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State Union Chief Worries Employers Will Dump Workers’ Health Plans Under Obamacare

The head of Tennessee’s chapter of the nation’s largest union federation is concerned the unintended consequences of the Affordable Care Act will cause Tennessee employees to be “booted” to the federally run exchanges by employers looking to save a buck.

Gary Moore, a former Democratic state lawmaker who now serves as president of the American Federation of Labor and Congress of Industrial Organization’s Tennessee wing, worries that workers here, especially those employed by smaller companies in the construction business, may lose their employer-provided medical coverage.

Moore told TNReport recently he’s concerned that one of the ways employers in Tennessee might “react to the Affordable Care Act” is by altering “the way that they provide insurance coverage to their employees now.” Specifically, companies facing cost-cutting pressures might choose to drop the more expensive, union-backed health insurance plans and “dump” those employees onto the federal exchange, he said.

“Will every employer do it? Probably not. But, will some of them? I can almost guarantee that they will,” said Moore, who served in the Tennessee House of Representatives from 2005 through 2012.

Moore’s concerns about union health plans echo those detailed in the resolution passed by the AFL-CIO at the organization’s quadrennial convention in September. The Tennessee state chapter of AFL-CIO represents more than 60,000 Tennesseans who’re members of 37 international unions and 273 local unions, according to the organization’s website.

The AFL-CIO resolution, which Moore voted to support during the organization’s meeting in Los Angeles, called for the Obama administration to take steps to ensure certain unintended consequences of the Affordable Care Act are avoided. If that’s not possible under the law’s existing structure, then the AFL-CIO “will demand the ACA be amended by Congress,” according to the resolution, which passed on a voice vote.

“Contrary to the law’s intent, some workers might not be able to keep their coverage and their doctors because the federal agencies’ current implementation plans will be highly disruptive to the operation of Taft-Hartley multiemployer plans, substantially changing the coverage available for millions of covered employees and their families,” the resolution stated. “The federal agencies tasked with implementing the law have unnecessarily imposed an interpretation of the Affordable Care Act which imposes additional costs and fees for which plan participants receive no benefit, unnecessarily driving coverage costs higher.”

While the majority of AFL-CIO members supported the resolution calling for the federal government to address their issues with President Obama’s signature law, some members that were present at the convention wanted to see the health care reform package completely repealed and replaced.

Moore said he wasn’t in that camp.

Although Obamacare has its problems, he maintains it is a step in the right direction and needs time to take hold.

“Any law that you pass is subject to have flaws in it,” said Moore. “You don’t address the flaws by not funding it. You come back to the following legislative session and you attempt to correct the problems.”

New Haslam Initiative Aims to Get Tennesseans in Shape

Tennessee Gov. Bill Haslam says it’s about time for the state to hop on the treadmill, eat better and make healthier choices.

Speaking in the gymnasium of a new Jackson health center Tuesday, Haslam announced his plan to start a new state foundation tasked with promoting healthy living in Tennessee communities.

“I love Tennessee, I think it’s the best state but we all know that we can do a better job taking care of ourselves,” Haslam told reporters following the event. “If we’ll exercise more, consume a better diet and either quit or don’t start using tobacco, we can make significant strides,” he said.

Tennessee consistently lands near the bottom on lists that rank states’ overall health.

On Tuesday Haslam emphasized the economic implications of a healthier population, telling the crowd that moving Tennessee closer to the top of the list would save the state money over the long run by reducing healthcare spending and would also do more to attract companies looking for a healthier (and thus potentially less expensive) workforce.

The new Governor’s Foundation for Health and Wellness will include a “coalition of made up of major employers, hospital systems, health insurers, YMCAs, local governments,” as well as “healthcare-focused foundations and civic organizations,” according to a press release from Haslam’s office.

The foundation’s first major initiative, aptly titled “Healthier Tennessee,” will include statewide outreach, education, and local incentive programs along with data collection and measurement, Haslam said.

Haslam Named Co-chair of Nat’l Governor’s Assoc. Health Care Task Force

Press release from the National Governor’s Association; May 21, 2013:

WASHINGTON—As lawmakers at both state and federal levels of government look for ways to improve the quality of health care and reduce the costs of public programs, governors are developing innovative Medicaid programs and must retain flexibility to implement these measures.

