effective way.”

The governor’s Office, TennCare and Finance Commissioner Larry Martin, “are coordinating to seek additional input from stakeholders,” before submitting the final budget to the Legislature.

Reductions in community and family care program funding proposed by the Tennessee Department of Intellectual and Developmental Disabilities at budget hearings late last year were largely avoided in the final budget proposal.

Senate Passes Repeal of ‘Intractable Pain Act’

After 14 years the Tennessee General Assembly is looking to do away with the state’s Intractable Pain Act of 2001, also know as the “Pain Patient’s Bill of Rights.”

Thursday morning the state Senate unanimously passed the repealing legislation, Senate Bill 157, sponsored by Sen. Janice Bowling, R-Tullahoma.

Bowling told members of the Legislature’s upper chamber that while the original law was “well-intentioned,” it was based on bad information. The law has resulted in years of negative consequences related to prescription drug abuse, she argued.

The House version, HB0031, sponsored by Rep. Ryan Williams, a Cookeville Republican, is scheduled to be heard in the House Health Committee next week.

The 2001 law — sponsored by former Sen. Roy Herron, who later served as the Tennessee Democratic Party’s state chairman  — passed the Senate with 31 votes in favor, and none against. The House agreed to the Senate version 95 to 2. Despite passing the legislature with near-unanimous support, the bill was returned unsigned by Gov. Don Sundquist.

“Doctors will now be able to doctor. There won’t be that patient’s bill of rights that will allow unscrupulous doctors to create these pill mills and pain clinics throughout the state that are just dispensing opiates,” Bowling told TNReport Wednesday.

Bowling told the Senate Health & Welfare Committee last week that the original law was passed “based on intentional misinformation” from Purdue Pharma “regarding a wonder drug that was supposed to be non-addictive, no side effects and have no street value.”

However, Bowling added, a couple months after the law was passed, the U.S Food and Drug Administration made the company relabel the drug, popularly known as OxyContin.

In 2007, an affiliate of Purdue Pharma pleaded guilty to the charge that it had falsely claimed for six years that OxyContin had lower risks for abuse and addiction than other competing pain medications at the time. The company was required to pay $600 million in fines and other penalties.

This is not the first time a drug pitched as a “non-addictive” substitute was found to be just the opposite: in the early 1900s Heroin was marketed by Bayer as a cough suppressant and a less-addictive substitute for morphine.

The 2001 law gives patients the option to treat their pain with opiate painkillers if other forms of treatment do not work, and if the physician determines the treatment is necessary. However, under the patient’s “bill of rights,” it also says the patient has the option to choose medication without having to “submit to an invasive medical procedure.”

Also, the physician may refuse to prescribe the medication, but the law required that the doctor “shall inform the patient” of others who will.

According to Bowling, the original act has created a myriad of “horrific” problems for Tennessee, including being known as the “Hillbilly Heroin Trail,” higher judicial costs, lost work-time, death from overdoses and an increasing number of babies being born with addictive drugs in their system.

In August 2014, the Tennessee Department of Mental Health & Substance Abuse Services announced that, as of July 2012, prescription pain killers had surpassed alcohol as the Volunteer State’s number one drug problem.

Bowling said the repeal of the law is being supported by the state’s district attorneys and the Tennessee Bureau of Investigation.

Barry Staubus, the Sullivan County district attorney general, told a northeast Tennessee television station earlier this week that because of the law, clinics that prescribe pain meds on demand — known derisively as “pill mills” — have legal protection. “Any doctor would have the defense saying they are mandated by the law to either give them these drugs or send them to somebody else,” he said.

Bowling tried unsuccessfully last year to pass the legislation. “There was a lobby against it,” she said. That doesn’t seem to be the case now. People “fully understand” the issue better this year, she said.

Name-Change for State Veterans Department Approved by Senate Committee

The administrators who run Tennessee’s Department of Veterans’ Affairs want to distance themselves from the federal agency of the same name.

A proposal to change the official moniker of the state department to “Department of Veterans Services” easily cleared its first hurdle in the General Assembly Tuesday.

The Senate State & Local Government Committee passed SB0116 with no discussion as part of its consent calendar. The administration-backed bill is scheduled to be heard by the House State Government Subcommittee Wednesday.

The re-branding was suggested late last year by the agency’s head, Many-Bears Grinder, during her department’s preliminary budget pitch to Gov. Bill Haslam.

Sharing a nearly identical name with the U.S. Department of Veterans Affairs — even though they’re entirely separate entities — has generated a lot of confusion, wasted time and frustration, both for veterans seeking services and the state department’s employees, Grinder said. The TDVA’s purpose is to connect Tennessee veterans with benefits provided by the federal agency, as well as to provide burial services.

