We don’t need no stinkin’ special session on Medicaid expansion. That’s pretty much the Republican response to House Democratic Leader Craig Fitzhugh’s call for Gov. Bill Haslam to bring lawmakers back to Nashville after the Graham-Cassidy bill failed in Congress.
It was the third iteration of repeal and replace for the Affordable Care Act to fail in Congress.
“Once again, the Affordable Care Act has been confirmed to be the law of the land,” says Fitzhugh, a 2018 gubernatorial candidate. He accuses Congress of wasting years and billions of dollars with partisan bickering, all leaving the health of Tennessee families at risk.
Tennessee is among some 20 states that refused to expand Medicaid and take advantage of federal funds as part of the Affordable Care Act. Fitzhugh and other Democratic leaders contend the state has allowed more than $3 billion to go elsewhere while Tennessee tries to figure out what to do with about 290,000 people who fall into a gap between TennCare and Obamacare.
Fitzhugh points out states refusing to expand Medicaid are seeing insurance options shrink, hospitals close and millions of people go uninsured and under-insured.
He figures if the governor could call a special session in September 2016 to revise DUI laws to ensure the state collected $60 million in highway funds, he could do the same with a much more important issue.
“Hospitals are the economic engines of our communities, providing good jobs and health care. It is imperative that we as the representatives of the people of Tennessee step up and do what is best for our citizens,” Fitzhugh says in a statement.
It must be noted the special session a little more than a year ago dealt more with the House dismissal of beleaguered and now-former Rep. Jeremy Durham for sexual misconduct than anything else, which made it a lot more interesting to cover, since sex sells better than transportation dollars.
But every once in a while, state lawmakers have to deal with tough issues.
For the most part, they’ve declined to consider Medicaid expansion. Haslam’s special session on Insure Tennessee yielded little but hard feelings two years ago when he proposed a market-based plan using Affordable Care Act dollars to cover the insurance gap for uninsured and under-insured Tennesseans.
The matter never made it to a House or Senate floor vote, mainly because the federal funding came with the stigma of Obamacare and fear that the federal government would drop its share of the bargain.
President Donald Trump has piled on, enabling Republicans to continue their assault on the Affordable Care Act, even though Congress can’t muster the votes to kill it.
Consider this statement from House Majority Leader Glen Casada of Franklin and House Majority Chairman Ryan Williams of Cookeville: “As Republican leaders of our state, we want to get rid of the disaster of Obamacare, not support a broken health care system that has become a drain on Tennessee families and backed insurance providers into a corner.
“Republicans want real solutions, not political promises that would result in more bureaucracy, higher costs, and drive a wedge between patients and doctors. Obamacare has caused insurance rates to skyrocket to a point where the middle class can no longer afford coverage.
“Medicaid expansion has been an abysmal failure for those states that have participated. Here in Tennessee, we are committed to improving the health and quality of life for all Tennesseans through free market principles that demonstrate real results.”
House Speaker Beth Harwell, who is making her own gubernatorial run, takes a similar tack, saying instead of holding a “wasteful” special session, the Legislature should ask Congress to return health care money to the states with no “strings” attached so Tennessee can come up with a “better, more affordable program.”
Asked about the matter before she could huddle with the rest of Republican leadership, Harwell said she might consider dusting off a 3-Star Healthy plan if the federal government would give Tennessee the “flexibility” to do it.
The Belle Meade Republican adds she spoke with Gov. Haslam about seeking another waiver from the U.S. Health and Human Services for the state’s TennCare program, including options for health savings accounts and a work requirement.
“So that might be part of expansion, I don’t know. That’s up to the governor,” she explains.
“But I don’t think calling the Legislature in for a special session is a wise way to go.”
Harwell also says states that expanded Medicaid are seeing an increase in opioid use, which is one of her targets for the 2018 session.
Unfortunately, opioid abuse is considered an “epidemic” in Tennessee, as well. Why else would Harwell appoint a task force to tackle it? The panel came back with – believe it or not – some pretty good recommendations on battling this scourge over the summer.