To assist in these efforts, the National Governors Association (NGA) today announced the members of a new Health Care Sustainability Task Force (Task Force). Oregon Gov. John Kitzhaber and Tennessee Gov. Bill Haslam will serve as co-chairs of the Task Force.

Other governors serving include Alabama Gov. Robert Bentley, Arkansas Gov. Mike Beebe, California Gov. Jerry Brown, New Mexico Gov. Susana Martinez, New York Gov. Andrew Cuomo, South Dakota Gov. Dennis Daugaard, Utah Gov. Gary Herbert and Vermont Gov. Peter Shumlin. NGA Health and Homeland Security Chair Maryland Gov. Martin O’Malley and Vice Chair Nevada Gov. Brian Sandoval will serve as ex-officio members.

“Right now states are looking to change how they do business in order to more effectively serve their constituents,” said Gov. Kitzhaber. “This Task Force will help states sit down together to figure out what’s working and what isn’t and identify how the federal government can best support these efforts.”

“Governors are working in their states to find ways to cut costs when it comes to health care,” said Gov. Haslam. “It is our responsibility to examine every possible option in an effort to make sure promising new initiatives can be fully utilized.”

The Task Force will focus on state innovations that require the redesign of health care delivery and payment systems with the objectives of improving quality and controlling costs. Through the sharing of state experiences and best practices, the Task Force will work to identify areas where federal legislative or regulatory action is necessary to reduce barriers and further support state initiatives.

Senate GOP, Lt. Gov. Approve of Haslam Medicaid Decision

Statement from Tennessee Lt. Gov. Ron Ramsey; March 27, 2013:

Lt. Governor Ron Ramsey (R-Blountville) said the following upon the conclusion of Governor Haslam’s address to a joint session of the 108th General Assembly:

“I applaud Governor Haslam’s decision to reject Obama’s medicaid expansion. Without bold reform of the Medicaid program tailored to Tennessee’s unique situation, there can be no compromise on this issue.”

“Four out of every ten dollars the federal government spends comes out of the back pockets of future generations. Tennessee must receive assurances that have not been forthcoming. Governor Haslam has laid out a plan for what true health care reform looks like. I commend him for his continued thoughtful and measured approach to this complex issue.”

Statement from State Sen. Bill Ketron, R-Murfreesboro; March 27, 2013:

NASHVILLE, Tenn. — “Governor Haslam offered a good solution, rather than expanding an unsustainable and broken program. Unlike Washington, Tennessee has been working hard to control health care costs. Hopefully, Washington will see our 20-year record of working through the problems we face with our healthcare system and agree to work with us on a plan that will truly be both beneficial to improving healthcare outcomes in our state and sustainable over the long run.”

Statement from State Sen. Brian Kelsey, R-Germantown; March 27, 2013:

NASHVILLE, Tenn. – “I applaud Governor Haslam’s decision today to reject Medicaid expansion as envisioned by ObamaCare in this year’s budget,” stated Senator Brian Kelsey (R – Germantown) following the governor’s announcement
this morning. “I am happy to receive the governor’s commitment not to expand Medicaid in future years without legislative approval.”

Sen. Kelsey is the sponsor of Senate Bill 804, filed to block Medicaid expansion in Tennessee. Sen. Kelsey originally filed Senate Bill 1 on Nov. 7, 2012 to block expansion. He redrafted the bill and filed SB 804 on January 31, 2013 with 15 of the 33 state Senators as co-sponsors. The bill is scheduled for a vote in the Senate Commerce Committee Tuesday afternoon, March 27. Sen. Kelsey serves as Senate Judiciary Committee Chairman.

VIDEO: Fitzhugh: Haslam ‘Failed to Deliver’ on Medicaid Expansion

Statement from the Tennessee House Democratic Caucus; March 27, 2013:

NASHVILLE, Tenn. – House Minority Leader Craig Fitzhugh has released the following video statement in response to Governor Haslam’s decision to not participate in the Medicaid expansion:

Earlier today, Governor Haslam announced Tennessee would turn down over $10 billion and not participate in Medicaid Expansion. This shocking decision comes after business groups, hospital associations, doctors, nurses, civic and faith leaders joined together to work with the Governor on this critical decision that impacts our citizens and our economy.

I truly believed that the governor was going to use this opportunity to show real leadership. Instead we’ve seen more of the hand-wringing and delayed action that we’ve become accustomed to.

