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‘Insure TN’ Brouhaha Brewing Between House, Senate?

Disagreement appears to have developed between the Republican-dominated chambers of the General Assembly over how to handle Gov. Bill Haslam’s “Insure Tennessee” proposal scheduled for discussion in a special session beginning Feb. 2.

On Thursday, leaders of the Tennessee Senate’s GOP supermajority indicated the upper chamber will be holding off on committee votes on the issue until the House approves a resolution authorizing Tennessee to sign up for the Affordable Care Act’s Medicaid expansion funding.

But that doesn’t seem to sit well with some Republicans in the House.

“Apparently, there was a Senate Republican Caucus meeting yesterday where it was fantasized to the effect that we would go through this process on Insure Tennessee through several committees before they even considered it in the Senate, and I would like to dispel that silly notion that they had in that Senate Republican Caucus meeting,” Majority Leader Gerald McCormick said Friday morning on the House floor.

“That will not happen,” said the Republican from Chattanooga, who is expected to attempt to guide the governor’s Insure Tennessee plan to approval in the House.

Haslam’s Medicaid expansion plan — the centerpiece of which is a system of Affordable Care Act-financed vouchers to allow the purchase of private-sector health insurance by lower income Tennesseans — has been met with skepticism by many members of the Republican Legislature, even as GOP leaders have pledged to keep an open mind about the expansion.

According to an emailed statement Friday from the office of Speaker of the House Beth Harwell, the lower-chamber leadership was under the impression “that the House and Senate would each run the resolutions concurrently. “

House Will Get First Crack at Haslam’s Medicaid Expansion Plan

It looks as if the Tennessee House of Representatives will take the lead on deliberations over Gov. Bill Haslam’s proposal to expand state Medicaid eligibility using federal Obamacare dollars.

The General Assembly is scheduled to go into an “extraordinary session” beginning Feb. 2 to approve or reject the Haslam administration’s “Insure Tennessee” plan, the centerpiece of which is a system of Affordable Care Act-financed vouchers for lower income residents to purchase private-sector health insurance.

The “vehicle” in the Legislature for discussing Insure Tennessee will likely be a “joint resolution” originating in the House that’ll be carried by the chamber’s GOP majority leader, Gerald McCormick of Chattanooga.

Before it gets to the full floor of the 99-member chamber, though, the joint resolution will have to win approval from several committees and subcommittees, among them the House Insurance and Banking Committee, the Health Committee, the Finance Committee and the Calendar and Rules Committee, a spokeswoman for Speaker Beth Harwell, R-Nashville, told TNReport.

McCormick indicated this week that the vote-count within the House GOP caucus appears very tight at present. There are 73 Republicans and 26 Democrats in the House. Fifty votes are required to pass a measure out of the chamber.

Although the Senate will likely hold hearings and discussions about Insure Tennessee while the resolution is working its way through the House, upper-chamber Republican leaders said Senate committee-votes won’t be taken until after — and only if — the resolution clears the House.

“If it fails in the first House sub(committee), we’re done,” Lt. Gov. Ron Ramsey, R-Blountville, who presides over the Senate, told majority-party lawmakers during a caucus meeting Thursday afternoon.

Both Ramsey and Senate Majority Leader Mark Norris estimate that as many as three-quarters of their caucus remains undecided on the Haslam plan. Among them are Jack Johnson of Franklin and Randy McNally of Oak Ridge, who chair powerful committees that will likely handle the resolution.

Republicans outnumber Democrats in the Senate by a tally of 28-5. It takes 17 votes to pass a measure in the Senate.

“We have members who are outspokenly opposed to the proposal,” Norris said at the Senate GOP caucus gathering. “There are other members here supportive of it. But most members are just in the middle with open minds.”

Norris, who has himself voiced reservations about Haslam’s plan, said he’s hopeful there’s a full and robust discussion about all facets of the proposal. He described Insure Tennessee as “very complicated” in the way it touches on numerous aspects of state and federal law, the Internal Revenue Code and previous developments in the history of TennCare, the state’s program for administering the federal Medicaid system.

