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Haslam Rejects Federal Dollars This Year, Offers ‘Third Option’ on Medicaid

Gov. Bill Haslam announced the state will not expand TennCare this year as called for by the federal health care law. The governor instead outlined what he called “a third option” for helping Tennesseans get coverage.

Haslam said neither a flat-out refusal to enlarge TennCare based on problems with the law nor an open-armed embrace – “expanding a broken system” – was the right path for Tennessee.

Under Haslam’s proposal, which he says the federal government will not agree to, payments to health care providers would be based on quality of care rather than just volume of services provided, and patients would have co-pays “so the user has some skin in the game when it comes to health care incentives.”

The state could also backtrack if the expansion of TennCare, the state’s version of Medicaid, wasn’t working.

“Our plan would have a definitive circuit-breaker or sunset that could only be renewed with the General Assembly’s approval based on when the amount of the federal funding decreases,” Haslam said Wednesday, speaking before the General Assembly.

Haslam also offered a critique of the law (Patient Protection and Affordable Care Act of 2010).

“To me, the scandal of the Affordable Care Act is that it doesn’t significantly address cost or alignment reform,” Haslam said. “And that’s what Washington does – it looks at a complex problem, realizes that some people aren’t going to like the changes, and as a solution, decides to spend more money.”

Read the full speech here.

 

Haslam Rejects State-Run Exchange

Siding with Tea Party activists and GOP lawmakers, Gov. Bill Haslam said Monday that Tennessee would not run its own insurance exchange under the federal health care law.

But Haslam said he wasn’t bowing to political pressure.

“Believe me, the politics haven’t changed,” the Republican governor said after a speech at a Rotary Club of Nashville luncheon at the Wildhorse Saloon on Second Avenue. “I knew what the politics were of this decision seven or eight months ago. I can assure you: while we listen to everybody, in the end we made what we think is the right decision.”

Haslam said that as late as Friday he would have considered moving forward with a state-run exchange if federal officials “could soothe some of our fears.”

If Haslam had said yes to a state-run exchange, he would have been the only southern Republican governor so far to have done so.

But politics, Haslam said, “had zero to do with our decision.”

Until Haslam’s decision, a debate had been raging in Tennessee over whether state officials should support the federal health insurance exchanges outlined in President Obama’s healthcare overhaul or disavow state-level cooperation and let federal officials run the exchange.

The Tea Party held a rally last week urging Haslam to ‘Just Say No’ to Tennessee taking ownership of an exchange. Few if any GOP legislators have expressed any willingness to support a state-run exchange.

“As caucus chairman I helped get six new guys elected to the Senate, and the first bullet point on all their mail pieces was that they could not vote for or support Obamacare,” Sen. Bill Ketron, R-Murfreesboro, told TNReport last week. “So you can’t expect them to come back in January and vote for it.”

Sen. Ken Yager, R-Harriman, said he had little choice but to fight against a state-run exchange if he was interested in staying on the right side of popular opinion in his district.

“The overwhelming majority of my constituents is opposed to it,” said Yager.

The exchanges are supposed to be up and running by Jan. 1, 2014.

Haslam did say it’s possible that Tennessee might be able to take over its exchange at some point in the future.

“To work together with [the federal government] in this way we have to be convinced that they are literally ready to do it,” Haslam said. “In the last two or three weeks since the original deadline they gave us, they’ve issued us … 800-plus pages of rules — and those are just drafts. So just think about what that means: That was after the original deadline, they’ve given us 800 pages of something that was passed two years ago.

“I’m not being political. I honestly think they don’t have this planned out.”

Republicans legislative leaders applauded Haslam’s decision.

“It would be dereliction of our duty as public servants to take on as a partner a federal government that is clearly out of its depth,” Lt. Gov. Ron Ramsey, R-Blountville, posted on Facebook. “I’m proud to stand with Governor Haslam as we continue to find ways to minimize the impact of this insidious federal law on the citizens of Tennessee.”

And House Speaker Beth Harwell, R-Nashville, said in a statement: “As I have stated many times before, I am vehemently opposed to Obamacare and the mandates that come along with it. The decisions regarding health care are best left to each Tennessean and their doctor—not a massive bureaucracy that is sure to send this country further into debt.”

Democrats chided Haslam for foregoing the state-run exchange.

