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Ramsey Announces Extraordinary Session Committee Memberships

Press release from Tennessee Lt. Gov. Ron Ramsey, R-Blountville; February 2, 2015:

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Haslam Pitches Insure TN to Joint Session of General Assembly

Press release from the office of Tennessee Gov. Bill Haslam; February 2, 2015:

Governor’s plan provides health care coverage to more Tennesseans at no cost to the state

NASHVILLE – Tennessee Gov. Bill Haslam this evening addressed a joint convention of the 109th General Assembly as legislators began an extraordinary legislative session to consider his Insure Tennessee plan.

The proposal, a two-year pilot program to provide market-based health care coverage to more than 250,000 Tennesseans who currently don’t have access to health insurance or have limited options, does not create any new taxes for Tennesseans and will not add any state cost to the budget.

“Two years ago, the General Assembly made two requests of us,” Haslam said.  “First, to bring a unique and specific plan to Tennessee that met the needs of our citizens and was financially responsible for our state and the country, and secondly, to bring that plan back to the General Assembly for a vote.

“I have done both of those things.  This plan is overwhelmingly supported by Republicans and Democrats in our state.  Tonight, I am asking for your vote to help Insure Tennessee.”

After the U.S. Supreme Court ruled in 2012 that the federal government could not force states to expand their Medicaid programs, the governor went before the legislature the next spring to announce that Tennessee would not expand its Medicaid program.  He also said at the time that he didn’t think it made sense for Tennessee to reject federal dollars that Tennesseans are paying for, that are going to other states and that could cover more Tennesseans who need insurance, so he started to work on a third way – a “Tennessee plan.”

“After nearly two years of hard work, we have a Tennessee-specific plan that addresses health outcomes and cost,” Haslam said. “This is not Obamacare. If it was, it wouldn’t have taken 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,” Haslam said.

Citing his own opposition to the Affordable Care Act, especially for its failure to address health care costs, Haslam continued, “As a Republican elected leader, I feel like we owe the country answers as to what we would do about health care.  For too long, we’ve said what we don’t like – mainly Obamacare.  This is a chance to show what we would do.”

The plan would provide coverage to more than 250,000 uninsured Tennesseans earning less than 138 percent of the federal poverty level, valued at slightly over $16,000 a year for an individual and $27,000 for a family of three.

Five key areas of the governor’s plan include: a fiscally sound and sustainable program; providing two new private market choices for Tennesseans; shifting the delivery model and payment of health care in Tennessee from fee-for-service to outcomes based; incentivizing Tennesseans to be more engaged and to take more personal responsibility in their health; and preparing participants for eventual transition to commercial health coverage.

The governor announced his Insure Tennessee proposal in December and issued a proclamation last month to convene the “extraordinary session” of the 109th General Assembly to consider a joint resolution.  The special session, the first of the Haslam administration, began today at 4 p.m. CST.

Kelsey Releases Open Letter from County GOP Chairmen Opposed to Insure TN

Press release from Tennessee Sen. Brian Kelsey, R-Germantown; February, 2, 2015:

NASHVILLE, Tenn. – Sen. Brian Kelsey (R-Germantown) and Rep. Jeremy Durham (R-Franklin) today will accept a letter from a statewide coalition of conservative leaders and activists who oppose Medicaid expansion. Sen. Brian Kelsey stated, “Republican opposition to Obamacare Medicaid expansion is gaining momentum. These county party chairmen reflect the grassroots Republican opposition that is taking hold in the legislature.” Kelsey and Durham will discuss the open letter on behalf of the legislature at a press conference today at 10:30 am, scheduled for Hearing Room LP30.

Signatories to the letter include current chairs and party members from counties served by rural hospitals, such as West Tennessee Healthcare in Weakley County. Signatories also include persons recently included on a list of circulated by supporters of Medicaid expansion who did not intend to support the governor’s proposal. Party chairs signing the letter:

