Medicaid expansion is dead in the Volunteer State. And it isn’t likely to get resurrected any time soon.
On Wednesday afternoon, the Tennessee Senate’s Health and Welfare Committee voted 7-4 to kill Gov. Bill Haslam’s “Insure Tennessee” plan, which he and his advisers designed as a “market-based” program to provide health coverage to around 300,000 Tennesseans using Medicaid expansion funding through the Affordable Care Act.
Haslam described “Insure Tennessee” as an innovative “third way” to furnish health insurance to the not-so-well-off. The governor had hoped his policy offering would satisfy both the Obama administration and the Republican supermajority controlling the Tennessee General Assembly.
The Senate Health Committee vote was the only one taken on the plan. But because of the outcome, that’s all that was needed.
The House sponsor of “Insure Tennessee,” Majority Leader Gerald McCormick, withdrew the plan from consideration shortly after it stalled in the Senate. While he’d expressed confidence that “Insure Tennessee” would have triumphed on the full House floor, McCormick was nevertheless doubtful it could’ve survived the lower-chamber committee system.
McCormick said he notified Gov. Haslam late Wednesday morning that trouble looked to be brewing for “Insure Tennessee.”
“(Haslam) was disappointed, but understanding,” said McCormick. “He understands the process very well.”
The Chattanooga Republican said Haslam did not press him to push ahead with a committee vote. “He knows his basic math pretty well,” said McCormick.
Haslam’s plan was pitched as cost-free to state government by Gov. Haslam. However, McCormick noted that questions were emerging Wednesday over whether the state might be on the hook for some previously unaccounted for administrative costs associated with the plan.
In any event, widespread GOP support never really coalesced around “Insure Tennessee,” with some of the Legislature’s most powerful lawmakers — like House Speaker Beth Harwell and Sen. Speaker Ron Ramsey — withholding their unreserved support. And Both Harwell and Ramsey were dropping hints that “Insure Tennessee” was facing an uphill climb in the special session.
Among the most prominent legislative Republicans absent from the “Insure Tennessee” backers’ list was Senate Majority Leader Mark Norris of Collierville.
Typically a dependable Haslam administration ally, Norris has more than once let it be known he was dissatisfied with how the governor and his staff went about formulating their plan for accessing Obamacare’s Medicaid expansion funding.
After the Senate committee’s defeat of “Insure Tennessee,” Norris told reporters he doubts the administration even made the right decision by calling for a special session. The matter might have fared better in regular session, he said.
“The bottom line is the process was ill-suited to the attention necessary from the beginning,” said Norris, who declined to lead the charge on Haslam’s proposal — a unusual move for a legislative majority leader who shares party identification with a governor. “This is not something that can lend itself to a special session. It’s too complex. It’s too important to do this way.”
“I think you began to see some of the issues that remained unresolved in enough members’ minds that it just wasn’t going to happen,” he said.
Below are some reactions from around the Capitol to “Insure Tennessee” hitting the end of the line before it picked up steam.
Durham & Kelsey: Obamacare Remains a Nonstarter in TN
Throughout the General Assembly’s special session on Gov. Bill Haslam’s “Insure Tennessee” plan, Republican state Rep. Jeremy Durham never seemed too concerned that the Legislature would give it the go-ahead.
The conservative Franklin lawmaker was the prime House sponsor last year of the “Stop Obamacare Act,” which declared that the governor would have to win legislative approval for any plan to use funding through the Affordable Care Act for expanding coverage to lower-income Tennesseans.
Durham, who serves as the House GOP whip, all along disputed assertions by House Majority Leader Gerald McCormick that “Insure Tennessee” had the necessary votes to win on the House floor.
According to his calculations, “maybe 15” of the chamber’s 73 Republicans were solid “yes” votes for the plan, Durham told TNReport on Tuesday.
Durham said the fact that “Insure Tennessee” was both financed through the Affordable Care Act and was, at least in many Republican lawmakers’ minds, an expansion of Medicaid, ensured its defeat from the outset.