Here are the facts.

300,000 Tennesseans will now be denied access to quality, affordable health care coverage; Coverage that wouldn’t have cost Tennessee taxpayers a dime for the first 3 years.

Estimates show that 90,000 jobs may be lost, and dozens of our rural hospitals are at risk of closing – leaving as many as 21 counties without a hospital altogether!

Tennessee’s economy will suffer as billions in federal dollars leave our state and go to California, New York and other states that have agreed to participate in Medicaid Expansion.

All of that says nothing about the moral obligation that we have as lawmakers to ensure the health and well-being of the least among us.

Governor Haslam says he is working on a “Tennessee Plan” to address these concerns. However, his announcement today came with few details and even fewer certainties for the hundreds of thousands of Tennesseans who have been counting on the governor to do the right thing.

While I hope that the Governor is serious about working with the federal government to create an alternative plan, past experience makes me question the sincerity of these efforts.

All too often with this administration, we have the Governor study, and study, and study an issue, only to come back later and say “no”.

My friends today is an illustration of why it matters who governs and this Governor has failed to deliver for the people of Tennessee. Our hearts go out to the thousands of people across this state who will suffer as a result of this decision. It is my hope and fervent prayer that in the future we can find a way to care for the least among us when they need it the most.

Herron: Medicaid Rejection Not ‘Pro-Life’ Decision

Statement from the Tennessee Democratic Party; March 27, 2013:

NASHVILLE, Tenn. — Tennessee Democratic Party Chairman Roy Herron issued a statement Wednesday in response to Governor Bill Haslam’s rejection of federal funding to expand Medicaid.

“Deuteronomy 30 urges us to ‘choose life,’ but self-proclaimed ‘pro-life’ Republicans applauded the governor denying health insurance to 300,000 Tennesseans in working families, even though that means each week another parent, another child, another loved one — or two — will die,” Herron said. “Reactionary and radical Republicans should never again call themselves ‘pro-life,’ not while condemning working Tennesseans without health insurance to die.”

In 2012, the New England Journal of Medicine reported in an article called “Mortality and Access to Care among Adults after State Medicaid Expansions” that lives can be saved by expanding Medicaid.

“Tennessee should choose science instead of selfishness, people instead of politics, life instead of death,” Herron said.

TN Hospitals ‘Disappointed’ in Haslam Medicaid Decision

Statement from the Tennessee Hospital Association; March 27, 2013:

Tennessee hospitals are disappointed the Governor couldn’t get the information he needs from CMS to move forward at this time with coverage of the expansion population.

The Governor has asked CMS to allow Tennessee to bring those who would be eligible for the Medicaid expansion into the health insurance exchange and provide them private coverage, thereby leveraging federal funding to transform healthcare in Tennessee without expanding the Medicaid rolls. Tennessee hospitals believe this is the correct approach for Tennessee.

We understand the need for clarity and we plan on working with the administration and the legislature to get the answers that will allow the state to make coverage available to the additional Tennesseans with incomes less than 138 percent of the federal poverty level.

We are hopeful we will get the necessary assurances from the federal government that will allow the Governor to pursue the vision he outlined this morning and there can be a special session of the legislature in Tennessee to take advantage of the 100 percent federal funding available this year.

Haslam Proposes ‘Tennessee Plan’ to Reform Health Care

Press release from the Office of Tennessee Gov. Bill Haslam; March 27, 2013:

NASHVILLE – Tennessee Gov. Bill Haslam today unveiled his plan to pursue real health care reform in the state.

Haslam announced that he will not expand TennCare rolls under the Affordable Care Act but instead is working to leverage the available federal dollars to purchase private health insurance for Tennesseans who would not otherwise have access to coverage.“Tennessee has shown the nation how to produce true reform in education, based on students’ results and educational outcome. We’re beginning to do the same thing with reforming government service – again by measuring outcome and results rather than just years of service as a state employee,” Haslam said. “I believe Tennessee can also be a model for what true health care reform looks like; reform that will take significant steps to save the state and the nation from the unsustainable path we are on now.”