  • Rachel Welch–Chairman, Putnam County Republican Party
  • Gayle Jones–Chairman, Giles County Republican Party
  • Barry Hutcherson–Chairman, Chester County Republican Party
  • Chris Thompson–Chairman, Pickett County Republican Party
  • Dolores DiGeatano, MD–Chairman, Fayette County Republican Party
  • David Baldovin–Chairman, Moore county Republican Party
  • Sue Jackson–Chairman, Obion County Republican Party
  • Daniel Williams–Chairman, Carroll County Republican Party
  • Ben Nixon–Chairman, Warren County Republican Party
  • Harold Kemp–Chairman, Macon County Republican Party
  • Constance Hightower–Chairman, Hamblen County Republican Party
  • Debbie Baldwin–Chairman, Benton County Republican Party
  • Judi Swilling–Chairman, Claiborne County Republican Party
  • Jimmy Knight–Chairman, Union County Republican Party
  • Fred Ellis–Chairman, Lincoln County Republican Party
  • Ken Coppinger–Chairman, Rhea County Republican Party
  • Richard Swink–Chairman, Robertson County Republican Party
  • Ronald Wayne King–Chairman, Scott County Republican Party
  • Robert Dunham–Chairman, White County Republican Party

An excerpt from the letter reads, “As conservatives in our communities, we have worked hard to elect leaders we trust will uphold our values of shrinking government, imposing less taxes and costs on businesses and individuals, and embracing a free market.

“We reject ObamaCare’s Medicaid expansion. And we need you to stand strong on these principles in the coming special session.” A copy of the letter is attached.

***

Dear Legislators:

As conservatives in our communities, we have worked hard to elect leaders we trust will uphold our values of shrinking government, imposing less taxes and costs on businesses and individuals, and embracing a free market.

We reject ObamaCare’s Medicaid expansion. And we need you to stand strong on these principles in the coming special session.

Although Governor Haslam originally opposed Obamacare, it appears he has chosen to abandon those principles now that he is safely in his second term. His proposal for Insure Tennessee is no more than expansion of Obamacare by another name.

Nearly 9 in 10 Tennesseans eligible for Medicaid expansion are working-age adults without dependent children to support, according to the Urban Institute. Instead of adding a whole new generation onto welfare programs like Medicaid, we need to get working-age adults working again. Our state deserves a clear path to jobs and prosperity―not an ObamaCare Medicaid expansion like Insure Tennessee.

We are also concerned about how this ObamaCare Medicaid expansion is funded. In particular, $716 billion will be cut from Medicare in order to pay for the Medicaid expansion and other parts of the law, according to The Heritage Foundation. Medicaid expansion breaks the Medicare promise we made 50 years ago. And if other state Medicaid expansions are any indication, Medicaid costs will skyrocket―putting Tennessee seniors at further risk.

We are all aware of the mess that TennCare created and the difficulty our state had when we had to end the program and kick 350,000 Tennesseans off the Medicaid rolls.

Governor Haslam’s “two year pilot program” reeks of the same issues that we had less than a decade ago. Tennessee should not make the same mistake again.

We reject the ObamaCare Medicaid expansion known as Insure Tennessee. On behalf of many local Republicans oppose this expansion, we urge you to do what’s right for Tennessee and stand strong against this proposal.

Sincerely,

Tennessee Republican Party Chairs

Beacon Releases Anti-Insure TN Ad

Press release from the Beacon Center of Tennessee; January 27, 2015:

The Beacon Center of Tennessee today launched a radio ad ahead of the legislative debate over a Medicaid expansion. Amid massive spending by expansion proponents—led by the hospitals that will benefit from the expansion—state lawmakers will convene next Monday to vote on Gov. Haslam’s proposed expansion of Medicaid to more than 200,000 able-bodied adults.

The 60-second ad, titled “That’s Just Not Fair,” features a discussion between a senior citizen and her daughter about the proposed Medicaid expansion. It is running on radio stations in the Knoxville media market. You can listen to the full ad here.

“As lawmakers consider expanding Medicaid in our state under Obamacare, it’s important to realize how we got here, and what the consequences of that decision will be,” said Beacon CEO Justin Owen. “Ultimately, Congress made cuts to Medicare to fund other parts of Obamacare, including the expansion of Medicaid in the states. As the ad notes, that’s just not fair to our seniors.”

Here is the full text of the one-minute radio spot, “That’s Just Not Fair”:

Mom: Hey Amy, I heard state lawmakers will be voting to expand Medicaid here soon. What’s that all about?

Amy: It would mean giving government health insurance to more than 200,000 able-bodied Tennesseans under Obamacare.

Mom: Well, even if they’re able-bodied, it’s free federal money so what’s the big deal?