“All those things interrelate,” said Norris, a lawyer from Collierville. “Regardless of which side of the issue you may find yourself on, all these issues could be very important, whether you are against it, whether you are for it or whether you are unsure which way to go.”

He added, “What we are trying to do is lay out a timely and orderly process to get everyone through it in the best way possible, so that you can truly say that you are representing your constituents.”

Norris said one of the goals is to avoid the accusation of passing legislation “and not knowing what is in it.”

“Nobody wants to be in that situation,” he said.

Insure Tennessee has been offered by the administration as a two-year pilot program, and it includes incentives for healthier lifestyles. It is designed to enable the state to draw down Medicaid expansion funding through the Patient Protection and Affordable Care Act to cover people making up to 138 percent of the poverty level — which could translate to more than 450,000 potentially eligible Tennesseans.

Slatery Joins Challenge to Obama Immigration Executive Order

Tennessee Attorney General Herbert Slatery, appointed to the position in September, took a step this week that is sure to win him popularity points with the Republican supermajority-controlled General Assembly.

Slatery announced Monday that the Volunteer State would be joining with 24 other states to sue President Obama over his recent executive order on immigration. “However frustrating and painstakingly long the federal legislative process may be, making law is the prerogative of Congress, not the executive branch,” Slatery said in a press release. He added that while Congress could “resolve” all of the issues raised by the executive directive by “timely enacting legislation,” the state shouldn’t “sit on the sidelines of this case.”

While the executive action was about immigration, Slatery said the lawsuit is “more about the rule of law and the limitations that prevent the executive branch from taking over a role constitutionally reserved for Congress.”

The executive order conflicts with existing federal law and replaces “presecutorial discretion” with a policy of “unilateral nonenforcement,” he said.

“Asking a court to review this issue is the prudent choice, especially when state resources will be taxed under the directives to provide benefits like unemployment compensation and health care,” Slatery’ statement said.

The executive order would affect about 4 million undocumented immigrants by halting the deportation of undocumented parents of citizens or permanent residents who have been here more than five years, as well as allowing immigrants over the age of 30 who were brought to the U.S. as children to qualify for deportation deferrals. Additionally, the action beefs up border security, allows for more visas for foreign investors and STEM degree holders and changes federal immigrant detention procedures.

In November, following the president’s announcement, state Rep. Andy Holt and state Sen. Mae Beavers filed a joint resolution to call on Gov. Bill Haslam to sue the president over his immigration action. However, at the time Slatery was hesitant to commit to joining other states in seeking legal action against the president, but said he would consider it.

Tennessee Lt. Gov Ron Ramsey praised the decision to challenge “the president’s unconstitutional action on immigration” made by Slatery, who was Haslam’s chief legal counsel prior to his appointment by the Tennessee Supreme Court.

“Barack Obama tossed aside not just  public opinion but key tenets of our constitutional democracy when he bypassed Congress to grant illegal immigrants defacto amnesty,” Ramsey said, and added he was “proud” Tennessee was joining the lawsuit.

Likewise, House Majority Leader Gerald McCormick agreed Slatery was correct in his decision to join the lawsuit on “the constitutional question of whether the president should have acted without congressional authority.”

When Obama visited Music City earlier this month to promote the new policy, he explained that he picked the Tennessee capital in part because the city has “one of the fastest-growing immigrant populations in the country.”

Speaking at the Casa Azafrán community center in Nashville, the president said the action he took was “a middle-ground approach” that “will make our immigration system smarter and fairer.” According to Obama, his action “isn’t amnesty or legalization or even a path to citizenship,” and only applies to a specific group of undocumented immigrants.

“What we are saying is that until Congress fixes this problem legislatively — and you have deep ties to this country and you are willing to get right by the law, and do what you have to do, then you shouldn’t have to worry about being deported or separated from your kids,” Obama said. He invited Congress to be involved in the process, as long as they “pass a bill that addresses the various components of immigration reform in a common-sense way.”

