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If Tennessee opts out of the Affordable Care Act, voters may have good reason to feel sick




For the past month, manufactured crises over the NRA's political firepower, the imminent threat of Islamic takeover, and the public's right to simultaneously bash gays and clog its arteries have successfully diverted (or refocused) the attention of Tennessee voters. But there's a rumble on the horizon not even pointed fingers and cries of "Shariah law!" can indefinitely defer.

To the dismay of the state's progressives — remember them? — Tennessee's triumphant Republicans are talking about refusing to expand Medicaid coverage under the federally approved Affordable Care Act, rejecting a jackpot of benefits in the process.

Their logic is head-spinning. By opting out, Tennessee gives up the lion's share of a $7 billion federal windfall for the state and nearly 30,000 new jobs in the health care field — and that's in the law's first five years. That's not to mention coverage for 200,000 more Tennesseans almost entirely paid for by the federal government.

It gets better. If Tennessee opts out, preventive care remains unaffordable for the state's citizens who are still uninsured, so emergency room visits don't decrease and everyone's premiums don't go down. What's more, Tennesseans still help pay for the program through our federal income taxes — only for every other American to enjoy.

And it's all to try to save $300 million in state dollars annually — a cost Republicans say the state can't afford, but which we probably will incur anyway no matter what we do.

Those conclusions are mostly derived from a cost-benefit study conducted earlier this year by the University of Memphis. Assessing the economic impact of the health care law, the study found that an additional $7.5 billion in federal money would be spent in Tennessee in the law's first five years. In 2014 — the first year alone —the study estimated an extra $454 million in federal spending would create 7,573 new jobs, growing to 29,440 jobs in 2019.

Had the agent of this good fortune been something other than the dreaded "ObamaCare" — say, the opening of a new industrial plant somewhere — the study might have ignited a wild statewide celebration. Instead, the study has been little noticed and hardly mentioned since its release in March, at the height of the maelstrom over the health care system overhaul.

On June 28 the Supreme Court — while upholding the constitutionality of the Affordable Care Act — gave states the right to opt out. In other words, states can refuse to expand Medicaid coverage to add 17 million Americans to the program's rolls when the act goes into effect in 2014.

The Republican governors of five states — Texas, Florida, Louisiana, Mississippi and South Carolina — already have announced they'll block the expansion, an action that many health care experts initially called unthinkable.

Gov. Bill Haslam's official position is that he's only considering opting out. But in his few public comments on the subject, he has cast serious doubt on whether he might do anything else.

"Obviously I am not a fan of the health care plan," the governor said right after the Supreme Court ruling. "The cost impact to the state is very significant."

Congressman Jim Cooper says bluntly: "They're playing politics in an election year."

Cooper is a Blue Dog Democrat, famously as fiscally conservative as any Republican. But he voted for the Affordable Care Act because "this is the most awesome deal ever offered." He calls the Republican criticism baffling.

"A lot of Tennesseans are hurting right now and they need help, and this is the only plan right now that I'm aware of to help them," Cooper tells the Scene. "I'm not aware of a Republican plan that even tries to help them. If you don't have your own plan, why turn down this help?"

If Haslam tries to opt in, he almost certainly will face a revolt by his own party. The tea party and most Republicans in the legislature will howl if he tries to accept any piece of the hated ObamaCare. If anything, last week's primary elections, which saw the tea party revolting against a number of GOP incumbents, will make lawmakers more unwilling to go along with ObamaCare for fear of attracting their own challenges in two years.

House GOP Leader Gerald McCormick — one of the state's more reasonable legislators — sees little chance Republicans will suddenly back-flip on a law they have denounced for two years and agree to expand Medicaid.

"I don't think you'll see wholesale support for increasing expenditures to the extent President Obama wants. Certainly we're not going to do that," McCormick says.

If anyone thinks the law's advantages are irresistible, even to Tennessee's Republicans, remember these are the same legislators who overwhelmingly adopted the so-called Health Freedom Act. A clear violation of the Constitution's Supremacy Clause, which holds that federal laws supersede those of the states, it purported nevertheless to fire a pre-emptive strike and nullify the Affordable Care Act, giving Tennesseans the right to disobey the law's individual mandate to buy health insurance.

"That's what this bill is about — it's about freedom. It's about giving people choice," the sponsor, then-Rep. Mike Bell, R-Riceville, said during one debate.

With a straight face, Bell — now a state senator — went on to explain that people who choose not to buy insurance can pay their medical bills with vegetables, like the Mennonites do in his district.

"They're some of the healthiest people you have ever seen," Bell said.

In her public comments, Sen. Mae Beavers, R-Mt. Juliet, another sponsor of the Health Freedom Act, seemed genuinely puzzled over what the president's signature law does.

"You should have a choice as to whether or not you want to take the national health care [plan] or your own insurance policy," she said in one interview — as if there actually is a national plan that the government's forcing everyone to buy.

It's "more or less telling the federal government, 'Stay out of our business, let us buy our own health care,' " she added.

Republicans were outraged when Chief Justice John Roberts dashed their dreams by affirming the constitutionality of the Affordable Care Act and its linchpin, the individual mandate.

Lt. Gov. Ron Ramsey, one of the state's most vociferous opponents of the law, complained that the ruling spoiled his Fourth of July holiday, when he said he typically spends time contemplating "a longer, historical view of our freedom and liberty." "This year that is impossible" because the Supreme Court upheld "the disaster that is ObamaCare."

"That decision resulted in the degradation of our liberty," Ramsey wrote on his Facebook page. "There is simply no other way to put it. ... This usurpation of our liberty called ObamaCare must be resisted."

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