Monday, December 22, 2014

Haslam's alternative plan to Medicaid expansion and what others are saying.

After almost two years of delay and negotiations, Govenor Haslam has come up with a unique plan to expand health care in Tennessee that embraces a more conservative approach and that is agreeable to the Obama administration's Department of Health and Human Services.  At this point I find it a reasonable plan which should be carefully examined  and passed unless major pitfalls emerge.

Obamacare counted on states to expand Medicaid to cover people with incomes of up to 138 percent of the federal poverty level and at the same time Obamacare cut or eliminated most federal aid to hospitals for unreimbursed care. By not expanding Medicaid, Tennessee did not get the federal money that would have went to Tennessee but we lost the money that was going to pay for unremimbursed care. Still, hospitals had to continue providing care to the uninsured indigent. As a result, several rural hospitals in Tennessee closed and more will be forced to close, if we do not expand medicaid or if Congress does not reinstate payment for unremimbursed care to a former level or we do not adopt Governor Haslam's plan.

Under Obamacare, if we would have expanded Medicaid, the federal government would have paid 100 percent of the cost for the first three years and supposedly 90 percent thereafter.  Many were dubious that the 90% thereafter would be realized and suspected the Federal government would shift more of the burden to the state.  There was also concern that the 10% the states were to pay after the first three years, would be 10% of a greater and greater dollar amount and end up consuming a greater and greater share of state revenues and cutting into other critical needs, the way Teencare had done when Tennessee had its experiment with Tenncare.

Rather than expand Medicaid, Governor Haslam resisted and sought a Tennessee alternative to Medicaid expansion. It took two years of negotiation to get an agreement to an alternative plan from U.S. Health and Human Services officials. His plan has two different ways to provide health care to the people who would have been covered had we accepted the Obamacare medicaid expansion. One portion of is plan would offer vouchers that low-income workers could use to participate in employers' insurance plans. The other is build upon TennCare, the state's current Medicaid program. New enrollees in TennCare under this proposal will pay modest premiums and copays, and the plan will include incentives for things such as annual health screenings and quitting smoking.

This seems like a reasonable proposal to me. Of course my preference would be for Congress to completely undo Obamacare and institute the package of Republican alternatives.  In the meantime, I think Haslam's plan is pretty good and the State legislature should pass it unless new facts emerge that expose serious pitfalls to the plan. The plan will insure more people and stop hospitals from closing and the copay and premiums, ensure the recipient has "skin the game," as they say.

I am a big supported of the Beacon Center and usually agree with their position on issues but was disappointed when they came out with this press release on the same day Haslam made his announcement that a  deal had been struck with the Department of Health and Human Services to allow the the Tennessee Plan to move forward. Here is the Beacon Center's press release:

Beacon Strongly Opposes Governor Haslam's Medicaid Expansion
NASHVILLE – The Beacon Center of Tennessee firmly opposes Governor Haslam's move to expand Medicaid and the reach of Obamacare's tentacles into our state. As our recent study with State Budget Solutions and Federalism in Action exposed, President Obama's Medicaid expansion would cost our state’s economy $3.6 billion, while causing more than 67,000 Tennesseans to lose their jobs. Medicaid has failed to help the uninsured and impoverished.
A similar plan in Arkansas has been nothing but a complete disaster. We should instead seek sustainable solutions that provide accessible, high-quality care that can actually make a difference in the lives of those most in need. The Beacon Center's healthcare reform package for 2015—to be released tomorrow—proves that Medicaid expansion is both unaffordable and immoral. We will actively work with our state lawmakers to soundly reject this proposal and instead pursue meaningful alternatives that put the quality of life for Tennesseans first.
I will study the Beacon Plan, but it took two years for Haslam to strike a deal with DHHS so if all opponents of Haslam's plan can offer is some pie-in-the-sky plan that has no chance of DHHS approval, I think it is preferable to accept the Haslam plan than watch hospital close and thousands  of Tennesseans have no insurance and no local hospital emergency room.

Americans for Prosperity is also opposed to the Haslam proposal.  I think some conservatives think that the chances of eventually repealing Obamacare are greater if there are suffering people and rather than see Obamacare take root, they would prefer to do all they can to prevent it from working. While we work to replace Obamacare, I think we also must deal with the realities as they are and govern.

Both Senators Lamar Alexander and Bob Corker have praised the plan. Here are what some other are saying:

Lt. Gov. Ron Ramsey as quoted in the press:
When a state has an opportunity to take power away from the federal government and institute real conservative reform, that is an opportunity that must be taken seriously. Governor Haslam has negotiated a deal which returns tax dollars back to Tennessee while using conservative principles to bring health insurance to more Tennesseans. I look forward to sitting down with my fellow legislators to take a hard look at what has been negotiated to make sure that the final deal, which must be approved by the legislature, is in the long-term financial interest of Tennessee.

A Facebook post from Professor Carol M. Swain, Ph.D:
The working poor need some relief. My mother's health care worker cannot afford Obamacare insurance. She can get a $31.00 premium w/ a $6,000 deductible. The policy will pay 50 percent of her cost after her deductible is met. She lost insurance after Obamacare passed. Republicans in Congress have done nothing to repeal Obamacare. Therefore, it makes sense for Governor Haslam or somebody to look after the welfare of the working poor.

Rep. Judd Matheny, R-Tullahoma as quoted in the press:
I appreciate what the governor has accomplished. This is not some cut and paste plan that other states have tried to sell as unique. I’ve talked with a lot of my colleagues, and I would say that not one has said they would reject the plan. We all have open minds, but there are going to be a lot of questions.

A Facebook post from  Rep. Jeremy Faison, R-Cosby:
I  just got off of the phone with a conference call with Gov. Bill Haslam. I'm encouraged Tennessee will be working to the best possible solution of the bad law Obama Care. From what I can gather so far, TN will be expanding Medicaid in such a way that it will work like a Federal grant to the state and we will run it. If you make less than 16k a year and are between the ages of 19 and 64, and you do not have access to healthcare insurance, this will be a plus for you. I will post more as I get a better understanding.
to see that

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  1. Nothing if FREE from the Federal Government.
    Anything you get from them comes from citizen's tax money.

    you can't rely on a promise of something happening three or four years down the pike.

    Always look a gift horse in the mouth, especially a government horse.

  2. Anonymous, I realize and agree that nothing is free and tax money is citizens money. However, if some of the money we send to Washington is going to be returned to Tennessee i think it is foolish not to accept it if the attached strings are not too unreasonable. Refusing federal money does not leave it in the pocket of the tax payer.