Amy: There’s no such thing as a free lunch, mom. In fact, the Medicaid expansion will be paid in part by $716 billion in cuts to seniors’ Medicare benefits.

Mom: To give health insurance to able-bodied adults?

Amy: You got it.

Mom: If they’re able-bodied, they can get a job…I can’t. And they want me to pay for them? That’s just not fair.

Amy: Well, that’s why it’s important for our state lawmakers to say no to Obama’s Medicaid expansion.

Mom: I agree. Don’t make seniors pay for more Obamacare in Tennessee. That’s just not fair.

To learn more about how a Medicaid expansion will impact your family, visit www.BeaconTN.org. That’s BeaconTN.org.

PAID FOR BY THE BEACON CENTER OF TENNESSEE

FGA: Legislators Who Support Insure TN Could Face Trouble in 2016

Press release from the Foundation for Government Accountability; January 20, 2015:

Nearly 80% of Volunteer State Voters Upset by $716 B in Cuts to Services for Seniors and the Needy to Pay for Insure Tennessee

A majority of Tennessee voters stand against ObamaCare’s Medicaid Expansion once they learn the true impacts the program will have on the state, with almost 60 percent of them opposed, says a Foundation for Government Accountability poll released today.

The poll was conducted after Gov. Bill Haslam reversed his opposition to ObamaCare to support Washington’s goal of expanding the welfare state in Tennessee, in spite of the lessons learned by the state’s failed TennCare program. Not too long ago, the TennCare Medicaid expansion nearly bankrupted the budget and forced lawmakers to kick hundreds of thousands of people off of the program to keep the state afloat. When reminded of the TennCare Medicaid expansion disaster, 62 percent of Tennessee voters said they were less likely to support the ObamaCare expansion Gov. Haslam’s wants today.

With ObamaCare still toxic, and the nightmares of the TennCare expansion debacle still fresh in peoples’ minds, Gov. Haslam is seeking to rebrand his ObamaCare Medicaid expansion plan, calling it “Insure Tennessee,” to dupe voters and legislators into thinking his welfare state expansion is both Tennessee-centric and market-based.

“There is nothing Tennessee-centric about caving to the dictates of Washington’s health care takeover through ObamaCare. Call it what you want, but the federal strings will be the same, the budget crunches will be the same, and the risks to patients and taxpayers will be the same. Insure Tennessee is ObamaCare expansion in disguise,” said FGA CEO Tarren Bragdon.

“Tennessee was able to climb out of the hole it dug itself after the TennCare expansion, but that may not be the case this time around. After the ObamaCare Medicaid expansion raises premiums, after the feds renege on their promises, after truly needy patients are pushed to the back of the line, the state may have no legal way to back out.”

While the U.S. Supreme Court ruled that ObamaCare’s Medicaid expansion was optional—doing so would turn these new expansion enrollees into a so-called mandatory population—the court did not clarify whether a state can back out of an ObamaCare expansion after passing it without losing their federal funding for all Medicaid enrollees. Upon learning that the state may not be able to reverse its decision after it expands Medicaid, two-thirds of Tennessee voters said they were less supportive. 73% of voters said they were less likely to support Haslam’s ObamaCare expansion plan knowing it could rob funding for critical priorities including education, safety and roads.

“Tennesseans don’t want Gov. Haslam’s ObamaCare Medicaid expansion. It’s time for the legislature to stand up for their citizens and protect them from a massive expansion of ObamaCare,” said Bragdon. “Gov. Haslam may be captivated by the allure of allegedly free money from Washington, but leaders in the Legislature need to keep a clear head and fight for what’s right for the people of Tennessee.”

When Haslam starts talking with legislators about Insure Tennessee, someone should remind him that the people of Tennessee don’t want to see the care of their parents, their health care system, their taxes, and their state jeopardized just so he can win points with the President. That’s no way for a conservative leader to lead, and that’s why 57 percent of Tennesseans and 78 percent of Republicans say they are less likely to reelect a candidate if they support ObamaCare’s Medicaid expansion, Insure Tennessee.

The FGA poll can be viewed here.