“I’m disappointed to see the Governor pandering to the far right of his party rather than doing what is best for the people of Tennessee,” House Democratic Leader Craig Fitzhugh said in a statement. “I would hate to know that I had a 70 percent approval rating statewide and couldn’t get my own party to support my initiatives.”

See the letter Gov. Bill Haslam wrote to Health and Human Services Kathleen Sebelius by clicking here.

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

Tea Party Marshaling Anti-Obamacare Muster

Members of the Nashville Tea Party are planning a rally outside the state Capitol at noon Wednesday. Their hope is to put GOP lawmakers and Gov. Bill Haslam on clear notice that grassroots conservatives want Tennessee to disavow state-level cooperation and support for the federal health insurance exchanges outlined in President Obama’s healthcare overhaul.

“We’re calling it the ‘Just Say No’ rally, and we’re trying to send a message to the governor,” said Ben Cunningham, leader of the Nashville Tea Party. “We’re encouraging him to just say no to a state-run exchange and let the federal government own this disaster.”

Cunningham said he expects people from all three of Tennessee’s Grand Divisions to attend.

The Patient Protection and Affordable Care Act mandates that states choose between creating a state-run exchange where individuals may purchase health insurance eligible for federal subsidies or allowing the government to create a federally run insurance exchange.

Either way, those exchanges are supposed to be up and running by Jan. 1, 2014.

Haslam continues to say he has not made a decision on what course his administration will formally set — even after the federal government extended the deadline to make a decision to Dec. 14. Haslam and other state officials have complained that the federal government has failed to answer key questions as to how state-run exchanges would work.

Many governors, such as Rick Perry in Texas and Jan Brewer in Arizona, have said they will not set up a state-run exchange.

Tennessee tea partiers “would like Gov. Haslam to join with those governors and say, ‘No, we’re not going to be a branch office of the federal government,’” said Cunningham. He said a petition to that effect is circulating and “is getting a very good response.”

“If they (the federal government) want to implement this program, have at it, but our experience in the past with Medicaid, with education funding, is always a bait-and-switch situation where they fund much of the expenditures on the front end, and then the states are left with huge expenses on the back end,” Cunningham said. “There is some indication now that the phone calls and the emails that the governor is getting are overwhelmingly against a state exchange.”

The governor has indicated that while he opposes Obamacare in general, and he thinks the health exchanges are a bad idea overall, he’d prefer it if the state run them rather than the feds. However, high-ranking Republicans in both houses of the state’s General Assembly have indicated that support is lacking among the majority party for the state taking on that responsibility.

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

Little Statehouse GOP Support for State-Run Insurance Exchange

Gov. Bill Haslam now has another month to decide and declare whether Tennessee intends to manage its own so-called medical insurance “exchange” as outlined in the controversial 2010 federal health care law.

After prodding from the Republican Governors’ Association, the Obama administration agreed late Thursday to give states more time to decide if they want to manage their own government-run health coverage marketplaces, or hand the duty over to the federal government.

“It is clear that putting in place the new programs you championed will be an enormous strain on state governments and budgets, as well as the federal government,” the governors wrote. “From the financial obligations and complex technicalities to ensuring the healthcare workforce and infrastructure will be in place to meet the new demand, the timeframe and many of the provisions in the (Patient Protection and Affordable Care Act) are simply unworkable.”

States now have until Dec. 14 to make their respective Affordable Care Act health-exchange decisions.

“We are hopeful in the coming weeks we will receive answers from Washington to the many questions we’ve asked in our effort to have a full picture of the future of exchanges in Tennessee,” Haslam said in a statement issued Friday morning.

Haslam has for a while been saying he favors the state running its own exchange. Haslam indicates he believes it would be better for insurance companies doing business here to answer to Tennessee regulators, and that a state-run exchange would better serve the unique features of the state’s health care system.

“Ultimately our citizens, through insurance companies, are going to pay for the cost of running that exchange,” Haslam said on Tuesday. “Who do we think can run it cheaper, us or the federal government? I’ll bet on us every time.”

But members of Haslam’s party in the Tennessee Legislature are anything but enthusiastic about the prospects of doing the federal government’s bidding with respect to the ACA.

In the wake of the president’s re-election, Tennessee faces a difficult policy decision  surrounding the subsidized insurance marketplaces mandated under Obamacare, the governor said this week. The three options include the state setting up and running the exchanges, letting the federal government do it or pulling together some kind of a hybrid model wherein state and federal bureaucracies share responsibility for creating or managing a system.