The GOP members of Tennessee’s congressional delegation have released statements sharply critical of both the president’s visit to Nashville earlier this month and his executive action, while the state’s federal Democratic representatives were more supportive.

One criticism many Republicans had for Slatery’s predecessor, Robert Cooper — legal counsel to former Democratic Gov. Phil Bredesen prior to his appointment in 2006, was that he had declined to join a multi-state lawsuit against the federal government over the legality of the Affordable Care Act. In fact, one reason members of the GOP wanted to see the three Democratically-appointed state Supreme Court justices unseated this August was to hold them accountable for Cooper’s decision not to join the Obamacare lawsuit.

However, while McCormick acknowledged to TNReport that Slatery likely had more conservative inclinations than his predecessor, he took his decision to join the lawsuit as “more of a constitutional question” than a sign of a difference in politics.

While the ACA actually passed Congress, McCormick said the president’s directive was different in that it “was just an executive action taken right after election day without the consent of the the people or the elected representatives of the people.”

Legislature Gearing Up for Tax Reform Debate

Tennessee Republicans are flush with even more power in the General Assembly after the 2014 general election, and members of the expanded supermajorities in both dens of the statehouse are sure that one thing’s for certain: there’s no time like the present to talk about tax cuts.

There’s some disagreement, though, about which ones to go after first.

The two biggest targets are the Hall tax on investment earnings and Tennessee’s highest-in-the-country sales tax.

While many of the Volunteer State’s conservative Republicans favor doing away with the Hall tax, some of the party’s legislative leadership have instead made populist arguments in favor chipping away at the state’s sales tax. Over the past several years since losing majority-party status, that’s been a priority as well for Democrats, who charge the tax hits Tennessee’s poor the hardest. And as pitiful as their numbers are in the Legislature, Democrats could play a role in helping shape the discussion, particularly in the House.

While some Republicans have in the past balked at discussing cuts to the state’s general sales tax — or the tax on food — due to fears that its reduction would be a potential step toward enacting a state income tax, Senate Majority Leader Mark Norris said he hopes a recently passed constitutional ban on taxing Tennesseans’ income would change the discussion.

“Every time since I’ve been here we’ve tried to have a discussion about the state’s revenue and expenses, people say ‘Oh, it’s Trojan Horse for the income tax,'” the Collierville Republican told reporters last week. However, the overwhelming passage of Amendment 3 on Nov. 4, a change in the Tennessee Constitution that expressly prohibits the enactment of income taxes at the state or local level, “should silence those critics,” said Norris.

In the wake of two-thirds of Tennessee voters approving the amendment, Republican state Sen. Brian Kelsey, R-Germantown, filed legislation earlier this month aimed at, over the next three years, entirely phasing out the Hall Income tax — a six percent tax on income received from investments over $1250 a year for individuals making more than $33,000 a year.

In response, Norris and state Rep.Gerald McCormick — the majority leaders in both legislative chambers, who routinely carry legislation for Republican Gov. Bill Haslam — filed a proposal to reduce the state sales tax from 7 percent to 6.75 percent.

Getting rid of the Hall Tax would cut about $260 million from the annual budget. Likewise, McCormick told the Times Free Press, the proposed sales tax cut would reduce annual state revenue by about the same.

Norris referred to his proposal as one of “the bookends” of the greater tax reform discussion.

“The bill was filed, so I filed a bill. Do you want to cut $260 million in revenue for these people, or $260 million revenue for all people? It sort of frames the issue,” Norris said last week.

But while two of the state’s top fiscal conservative groups generally support reducing the tax burden of all Tennesseans’, they’re standing firm on their particular support for specifically doing away with the the Hall tax first — and they say that ought to be lawmakers’ first priority.

Tennessee’s chapter of Americans for Prosperity is “committed to assisting in the repeal of the Hall Income Tax,” said the group’s spokeswoman, Tori Venable. “Repealing this regressive tax will help our state as a whole, not just those who will benefit from the tax cut. The assurance of the Hall Income Tax repeal will help our state recruit more businesses, increasing job growth and economic output,” she wrote in an email to TNReport.