Insure TN Advocacy Group Kicks Off Ad, Direct Mail Campaign

Press release from the Coalition for a Healthy Tennessee; January 20, 2015:

Radio, direct mail launch on 1/20/15 fuels statewide grassroots efforts

NASHVILLE – The Coalition for a Healthy Tennessee this week began radio ads and direct mail across the state to support passage of Insure Tennessee, the conservative, market‐based health care reform plan proposed by Governor Bill Haslam.

The media launch is an addition to the vibrant statewide grassroots campaign underway that involves thousands of business, health care and civic organizations across Tennessee who are making contact with legislators. The Coalition’s media presence includes www.insuretennesseenow.com, @InsureTNNow and facebook.com/insuretennesseenow.

“It is vital for people to know that what Governor Haslam is proposing is conservative, free‐market health care reform and not more of the same Medicaid from Washington, D.C. Insure Tennessee is distinctly not traditional Medicaid expansion,” said coalition spokesman Charlie Howorth, executive director of the Tennessee Business
Roundtable. “By departing from the Washington model, Governor Haslam has found a way to provide coverage for working Tennesseans caught in the coverage gap and to stabilize rural hospitals that are currently at risk of closure. We can achieve this with no new taxes and no cost impact to the state.”

The Coalition’s radio spots began airing today in markets across Tennessee. The entire radio script reads as follows:

“Time and time again, Tennesseans have rejected the Obama agenda and his Obamacare plan that moves health care decisions out of our state and into the hands of DC bureaucrats. 

“That ‘s why Governor Haslam has introduced the Insure Tennessee Plan to cover hundreds of thousands of hard‐working Tennesseans. It’s a conservative, market‐based approach that will result in no new taxes, no new state government spending, and stability for our state’s rural hospitals.

“No new taxes and no new state government spending to make sure more of our fellow hard‐working Tennesseans have health care… That’s the conservative way, that’s the Tennessee way. 

“Call 1‐800‐449‐8366 to tell your legislator to stand with Governor Haslam and Insure Tennessee Now or go to Insure Tennessee Now Dot Com for more information on Insure Tennessee. Paid for by The Coalition for a Healthy Tennessee.”

The Coalition’s first direct mail piece, attached here, emphasizes that Insure Tennessee is “a Common Sense, Conservative Solution for True Health Care Reform in Tennessee.”

The Coalition has more than 100 members, including many large member organizations, including chambers of commerce and other health care, business and civic organizations committed to gaining approval of Insure Tennessee. The group last month launched a website – www.InsureTennesseeNow.com – and is conducting grassroots advocacy in all 95 counties. The group is led by the Tennessee Business Roundtable.

Public health care forums featuring Insure Tennessee will held in Chattanooga, Jan. 22; Jackson, Jan. 30; and Tri‐Cities, Feb. 6. Forums have been conducted in Nashville, Memphis and Knoxville.

The campaign, including paid media, is entirely funded by private supporters of Insure Tennessee through the Coalition for a Healthy Tennessee.

Fitzhugh Celebrates Fall with New Call for Medicaid Expansion

Press release from the Tennessee House Democratic Caucus; September 23, 2014:

NASHVILLE, Tenn. (September 23, 2014) – House Democratic Leader Craig Fitzhugh is celebrating the beginning of fall as a countdown to the release of Governor Haslam’s long-awaited “Tennessee Plan” to expand Medicaid.

To mark the start of the season, Leader Fitzhugh has released a video asking Governor Haslam to make good on his pledge. Transcript to follow:

“Hi, I’m House Democratic Leader Craig Fitzhugh.

“Today marks the beginning of fall. This is the time of year that I look forward to cooler weather, changing leaves and UT Football.

“This year, I’m also looking forward to Governor Haslam’s “Tennessee Plan” for expanding Medicaid. A few weeks back, the Governor promised to submit a plan this fall.

“Well, Governor, fall starts today and the countdown for Medicaid expansion begins anew. I hope the Governor makes good on his promise. Meanwhile, we’ll be back throughout the coming weeks with updates about how the Governor’s dithering affects you, the tax payer.

“Again, I’m House Democratic Leader Craig Fitzhugh. Fall is here and—I truly hope—we can soon say the same thing about the Governor’s Tennessee Plan. Thanks.”

In August, Governor Haslam told reporters that he would probably go to the Department of Health and Human Services with a plan this fall that “makes sense for Tennessee.” Over the past year, House Democrats have implored Governor Haslam to follow the lead of Republican Governors like John Kasich of Ohio and Jan Brewer of Arizona who have put the residents of their state first by accepting federal funds to expand Medicaid.