“Let me be clear, I oppose the Affordable Care Act,” Haslam said today. “Unfortunately, the Supreme Court upheld a majority of it this summer, including the provision that states are required to either participate in a federal exchange or establish their own.”

Both parties’ leaders in the Legislature agree, as far as it goes, that the state is indeed better suited to run the Tennessee exchange than the federal government.

“Government closest to the people governs best, and that should be a guiding principle as we implement the new health care law,” Senate Minority Leader Jim Kyle, D-Memphis, said this week. House Minority Leader Craig Fitzhugh, D-Ripley, told TNReport.com he believes a state-run health exchange system “would give us a little more control, and I think Tennessee would probably like to have that.”

However, GOP lawmakers, who overwhelmingly control both chambers of the Tennessee General Assembly, are expressing doubt that the federal government can be trusted to honor the integrity of whatever systems states develop on their own.

The key details about how the exchanges are theoretically supposed to operate have yet to trickle down through the federal regulatory pipeline, which has only added to the sense of uncertainty, and Republican legislative leaders believe the unpredictability is just getting started. A prevailing sentiment among GOP state representatives and senators is that Obamacare planners in Washington clearly anticipate keeping the states on short leashes, and that federal intervention into the state-run systems will be commonplace as the administration attempts to micromanage.

Republicans suspect that when all is politically said and done, the “state-run” exchange will be so laden with federal red tape, mandates and market manipulation that Tennessee would be better served steering clear and letting the feds drive from the outset.

Glen Casada, chairman of the House Health and Human Resources Committee, said that over the past few months he’s reversed his opinion on who should run the health insurance exchanges. Casada, R-College Grove, said he used to think states ought to handle them, but no longer.

“I just cannot see a reason to implement a state exchange when the (U.S.) Health and Human Services Department will not commit to us on what we can do exactly, and for how long,” Casada told TNReport Wednesday. “If the feds came out and were very clear on what we could and could not do, with guarantees that we could keep doing what we wanted to do, you would probably see some Republican House members interested (in a state-run exchange). But under the current criteria it looks like we have to operate under, I don’t think you are going to find too many in the House Republican caucus interested.”

Skepticism and frustration pervades the upper-chamber GOP caucus, too.

“The federal government has put the state of Tennessee between a rock and a hard place on the issue of health care exchanges,” said Senate Speaker Ron Ramsey, R-Blountville. “The Obama administration has refused to answer questions and provide information necessary to make decisions by its arbitrary deadline.”

Ramsey, the state’s lieutenant governor, added that the Haslam administration is going to need a stamp of approval from the Tennessee General Assembly if it decides that setting up a state-run system is the best way to go.

“No state exchange can be implemented without the consent of the Legislature,” said Ramsey. “This issue is not going away. The Republican majority will continue to do what we must to keep all options open to minimize the impact of this insidious federal law on the citizens of Tennessee.”

Sen. Mike Bell, chairman of his chamber’s Government Operations Committee, said he has no plans right now to support any sort of state-run exchange — and thinks he’s by no means alone in the caucus.

Bell, R-Riceville, said he is “still holding out hope” that Republicans in Congress can roadblock funding for Obama’s health care law “and thereby delay or possibly even kill it at the federal level.” Bell said resistance by the states could also force the feds to abandoned their plans.

“The very weight of the responsibility for setting up that bureaucracy to run 20 or 30 state exchanges will be so heavy the federal government won’t be able to do it,” he said. “I hold out hope — now, it’s a faint hope, but I hold out hope — that there’s something that still could stop this.”

House Democrats on Friday jabbed at Haslam to quit stalling and set a course for the state.

“The Governor has had ample time to decide whether or not he wants to establish a Tennessee plan for a Health Insurance Exchange,” Fitzhugh said in a caucus release. “Now is not the time for more delays, now is the time to create an open process that brings all interested parties to the table, Democrats, Republicans, consumer advocates, insurance companies, small businesses and others, to start deciding what this Tennessee Health Insurance Exchange will look like.”

Medicaid Expansion’s 5-Year Price Tag: $200 Million

An expansion of taxpayer-financed health insurance for the poor as prescribed by Obamacare would cost the state nearly $200 million through 2019, the state’s top TennCare official said this week.

And in each year after that, the expansion would cost $100 million or more, TennCare Director Darin Gordon said during a state budget hearing for his agency. The Haslam administration is deciding whether to enlarge the state’s Medicaid program by lifting eligibility to as high as 138 percent of the poverty level — or about $31,800 for a family of four.