The emergence over the past year of scandals that have afflicted the federal agency have only exacerbated the problems, with the state being “inundated” with complaints meant for the feds.

In April of 2014, news broke that about 40 vets had died waiting for care at the Phoenix VA Hospital, prompting an internal investigation by the VA into the Veterans Health Administration system. That investigation found that upwards of 120,000 veterans had not received timely care, and a criminal investigation was launched by the Federal Bureau of Investigation.

Eric Shinseki, the head of the VA at the time, also resigned as a result of the scandal. Robert McDonald, the current head of the VA who took over amid the scandal, was recently discovered to have lied when he told a homeless veteran in Los Angeles that he had also served in the Army Special Forces.

The federal government’s problems delivering aid and services to those in need who served in the armed forces are hitting home here in Tennessee. In September of last year, the TDVA and the Department of Mental Health & Substance Abuse Services announced that suicides by veterans were on the rise, and that since 1990, veterans made up about 21 percent of all of the suicide deaths in the state.

The Tennessee Military Department’s commander told Haslam late last year that in an effort to bridge the gap in post-deployment counseling, five years ago his department had begun providing outreach to soldiers returning home from combat zones. Maj. Gen. Max Haston said his department is trying to pick up some of the slack. Since 2013 more than 600 current and former service members received counseling, and since 2011 more than 80 guard members have been talked down from hurting themselves, he said.

And during the Legislature’s special session to consider Haslam’s proposed Medicaid expansion plan, supporters touted an estimated 25,000-30,000 Tennessee veterans who lack health coverage through either Obamacare’s insurance exchanges or the VA.

House Majority Leader Gerald McCormick, a Chattanooga Republican who sponsored the governor’s failed “Insure Tennessee” plan, argued that responsibility for help those who served is shared by the state. “Maybe they need a hand up right now with their health care coverage,” said McCormick. “And maybe they’re suffering from some problems that they encountered while they were in the military.”

Proposal Filed to Limit Cough-Medicine Sales to Minors in TN

In an attempt to make it harder for teens to get high on commonplace store-bought medicines, one Middle Tennessee lawmaker wants to put age restrictions on the sale of cough syrup.

State Rep. William Lamberth, a Cottontown Republican, has filed legislation intended to keep cough and cold remedies containing dextromethorphan, or DXM, out of the hands of unsupervised minors.

dmx coughDXM is a “pretty powerful cough medicine” that adolescents have been known to abuse, and which has “some very deadly and disastrous side effects” for children who ingest large quantities of it, Lamberth told TNReport.

Lamberth said he doesn’t really want to make it harder for Tennesseans with legitimate ailments to sooth their symptoms, but believes there’s a pressing need for adults to supervise minors using the medications.

While a recommended dose has very little to no psychoactive effects, DXM has strong dissociative properties similar to PCP or Ketamine when substantial volumes are ingested. Recreational use of DXM can also cause a false positive for PCP on some drug tests.

According to WebMD, using DXM recreationally can cause fever, increased heart rate, vomiting, impaired judgment, slurred speech, hallucinations and dissociative effects. Additionally, DXM is often paired with acetominophen — Tylenol — in cold medications, high doses of which can cause liver failure.

In 1993, Jim Hogshire, an editor for Harper‘s magazine, wrote a first-person account of his experience taking more than the recommended dose of Robitussin. According to Hogshire’s account, he took eight ounces of Robitussin before bed and woke up around 4 am with “a reptilian brain.”

“My whole way of thinking and perceiving had changed. I had full control over my motor functions, but I felt ungainly. I was detached from my body, as if I were on laughing gas,” Hogshire wrote.

The new law proposed for Tennessee would require people who look under 30 to show ID for purchases of medication containing DXM. The legislation includes an exemption for emancipated minors to purchase DXM medication without an adult.

Because most of the cough medicine abuse he’s aware of has been by adolescents — “junior high and early high school age” — Lamberth said he’s not too concerned with potential abuse by the adults.

At 18 you can vote, join the military and experience any number of additional things that “trigger” upon becoming an adult, and purchasing cold medication containing DXM “will be one of those things,” said Lamberth, a former state prosecutor.

Many other states have implemented age-requirements on cough and cold medicine products, Lamberth said. Some of the states with age-restrictions on DXM products are: Arizona, California, Louisiana, New York and Washington.

DXM is not currently a controlled substance in the U.S., but according to a 2010 DEA report, the drug could be added to the Controlled Substances Act “if warranted.”