Haslam’s plan would take on the critical issue of aligning incentives among users, payers and providers of health care. The plan would:

  • Leverage available federal dollars to purchase private health insurance for Tennesseans up to 138 percent of the federal poverty level who don’t have access to health insurance, which would translate to 175,000 more insured Tennesseans;
  • Allow co-pays for those who can afford to pay something;
  • Include a definitive circuit-breaker or sunset of the plan that could only be renewed with the General Assembly’s approval;
  • And reform the payment structure for providers so they are compensated for health outcomes, not just based on services performed.

“Hospitals and medical providers have put a lot of sincere effort into working with us toward payment reform,” Haslam said. “I cannot emphasize enough how much I’ve been impressed with our hospitals’ willingness to work with us. To succeed, we also need cooperation from the Department of Health and Human Service (HHS), and we can’t get the same assurances from them at this point. Until we get those assurances, I cannot recommend that we move forward on this plan.

“All we’re asking from Washington is to allow us to use the federal funds to provide coverage on the health care exchange in the same way many other Tennesseans will access coverage regardless of whether or not we expand. It’s a reasonable ask,” Haslam continued.

But as a result of the lack of clarity from HHS, the governor will not ask the General Assembly for approval to accept the Medicaid expansion federal funds as he continues to work for the flexibility needed to implement his plan.

Gov. Haslam Prepared Remarks:

“I appreciate the opportunity to speak this morning. I’m well aware this is an extremely busy time, and I’m grateful for the opportunity to come before you today. It is the first time I’ve asked to do this outside of the State of the State, but I asked for this opportunity because…

There is no more important issue, or more complex issue facing our country and our state today than healthcare, and I wanted to update you about where we are regarding Medicaid expansion.

This may look like a simple decision. On one side, people think how could we not accept federal money to expand Medicaid to cover more Tennesseans and on the other, why in the world would we accept funds tied to ObamaCare knowing the federal government can’t pay for it? But it isn’t that easy.

Let me start by saying there are two basic reasons I don’t like ObamaCare.

The first is cost. Regardless of whether we decide to cover any additional people through the Act, Obamacare will cost the state of Tennessee almost two billion dollars over the next eight years.

I want to be clear – That is our additional cost regardless of whether or not we cover any new enrollees.

Secondly, and maybe even more important than not addressing cost, it doesn’t address the real issues of health
reform – users and payers not being aligned and providers and payers not being in alignment.

When you go to the grocery store, there is a shopper, a product and the store. The shopper knows what the store charges for each item and pays for those items.

With health care, shoppers go to the store, pick out whatever they like – sometimes with a representative of the store suggesting additional items – and then going to check out knowing that someone else will pay the bill. Governor Bredesen made this comparison in his book, Fresh Medicine.

The shopper also rarely knows what the store is charging. Only in health care do we buy something without first knowing the cost.

On the provider side, providers are paid based on a fee for each service or product, not on the outcome of care.

Market tension is what controls cost and promotes quality. There is no market tension when you buy or sell health care goods and services.

To me, the scandal of the Affordable Care Act is that it doesn’t significantly address cost or alignment reform.

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.

So, many of us are tempted to say, “That’s right, Washington created the problem. They can fix it,” but it’s not just their problem, it’s ours.

  1. We all know that in Tennessee, we have serious problems with health care.
  2. We’re doing a better job than the rest of the country in controlling costs of Medicaid growth, but they’re still taking a larger and larger percentage of our budget.
  3. We’ve all met people across this state who don’t have healthcare coverage and whose families are in incredibly difficult positions that we agree should have coverage. A lot of us in this room have a real concern for those the Bible refers to as “the least of these.”
  4. Our hospitals – and I know it is harder to identify with the image of a struggling hospital than a struggling Tennessean – but they’ve been put in a very difficult position by the Affordable Care Act.
    They are losing many of the funds which they received to provide healthcare for our state’s indigent. While many hospitals can survive this, I am convinced that several of our hospitals will be left in an impossible situation and will not survive this transition. Some of our communities – rural and urban – could very well lose their community hospital.
  5. Tennessee businesses could also pay a steep price. In addition to the myriad of taxes and fees associated with the Affordable Care Act, our businesses stand to lose 50 to 70 million dollars a year.
  6. Finally, there is at least 20 million dollars a year at stake for our local governments who currently take responsibility for indigent care in their communities.

Let me read you a quote: “Soaring health care costs make our current course unsustainable…And the ever-increasing cost of Medicare and Medicaid are among the main drivers of enormous budget deficits that are threatening our economic future. In short, the status quo is broken, and pouring money into a broken system only perpetuates its inefficiencies.”