The administration is also weighing whether the state should run its own insurance exchange, an online comparison tool to buy and receive subsidized health insurance, or allow the federal government to run an exchange for Tennesseans. The deadline to decide is Friday.

Both questions stem from the Patient Protection and Affordable Care Act, signed into law two years ago. Its major provisions kick in in 2014, but states are in the process of planning implementation now.

The question of state-based or federal exchanges largely turns on whether the state wants to retain control over what plans would be on the menu and the costs of administering the exchange, though officials said questions still surround the nuts-and-bolts requirements for an exchange.

Under a federal exchange, “they’re going to decide what the offering is,” Gov. Bill Haslam said, “so they could have the ability to just pick the national insurers, the six or seven folks that offer national coverage. And regionals and everybody else would never be on the menu.”

Beyond health care reform, Gordon outlined $164.8 million in cost increases to state taxpayers for fiscal year 2014. More than two-thirds of that amount is based on inflation and expected enrollment in TennCare and CoverKids, a state health insurance program for children 18 and younger.

This year, the Health Care Finance and Administration agency has a $9.6 billion budget, with $3.05 billion coming from state taxpayers. The agency oversees TennCare and certain other health insurance-related programs.

Harwell: Widespread Hunger in TN House for Another Slice Off State’s Fat Grocery Tax

Lowering the sales tax on food, overhauling workers’ compensation, the possible expansion of Medicaid in Tennessee and school vouchers will likely be top topics for debate, state House Speaker Beth Harwell said Thursday when discussing the GOP’s 2013 legislative agenda.

“I’ll think we’ll make another move to lower the sales tax on food in the state,” the Nashville Republican said, pointing to Gov. Bill Haslam’s plan to lower the tax bite to 5 percent — equal to about $9.60 less in taxes for a household in a year, based on average spending of $3,838 a year for groceries. State lawmakers cut the rate from 5.5 percent to 5.25 percent this year.

“Workers’ comp is something the governor is probably going to have on his agenda,” Harwell said. “And we’ll see a lot of other legislation coming from individual members, I’m sure.”

Regardless of the issues, it’s all but certain that the GOP will have its way, with both the Senate and the House enjoying supermajorites — the ability to pass legislation without a single Democratic vote — and Republican Bill Haslam in the governor’s office.

“Our Republican caucus is as united as I’ve ever seen it,” Harwell said.

That’s not to say that Tennesseans won’t see some fireworks from Democrats. Issues such as school vouchers and charter schools will largely affect the state’s large urban areas that have strong Democratic control, and certainly Democrats will make a way to have their voice heard.

Harwell did not take a position on either vouchers or an expansion of Medicaid.

“The whole issue of vouchers is one that the legislature will spend a considerable amount of time debating and discussing,” Harwell said.

On Medicaid: “My first-blush reaction is that I’m not in favor of expansion. However, when you look at the numbers there is some justification financially as to why we might want to expand it.”

Trent Seibert can be reached at trent@TNReport.com on Twitter at @trentseibert and at 615-669-9501.

Obamacare Adversary Calls for More Patient, Doctor Control

A prominent national free-market critic of the federal Affordable Care Act laid out his vision for “curing” America’s “health care crisis” during a private event in Nashville Wednesday hosted by the Beacon Center of Tennessee.

The event was closed to the media, but Goodman spoke with TNReport for a few minutes before the event.

“The biggest problem with the health care market, unlike other markets, is that we have completely suppressed normal market forces,” said John C. Goodman, who leads the National Center for Policy Analysis, a group that promotes private-sector alternatives to government programs and regulations. “As a consequence no one ever sees a real price for anything … and we have a bureaucratic, dysfunctional system.”

The way out, Goodman says, is to liberate the consumer and give patients more control over their own health care spending.

Goodman says changes to the healthcare landscape are possible and points to a recent innovation at Walmart as an example. Earlier this month Walmart announced a program that offers workers heart, spine, and transplant surgeries with no expenses for the worker — as long as the surgery is performed at one of six hospital systems across the U.S.

“That’s an example of an employer doing something pretty radical to step outside the normal, third-party payer system,” he said.

He also said that government requiring individuals to buy insurance opens the door for special interests to take advantage.

“Once you start specifying what the individual has to buy, then all the special interests come in, as they did in Massachusetts. Then you’ll get the acupuncturists, the in vitro fertilization folks and the naturopaths,” Goodman said. “Every special interest will want to be part of the insurance plan, and then it will be very expensive.”