Lamberth told TNReport he’s discussed the impact of this restriction with members of the pharmaceutical industry. “I don’t have any facts or figures — that’s more anecdotal evidence — but it’s my understanding from doctors, pharmacists and everything else that it’s definitely a beneficial law,” he said.

The Tennessee bill is sponsored in the General Assembly’s upper chamber by Sen. Ferrell Haile, R-Gallatin.

U.S. House GOP Votes to Kill Obamacare

Last week the U.S. House of Representatives voted once again to repeal President Obama’s controversial national health-reform law known as the Patient Protection and Affordable Care Act.

As in past votes of its kind, Republicans voted in favor and Democrats opposed.

Since gaining control of Congress’ lower chamber in 2010 on the wave of an upwelling of voter-discontent with the Affordable Care Act, Republicans have made anti-Obamacare votes a regular feature of the chamber’s legislative business.

These efforts have been seen as mostly symbolic, as the Senate had been under Democratic control — until now. This past November Republicans won nine previously Democrat-held Senate seats, giving them an eight-seat advantage in the 100-member upper chamber. While there is a 10-seat difference between the GOP’s 54 seats and the Democrats 44 seats, the chamber’s two Independents — Vermont’s Bernie Sanders and Maine’s Angus King — caucus with the Democrats.

Republican critics of the Affordable Care Act hope to force Obama to unholster his veto pen, which he has promised to do should any of the GOP’s efforts to roll back his signature policy reach his desk.

However, even though Republicans control the Senate, their numbers likely aren’t strong enough to overcome Democratic opposition. Senate Majority Leader Mitch McConnell, R-Ky., has cautioned House Republicans to be realistic in what they send to the Senate.

H.R. 596 passed on a 239-186 vote. Three Republicans joined Democrats in voting against the legislation.

Tennessee’s congressional delegation voted along party lines, although Rep. Phil Roe was absent due to a family illness. Roe, Black and Blackburn issued statements in support of the bill, which was also co-sponsored by Roe and Black.

The 40 Hour Work Week

Another Obamacare-related bill recently passed by the House with little action in the Senate would revise the Internal Revenue Code to define “full-time worker” as someone working 40-hours-a-week or more — the definition used before the ACA changed it to 30-hours-a-week or more.

The House passed H.R. 30 on January 8 by a vote of 252 to 172, with 12 Democrats crossing the aisle to vote with the GOP. No Republicans voted against the bill.

The Tennessee congressional delegation votes again broke down alone party lines, with the seven Republicans voting for the measure and the two Democrats voting against.

Reps. Roe and Blackburn praised the House’s action, which they said will help keep the American worker from being forced into part time work as employers try to avoid higher costs from health insurance requirements.

However, according to the Congressional Budget Office, the legislation is expected to “increase budget deficits by $18.1 billion over the 2015-2020 period and by $53.2 billion over the 2015-2025 period.”

According to the CBO analysis, by changing the definition of “full-time worker” under law, the bill will reduce the number of those with employer coverage by 1 million, increase the number of people receiving government subsidized care by 500,000 to 1 million and increase the number of uninsured by less than 500,000.

In the Senate, where it has 35 sponsors, S. 30 is currently assigned to the Finance Committee, and has seen no other movement.

Alexander is co-sponsoring the legislation, which didn’t fare very well in a recent a Health, Education, Labor & Pensions Committee hearing.

VIDEOS: Responses to Insure Tennessee’s Early Termination

Medicaid expansion is dead in the Volunteer State. And it isn’t likely to get resurrected any time soon.

On Wednesday afternoon, the Tennessee Senate’s Health and Welfare Committee voted 7-4 to kill Gov. Bill Haslam’s “Insure Tennessee” plan, which he and his advisers designed as a “market-based” program to provide health coverage to around 300,000 Tennesseans using Medicaid expansion funding through the Affordable Care Act.

Haslam described “Insure Tennessee” as an innovative “third way” to furnish health insurance to the not-so-well-off. The governor had hoped his policy offering would satisfy both the Obama administration and the Republican supermajority controlling the Tennessee General Assembly.

The Senate Health Committee vote was the only one taken on the plan. But because of the outcome, that’s all that was needed.

The House sponsor of “Insure Tennessee,” Majority Leader Gerald McCormick, withdrew the plan from consideration shortly after it stalled in the Senate. While he’d expressed confidence that “Insure Tennessee” would have triumphed on the full House floor, McCormick was nevertheless doubtful it could’ve survived the lower-chamber committee system.

McCormick said he notified Gov. Haslam late Wednesday morning that trouble looked to be brewing for “Insure Tennessee.”