It has been 545 days since Governor Haslam announced to a joint convention of legislators that he would seek a “Tennessee Plan” to expand Medicaid, and 266 since Tennessee began losing $2.5 million a day in federal funds, costing taxpayers $665,000,000 in lost revenue.

Haslam Announces 135 Job Expansion at Federal-Mogul in Rutherford Co

Press release from the Office of Tennessee Gov. Bill Haslam; August 27, 2014:

NASHVILLE—Tennessee Gov. Bill Haslam and Economic and Community Development Commissioner Bill Hagerty along with Federal-Mogul officials announced today the company will invest $6.2 million to expand its current distribution facility in Smyrna, Tennessee and create 135 new jobs in Rutherford County.

“We are thankful for Federal-Mogul and their continued investment in our state and the new jobs they are creating in Middle Tennessee,” Haslam said. “When companies like Federal-Mogul choose to reinvest here, it speaks volumes about our workforce and the quality of Tennessee-made products, and today’s announcement is another step toward our goal of becoming the No. 1 location in the Southeast for high quality jobs.”

“Tennessee continues to set itself apart as a global leader in the automotive industry,” Hagerty said. “Major automotive manufacturers like Nissan, Volkswagen and General Motors support a robust pipeline of more than 900 automotive manufacturers and suppliers located throughout our state. I am pleased Federal-Mogul will continue to be a part of why Tennessee has been named the No. 1 state in the nation for automotive manufacturing strength an unprecedented four years in a row, and I appreciate the new jobs they are creating in our communities.”

“Federal-Mogul is pleased to continue investing in Smyrna,” Paula Silver, Federal-Mogul’s vice president of Corporate Communications and Investor Relations, said. “We have a dedicated and hard-working team here that takes pride in distributing high quality products for our customers. We are excited to grow our Smyrna operations and create more job opportunities.”

Federal-Mogul is expanding its existing Worldwide Aftermarket Distribution Center in Smyrna, due to the recent purchase of part of Affinia’s product line. Affinia is a leader in the manufacturing and distribution of automotive replacement products.

As part of this expansion, Federal-Mogul will increase its Smyrna footprint from 600,000 square feet to 800,000 square feet. This larger warehouse and distribution capacity will allow the facility to become more productive.

“Today’s announcement of 135 new jobs by Federal-Mogul is great news for the Town of Smyrna and Rutherford County,” Smyrna Mayor Mary Esther Reed said. “The Town of Smyrna continues to experience positive job growth and we thank Federal-Mogul for their confidence in our community for this additional investment.”

Federal-Mogul Holdings Corporation is a leading global supplier of products and services to the world’s manufacturers and servicers of vehicles and equipment in the automotive, light, medium and heavy-duty commercial, marine, rail, aerospace, power generation and industrial markets. The company’s products and services enable improved fuel economy, reduced emissions and enhanced vehicle safety.

“TVA and Middle Tennessee Electric congratulate Federal-Mogul on its announcement to expand in Smyrna, Tennessee,” TVA Senior Vice President of Economic Development John Bradley said. “We are pleased to partner with the state of Tennessee, Rutherford County Chamber of Commerce, and city and county officials to assist Federal-Mogul’s additional investment to create new jobs.”

In addition to its Smyrna location, Federal-Mogul has operations in Smithville and Sparta, Tennessee. In total, approximately 1,000 people are employed at Federal-Mogul’s three Tennessee locations.

People interested in applying for these new jobs in Smyrna should contact Missy Rogers, human resources manager, at Missy.Rogers@federalmogul.com.

Haslam Announces $185M Expansion of Spring Hill GM Complex

Press release from the Office of Tennessee Gov. Bill Haslam; August 27, 2014:

NASHVILLE – Tennessee Gov. Bill Haslam and Economic and Community Development Commissioner Bill Hagerty along with General Motors officials announced today the company will invest $185 million to make small gas engines at its Spring Hill manufacturing complex. GM also identified the next-generation Cadillac SRX as a future mid-size vehicle to be produced at Spring Hill.