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

Haslam Among Republican Governors Who Believe Block Grants Would Improve Obamacare

Gov. Bill Haslam was mentioned prominently in a Forbes piece Thursday, after he and four other GOP governors said they would consider an expansion of Medicaid under the federal health care reform law if the money were awarded as a block grant.

“Obviously, as a Republican, I’m with those folks who say, if you can block grant us Medicaid, we’d look at it differently,” Haslam said, according to Politico. The governors were at a weekend meeting of the National Governors Association in Virginia.

The block grant idea is dear to the hearts of conservatives, who say the setup would free states from onerous federal restrictions and give states the power to keep expenses in check. Governing magazine explains the history and criticism that such a plan would reduce the number of people covered, especially in times of economic strain.

The governors have the option of saying no to a Medicaid expansion in their states without losing existing Medicaid funding, based on the U.S. Supreme Court ruling last month that upheld the Affordable Care Act.

This week the state held a meeting at Vanderbilt to seek input on what insurers should be required to cover in plans offered in the state, according to the Tennessean:

These rules will apply to individual policies and small-employer group plans, including those offered through the state insurance exchange after Jan. 1, 2014. The federal law, often referred to as Obamacare, directs that these plans have the same level of coverage as those typically offered by a large employer. But the law leaves it up to the states to set those benchmarks. …

States have 10 basic plans currently offered by large employer groups from which to choose a benchmark, but they can modify whichever reference plan they choose.

The meeting attracted people with health complaints from loss of hearing to infertility, wanting to make sure the state’s standards would require their ailment be covered, WPLN reported.

Another component of the health care law got a boost from a Tennessean Wednesday. Former Sen. Bill Frist urged states to set up their own health insurance exchanges. The exchanges will foster competition and are “the most innovative, market-driven, and ultimately constructive part of the law,” Frist wrote in a column for The Week.

Opponents of the law have urged the opposite. The Cato Institute calls them “the new government bureaucracies” for forcing people “to purchase Obamacare’s overpriced and overregulated health insurance.”

In May, the Kaiser Family Foundation expressed doubt that Tennessee would meet a deadline to submit a plan for its exchange this fall. The state has accepted more than $9 million in federal tax dollars for planning and establishment efforts.

Matheny Predicts More Tort Reform at Doctors Town Hall

House Speaker Pro Tem Judd Matheny says the Legislature will probably seek more tort reform next year, and Gov. Bill Haslam, no fan of the new federal health care law, says it’s time to start talking about how to implement the new act anyway.

Those developments show that health care issues remain very much on the table for Tennessee. While tort reform is usually thought of as a legal issue, proponents of limiting malpractice and wrongful death lawsuits have cited litigation as a driver of health care costs.

Matheny, R-Tullahoma, told a Doctors Town Hall audience at Lipscomb University in Nashville on Saturday that he hopes this year’s tort reform legislation is only “the first step of several steps in issues we hope to deal with in regard to tort reform.”

During a break in the formal discussion, Matheny elaborated on those plans and pointed to a so-called “loser pays” effort that could be the next measure in tort liability in Tennessee.

“I just know the General Assembly is very interested in additional tort reform,” Matheny said.

“‘Loser-pays’-type scenarios are ones we will look at, especially with regard to what would be perceived as malicious lawsuits.”

Matheny said potential legislation would address situations where there are possibly second or third appeals in cases.

“A case in point would be if somebody filed a third appeal and the answer was the same as the first two, whether both are in the negative or both in the positive. That person would be responsible for the legal fees,” he said.

The approach would be to confront those who are seen as abusing the system. It would follow a tort reform measure passed this year and spearheaded by Haslam that put caps on non-economic damages in civil cases at $750,000, although the law creates exceptions in cases that involve intentional misconduct, destruction of records or activity under the influence of drugs or alcohol.

Those caps go to $1 million in what are categorized as “catastrophic” cases, which are defined in the law as conditions of paraplegia, quadriplegia, amputation, especially severe burns or the wrongful death of a parent leaving minor children. The new law also caps punitive damages at two times compensatory damages or $500,000, whichever is greater.

Matheny said he would like to see the caps in the law go even lower — to around $250,000 or $300,000 — but he said he did not foresee the Legislature taking that path.