“(Haslam) was disappointed, but understanding,” said McCormick. “He understands the process very well.”

The Chattanooga Republican said Haslam did not press him to push ahead with a committee vote. “He knows his basic math pretty well,” said McCormick.

Haslam’s plan was pitched as cost-free to state government by Gov. Haslam. However, McCormick noted that questions were emerging Wednesday over whether the state might be on the hook for some previously unaccounted for administrative costs associated with the plan.

In any event, widespread GOP support never really coalesced around “Insure Tennessee,” with some of the Legislature’s most powerful lawmakers — like House Speaker Beth Harwell and Sen. Speaker Ron Ramsey — withholding their unreserved support. And Both Harwell and Ramsey were dropping hints that “Insure Tennessee” was facing an uphill climb in the special session.

Among the most prominent legislative Republicans absent from the “Insure Tennessee” backers’ list was Senate Majority Leader Mark Norris of Collierville.

Typically a dependable Haslam administration ally, Norris has more than once let it be known he was dissatisfied with how the governor and his staff went about formulating their plan for accessing Obamacare’s Medicaid expansion funding.

After the Senate committee’s defeat of “Insure Tennessee,” Norris told reporters he doubts the administration even made the right decision by calling for a special session. The matter might have fared better in regular session, he said.

“The bottom line is the process was ill-suited to the attention necessary from the beginning,” said Norris, who declined to lead the charge on Haslam’s proposal — a unusual move for a legislative majority leader who shares party identification with a governor. “This is not something that can lend itself to a special session. It’s too complex. It’s too important to do this way.”

“I think you began to see some of the issues that remained unresolved in enough members’ minds that it just wasn’t going to happen,” he said.

Below are some reactions from around the Capitol to “Insure Tennessee” hitting the end of the line before it picked up steam.

Durham & Kelsey: Obamacare Remains a Nonstarter in TN

Throughout the General Assembly’s special session on Gov. Bill Haslam’s “Insure Tennessee” plan, Republican state Rep. Jeremy Durham never seemed too concerned that the Legislature would give it the go-ahead.

The conservative Franklin lawmaker was the prime House sponsor last year of the “Stop Obamacare Act,” which declared that the governor would have to win legislative approval for any plan to use funding through the Affordable Care Act for expanding coverage to lower-income Tennesseans.

Durham, who serves as the House GOP whip, all along disputed assertions by House Majority Leader Gerald McCormick that “Insure Tennessee” had the necessary votes to win on the House floor.

According to his calculations, “maybe 15” of the chamber’s 73 Republicans were solid “yes” votes for the plan, Durham told TNReport on Tuesday.

Durham said the fact that “Insure Tennessee” was both financed through the Affordable Care Act and was, at least in many Republican lawmakers’ minds, an expansion of Medicaid, ensured its defeat from the outset.

“Anytime you are trying to expand entitlements in a Red State, it is going to be difficult,” he said.

Brian Kelsey, the “Stop Obamacare Act” sponsor in the Senate, said he’s always been a supporter of the kinds of reforms Haslam’s “Insure Tennessee” proposed for a new population of Medicaid funding recipients. But the Germantown Republican said he fundamentally disagrees both with expanding Medicaid in any capacity or with cooperating with the Obama administration on executing the Affordable Care Act.

Beavers Glad Its Gone

Tennessee state Sen. Mae Beavers, R-Mt. Juliet, has always been among the General Assembly’s most ardent Obamacare foes.

Unsurprisingly, she was quite pleased “Insure Tennessee” was quickly dispensed with. “I don’t think it ever had a chance and I am glad it’s over,” Beavers told TNReport. “I’m glad it’s gone.”

Beavers was not disappointed that she didn’t get a chance to pick apart the plan herself in a committee hearing. “I certainly heard the (administration’s) presentation at least a dozen times,” she said. “I think I could give it myself by now. ”

Beavers also questioned the veracity of an opinion survey the Haslam administration was circulating this week indicating majority support for “Insure Tennessee” among GOP voters in Tennessee, even while showing those same voters overwhelmingly continue to oppose Obamacare.

“We all know how polls are — it depends on how you ask the questions,” she said. “I look at the first figure that we were given in the poll, and that was that 85 percent of the people were against Obamacare. The only thing that I understand polls worse than that right now is the Common Core curriculum.”

In 2011 Beavers won passage of the Tennessee Health Freedom Act, which sought to counteract the Affordable Care Act’s mandate that all Americans carry a minimum level of health coverage by declaring “every person within this state is and shall be free to choose or to decline to choose any mode of securing health care services without penalty or threat of penalty.”