“We want to congratulate GM on this important investment in its future in Spring Hill and Middle Tennessee,” Haslam said. “Today’s announcement speaks volumes around the country and world about our state’s business-friendly climate and strengths in automotive manufacturing, bringing us another step closer to our goal of making Tennessee the No. 1 location in the Southeast for high quality jobs.”

“Today’s announcement demonstrates how globally competitive Tennessee is in automotive production and underscores the tremendous momentum our state possesses in the automotive sector,” Hagerty said. “The quality craftsmanship and artisan strength of our workforce has proven time and again that Tennessee is the best place to invest and grow.”

The investment supports GM’s new small displacement engine, which is part of an all-new Ecotec engine family that will be used by five GM brands in 27 models by the 2017 model year, powering many of the company’s high-volume small car and compact-crossover vehicles.

Spring Hill is among six manufacturing locations around the globe that will produce the new engine, and an additional $48.4 million investment is planned for the Bedford, Indiana powertrain castings plant.

“The new Ecotec engine family represents the most advanced and efficient small displacement gasoline engines in GM’s history,” Arvin Jones, GM North America manufacturing manager, said. “It was a good business decision to produce this powertrain in Spring Hill and Bedford. Both teams have strong performance records, especially in quality.”

The new Ecotec portfolio includes 11 engines with three- and four-cylinder variants ranging from 1.0L to 1.5L – including turbocharged versions – and power ratings ranging from 75 horsepower (56 kW) to 165 horsepower (123 kW), and torque ranging from 70 lb-ft (95 Nm) to 184 lb-ft (250 Nm).

GM Spring Hill currently manufactures the award-winning Ecotec 2.0L turbocharged direct injection 4-cylinder engine, the Ecotec 2.4L direct injection 4-cylinder engine and Ecotec 2.5L direct injection engine, which powers the 2014 Chevrolet Malibu and Chevrolet Impala.

The naming of the Cadillac SRX program follows GM’s previously announced $350 million investment in Spring Hill for two future mid-size vehicles expected to create or retain approximately 1,800 jobs.

Haslam: Medicaid Expansion Talks Didn’t Get Down-and-Dirty with New HHS Top

Tennessee’s Republican governor, Bill Haslam, said he had a “great conversation” with Sylvia Mathews Burwell when she was in Nashville a little over a week ago for the for the National Governors Association summit.

But Gov. Haslam said he and Burwell, the Obama administration’s new U.S. Health and Human Services Secretary, didn’t get into particulars with respect to working out a deal that might enable the state to draw down Affordable Care Act money from Washington earmarked for expanding the number of people in Tennessee eligible for government-finance health insurance.

“It wasn’t that kind of specific conversation in terms of where we are in the issues,” Haslam told TNReport in Winchester Monday. The governor was visiting the Franklin County seat to announce he was handing out half a million dollars in taxpayer-funded grants for city-center revitalization and regional recreation upgrades, like renovations to campsites and trails in Tims Ford State Park, and new lights at a local ball field.

“I do think we continue to make progress,” the governor said of the meeting with Burwell. “We had a good conversation about that, as well as numerous — you know, HHS obviously encompasses a lot of areas for the federal government, so we had a pretty broad range of conversation.”

Haslam said part of his talk with Burwell was a process of  “just getting to know each other.” He added that the two discussed “the history of where we are, and then both the financial and political realities that we’re dealing with in Tennessee.”

“I was very impressed by her,” Haslam said.

About two weeks ago, Haslam told TNReport at another grant announcement in Southeast Tennessee that he was hoping t0 find some middle-ground for facilitating Obamacare’s Medicaid-expansion provision in the Volunteer State when she stopped off in Middle Tennessee for the NGA festivities.

Haslam noted that although he’d met Burwell previously when she was filling a different role in the Obama administration, he was looking forward to talking with her for the first time since she’d taken charge at HHS. Haslam said that he hoped new blood at HHS could mean getting “some of the logs unjammed.”

Haslam told the Chattanooga Times Free Press following the NGA meeting that while his conversation with Burwell was upbeat, there were several “bright lines” that divided the state and the feds policy-wise. Some of those divisions include what’s covered and how to incentivize better health choices — which includes Haslam’s desire to use co-payments for the expansion.

In related news, the federal government has kicked off a new $100 million initiative program — developed with input from the National Governor’s Health Care Sustainability Task Force, and praised by Haslam — intended to help states improve their Medicaid programs.