Tenn. awaits alternative to Medicaid expansion
Haslam: State in talks with Washington
NASHVILLE— Larry and Linda Drain took turns at a microphone telling how they separated last December after 33 years of marriage so she could remain on TennCare, Tennessee’s Medicaid program.
“When Obamacare came and I went to sign up last year, I found that I made $5,000 too little to qualify,” Larry Drain of Maryville said at a rally Monday outside the state Capitol where about four dozen people urged state officials to expand Medicaid. “Shortly after that, I found that the income I do have (about $11,000 a year from Social Security early retirement) was going to take away my wife’s TennCare.”
His wife, who has epilepsy and
other chronic health problems, spoke next. “Many people in Tennessee are pro-life, but it’s not possible to be pro-life if you deny people access to the health care they need. Many people in Tennessee are profamily. It is not possible to be pro-family if you force married couples to split up in order to maintain their health coverage.”
She remains covered but her husband falls into Tennessee’s coverage gap. His income isn’t enough to qualify for the federal subsidies that would enable him to buy private health insurance on the federal insurance exchange, or marketplace, created by the Affordable Care Act.
And because Tennessee hasn’t expanded Medicaid, which the ACA intended to cover the working poor who don’t qualify under traditional Medicaid, he isn’t covered there either.
Monday’s rally was another step in a process that began in Tennessee about 20 months ago and whose outcome is still undetermined.
On March 27, 2013, Gov. Bill Haslam told the state legislature he would not propose expanding Medicaid under the terms of the Affordable Care Act, or “Obamacare,” but would instead pursue federal approval for an alternative approach.
The “Tennessee Plan” he outlined would use the hundreds of millions of federal dollars that would have expanded traditional Medicaid in the state to buy private health insurance for uninsured Tennesseans with incomes up to 138 percent of the poverty level, the people who would be covered by the ACA’s Medicaid expansion. There would be incentives for healthier living and copays for those who could afford them.
Nearly two years later — as the second openenrollment period for coverage through the federal marketplace began Saturday — Tennessee is still negotiating with Washington on a Tennessee plan that would allow the money to flow into Tennessee and cover an additional 165,000 uninsured residents.
The governor reported at an orientation session of newly elected state House members Wednesday that he’s told President Barack Obama’s administration there needs to be an agreement soon because he has to get it approved by the state legislature, which convenes Jan. 13.
“We’ve said from the very beginning that expanding traditional Medicaid was probably not an option,” Haslam said. “I think if that went for a vote in either one of the (legislative) chambers, it would lose rather decisively. But we do think it’s important, and I’m in favor of more people having health coverage if we can do it in a way that incentivizes better behavior and better results.
“So we’re in the middle of having those conversations with Washington. I’ve been real clear with them: the legislature will come into session in mid-January and we need to have plenty of time to have that discussion.”
Haslam also said he won’t propose expansion if he determines it will bust the state budget. The ACA provides 100 percent federal funding for the costs of expansion during its first three years, 2014 through 2016. After that, federal funding phases down to 90 percent over four years, where it will remain.
Tennessee’s last experience with expanded Medicaid — which was essentially what TennCare was from its inception in 1994 until a major scaleback in 2006 — is the big reason why, Haslam said, tuition at the state’s public universities has spiraled: TennCare costs grew so rapidly, there was little money left for anything else.
“As much as we would like to provide more health care for folks, if doing that means squeezing out everything else, then we can’t do it. ... We’ll see if we can get that worked out. I honestly don’t know. I was back up there seven weeks ago and had a very optimistic visit with the administration, but seven weeks later we still don’t have anything done,” Haslam said.
He spoke last week with U.S. Health and Human Services Secretary Sylvia Mathews Burwell and Obama, who called Haslam late Tuesday to congratulate him on his re-election.
TennCare currently covers about 1.25 million Tennesseans, primarily lowincome pregnant women, children and people who are elderly or have a disability, for a total cost of about $10 billion, including about $3.2 billion in state funding. It has 234,528 enrollees in Shelby County and 65,007 in Knox County. About 760,000 of its enrollees live outside the four urban counties. Over 300,000 Tennesseans, mostly in working families, are without health coverage.
Michele Johnson, a lawyer and executive director of the Tennessee Justice Center, a small nonprofit public-interest law firm that provides free legal advice to low-income families, said Friday that while Tennessee waits, it loses $2.7 million a day in federal funding.
“Other Republican states have gone ahead with innovative programs to get their people covered. These other states have shown us what the federal government will allow, but nothing is going to happen unless we submit a proposal. The wait is tragic because we know from the families we work with that many families are being ruined financially, people are going without treatment and Tennessee hospitals on which we all rely are facing major cuts or even closure,” Johnson said.
Johnson estimated that nearly 250,000 Tennesseans have directly benefited from the ACA: About 60,000 young adults allowed to stay on their parents’ health coverage to age 26; about 151,000 who obtained insurance through the federal exchange; and an undetermined number who became eligible under other technical eligibility changes.