Lindsay Boyd, policy director for the Beacon Center of Tennessee, a 10-year-old Nashville-based free-market think tank, told TNReport via email that, first and foremost, the Hall Tax has to go. It “deters Tennessee families from settling in our state and small business entrepreneurs from investing in our economy,” Boyd said. She added that chipping away at the sales tax is a good idea, but it’s not going to show immediate results and definitely shouldn’t detract from the Hall tax discussion.

“A minuscule cut to the sales tax, as proposed by Rep. McCormick and Sen. Norris, may be a discussion we should resume once we free Tennesseans from the worry of having their hard earned dollars punitively and heftily taxed by the Hall tax on investment income- remembering that 40 percent of those who pay the Hall income tax earn less than $50,000 per year,” Boyd said.

Last session’s House GOP Caucus chairman, Franklin Rep. Glen Casada, told TNReport he favors prioritizing Hall tax elimination. Eliminating it as quickly as possible is an “excellent idea,” he said, because it would attract senior citizens to the state.

“It’s a wise, prudent financial move,” said Casada,who added that it’s unfair to ding people who’ve “played by the rules” and have saved money for retirement — and are not relying on government assistance.

Casada said he favors reducing taxes in general — but wants to begin with getting rid of the Hall tax, “and then start cutting sales tax on food.”

For an alternative perspective — or another tax-cutting idea to add to the mix — look no further than the House majority leader.

McCormick told TNReport this week that he thinks franchise and excise taxes should be looked at too. “I just think we need to look at all of them at the same time, and then decide if we can afford to cut taxes who we want to cut them for,” he said.

McCormick added that he was concerned cutting the Hall tax would “disproportionately” benefit higher income Tennesseans. The Legislature should “look at something that might also help those that are on the bottom rungs of the income levels.”

Haslam has suggested any legislators interested in cutting their constituents taxes should also be looking for cuts to make in state expenses. “I believe in cutting taxes. We’ve cut taxes since we’ve been here. We also believe in balancing the budget. And I think it’s important when you’re talking making any changes to revenue in the state, what are the commensurate changes you’re going to make in the expense structure as well?” Haslam said earlier this month.

Governor Selling Free College to High School Seniors

With summer winding down and school kicking off, Gov. Bill Haslam is on a statewide tour promoting the benefits of higher education to seniors who’ll graduate high school this year.

This week Haslam is traveling the Volunteer State  pitching his “Tennessee Promise,” a new program offering two years of community college or technical school free to any student interested. The governor says the initiative, which the state Legislature overwhelmingly OK’d last spring, is unique to Tennessee.

“Every Tennessean, if you graduate from high school, we will ensure that you can go to community college for two years — or to technology school — absolutely free of tuition and fees,” Haslam told a gymnasium packed with students at Red Bank High School near Chattanooga Tuesday.

This year’s deadline for sign-up is Nov. 1, Haslam said. The governor told reporters after the event that he’s still running into high school seniors who’re unaware the program exists, which is one of the reasons he’s out talking it up.

The Tennessee Promise is part of Haslam’s “Drive t0 55” initiative, which aims to increase the number of high school grads in the state with some form of higher education certificate to 55 percent — the percentage of jobs in the state that will require some sort of degree in about 10 years. Currently the number of degree-holding Tennesseans is at 32 percent, Haslam said.

“We’re trying to increase the whole spectrum of qualified candidates in the workforce in Tennessee,” he said.

The governor said big companies like Volkswagen and mom-and-pop shops alike have shared similar concerns with him about Tennessee — namely, that the Volunteer State needs to do a better job prepping skilled laborers for the job market.

Haslam noted to the students, though, that even though the two years of school they’re being offered is “free” to them financially, they’re going to be expected to produce results.

“Your obligation is to complete high school, fill out the financial aid forms, work with a mentor — which we will provide you, who will help you with all of that — and then perform eight hours of community service,” Haslam said.

