Asking for the Moon: How Haslam Blew Up Medicaid Talks



Gov. Bill Haslam is blaming that evil Obama administration for the failure to strike a deal to expand Tennessee’s Medicaid program under the Affordable Care Act. He insists he’s negotiating in good faith. But the talks collapsed this week with the governor making what obviously are unrealistic demands.

Democrats are calling it a political ploy to dodge responsibility for turning away billions in federal cash: Haslam asks for the moon, then throws up his arms and claims he’s the only reasonable one at the bargaining table.

The governor says he wants to do what Arkansas is talking about doing: Using Medicaid money to send people to the Affordable Care Act’s health insurance exchanges to shop for private plans along with Americans who qualify for subsidies under the law.

But that’s not all Haslam wants. To curtail state costs in the cash-strapped entitlement program, he wants to force these new beneficiaries to accept whatever plans are available on the exchange even if they offer less comprehensive benefits and charge higher co-pays than Medicaid.

“We’d like it to be very much like the commercial product that’s on the exchange to the greatest extent possible. We think that makes sense,” TennCare director Darin Gordon says.

That's against strict Medicaid rules, which require that beneficiaries receive the same cost-sharing and benefit packages in private plans as they would in the public program, and Haslam should have known Washington wouldn't go for what he was proposing. As the Washington Post’s Wonkblog points out in its report on yesterday's developments:

Medicaid experts I’ve spoken with have made it clear that such an approach wouldn’t fly: Even if they receive private coverage, the Medicaid agency would need to ensure they aren’t spending more out of pocket than they would in the public plan.

To health care advocates, the governor is naive or cynical, and it hardly matters which. They see no hope for Haslam working out a deal on his take-it-leave-it terms. One health care insider who asks not to be named for fear of pissing off Haslam gives this account of the so-called negotiations with the Department of Health and Human Services.

"HHS said, 'We’re always willing to talk. We want to be as flexible as we can and work with the states, but these items that you have put out here, some of them we can talk about and some of them are absolute non-starters.' At which point, the state folks broke it off and said, 'It’s all or nothing.' That’s not a serious negotiation."

Haslam and Gordon talk with reporters yesterday:

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