“There will probably be a lot of (tort reform) legislation filed, but there will probably be one thing that rises to the top and is carried by the body,” Matheny said. “I don’t know what that will be yet, but I think there will be some additional tightening.”

Matheny said he has not spoken to Haslam about further tort reform and that Haslam probably wants to give the most recent law a chance to take effect. But there seems to be little doubt that the Legislature is prepared to consider further steps on the topic.

“It’s important to remember that sometimes progress is made in baby steps and after a three- or four-year period maybe we can look back and really see some true progress,” Matheny said.

Spine surgeon says government doesn’t help

The town hall audience Saturday at Lipscomb was an overwhelmingly conservative crowd, with 10 panelists and audience members expressing dislike of the 2010 federal health care overhaul.

Dr. Lee Heib, a spine surgeon and president of the Association of American Physicians and Surgeons, spoke of her practice as a small business owner.

“If you have to run a small business, if you have to produce something, when has the government come in and made your job easier or more cost-effective? It’s never done that. Trust me, it doesn’t do it in medicine either,” she said.

Andrew Schlafly, general counsel for AAPS, who went to law school with President Barack Obama, said the fundamental problem with the new health care law is that it forces citizens to purchase coverage.

“That is the foundation of it, and that is basically un-American,” Schlafly said. “To force people to buy something you don’t want to buy, it’s never been done before. You can look through the Constitution. You can read it backward and forward and ask yourself, ‘What gives the federal government the authority to force us to buy something we don’t want to buy?'”

That’s the question raised by the Thomas More Law Center in Michigan, which has asked the Supreme Court to review a lower court decision upholding the Patient Protection and Affordable Care Act. The Sixth Circuit Court of Appeals, in Cincinnati, ruled against the center earlier this summer, finding the law to be constitutional.

Legal challenges regarding the act also are pending in the Fourth and 11th circuits. It has not been determined if the high court will take up the issue.

The town hall meeting included state Sen. Mae Beavers, R-Mt. Juliet, who spoke to the audience of about 125 people about her Tennessee Health Freedom Act (SB079), which Haslam has signed, which says government cannot force a person to purchase a product as the new federal law does, and prevents penalties against those who wish to opt out of the system.

Beavers also touted her Health Care Compact legislation (SB326), a states’ rights measure, which would allow states to join forces to control their health care funds. That bill passed in the state Senate this year but not in the House.

Ben Cunningham of Tennessee Tax Revolt told the audience the federal health care overhaul would be such a burden on the state it would force talk of a state income tax.

U.S. Rep. Marsha Blackburn, R-Brentwood, spoke of Tennessee’s problems with TennCare as an example of what can go wrong with government-run health care.

Haslam: State should prepare to implement health care act

Haslam, meanwhile, said in a recent interview that time is a factor in whether to address the new federal health care legislation, commonly referred to as “Obamacare,” which has been overshadowed recently in Washington. The most significant aspects of the law do not kick in until 2014, but the law requires states to be ready in several ways when that time comes.

“I quite frankly am surprised that as the clock ticks closer to 2014 there’s not more conversation,” Haslam said.

But he noted one group is paying very close attention to the issue.

“There is a lot of conversation among governors, saying, ‘We need to be prepared to implement this if it does happen,'” Haslam said, adding that “it would be irresponsible not to.”

The 2010 election year brought a significant uproar about the new law, with talk of repealing it after a new Congress was put in place. But Haslam, who opposes the plan, said the furor about the law has seemed to subside since then.

“A year ago, in the middle of the campaign, that was all the talk,” Haslam said. “I don’t know if in Washington the whole budget and debt issue has eclipsed everything else. I don’t know if that’s the situation.”

The foremost issue in the new law is for states to set up exchanges — marketplaces involving competing insurance plans — where people would shop for what best fits their needs. States must set up their own exchanges or allow people to move into a federal exchange.

Tennessee is already working with various stakeholders and what are known as Technical Assistance Groups (TAGs) on the state’s options. The state is accepting comments and questions about the exchange process at insurance.exchange@tn.gov.

Haslam said the law’s implementation in Tennessee would likely be run through TennCare and the state Department of Finance and Administration. A finance spokeswoman referred questions on the matter to TennCare.

“We’re still watchfully waiting for guidance from CMS,” said Alyssa Lewis, communications manager for TennCare, referring to the federal Centers for Medicare and Medicaid Services. “We’re seeing what’s going to happen when there is more certainty. It’s to see what the options are, and what the appropriate options are for Tennessee.”

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