Do you know who said that? President Obama in 2009.

Unfortunately, President Obama’s plan was reform in name only and is costing us a lot of money. That’s why a lot of us in this room don’t like the plan.

But I believe it is our job as leaders to pursue real health care reform here in Tennessee. It is our job to say what we’re for in terms of addressing the biggest issue facing us.

For the last several months, I’ve been working toward a “Tennessee Plan” for health reform to change the way health care coverage looks in Tennessee.

I understand those who don’t think it makes sense for us to just say that Tennessee isn’t going to accept the federal dollars because we don’t like ObamaCare.

But this state also has nearly 20 years of experience providing health care coverage through a Medicaid managed care program, and we are all too familiar with all of the federal rules and restrictions that prevent us from operating the program as efficiently as possible.

A pure expansion of Medicaid – expanding a broken system – doesn’t make sense for Tennessee either.

That’s why I’ve been working toward a third option: to leverage the federal dollars available to our state to transform health care in Tennessee without expanding our TennCare rolls.

I’d like to put in place a program to buy private health insurance for Tennesseans that have no other way to get it by using the federal money.

I fundamentally believe that people having health care coverage is better for our citizens and state than people not having coverage.

The plan would include co-pays for those that can afford to pay something, so the user has some skin in the game when it comes to health care incentives.

We would work with providers to lower the cost of care and to move from a model of paying for every service regardless of the result, to a payment method that is based on outcomes and quality care.

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.

During that period when our costs are covered 100 percent by the federal government, we’d work with our medical care providers to implement true payment reform. I am confident that working together, we could truly reduce medical costs.

We’d have a one-time opportunity to encourage their cooperation because health care providers will know that for the next three years, a portion of the population which had previously been receiving services with no reimbursement to the hospitals or doctors, will now have insurance.

But those same providers would clearly know that coverage for that population will go away unless they can prove to us that at the end of three years, when we start paying a percentage of the costs of the new population our total costs would stay flat.

That is a high bar for our providers. But I’m convinced that they can do it, and my conviction is based on the fact that the hospitals and medical providers have put a lot of sincere effort into working with us toward payment reform. I cannot emphasize enough how much I’ve been impressed with our hospitals’ willingness to work with us.

To succeed, we also need cooperation from the Department of Health and Human Services, and we can’t get the same assurances from them at this point.

Until we get those assurances, I cannot recommend to you that we move forward on this plan. Our budget amendment will not include language to accept the federal funds.

There are a lot of federal requirements that come with Medicaid that make it difficult to provide quality care in the most cost-effective way possible. Instead of insuring more people through an inherently flawed system, we’d hoped to purchase private insurance to insure as many as 175,000 more Tennesseans.

To do that, HHS says we have to provide additional benefits, above and beyond what everyone else in the exchange will receive.

We’ll also have to follow certain Medicaid-driven guidelines when it comes to co-pays and the appeals process instead of allowing these individuals to be treated like everyone else in private insurance plans.

The end result is that these Tennesseans would be receiving services from both the private insurer and TennCare.

We have experience with such a scenario today in the form of dual eligibles – people who receive both Medicare and TennCare. It is dysfunctional and not in the state’s best interest to set up again.

The whole reason to accept these federal dollars would be to leverage them to shape and impact health care coverage in Tennessee.

All we’re asking from Washington is to allow us to use the funds to provide coverage on the health care exchange in the same way many other Tennesseans will access coverage whether or not we expand. It’s a reasonable ask.

In the past several years, Tennessee has shown the nation how to produce true reform in education, based on students’ results and educational outcome. We are beginning to do the same thing with reforming government service – again by measuring outcome and results rather than just years of service as a state employee.

I honestly feel that we have a once in a lifetime opportunity to do the same thing in healthcare: To have a healthcare system that is based on outcomes. To have a healthcare system that is based on a healthier Tennessee, which I think we can all agree is essential for our future.

Our plan can save Tennessee money, and if it does, it will also save the federal government at least three dollars for every one dollar we save and in some cases even more.

I believe that Tennessee can be a model for what true healthcare reform looks like – to cover more Tennesseans and to take significant steps to save Tennessee and the United States from the unsustainable path we are on now.

