I'm Leaning Toward "Haslam Implements the Medicaid Expansion"



Two interesting stories came out in the past couple of days about whether Haslam and the state legislature would expand TennCare or opt out, as the Supreme Court just ruled we could do. These stories have kind of changed me from not having even a clue what the governor would do to thinking that this is going to happen.

As the Commercial Appeal explains, implementing this is not going to be cheap. They're talking about a $1.5 billion price tag.

Under the Affordable Care Act, the federal government agrees to pick up the entire tab from 2014 to 2016 for expanding TennCare. It's an offer that could be worth $11 billion from the federal government and could cover some 200,000 now-uninsured Tennesseans. But to get the money, the state would have to spend an estimated $716 million to $1.5 billion over five years, based on Congressional Budget Office projections.

Yikes. But, if we don't expand TennCare, then we end up in a situation where Tennesseans pay federal taxes for a program they see no benefits from because our state doesn't participate. That's also not very good. As Arkansas Gov. Mike Beebe says, "I don't want to send it to Massachusetts or California and ignore our own people."

But I don't think that will be the reasoning that persuades Gov. Haslam (though I won't be surprised if he uses that line of reasoning to try to sell this to conservatives). What's going to persuade Haslam is that hospitals want this. This article from the AP spells that out clearly:

The head of the Tennessee Hospital Association says hospitals across the state are going to suffer if TennCare is not expanded under the new federal health care law.

Craig Becker, the president of the Tennessee Hospital Association, told the Chattanooga Times-Free Press, "It’s pretty clear that that is absolutely our Achilles' heel right now.”

I don't think Haslam wants to anger hospitals, and I don't think he wants to preside over the closing of rural hospitals. It's already mortifying enough that doctors fly into our state to deliver free health care like we're some kind of giant refugee camp. Our approach to healthy citizenry can't be to hope everyone in the state has a good enough vehicle to get to a city to crowd into those emergency rooms.

We'll see. But for now, I'm leaning toward Haslam finding a way to make this happen.

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