Ogles: Time to Move On

Andrew Ogles, director of the Tennessee Chapter of Americans for Prosperity, the General Assembly for rejecting Haslam’s plan. His conservative group funded radio ads targeting lawmakers perceived as friendly to “Insure Tennessee.” AFPTN also drew out dozens of red-garbed anti-Obamacare partisans to sit in on the “Insure Tennessee” hearings and root for its defeat.

Ogles said AFPTN activists would like to see “positive reforms” to the health-care system discussed in Tennessee.

“But anything that is going to expand Medicaid or further expand Obamcare is bad policy,” he said.

Overbey: Insure TN Should Have Passed

Doug Overbey, who carried Gov. Bill Haslam’s “Insure Tennessee” plan in the Tennessee Senate, said he was disappointed the proposal went down early. He thinks it should have passed, and would have if it had been allowed an opportunity to gain traction.

“As you present legislation sometimes people have a different understanding of the facts, sometimes folks have a different understanding of the law,” he said. “So how all that came about for each individual I can’t tell you. But I do think the testimony was very clear that the current system is broken, that the solution put forward by Gov. Haslam was the right solution at the right time and the right place, and why that didn’t carry the day I am not sure I can tell you right now. I wish it had and I think it should have.”

Hensley: ‘Obamacare’ an Insurmountable Obstacle

Tennessee Sen Joey Hensley, himself a physician, echoed Gov. Haslam’s assertion that policymakers need to keep focusing on health care issues.

“We certainly need health care reform in general,” said the Hohenwald Republican.

The defeat of “Insure Tennessee” doesn’t end that discussion, he said. However, he added that most GOP lawmakers just aren’t going to go along with anything they see as “adding to the weight” of existing government health-care spending programs.

While Haslam’s “Insure Tennessee” was advertised as a unique and novel approach for drawing down federal funding for health coverage that wasn’t a traditional Medicaid expansion, “it would still be TennCare,” Hensley said.

The governor’s “Insure Tennessee” plan was too closely associated with Obamacare in many Republicans minds, and that became an insurmountable political obstacle for it in the General Assembly, said Hensley.

Fitzhugh: GOP Failing

Tennessee House Minority Leader Craig Fitzhugh criticized the majority party for its handling of the “Insure Tennessee” deliberations.

Fitzhugh complained that not having any House committee votes or actual debate among lawmakers themselves short-circuited the legislative process in an unhealthy and unproductive manner.

“It does matter who governs,” Fitzhugh said, echoing a line oft-used by Republican Lt. Gov. Ramsey. “And it’s not going quite very well right now. I don’t see how anybody can take any bit of satisfaction out of what happened today.”

Harris: Tough to Process Defeat

Senate Minority Leader Lee Harris, a Memphis Democrat and freshman lawmaker, said he was “shocked and speechless” by the Medicaid expansion plan’s early end.

Harris said he’d hoped to “work through some of the issues that folks have with it and make policy.” He added that he was disappointed that more people didn’t have a chance to take part in the discussion.

While the governor probably won’t bring his proposal back up during regular session, Harris said it’s “feasible” that Democrats might decide to bring their own legislation. However, he added he can’t say for sure because it’s hard for him “to process.”

“Since we didn’t even really get it off of first base it’s hard to kind of understand what happened there,” Harris said.

Yarbro Disappointed Insure TN Didn’t Get More Consideration

Jeff Yarbro, a Nashville Democrat and the minority party’s caucus chairman in the Tennessee Senate, said the 7-4 vote of the Health Committee — on which he, too, served — was “obviously disappointing,”

Like other supporters of “Insure Tennessee” Yarbro thought the issue deserved a wider discussion in the Legislature than what it in  fact received.

“I think it’s disappointing that seven votes can make the decision for 6-and-a-half million Tennesseans,” he said.

Yarbro, also a first-year member of the General Assembly, added that the conversation’s not over, and the Democrats will continue to work with the governor and “people of both parties that have common sense.”

Massey: Health Committee Should’ve Stuck to Health Issues

Tennessee Sen. Becky Duncan Massey, a Knoxville Republican,was one of those on the Health Committee who voted in favor of “Insure Tennessee.”

Massey said the “charge” of the committee in discussing “Insure Tennessee” was supposed to be limited to health benefits and health concerns, “not to vote on any of the other peripheral things that were going to be voted on by the other committees.”

In Massey’s view, the overall health benefits of the governor’s plan were “indisputable.” Discussions around the source of funding and the national debt did not have a legitimate place in deliberations about the plan from a pure health-policy perspective, she said.

The Senate “needed to hear the full debate,” Massey said.