Yet the lack of Medicaid expansion is an abysmal failure in Tennessee, too. And with Congress unable to make much headway on the matter, the Republican-controlled General Assembly appears happier slinging sticks and stones than looking for solutions.
Haslam’s take
The Republican governor, who draws the ire of tea party types for his Insure Tennessee push, remains frustrated with Washington, D.C.’s inability to come up with something that might create some stability within the insurance market.
He’s leery, though, of asking the General Assembly to come back to Nashville.
“I don’t know that (with) a special session we would get any different result than we got the last time we had a special session,” Haslam tells reporters.
The moderate Haslam likes a bipartisan approach taken by U.S. Sen. Lamar Alexander, one ensuring Congress would fund “cost-sharing reduction” provisions as spelled out by the Affordable Care Act in which federal funds go to insurers to cut out-of-pocket costs such as deductibles and co-insurance for low-income enrollees.
The House of Representatives sued the Obama administration, contending the payments are illegal without congressional approval. The litigation is pending, and uncertainty about whether the Trump administration will continue to make those payments caused BlueCross BlueShield and Cigna to raise their premiums a total of 21 percent and 37 percent statewide for healthcare.gov marketplace coverage, according to the Sycamore Institute.
About two-thirds of those increases are attributed to uncertainty about the federal cost-share reduction payments, the institute reports.
As a result, premiums are set to go up nearly 100 percent in the Memphis and Knoxville regions but only 9 percent in Greater Nashville and 50 percent statewide, the institute states.
Monthly premiums for a 55-year-old non-smoker in the Greater Knoxville and Greater Memphis areas would jump to more than $1,430 from $725, according to the Sycamore Institute’s analysis of federal filings.
Haslam acknowledges insurers have “priced some uncertainty” into their premiums, the problem Alexander and Democratic Sen. Patty Murray have been trying to attack.
“I was hoping that would be a step one and we could make some progress. I guess they’re trying to resurrect that,” Haslam acknowledges.
As he weighs a 2018 U.S. Senate run in the wake of Sen. Bob Corker’s decision to step away, Haslam points out the American people are about as frustrated as he is with the failure of Congress to shore up health care and insurance.
“And I think that’s why everybody looks at Washington and says we’re not getting anything done, and why a lot of people go, ‘I don’t know that I believe in the process anymore because they’re arguing about the politics of it instead of how can we make it better than it is today,’” he points out.
Haslam previously said he believes the cost of health care is the biggest problem but one Congress hasn’t even addressed.
The analysis
While some folks are fiddling and Rome is burning, Haslam is correct in stating cost is the key.
By the time the hospital, medical clinic, doctors, insurance companies and pharmaceutical companies take their cut for a medical procedure, it’s no wonder people are going broke trying to pay for health care.
Consider this: A few years ago, after a certain company bought me out, my insurance ended immediately. COBRA payments were off the charts and retroactive, yet my son needed immunizations to enroll at MTSU.
When we went to the medical clinic, they informed me my old health card was invalid, which I had told them already when they asked for it. A few minutes later they came back and said I would have to pay out of pocket for the shots.
“It’s going to cost $9,” the woman said, apparently wondering if I could pony up that staggering amount.
Considering I would have had to make a $20 co-pay under my old coverage, then get a nice bill in a couple of months, I told my son, “Get your butt in there and take those shots before the price goes up.”
Clearly, the cost rises when you have insurance, and sometimes they’ll negotiate the price of a procedure, something that won’t happen when you have insurance.
So, when people say they don’t want to try to figure out what’s wrong with our health care system, what they really mean is they’d rather sit around complaining about the status quo, which if it is doesn’t break you will make you sick as hell.
Sam Stockard is a Nashville-based reporter covering the Legislature for the Nashville Ledger and Memphis Daily News. He can be reached at sstockard44@gmail.com.