According to the program’s website, Tennessee Promise is a “last-dollar scholarship, meaning it will cover college costs not met from Pell, HOPE, or TSAA.”

The money to fund the “last-dollar” program came from reserve funds from the Tennessee Lottery, initially created for the HOPE Scholarship, which was aimed at high-achieving students.

“It was helping some students, but not enough to where we could get to a larger percentage of Tennesseans having a degree,” Haslam said after the event. “So, we took some reserve money that had built up in the lottery fund, and used that to form an endowment. So, this is a promise, the money’s not going to go away, we’re only spending the interest off of that endowment.”

When the free tuition plan was announced earlier this year, there were some concerns that it could hurt four-year higher education institutions. However, Haslam said he’s confident the program will “increasing the size of the funnel opening” for kids to go to school.

More young adults headed to post-secondary institutes means more graduates, which translates to a better-skilled and better-educated workforce that’ll be more attractive to companies thinking about moving here, he said.

Haslam added that the trend he expected to see is students going to a community college for two years, and then continuing on to a four-year school.

Tennessee House Majority Leader Gerald McCormick, a Chattanooga Republican and the sponsor of the legislation in the General Assembly’s lower chamber, told reporters after the event that the Tennessee Promise “is going to be the highlight of the governor’s first term,” and that he hopes to see it built-on over the next four years.

“It was the most important bill I believe I’ve ever moved,” McCormick said.

Haslam, House Leaders Release Statements on State Rep. Lois DeBerry’s Passing

Statement from the Office of Tennessee Gov. Bill Haslam; July 28, 2013:

“Coming in as a new governor, Lois quickly became one of my favorite people on Capitol Hill because of her wit, charm and dedication to her constituents. Lois was a history maker, a wonderful woman, a great legislator and a true friend. I will miss her.” — Gov. Bill Haslam.

Statement from the Office of Tennessee Speaker of the House Beth Harwell; July 28, 2013:

“Lois DeBerry dedicated her life to service. From the Civil Rights Movement, to becoming the first female African-American Speaker Pro Tempore, Lois always made public service a priority. The impact she has had on this great state, the lives of countless Tennesseans, and people all across the country is astounding. She certainly made her mark on history, and it was an honor to know her and serve alongside her in Tennessee General Assembly. I valued our friendship, and will deeply miss her sage advice, and her remarkable sprit and smile. Her dedication to children’s issues, women’s issues, and criminal justice reform have resulted in a better Tennessee. My thoughts and prayers are with her family.” — Speaker Beth Harwell

“Lois DeBerry was my friend and my mentor. From my first day on the hill in 1994, she was someone I could turn to in every situation. She taught me the importance of working across party lines to get things done for the state, but also to never be afraid to stand up for a cause–even if sometimes you stand alone. Lois was a fighter. She always fought and fought hardest for children. She fought for those on the margins of society and for the city of Memphis which she loved so dearly. Most recently she waged a courageous battle against cancer, inspiring everyone with her upbeat attitude and her determination to survive. I loved Lois DeBerry. Her absence will leave a hole in the House that no one can fill; we are a better state for the service she provided. God rest her soul and be with her family during this difficult time.” — Leader Craig Fitzhugh

Statement from the Office of Tennessee House Majority Leader Gerald McCormick; July 28, 2013:

“I am deeply saddened to learn of the death of Speaker Pro Tempore Emeritus Lois DeBerry, a legendary figure in Tennessee political history. I had the distinct privilege to serve with Lois in the House of Representatives for 9 years, and I enjoyed our friendship. Her knowledge, experience, and delightful personality will surely be missed. My thoughts and prayers are with her family during this difficult time” — Majority Leader Gerald McCormick

Haslam Signs Bill Specifying Definition of ‘Criminal Gang Offense’

Press release from the Office of Tennessee Gov. Bill Haslam; June 26, 2013:

MEMPHIS – Tennessee Gov. Bill Haslam today held a ceremonial bill signing in Memphis for legislation that rewrites and simplifies the criminal gang offense enhanced punishment law.