Roberts Wanted Agreement Nailed Down

Kerry Roberts, a Republican member Senate Health Committee that voted down “Insure Tennessee,” said his opposition came down to not trusting the federal government with the state’s financial future.

The Republican from Springfield said he worried that without a solid written agreement between the state and the feds, Washington could potentially go back on the handshake deal Haslam had negotiated with the secretary of the U.S. Health and Human Services Department, the agency that manages Medicaid.

The federal government “holds leverage” over the state of Tennessee to the tune of “20 percent of our state budget.”

“We have got to look out for the people of Tennessee — we can’t agree to anything that puts 20 percent of our state budget at risk,” he said.

Niceley: No Trusting Federal Government

Frank Niceley, a member of the Tennessee Senate Health and Welfare Committee that voted to kill Gov. Bill Haslam’s “Insure Tennessee” plan, is a little perplexed why the matter was even presented to lawmakers.

Niceley said he never doubted that “Insure Tennessee” was DOA.

The federal government under the Obama administration has a bad name in the Tennessee General Assembly, at least among Republicans, he said.

“How do you trade with somebody who just blatantly doesn’t tell the truth?” asked Niceley.

All the same, the Strawberry Plains Republican said he wants to see the policymakers continue talking about reforms and initiatives that’ll encourage better health among Tennesseans.

Health Care Problems Not Going Away, says Haslam

Meeting with reporters shortly after the most significant legislative defeat of his tenure, a disappointed Bill Haslam said the problems surrounding health care he sought to address with “Insure Tennessee” aren’t going away.

Hundreds of thousands of people in the state don’t have access to necessary care, he said. Furthermore, health care costs in Tennessee and across the country are “out of control,” the governor added.

“We haven’t done anything to address those two issues,” he said.

And while Haslam said he and his staff are still trying to process what went wrong with “Insure Tennessee,” he pledged that “you are going to see us continue to focus on trying to find a way” to tackle those problems.

On a 7-4 vote Monday, the Senate’s Health and Welfare Committee effectively killed the governor’s attempt to win the Legislature’s approval for “Insure Tennessee,” a plan his administration had negotiated with the federal government to draw down billions in funding to offer coverage for 300,000 or so residents.

The governor noted that he never thought it was going to be easy to get the Legislature to approve any kind of plan that would at the same time be agreeable to the Obama administration, which is holding the pursestrings to the Medicaid expansion dollars Tennessee was seeking under “Insure Tennessee.”

But the Haslm was hesitant to blame the “Insure Tennessee” defeat on anyone in particular, or any one facet of the political drama that’s unfolded over the past several days. As for why the plan never gained momentum, he said “different things for different people” were sticking points.

Many Republican lawmakers “just couldn’t quite get comfortable with the policy,” or couldn’t be convinced the federal government was trustworthy going forward, Haslam said.

“That was a hard hurdle to get over,” he said. “For other people, it was just, ‘I am just afraid this is Obamacare.’ And as much as we tied to show the difference as to why this is not, some people just couldn’t get past that hurdle.”

The governor also said it seems unlikely that he’ll be able to get any sort of concession from the Obama administration that could be used to prod reluctant lawmakers into go along with the plan later.

“It’s not in my nature just to give up, but I don’t really know what we’d do there,” he said. “We really did negotiate a deal with (the U.S. Health and Human Services) that, I think, went as far as they can do within the Affordable Care Act law that they have to deal with.

“We continue, obviously, to see ideas — Indiana’s plan and and other things — that we think could have been and were part of our plan,” Haslam continued. “But right now I don’t know what we would go to and ask them (that’s) different from what we got that they can do within the law. Also, we don’t like the law, and I don’t like the law either, but right now it is the law, so I don’t know what else we would go and ask them for.”

Hearings Continue on ‘Insure Tennessee’

State lawmakers in Nashville are into their second day of hearings on Gov. Bill Haslam’s plan to use federal Medicaid expansion funding to establish a new health-coverage plan for lower income Tennesseans.

It’s unclear what is in store for the plan at this point. A vote of some kind in either the House or Senate could come later Wednesday.

Speculation around the Capitol is that Haslam’s “Insure Tennessee” plan doesn’t have the support to get through hostile Republican-dominated committees in either chamber of the General Assembly. On the other hand, supporters claim the votes may be there to pass it on the full-chamber floors, particularly in the House.

Gerald McCormick, the House majority leader, is carrying Haslam’s legislation. He said Tuesday that if “Insure Tennessee” wins in the House then supporters could “shame” the Senate into passing it.