“Anytime you are trying to expand entitlements in a Red State, it is going to be difficult,” he said.
Brian Kelsey, the “Stop Obamacare Act” sponsor in the Senate, said he’s always been a supporter of the kinds of reforms Haslam’s “Insure Tennessee” proposed for a new population of Medicaid funding recipients. But the Germantown Republican said he fundamentally disagrees both with expanding Medicaid in any capacity or with cooperating with the Obama administration on executing the Affordable Care Act.
Beavers Glad Its Gone
Tennessee state Sen. Mae Beavers, R-Mt. Juliet, has always been among the General Assembly’s most ardent Obamacare foes.
Unsurprisingly, she was quite pleased “Insure Tennessee” was quickly dispensed with. “I don’t think it ever had a chance and I am glad it’s over,” Beavers told TNReport. “I’m glad it’s gone.”
Beavers was not disappointed that she didn’t get a chance to pick apart the plan herself in a committee hearing. “I certainly heard the (administration’s) presentation at least a dozen times,” she said. “I think I could give it myself by now. ”
Beavers also questioned the veracity of an opinion survey the Haslam administration was circulating this week indicating majority support for “Insure Tennessee” among GOP voters in Tennessee, even while showing those same voters overwhelmingly continue to oppose Obamacare.
“We all know how polls are — it depends on how you ask the questions,” she said. “I look at the first figure that we were given in the poll, and that was that 85 percent of the people were against Obamacare. The only thing that I understand polls worse than that right now is the Common Core curriculum.”
In 2011 Beavers won passage of the Tennessee Health Freedom Act, which sought to counteract the Affordable Care Act’s mandate that all Americans carry a minimum level of health coverage by declaring “every person within this state is and shall be free to choose or to decline to choose any mode of securing health care services without penalty or threat of penalty.”
Ogles: Time to Move On
Andrew Ogles, director of the Tennessee Chapter of Americans for Prosperity, the General Assembly for rejecting Haslam’s plan. His conservative group funded radio ads targeting lawmakers perceived as friendly to “Insure Tennessee.” AFPTN also drew out dozens of red-garbed anti-Obamacare partisans to sit in on the “Insure Tennessee” hearings and root for its defeat.
Ogles said AFPTN activists would like to see “positive reforms” to the health-care system discussed in Tennessee.
“But anything that is going to expand Medicaid or further expand Obamcare is bad policy,” he said.
Overbey: Insure TN Should Have Passed
Doug Overbey, who carried Gov. Bill Haslam’s “Insure Tennessee” plan in the Tennessee Senate, said he was disappointed the proposal went down early. He thinks it should have passed, and would have if it had been allowed an opportunity to gain traction.
“As you present legislation sometimes people have a different understanding of the facts, sometimes folks have a different understanding of the law,” he said. “So how all that came about for each individual I can’t tell you. But I do think the testimony was very clear that the current system is broken, that the solution put forward by Gov. Haslam was the right solution at the right time and the right place, and why that didn’t carry the day I am not sure I can tell you right now. I wish it had and I think it should have.”
Hensley: ‘Obamacare’ an Insurmountable Obstacle
Tennessee Sen Joey Hensley, himself a physician, echoed Gov. Haslam’s assertion that policymakers need to keep focusing on health care issues.
“We certainly need health care reform in general,” said the Hohenwald Republican.
The defeat of “Insure Tennessee” doesn’t end that discussion, he said. However, he added that most GOP lawmakers just aren’t going to go along with anything they see as “adding to the weight” of existing government health-care spending programs.
While Haslam’s “Insure Tennessee” was advertised as a unique and novel approach for drawing down federal funding for health coverage that wasn’t a traditional Medicaid expansion, “it would still be TennCare,” Hensley said.