Gang-related crimes are of increasing concern across Tennessee, in the state’s rural and urban communities, and the bill, HB 196/SB 202, changes the definition of “criminal gang offense” from a vague and broad definition to a specific list of offenses that will make it easier for prosecutors to seek a greater sentence.

“The good news is the number of reported violent crimes in Tennessee is decreasing. Yet, we continue to have one of the highest violent crime rates in the nation,” Haslam said. “This legislation gives prosecutors another tool to fight criminal gang activity and help make Tennessee safer.”

According to the Tennessee Bureau of Investigation, through May of this year murders are down almost 22 percent, robberies have decreased almost 17 percent, and aggravated assaults have declined more than 20 percent compared to 2010.

The offenses included in the legislation are crimes that Tennessee communities combat every day, such as robbery, carjacking, and drug possession with intent to sell, among others. Under this new law, if one of the defined offenses is committed, prosecutors must also prove the defendant committed the crime as a part of a criminal gang and must prove the defendant is a member of the criminal gang to enhance the sentence.

The gang enhanced-sentencing bill is one of several pieces of legislation introduced by the administration to address the challenge of gang violence in Tennessee. Other laws enacted since 2011 create tougher sentences for certain types of crimes committed by three or more acting in concert, tougher sentences for convicted felons who persist in illegally possessing guns, and mandatory sentences for repeat domestic violence offenders where physical injury is involved.

Senate Majority Leader Mark Norris (R-Collierville), House Majority Leader Gerald McCormick (R-Chattanooga) and State Rep. Barrett Rich (R-Hickory Withe) sponsored the legislation in the General Assembly.

Workers’ Comp Reform Receives Haslam Signature

Press release from the Office of Tennessee Gov. Bill Haslam; May 7, 2013:

CLARKSVILLE – Tennessee Gov. Bill Haslam today held a ceremonial bill signing at Clarksville Foundry, Inc. for his workers’ compensation reform legislation, HB 194/SB 200, approved by the General Assembly.

Workers’ compensation premium rates for employers in Tennessee are higher than the national average and higher than all of Tennessee’s bordering states, and the state is one of only two that adjudicated workers’ compensation claims in the trial courts, often delaying benefits to employees and producing inconsistent results.

The governor’s bill simplifies the system while allowing employees to receive benefits faster and return to work sooner, bringing increased predictability to the business environment.

“As I traveled the state during my first two years in office, I heard consistently from Tennesseans that reforming workers’ compensation would be a significant step toward improving our business climate and growing jobs,” Haslam said. “Our legislation brings clarity and fairness to the system and builds on our ongoing efforts to make Tennessee the No. 1 location in the Southeast for high quality jobs.”

The legislation

  • Provides disability benefits to an injured worker quicker;
  • Improves the quality of medical treatment;
  • Provides a clearer standard for causation and a neutral application of the law;
  • Allows employees to file claims in a court within the Division of Workers’ Compensation rather than trial court;
  • And creates a new ombudsman program in the division to help unrepresented employees and employers receive the assistance they need.

The bill was sponsored by Senate Majority Leader Mark Norris (R-Collierville), Sen. Jack Johnson (R-Franklin), House Majority Leader Gerald McCormick (R-Chattanooga) and Rep. Kevin Brooks (R-Cleveland).

Governor’s Workers’ Comp Revamp Chugging Forward

Gov. Bill Haslam’s pro-business workers’ compensation reform legislation sailed through committees in the House and Senate last week and is headed for the next round of hearings in both chambers this week.

Rep. Jimmy Eldridge

Rep. Jimmy Eldridge

Rep. Jimmy Eldridge, chair of the House Consumer and Human Resources Committee, said the “Workers’ Compensation Reform Act of 2013” must pass through four more committees before reaching the House floor.

“I’d like to see this bill go to give all the members of the Tennessee General Assembly on the House side the opportunity to engage in the conversation and good debate on this important piece of legislation,” said the Republican from Jackson.

