Gov. Bill Haslam delivered what many Tennessee state lawmakers on both sides of the partisan aisle said was an exceptional speech Monday evening.
Haslam spoke before a joint meeting of the Legislature to launch a special session that’ll have lawmakers spending the next few days picking apart the details of his “Insure Tennessee” plan. The Republican governor hit upon a range of reasons why he thinks the General Assembly ought to approve his customized Medicaid expansion plan.
But there was also a common agreement among legislators afterward that if the governor’s going to win them over, it’ll take more than just “talking points” once critics start zeroing in on the particulars of his new health-care-for-the-poor initiative.
The governor’s proposed two-year pilot program would be funded by nearly $3 billion in federal money through the Affordable Care Act. Its aim is to provide health coverage to around 300,000 people with incomes below 138 percent of the poverty line.
Struck in the Middle
Haslam described it as “a third way” between rejecting and embracing Obamacare.
“Insure Tennessee” is designed to “leverage those federal dollars to really begin the work of fixing what is wrong with our health care system, to better align incentives for providers and consumers,” he said.
“Regardless of where you are on the political spectrum, I think everyone agrees that our current system of health care does not work,” said Haslam. “It doesn’t work in two ways: access nor cost. First, there are too many people who need medical care that aren’t getting it. Secondly, everyone should realize that we have to do something to address health care costs.”
The governor’s administration has described “Insure Tennessee” as a “market-based” plan because it requires co-pays and issues vouchers for private insurance. And for the unemployed who will be getting their coverage through the government in similar fashion to the existing TennCare recipients under the plan, “Insure Tennessee” enrollees will be charged premiums as they participate in a so-called “Healthy Incentives” program.
The upshot of “Insure Tennessee,” said the governor, is that it “introduces personal responsibility and patient engagement through choice, incentives, and co-pays in a way that doesn’t happen with Medicaid.”
“This is not Obamacare,” declared Haslam. “If it was, it wouldn’t have taken us this long to negotiate. We have done what you asked us to do and what we said we would do. We found a unique, Tennessee solution.”
A Mix of Similar Reactions
In order to get his plan passed, the governor needs votes wherever he can find them — and he’s even said he’s counting on every minority-party lawmaker in the statehouse to get on board in order to bring in the legislative win.
House Democratic Leader Craig Fitzhugh said Haslam more than likely hit the right notes to lure in laggards from his caucus.
“Remember, we were for a fuller expansion, so some (Democrats) are a bit disappointed that it is limited in some way,” said Fitzhugh. “But the fact of the matter is that it’s going to cover about the same number of citizens that we thought full expansion was.”
Fitzhugh said he’s more worried, though, about how Haslam’s going to get skeptical Republicans to go along.
“In his caucus, he’s the governor and he swings a mighty big stick — and I think he needs to take a couple of cuts,” said Fitzhugh.
Like Fitzhugh, GOP Caucus Chairman Glen Casada said the governor made a “very good speech — very impassioned.”
“It had emotion and it had logic,” said Rep. Casada, who opposes the governor’s plan. “I just don’t think he convinced anyone tonight. Most of the House Republicans have analyzed this for weeks. And they just see that it’s not good for the overwhelming majority of the citizens of the state.”
Casada described Haslam’s plan as presently “dead in the House.”
One of the significant hangups for GOP lawmakers as they scrutinize Haslam’s bargain with the Obama administration will be that many are just not going to take it for granted that “Insure Tennessee” will be run like the Haslam administration wants, said Casada.
Under any plan funded and overseen by Washington, the state “is not in full control,” and a lot of lawmakers see that as a dealbreaker, he said.
“When we try to implement free market principles to this, the feds — the (Centers for Medicare & Medicaid Services), in particular — will nix it,” said Casada. “When you don’t pay your monthly premium, and Tennessee asks to take you off, the feds will trump us, and they will say, ‘No you can’t do that, Tennessee.'”
Casada said that will be among the central questions lawmakers examine as the spend the next couple days probing Haslam administration officials on the particulars of “Insure Tennessee.”