Health Care Transparency and Elections

Candidates Continue Pushing Back on Health Care Mandates

Much of the objection to the law is bolstered by the fact that many of the requirements do not kick in until 2014, which opponents view as enough time to undo the damage.

Congress had its say on health care reform, but gubernatorial candidates in Tennessee have their second opinions.

And they’re sticking to them.

As soon as the Patient Protection and Affordable Care Act was passed, an immediate cry went up across the country to repeal the law, an idea that certainly has legs. While one line of thought says states should accept the act as the law of the land and concentrate on how to deal with it, many voices are still saying no.

Much of the objection to the law is bolstered by the fact that many of the requirements do not kick in until 2014, which opponents view as enough time to undo the damage.

“The mandates to Tennessee don’t begin until 2014 and we should not give up or give in until we have our voices heard in the election of 2010 and 2012,” said U.S. Rep. Zach Wamp, a Republican candidate who voted against the bill as a member of Congress.

“Parts of the federal health care bill are going to be implemented this year. Some things are going to be permanent, but in terms of the state going ahead with preparation for the mandates on Medicaid, we don’t even have the money to keep the budget balanced with non-recurring revenues right now, let alone how we would ever pay for the mandates.”

When the health care overhaul was in the discussion phase, Democratic Gov. Phil Bredesen said it could become “the mother of all unfunded mandates.” Republican candidates for Bredesen’s job, particularly Lt. Gov. Ron Ramsey, have jumped on that line repeatedly in the campaign as a sign of agreement between them and Bredesen.

After the bill passed, Bredesen said that while he didn’t like it, it was time to figure out how to cope with the new law. But Bredesen is in the final year of his final term. Yet the idea of trying to deal with the reform package has not been completely dismissed. Jeff Yarbro, the Nashville attorney challenging veteran state Sen. Douglas Henry in the Democratic primary, speaks of the opportunity for states to be the laboratories for implementing reforms and points to Tennessee’s strong health-care industry as an asset in that effort.

Bill Haslam, mayor of Knoxville and another Republican candidate for governor, said there should be a lot of discussion about the financial implications of the legislation on the state.

“We’re still four years out from the first stages of it,” Haslam said. “There’s still a lot of water to go under the bridge. We do need to be talking about the cost of that and how we’re going to handle that cost.”

It’s clear that the law remains widely unpopular. Part of that is because many people have felt confused by the legislation, according to a poll by the Kaiser Family Foundation, which does extensive research on health care isses.

Another Republican gubernatorial candidate, Joe Kirkpatrick, said, “Working with it is not an option.”

Ramsey guided a resolution through the Senate calling on state Attorney General Bob Cooper to file a lawsuit challenging the health care reform law on grounds that it is unconstitutional. Cooper has not given any indication he will do so.

Mike McWherter, the likely Democratic nominee for governor, has said he wants to avoid the mandate that would come with reform.

“As the next governor, I’m going to be working closely with the congressional delegation, Republican and Democrat alike, to see that we don’t have a huge unfunded federal mandate coming down and burdening our taxpayers,” McWherter said. “I believe our governor needs to work very closely with our congressional delegation to make sure that doesn’t happen.”

McWherter has said openly that he will rely heavily on what Bredesen says about the issue, given Bredesen’s background in the health care industry.

In a recent forum in Gatlinburg, Republican candidates were asked about TennCare, the state’s version of the federal Medicaid program. Both Wamp and Haslam credited Bredesen and Darin Gordon, director of TennCare, for the reductions they have made.

“Governor Bredesen and Darin Gordon have done one really good thing,” Wamp said. “They lowered the benefit structure so we’re no longer a magnet for people in surrounding states to come here to get benefits. That’s one reason why costs are contained. It wasn’t that way for a long time.”

Haslam said Wamp was right and that Bredesen and Gordon had cut TennCare rolls by 140,000 people and put limits on what the state would pay providers. But Haslam said the new problem was that the law would add 250,000 people back to the rolls, so all the work that had been done to cut the cost just got thrown back at the state, and more.

At that, Brandon Dodds, an independent candidate for governor and an optometrist in Dyer County, had heard enough.

“I can tell you if you think Bredesen has done a good job, you’re just wrong,” Dodds said. “You could not devise a more inefficient system of treating patients. As a medical provider, doctors can’t practice medicine with their hands tied behind their backs.”

While much of the debate continues to focus on parts of the law that kick in in 2014, the White House points to its immediate benefits.

A White House summary of aspects of the law that apply this year says 66,500 small businesses in Tennessee could benefit by a tax credit the law provides; the law may help some of the 85,000 Tennesseans who hit the “donut hole” in their Medicare Part D coverage; a $5 billion temporary program to help stabilize coverage for early retirees begins June 1; coverage begins Sept. 23 for maintaining coverage for children on plans until they turn 26; several consumer protections including no lifetime limits on coverage kick in Sept. 23; community health centers benefit beginning Oct. 1; and beginning Oct. 1 scholarships and loan repayments will be provided for health care providers where there is a shortage of professionals in their field.

As for Medicaid, where so much of the concern exists about mandates, the Kaiser Family Foundation reported this week that Medicaid enrollment nationally will increase by 15.9 million people under the plan and that the overall cost of Medicaid expansion in 2014-2019 would be an increase of $443.5 billion in federal funds and $21.1 billion in states’ spending.

The group broke down the numbers for each state, and Tennessee, in its estimation, would see 330,932 new enrollees involving $716 million. The federal tab on Tennessee’s new enrollment would be $11.1 billion. Those figures are based on what the organization said would be a standard participation scenario. Kaiser also calculated what it called an enhanced outreach scenario, which would have new enrollees total 474,240 people at a cost of $1.5 billion to the state and $13.1 billion by the federal government.

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