Despite its passage, it was clear not every member of Eldridge’s committee thinks the bill addresses the issues businesses say are driving costs upward.Tennessee workers' comp bill

“Where we’re messing up is in our medical costs. This bill doesn’t address that at all,” Democratic Caucus Chair Mike Turner told the committee. “I don’t care what they tell you, they’re not telling you the whole truth about this bill.”

House Bill 194 passed the House Consumer and Human Resources Committee along party lines, 7-3. Its companion, SB 200, sailed through the Senate Labor and Commerce Committee, 9-0.

Jeff Bates, managing partner of TA Staffing in Nashville, and Brian Hunt, general manager of Southern Champion Tray in Chattanooga, both addressed the House committee in favor of the reforms.

Bates said 10 percent of the claims his company sees take 75 percent of money paid out for workers’ comp.

“You have to protect the truly injured worker, but at the same time you can’t have lingering claims controlling and bogging down the system to the point where it costs three to four times as much to settle a claim in Tennessee as it does in other states,” Bates said.

Hunt said 70 percent of the injuries at his company are “categorized as strains and sprains. They also account for 79 percent of our compensation dollars.” He noted that over the past five years the company has shelled out indemnity payments totaling nearly $1 million.

Rep. Kevin Brooks, who presented the bill on behalf of House sponsor Rep. Gerald McCormick of Chattanooga, said these issues emerged from a two-year study:

  • Tennessee’s rates are higher than neighboring states.
  • Employees are being harmed by lengthy delays in the current system.
  • Employers and employees are having trouble “navigating what is a complex and difficult workmans’ compensation system.”

Rocky McElhaney, a Nashville attorney who spoke on behalf of the Tennessee Association for Justice, said higher costs were a “red herring” to distract from harm to workers.

Rocky McElhaney

Rocky McElhaney

“Since the 2004 reforms, benefits paid to injured workers in Tennessee have already decreased 41 percent,” McElhaney said. “We’re paying workers less on average than our competing states.”

McElhaney said payments to physicians are actually what’s driving costs. He said state statistics showing how long cases take to adjudicate were skewed because only a sampling of cases were used.

In 2012 cases took 166 days start-to-finish on average, down from 309 days in 2008, McElhaney said, citing data from the Administrative Office of the Courts.

Rep. Glen Casada disputed the claim that the bill is heavily skewed toward employers.

“We as legislators must look at the macro of this, which is when Goodyear leaves, and their number one statement on why they left was workmans’ comp costs,” the Franklin Republican said. “All of a sudden, we’re not looking at dozens, we’re looking at 1,900 that are no longer here in Tennessee working.

“If that were to have a ripple effect, Bridgestone, Nissan – and I could go down the list – all of a sudden thousands of folks that work no longer have jobs in Tennessee. That is my concern.”   

HB 194 goes before the House Government Operations Committee Tuesday. SB 200 goes before the Senate Government Operations Committee Wednesday.

Amelia Morrison Hipps may be reached at amhipps@capitolnewstn.com, on Twitter @CapitolNews_TN or at 615-442-8667.

Long Shadow of TennCare Cuts Creeps into Medicaid Expansion Debate

There’s worry among critics of Obamacare that the federal government can’t be trusted long-term to faithfully fund its share of expanding state-run medical insurance programs for the poor, as presently advocated by the president.

This concern perhaps looms larger in Tennessee than in other states. It was not that long ago that Gov. Phil Bredesen, faced with ballooning health care costs, starting cutting Tennesseans from TennCare, the state’s Medicaid program.

In the first wave, 170,000 people were cut from the rolls. Over the course of Bredesen’s administration, the state eliminated coverage for another 100,000 people with disabilities. When you add the state’s eligibility restrictions that were put into place, ultimately 350,000 people in Tennessee were cut from TennCare.

Some state elected officials, such as House Minority Leader Craig Fitzhugh, D-Ripley, have said that embracing President Obama’s call to expand the TennCare/Medicaid program is the moral thing to do.

