Lawmakers, Public to Get First Detailed Look at Haslam’s Obamacare Compromise

The specifics of Tennessee Gov. Bill Haslam’s plan to expand Medicaid eligibility under the Patient Protection and Affordable Care Act are set to be released Thursday.

The Republican governor announced Wednesday that he’s ready to unveil the particulars of an arrangement he says he’s reached with the Obama administration on granting government-funded health insurance to a greater swath of lower-income Tennesseans.

Last month Haslam made the surprise announcement that his administration had developed a plan for getting in line with the other 27 states in the country that have voluntarily signed on to one of Obamacare’s key provisions. Tennessee is among a handful of others that haven’t yet approved Medicaid expansion, but are considering it.

Of the eight states that border Tennessee, only Arkansas and Kentucky have OK’d Medicaid expansion through the ACA. However, North Carolina Gov. Pat McCrory, as well as Utah Gov. Gary Herbert, both Republicans, met with the president this week about expansion proposals they are contemplating. Like that offered by Haslam, the proposals being offered up by McCrory and Herbert are unique to their respective states.

Dubbed “Insure Tennessee,” Haslam’s plan was first cursorily outlined in December. It includes two “private market choices” involving vouchers and health reimbursement accounts for an estimated 200,000 people to get federally subsidized insurance.

The governor promised that Insure Tennessee won’t cost state government anything — that any of it not paid for by U.S. taxpayers would be borne by the Tennessee Hospital Association’s members. Haslam called the plan “a catalyst to fundamentally changing health care in Tennessee.”

But he acknowledged Wednesday that he’s going to face stiff resistance from members of his own party.

“This is a big deal,” the governor said. He added, “We knew up front that this would be a controversial proposal, and I think it is up to us to make the case why this is the right thing to do for Tennessee, both for the long-term physical health of the state, but also the financial health of the state — as well as everybody else impacted from hospitals to individuals who might be covered by the plan.”

Last year the General Assembly passed a law requiring the governor to win the Legislature’s blessing to involve the state in the ACA’s Medicaid expansion scheme. That law was labeled the “Stop Obamacare Act” by its sponsors, and it was supported by all Republicans in both chambers of the GOP supermajority-controlled statehouse.

Asked during a press conference Wednesday if getting the General Assembly’s stamp of approval on Insure Tennessee will require the support of Democrats, the governor said, “I think that is probably a fair observation — that for this to pass, all the Democrats will have to be for it, and obviously we will have to have enough people to get the 50 in the House and the 17 in the Senate.”

Republicans control the Senate 28-5. In the House there are 73 GOP lawmakers and 26 Democrats.

The House and Senate sponsors of the 2014 Stop Obamacare Act — Rep. Jeremy Durham of Franklin and Sen. Brian Kelsey of Germantown — both indicated last month after the outlines of the Insure Tennessee plan were announced that they won’t support it.

“Republicans were elected to reduce entitlements and decrease the national debt, not to expand entitlements and increase the national debt,” Durham, the lower chamber’s majority whip, told TNReport Dec. 16. “Republicans are winning the argument against Obamacare at the national level and I just don’t see that this is the time to compromise our conservative principles at the state level.”

At the time, Durham said he didn’t anticipate Haslam’s plan had “any chance of passing.”

Kelsey indicated that while he thinks GOP lawmakers will go into discussions of Haslam’s plan with “an open mind,” he’s likely not voting for it himself.

“I have proposed similar reforms for our neediest Medicaid recipients in the past,” Kelsey said through a spokesman last month. “Unfortunately, the governor’s plan is proposed as an expansion for able-bodied, childless adults. Tennesseans elected Republicans to shrink government, not expand it– and certainly not to expand it for Obamacare.”

The governor appears committed to battling conservatives in his party over the issue. But he told reporters Wednesday he fully comprehends where fellow Republicans who oppose him on Medicaid expansion are coming from.

“Believe me, I understand how hard this is. We worked on it forever to get it right,” said Haslam. “I hope people appreciate that we have negotiated a really good deal for Tennessee. It works financially for the state, as well as long-term who we want to be as a state. Obviously, everybody has to dig into that and decide for themselves.”