The governor’s “Insure Tennessee” plan was too closely associated with Obamacare in many Republicans minds, and that became an insurmountable political obstacle for it in the General Assembly, said Hensley.
Fitzhugh: GOP Failing
Tennessee House Minority Leader Craig Fitzhugh criticized the majority party for its handling of the “Insure Tennessee” deliberations.
Fitzhugh complained that not having any House committee votes or actual debate among lawmakers themselves short-circuited the legislative process in an unhealthy and unproductive manner.
“It does matter who governs,” Fitzhugh said, echoing a line oft-used by Republican Lt. Gov. Ramsey. “And it’s not going quite very well right now. I don’t see how anybody can take any bit of satisfaction out of what happened today.”
Harris: Tough to Process Defeat
Senate Minority Leader Lee Harris, a Memphis Democrat and freshman lawmaker, said he was “shocked and speechless” by the Medicaid expansion plan’s early end.
Harris said he’d hoped to “work through some of the issues that folks have with it and make policy.” He added that he was disappointed that more people didn’t have a chance to take part in the discussion.
While the governor probably won’t bring his proposal back up during regular session, Harris said it’s “feasible” that Democrats might decide to bring their own legislation. However, he added he can’t say for sure because it’s hard for him “to process.”
“Since we didn’t even really get it off of first base it’s hard to kind of understand what happened there,” Harris said.
Yarbro Disappointed Insure TN Didn’t Get More Consideration
Jeff Yarbro, a Nashville Democrat and the minority party’s caucus chairman in the Tennessee Senate, said the 7-4 vote of the Health Committee — on which he, too, served — was “obviously disappointing,”
Like other supporters of “Insure Tennessee” Yarbro thought the issue deserved a wider discussion in the Legislature than what it in fact received.
“I think it’s disappointing that seven votes can make the decision for 6-and-a-half million Tennesseans,” he said.
Yarbro, also a first-year member of the General Assembly, added that the conversation’s not over, and the Democrats will continue to work with the governor and “people of both parties that have common sense.”
Massey: Health Committee Should’ve Stuck to Health Issues
Tennessee Sen. Becky Duncan Massey, a Knoxville Republican,was one of those on the Health Committee who voted in favor of “Insure Tennessee.”
Massey said the “charge” of the committee in discussing “Insure Tennessee” was supposed to be limited to health benefits and health concerns, “not to vote on any of the other peripheral things that were going to be voted on by the other committees.”
In Massey’s view, the overall health benefits of the governor’s plan were “indisputable.” Discussions around the source of funding and the national debt did not have a legitimate place in deliberations about the plan from a pure health-policy perspective, she said.
The Senate “needed to hear the full debate,” Massey said.
Roberts Wanted Agreement Nailed Down
Kerry Roberts, a Republican member Senate Health Committee that voted down “Insure Tennessee,” said his opposition came down to not trusting the federal government with the state’s financial future.
The Republican from Springfield said he worried that without a solid written agreement between the state and the feds, Washington could potentially go back on the handshake deal Haslam had negotiated with the secretary of the U.S. Health and Human Services Department, the agency that manages Medicaid.
The federal government “holds leverage” over the state of Tennessee to the tune of “20 percent of our state budget.”
“We have got to look out for the people of Tennessee — we can’t agree to anything that puts 20 percent of our state budget at risk,” he said.
Niceley: No Trusting Federal Government
Frank Niceley, a member of the Tennessee Senate Health and Welfare Committee that voted to kill Gov. Bill Haslam’s “Insure Tennessee” plan, is a little perplexed why the matter was even presented to lawmakers.
Niceley said he never doubted that “Insure Tennessee” was DOA.
The federal government under the Obama administration has a bad name in the Tennessee General Assembly, at least among Republicans, he said.
“How do you trade with somebody who just blatantly doesn’t tell the truth?” asked Niceley.
All the same, the Strawberry Plains Republican said he wants to see the policymakers continue talking about reforms and initiatives that’ll encourage better health among Tennesseans.