Senate and House committees on Tuesday heard presentations for and against “Insure Tennessee,” which is the governor’s attempt at a “third way” for Tennessee to go between flatly rejecting participation in the Affordable Care Act’s Medicaid expansion money and signing up for Obamacare as-is.

Several other states led by Republicans — like Arkansas, Ohio and Indiana — are attempting to tap federal dollars for expanding Medicaid. They, too, would like to implement cost-controlling and patient-responsibility-enhancing approaches.

Gov. Haslam’s “Insure Tennessee” plan includes a mix of co-pays, incentives and vouchers that he and his administration officials say is unique to, and designed especially for, Tennessee’s lower-income uninsured population.

Haslam’s people say the “market-based” elements in the plan make it such that it isn’t really “Obamacare” at all.

Brian Kelsey, a Republican state senator from Memphis who opposes Haslam’s plan, pressed members of the governor’s staff on the issue during a Tuesday afternoon committee hearing. Kelsey said that the Medicaid expansion population the Haslam administration is targeting for federally financed health coverage — those who make 138 percent of the poverty line or less and are not already getting TennCare benefits — is the same population envisioned for coverage under the Affordable Care Act.

Mark Cate, the governor’s chief of staff, acknowledged that “this all falls under the Affordable Care Act.”

“The opportunity to cover the newly eligibles, to have the 90-10 match, that did come from the Affordable Care Act, you are correct,” Cate said to Sen. Kelsey.

Later in the same hearing, though, Haslam’s staff sought to emphasize how the particulars of “Insure Tennessee” differ from the basics of the Affordable Care Act.

That it has taken the Haslam administration nearly two years to develop the essential components of “Insure Tennessee” shows it isn’t just Obamacare, said Wendy Long, chief medical officer for the state’s Bureau of TennCare.

“If this is Obamacare, then why are we even asking for a waiver,” Sen. Richard Briggs, a Knoxville physician, asked Long. Briggs was referring to the application the state has filed with the federal government for special permission to use Medicaid expansion money in ways not spelled out in the Affordable Care Act.

“Because it is not Obamacare,” responded Long. “We would not have to pursue a waiver amendment if we were simply adding people to our Medicaid rolls.”

The co-pays, modest premiums, incentives and employer-contribution aspects all “had to be negotiated as an alternative to a Medicaid expansion,” she said.

“All of this is completely outside the norm of traditional Medicaid expansion,” Long said.

Over in the House, Majority Leader McCormick granted under questioning that “Insure Tennessee” and the Affordable Care Act are “linked together” in terms of funding.

“But I don’t think it’s accurate just to say this is Obamacare. People say that, because everyone knows Obamacare is very unpopular, and it’s a political statement to say that,” McCormick said.

He also noted that the overarching Medicaid system is a federal program that was established in 1965 — decades before the Affordable Care Act became law. President Obama was three years old when Medicaid was launched “if you believe the accuracy of his birth certificate,” said McCormick.

Referring to radio ads run last month by the Tennessee chapter of the conservative group Americans for Prosperity, McCormick lamented that Republicans in the House perceived as friendly to the Haslam plan have witnessed “misinformation spread about them.”

An AFPTN spot criticizing House Assistant Majority Leader Kevin Brooks of Cleveland suggested the Chattanooga-area Republican is going back on promises to fight Obamcare. Brooks was one of a number of House Republicans who added their names as co-sponsors to a bill that would have banned Tennessee from expanding Medicaid under the Affordable Care Act. The measure was eventually watered down to merely require that the governor win the Legislature’s approval for any expansion attempt — which is what Haslam is attempting now.

While the Haslam administration has for weeks made arguing that Haslam’s plan isn’t really “Obamacare” a central point in their public relations offensive, a new go-to talking point aimed at winning over reluctant Republicans has emerged this week.

McCormick told lawmakers that the equivalent of “two divisions” of military veterans in Tennessee aren’t getting the medical care they need from the federal government, and that “Insure Tennessee” can be used to give them coverage.

“We’ve got 25,000 to 30,000 veterans that are eligible for this,” McCormick said in the House Insurance and Banking Committee. “These are people who have worked, certainly have worked for our country, maybe some of them are working now in very low wage jobs, maybe some of them are desperately looking for work and need our help looking for that work. And maybe they need a hand up right now with their healthcare coverage. And maybe they’re suffering from some problems that they encountered while they were in the military.”

Asked in the Senate Health Committee why care for veterans has become a state government issue, TennCare’s Dr. Long said the federal Veterans’ Administration isn’t keeping with the needs of Tennesseans returning from America’s oversees wars.

“Veterans have different levels of benefits through the VA, depending on the type of service,” said Long. “Most of the veterans from these most recent wars who are home maybe served a term or were over for four or six years don’t come back to comprehensive health care from the VA at all.

