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Hearings Continue on ‘Insure Tennessee’

Key question: Obamacare or Not Obamacare?

State lawmakers in Nashville are into their second day of hearings on Gov. Bill Haslam’s plan to use federal Medicaid expansion funding to establish a new health-coverage plan for lower income Tennesseans.

It’s unclear what is in store for the plan at this point. A vote of some kind in either the House or Senate could come later Wednesday.

Speculation around the Capitol is that Haslam’s “Insure Tennessee” plan doesn’t have the support to get through hostile Republican-dominated committees in either chamber of the General Assembly. On the other hand, supporters claim the votes may be there to pass it on the full-chamber floors, particularly in the House.

Gerald McCormick, the House majority leader, is carrying Haslam’s legislation. He said Tuesday that if “Insure Tennessee” wins in the House then supporters could “shame” the Senate into passing it.

Senate and House committees on Tuesday heard presentations for and against “Insure Tennessee,” which is the governor’s attempt at a “third way” for Tennessee to go between flatly rejecting participation in the Affordable Care Act’s Medicaid expansion money and signing up for Obamacare as-is.

Several other states led by Republicans — like Arkansas, Ohio and Indiana — are attempting to tap federal dollars for expanding Medicaid. They, too, would like to implement cost-controlling and patient-responsibility-enhancing approaches.

Gov. Haslam’s “Insure Tennessee” plan includes a mix of co-pays, incentives and vouchers that he and his administration officials say is unique to, and designed especially for, Tennessee’s lower-income uninsured population.

Haslam’s people say the “market-based” elements in the plan make it such that it isn’t really “Obamacare” at all.

Brian Kelsey, a Republican state senator from Memphis who opposes Haslam’s plan, pressed members of the governor’s staff on the issue during a Tuesday afternoon committee hearing. Kelsey said that the Medicaid expansion population the Haslam administration is targeting for federally financed health coverage — those who make 138 percent of the poverty line or less and are not already getting TennCare benefits — is the same population envisioned for coverage under the Affordable Care Act.

Mark Cate, the governor’s chief of staff, acknowledged that “this all falls under the Affordable Care Act.”

“The opportunity to cover the newly eligibles, to have the 90-10 match, that did come from the Affordable Care Act, you are correct,” Cate said to Sen. Kelsey.

Later in the same hearing, though, Haslam’s staff sought to emphasize how the particulars of “Insure Tennessee” differ from the basics of the Affordable Care Act.

That it has taken the Haslam administration nearly two years to develop the essential components of “Insure Tennessee” shows it isn’t just Obamacare, said Wendy Long, chief medical officer for the state’s Bureau of TennCare.

“If this is Obamacare, then why are we even asking for a waiver,” Sen. Richard Briggs, a Knoxville physician, asked Long. Briggs was referring to the application the state has filed with the federal government for special permission to use Medicaid expansion money in ways not spelled out in the Affordable Care Act.

“Because it is not Obamacare,” responded Long. “We would not have to pursue a waiver amendment if we were simply adding people to our Medicaid rolls.”

The co-pays, modest premiums, incentives and employer-contribution aspects all “had to be negotiated as an alternative to a Medicaid expansion,” she said.

“All of this is completely outside the norm of traditional Medicaid expansion,” Long said.

Over in the House, Majority Leader McCormick granted under questioning that “Insure Tennessee” and the Affordable Care Act are “linked together” in terms of funding.

“But I don’t think it’s accurate just to say this is Obamacare. People say that, because everyone knows Obamacare is very unpopular, and it’s a political statement to say that,” McCormick said.

He also noted that the overarching Medicaid system is a federal program that was established in 1965 — decades before the Affordable Care Act became law. President Obama was three years old when Medicaid was launched “if you believe the accuracy of his birth certificate,” said McCormick.

Referring to radio ads run last month by the Tennessee chapter of the conservative group Americans for Prosperity, McCormick lamented that Republicans in the House perceived as friendly to the Haslam plan have witnessed “misinformation spread about them.”

An AFPTN spot criticizing House Assistant Majority Leader Kevin Brooks of Cleveland suggested the Chattanooga-area Republican is going back on promises to fight Obamcare. Brooks was one of a number of House Republicans who added their names as co-sponsors to a bill that would have banned Tennessee from expanding Medicaid under the Affordable Care Act. The measure was eventually watered down to merely require that the governor win the Legislature’s approval for any expansion attempt — which is what Haslam is attempting now.

While the Haslam administration has for weeks made arguing that Haslam’s plan isn’t really “Obamacare” a central point in their public relations offensive, a new go-to talking point aimed at winning over reluctant Republicans has emerged this week.

McCormick told lawmakers that the equivalent of “two divisions” of military veterans in Tennessee aren’t getting the medical care they need from the federal government, and that “Insure Tennessee” can be used to give them coverage.

“We’ve got 25,000 to 30,000 veterans that are eligible for this,” McCormick said in the House Insurance and Banking Committee. “These are people who have worked, certainly have worked for our country, maybe some of them are working now in very low wage jobs, maybe some of them are desperately looking for work and need our help looking for that work. And maybe they need a hand up right now with their healthcare coverage. And maybe they’re suffering from some problems that they encountered while they were in the military.”

Asked in the Senate Health Committee why care for veterans has become a state government issue, TennCare’s Dr. Long said the federal Veterans’ Administration isn’t keeping with the needs of Tennesseans returning from America’s oversees wars.

“Veterans have different levels of benefits through the VA, depending on the type of service,” said Long. “Most of the veterans from these most recent wars who are home maybe served a term or were over for four or six years don’t come back to comprehensive health care from the VA at all.

A University of Tennessee study commissioned by supporters of “Insure Tennessee” last month found that 30,000 veterans in the state are living under the poverty line “and in need of basic health care,” Long said.

A group calling itself the “Heartland Accountability Project” began running radio ads this week accusing Sen. Kelsey of “selling out military veterans and their families” for his outspoken efforts to derail “Insure Tennessee.”

Mark Engler and Alex Harris contributed to this report.

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