“It would be frankly nearly irresponsible — certainly, morally irresponsible — not to expand the Medicaid population, especially because it is in fact going to be cost effective to Tennessee and Tennesseans,” Fitzhugh said recently.

But others remember the long shadow of cutting so many people from TennCare. If Medicaid is expanded in Tennessee and, once again, the program becomes unaffordable, will state officials have to rip hundreds of thousands of people off the rolls again?

“We believe it’s immoral to expand,” said Justin Owen, president of the free-market Beacon Center of Tennessee. “If history is any indication, TennCare will become so bloated, people will have to be cut from the program.”

Owen fears making so many Tennesseans dependent on a program and then “pull the rug out from under them when they can least afford it,” he said. “Go talk to the several hundred thousand people who had to be removed, about the strife they went through. It’s not like we’re speaking about a theoretical.”

And even with the federal government footing the bill with the taxpayer dollars it collects, costs still may be an issue.

Gov. Bill Haslam told reporters last week that despite those who argue that expanding Medicaid seems like a “no brainer” given that the federal government is currently promising to to fund the lion’s share of the expansion costs, there is still the issue of how the state will pay its share.

“The problem is that our budget is slowly getting eaten up by TennCare,” said Haslam. “Prior to (Gov. Phil Bredesen) cutting the rolls, the TennCare budget was about 30 percent (of the state budget.) He did everything he could to try and reform the program, couldn’t, so he just had to cut the rolls. That process took it down to about 24 percent of the budget.”

“We’ve already crept back up to where it is 26 or 27 percent of the budget,” Haslam added. “When you do that, things get squeezed out.”

Haslam said $900 million to $1 billion the state will have to dig up for its share of of Medicaid expansion to match the federal government’s $10 billion will result in belt-tightening in other areas of state government, such as higher education, prisons and childrens’ services.

“I want to find out how much it’s going to cost the state,” House Majority Leader Gerald McCormick, R-Chattanooga told TNReport. “I know for the first three years the federal government is supposed to pay for it all and if we can trust them to do that, that would be helpful.”

And President Obama’s expansion plan may not be the last.

History shows that Congress has expanded Medicaid in ways large and small since 1967 that required states to broaden and deepen coverage.

For example, in the 1980s, expansions included:

+ Medicaid covering children whose low-income families did not receive direct federal cash assistance. Pregnant women and their infants would get covered.

+ Undocumented immigrants and the homeless getting emergency care through Medicaid.

+ The Medicare Catastrophic Coverage Act, an expansion of Medicaid to cover long-term care for the elderly and disabled not already covered by Medicare.

Some expansions in the 1990s included:

+ Making it easier for nursing homes to recover payments from the estates of Medicaid beneficiary’s estates.

+ Requiring states to cover families under higher eligibility thresholds.

+ Allowing states to cover working disabled individuals with incomes above 250 percent of federal poverty level.

But it will be rural hospitals that will likely on the front line in the 2013 debate over Tennessee Medicaid expansion.

A University of Memphis health care study released last winter argued that Obamacare will produce an economic windfall to the state. Medicaid expansion advocates like Fitzhugh say more federal Medicaid dollars are needed to help financially sustain health care facilities outside urban population hubs.

“You’re talking about rural hospitals,” said Fitzhugh. “An expansion of Medicaid will allow people to have insurance, will allow them to know that if they get sick, they have some kind of coverage.

Haslam said he’s asking hospitals in Tennessee to estimate the costs and benefits of expansion — and of sticking with the status quo — to the operation of their facilities.

“Right now, if somebody walks into a hospital and they don’t have TennCare and the hospital takes care of them, they get reimbursed to a degree for that uninsured person,” said the governor.

Haslam said he isn’t likely to make a decision on whether support expanding the state’s low-income health insurance program, TennCare, until after his administration has more thoroughly investigated the pros and cons of the matter — and that decision may come after the legislative session.

“One of things that we want to do is make a thoughtful decision about the impacts,” Haslam said.

Trent Seibert can be reached at trent@tnreport.com, on Twitter (@trentseibert) or at 615-669-9501.