A University of Tennessee study commissioned by supporters of “Insure Tennessee” last month found that 30,000 veterans in the state are living under the poverty line “and in need of basic health care,” Long said.

A group calling itself the “Heartland Accountability Project” began running radio ads this week accusing Sen. Kelsey of “selling out military veterans and their families” for his outspoken efforts to derail “Insure Tennessee.”

Mark Engler and Alex Harris contributed to this report.

Haslam Speech Kicks of Special Session on ‘Insure Tennessee’

Gov. Bill Haslam delivered what many Tennessee state lawmakers on both sides of the partisan aisle said was an exceptional speech Monday evening.

Haslam spoke before a joint meeting of the Legislature to launch a special session that’ll have lawmakers spending the next few days picking apart the details of his “Insure Tennessee” plan. The Republican governor hit upon a range of reasons why he thinks the General Assembly ought to approve his customized Medicaid expansion plan.

But there was also a common agreement among legislators afterward that if the governor’s going to win them over, it’ll take more than just “talking points” once critics start zeroing in on the particulars of his new health-care-for-the-poor initiative.

The governor’s proposed two-year pilot program would be funded by nearly $3 billion in federal money through the Affordable Care Act. Its aim is to provide health coverage to around 300,000 people with incomes below 138 percent of the poverty line.

Struck in the Middle

Haslam described it as “a third way” between rejecting and embracing Obamacare.

“Insure Tennessee” is designed to “leverage those federal dollars to really begin the work of fixing what is wrong with our health care system, to better align incentives for providers and consumers,” he said.

“Regardless of where you are on the political spectrum, I think everyone agrees that our current system of health care does not work,” said Haslam. “It doesn’t work in two ways: access nor cost. First, there are too many people who need medical care that aren’t getting it. Secondly, everyone should realize that we have to do something to address health care costs.”

The governor’s administration has described “Insure Tennessee” as a “market-based” plan because it requires co-pays and issues vouchers for private insurance. And for the unemployed who will be getting their coverage through the government in similar fashion to the existing TennCare recipients under the plan, “Insure Tennessee” enrollees will be charged premiums as they participate in a so-called “Healthy Incentives” program.

The upshot of “Insure Tennessee,” said the governor, is that it “introduces personal responsibility and patient engagement through choice, incentives, and co-pays in a way that doesn’t happen with Medicaid.”

“This is not Obamacare,” declared Haslam. “If it was, it wouldn’t have taken us this long to negotiate. We have done what you asked us to do and what we said we would do. We found a unique, Tennessee solution.”

A Mix of Similar Reactions

In order to get his plan passed, the governor needs votes wherever he can find them — and he’s even said he’s counting on every minority-party lawmaker in the statehouse to get on board in order to bring in the legislative win.

House Democratic Leader Craig Fitzhugh said Haslam more than likely hit the right notes to lure in laggards from his caucus.

“Remember, we were for a fuller expansion, so some (Democrats) are a bit disappointed that it is limited in some way,” said Fitzhugh. “But the fact of the matter is that it’s going to cover about the same number of citizens that we thought full expansion was.”

Fitzhugh said he’s more worried, though, about how Haslam’s going to get skeptical Republicans to go along.

“In his caucus, he’s the governor and he swings a mighty big stick — and I think he needs to take a couple of cuts,” said Fitzhugh.

Like Fitzhugh, GOP Caucus Chairman Glen Casada said the governor made a “very good speech — very impassioned.”

“It had emotion and it had logic,” said Rep. Casada, who opposes the governor’s plan. “I just don’t think he convinced anyone tonight. Most of the House Republicans have analyzed this for weeks. And they just see that it’s not good for the overwhelming majority of the citizens of the state.”

Casada described Haslam’s plan as presently “dead in the House.”

One of the significant hangups for GOP lawmakers as they scrutinize Haslam’s bargain with the Obama administration will be that many are just not going to take it for granted that “Insure Tennessee” will be run like the Haslam administration wants, said Casada.

Under any plan funded and overseen by Washington, the state “is not in full control,” and a lot of lawmakers see that as a dealbreaker, he said.

“When we try to implement free market principles to this, the feds — the (Centers for Medicare & Medicaid Services), in particular — will nix it,” said Casada. “When you don’t pay your monthly premium, and Tennessee asks to take you off, the feds will trump us, and they will say, ‘No you can’t do that, Tennessee.'”

Casada said that will be among the central questions lawmakers examine as the spend the next couple days probing Haslam administration officials on the particulars of “Insure Tennessee.”