So here are my two promises: First, we commit to you that we have no intention of pursuing this path without your engagement, involvement and approval. Second, we’ll continue to pursue a vision for a healthier Tennessee with access to health care, but at a lower cost for our state and our country.

It’s my hope that we can provide quality healthcare for more Tennesseans while transforming the relationship among health care users, providers and payers. If Tennessee can do that, we all win.

Thank you for the privilege of being here and for the honor of working with you as your Governor.”

Beacon Center Supports Haslam Medicaid Decision

Press release from the Beacon Center of Tennessee; March 27, 2013:

NASHVILLE – Gov. Bill Haslam announced today that he would not currently seek Tennessee’s participation in a Medicaid expansion as envisioned by President Obama’s signature healthcare law. Instead, Haslam will focus on reforming the entitlement program known in the state as TennCare.

The Beacon Center of Tennessee applauds Gov. Haslam on his decision. The governor has spent much time and energy studying the impact of a Medicaid expansion. After the federal government rejected his request for flexibility to reform TennCare in lieu of an outright expansion, he rightly concluded that merely expanding the program now is bad policy for both TennCare recipients and taxpayers alike.

Over the past several months, the Beacon Center has worked to inform policymakers and the general public that a Medicaid expansion would be unaffordable and immoral. Through policy reports, media interviews, opinion articles, and an infographic, the Beacon Center made the case that both taxpayers and TennCare recipients would be harmed by an expansion.

“We are proud of Gov. Haslam for standing up against this ill-conceived plan to add more struggling Tennesseans to a broken TennCare program,” said Beacon Center CEO Justin Owen. “Even President Obama himself said that healthcare reform should not be just about adding more people to the rolls of the government-run healthcare program before seeking to do just that.”

TennCare already eats up 27 cents on every dollar in the state budget, higher than the national average. Rather than expand the program, the governor and lawmakers should consider meaningful reforms that will make TennCare more sustainable and increase recipients’ access to care. A Medicaid expansion would have done the exact opposite, thus making it unaffordable and immoral.

“Now is the time to roll up our sleeves and press for real reforms that will improve the quality of life for TennCare enrollees and protect taxpayers’ wallets,” Owen said. “We look forward to helping advance reforms that will do just that.”

The Beacon Center of Tennessee’s mission is to change lives through public policy by advancing the principles of free markets, individual liberty, and limited government.

Senate Dems: Haslam Plan ‘No Solution’ for Uninsured, Rural Hospitals

Press release from the Tennessee Senate Democratic Caucus; March 27, 2013:

‘Tennessee Plan’ leaves uninsured, rural hospitals with no solution

NASHVILLE, Tenn. – Gov. Bill Halsam promised a decision on expanding Medicaid today, but instead delivered a “no” dressed up as a year of delayed action and indecision.

“We expected clarity today on Medicaid, but all we got was confusion,” Senate Democratic Caucus Chairman Sen. Lowe Finney said. “Our rural hospitals and the uninsured will be the ones to suffer.”

The governor gave a definitive “no” on expanding Medicaid. He instead pitched a so-called “Tennessee plan,” but it’s unclear whether the plan will work. Meanwhile, federal payments to hospitals for uncompensated care will end Jan. 1.

“This is a time when the people of Tennessee need clear, precise and bold leadership, and Governor Haslam offered none of that today,” House Democratic Caucus Chairman Mike Turner said. “It’s a failure of our moral obligation to protect the health and welfare of the most vulnerable among us. It’s a failure that will be paid with the lives of the working poor in our state – this is quite simply shameful.”

According to the Tennessee Hospital Association, the projected statewide job loss without the Medicaid expansion will be 90,000 jobs. In addition, they estimate that there will be an economic loss to the state of nearly $13 billion.

“I truly believed that the governor was going to use this opportunity to show real leadership,” House Democratic Leader Craig Fitzhugh said. “Instead we’ve seen more of the hand-wringing and delayed action that we’ve become accustomed to. Lives will be lost while we wait for a real decision.”

Hospital administrators, health care advocates, chambers of commerce, mayors of cities both big and small, and many others have implored the governor over the past year to expand Medicaid.

“The governor made this decision in a vacuum without consulting leaders from either party,” Senate Democratic Leader Jim Kyle said. “We’ve heard from a broad coalition of groups who will suffer if we don’t expand Medicaid, and apparently their concerns fell on deaf ears.

“It matters who governs.”