Medicaid Expansion Bites the Dust in Tennessee
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Over the course of just 48 hours last week, Republican Tennessee governor Bill Haslam watched his two-year flirtation with the Medicaid expansion, made available through the Affordable Care Act, get buried by the state legislature.

It was a quick and unceremonious end to what Haslam hoped would be his legacy achievement on health care in the Volunteer State. For roughly twenty-one months, the governor and his policy counsel worked hard to finesse Republican legislators into softening their stance toward his plan, called Insure Tennessee. But in the end, no amount of massaging could win over conservatives in the capitol.

Of course, it’s not that the GOP legislative supermajority has been blind to the healthcare needs of Tennesseans. According to Haslam, it was the legislature that started him down the Insure Tennessee path in the first place when it asked him to identify and suggest ways to address the state’s needs. The problem was that the governor ultimately decided the best fix lay in the expansion of Medicaid services under Obamacare.

But in Tennessee, as is the case in many places across the country, anything related to Obama is a conversation stopper. End of discussion. No matter how hard Haslam tried, he and his team could not overcome the connection between his plan and Obamacare. As one freshman senator put it, “If this bill was called Bubbacare instead of being compared to Obamacare…there wouldn’t be any trouble getting it passed.”

With that sentiment framing last week’s deliberations, Insure Tennessee didn’t stand a snowball’s chance in Phoenix. Eventually, it didn’t even get out of the committee stage. Uncertainty about its passage seemed to hang thick in the air immediately following Haslam’s impassioned speech last Monday to kick off the special legislative session. And less than two days later, the senate Health Committee put the measure out of its misery with a 7-4 vote to kill it.

No doubt, other red state governors contemplating similar Medicaid expansion proposals took notes as they watched events unfold in Tennessee. The pitch had some sweet sounds to it, specifically the idea that 280,000 low-income residents would gain healthcare access without adding any immediate weight to the state budget, since the federal government would foot the bill for the first two years of the program.

However, opposition groups—such as the Beacon Center of Tennessee—deftly highlighted the possible long-term downsides of expansion, namely that after its initial two-year pilot run, the state would, indeed, begin picking up a gradually increased portion of the tab. Also of concern to many legislators was the fact that, even though Haslam pitched Insure Tennessee as a “pilot-program,” it would be very difficult to dismantle it if it proved to be unworkable down the road.

At the end of the day, the failure of Medicaid expansion in Tennessee can be largely attributed to the growing divide and lack of trust between conservative Americans and the White House. Lawmakers in Nashville were being asked to roll the dice and pass a substantial piece of legislation that had too many question marks around it. Question marks to be addressed at some uncertain future date by the federal government.

Lieutenant governor Ron Ramsey summed up the legislature’s skepticism well when weighing in on Insure Tennessee’s defeat: “Ultimately, the absence of a clear, written agreement between the federal government and the State of Tennessee made passage impossible. Tennessee has always been a well-run, fiscally responsible state. We could not in good conscience put our stamp of approval on a mere verbal agreement with the Obama administration.”

You can’t say the man doesn’t have a point there. 

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