Democrats urge Insure TN be reconsidered; Haslam says not now

With the Republican plan for repealing and replacing Obamacare dead in Washington for now, at least four states that previously rejected Medicaid expansion – Kansas, Maine, North Carolina and Virginia – have moves afoot to reconsider the idea.

Tennessee Democrats would like to see the Volunteer State become the fifth, reports WPLN, but Gov. Bill Haslam says it’s too early. In 2015, Haslam proposed a Medicaid expansion plan, dubbed Insure Tennessee, that was killed by the Legislature.

Gov. Bill Haslam said Tuesday he is not currently considering another legislative special session to expand the state’s Medicaid program under the federal Affordable Care Act, also called Obamacare.

“The sooner the better, so we can begin collecting and allowing up to 300- or 400-hundred thousand people to be covered under Medicaid,” says House Minority Leader Craig Fitzhugh, D-Ripley.

Fitzhugh proposes repealing a state law that requires the legislature to sign off on Medicaid expansion. That would free up Governor Bill Haslam to negotiate a plan with the Trump administration. (Note: It’s HB846, on notice for the House Insurance and Banking Subcommittee next week.)

Haslam says he’s instructed TennCare officials to review their options. But it’s too soon to come up with a plan.

“I think it’s early. I mean, we literally just had, Friday, the country took a change of direction no one was expecting,” he says.

Haslam adds it’s probably too late in the legislative session to propose an expansion plan this year. Lawmakers are likely to adjourn around the end of April, and the administration has focused on passing the state budget and a road-funding plan.

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Haslam, other GOP govs, fret over lack of flexibility in health care bill

“Flexibility” has become a buzzword among 15 Republican governors raising concerns about U.S. House GOP’s health care bill, reports Politico, including Tennessee’s Bill Haslam on it list. No governors have publicly expressed strong support for the American Health Care Act.

Further from an AP report: The nonpartisan Congressional Budget Office estimates that GOP legislation would increase the ranks of the uninsured by 14 million people next year alone, and 24 million over a decade. Haslam says it’s not clear how many people would be affected in Tennessee, and that the legislation could still change in Congress.

The Republican governor said Tuesday that the main thing the state is looking for in the overhaul is more flexibility to deal with areas like increased enrollment during an economic downturn or escalating costs for medications. He says that flexibility was not included in the in the original version of the proposed overhaul.

Similar language was used by the director of TennCare in an appearance before the House Finance Committee on Tuesday, reports the Tennessean. She said the proposal is structured to reduce Medicaid funding without loosening up regulations for states to further tailor programs.

“We definitely have concerns at this point in time,” said Long, adding the agency would continue to be in touch with the state’s federal congressional delegation to monitor amendments.

TN hospitals oppose GOP’s Obamacare replacement plan

NASHVILLE, Tenn. (AP) — The Tennessee Hospital Association has come out against a new plan in Congress to repeal and replace the Obama health care law, saying the proposal poses “a dark forecast for the future of hospitals in Tennessee.”

THA, which represents 147 acute-care hospitals and health-care facilities across the state, said in a statement Friday that Obamacare has been a challenge. Obamacare is the informal name for the Affordable Care Act.

But the organization said it believes more will lose coverage under the new House GOP bill because it reduces the amount of federal aid people would get to help them pay for their insurance.

“Primarily, we believe a significant number of the roughly 230,000 Tennesseans currently covered could lose their coverage because of an inability to pay for insurance due to significantly reduced federal subsidies,” said THA president and CEO Craig Becker.

THA is affiliated with the American Hospital Association, which announced its opposition to the new proposal earlier this week.

In Tennessee, THA is concerned that the new plan would mean hospitals are going to have to provide free care for more uninsured people while getting even less money to treat Medicaid patients.

Note: The full AP story is HERE; the THA press release is HERE.

Politico: TN is ‘Exhibit A’ for Republicans pushing Obamacare repeal

Under the headline ‘Tennessee becomes Exhibit A in GOP’s Obamacare repeal push,’ Politico reviews the state’s health care system troubles, most recently highlighted by Humana’s move to cease operations in 16 counties where it is now the only provider and Blue Cross Blue Shield closing in much of the state while announcing “some of the sharpest premium spikes in the nation.”

Republicans warn that other states could look just as dire unless they get rid of Obamacare and replace it with a market-driven system.

“The Affordable Care Act is too expensive to afford,” Rep. Marsha Blackburn (R-Tenn.) said during a town hall meeting over the Presidents Day break in Fairview, about 30 miles southwest of Nashville. “Our goal is that health care is going to be more flexible, more usable and more affordable to everyone.”

But even here, despite all the turbulence, resistance is mounting to Congress scrapping the law without a credible replacement plan, because it could unleash even more chaos. Obamacare defenders believe their message is starting to resonate, especially with the state’s Republican senators, Lamar Alexander and Bob Corker.

…The challenge, then as now, is insurers have struggled to get enough healthy people into the coverage pool to offset the cost of caring for older, sicker individuals. Some in the desirable cohort have flouted the health law’s mandate that most people be covered and instead paid penalties, happy not to deal with rising premiums.

“What happened is the people who are healthy paid the penalty and moved on,” said state Rep. Cameron Sexton, a Republican who chairs the House Health Committee. “And then, the people who were really sick picked up the insurance because they needed it, and the risk to the insurance companies was far greater than they ever expected.”

…Michele Johnson, executive director of the Tennessee Justice Center, said the problems have been exacerbated by the state’s failure to expand Medicaid eligibility under the health law. Johnson pointed to neighboring Kentucky, which opted in and dramatically lowered its uninsured rate, as evidence that such a move would have helped stabilize the individual market and reduce premiums.

“We chose not to do it and then they’re like ‘This thing is dying.’” Johnson said. “That’s because you have your hand around its neck killing it.”

Note: Alexander has an op-ed piece declaring there’s an ‘Obamacare emergency’ in Tennessee. His bottom line (as it appears in Jackson Sun version):  It’s time to stop fighting like the Hatfields and the McCoys over Obamacare. Tennesseans expect the new Congress and administration to work together to quickly fix the Obamacare emergency in our state.

Haslam report from Washington: Things ‘pretty fluid’ on Obamacare, but he’s encouraged

After  a long weekend in Washington, including meeting with President Trump along with other governors, Gov. Bill Haslam says things are “pretty fluid” on repealing and replacing Obamacare in the nation’s capitol but he’s encouraged that the presidential administration, Congress and governors are working together on the matter.

Further from the Times-Free Press:

“What we’re trying to do is have everybody be on the same page with something that can actually pass and will work in the states,” Haslam said.

In play are several key aspects as Republicans seek to change the Affordable Care Act, also known as Obamacare, as well as the traditional Medicaid program for the poor, thereby saving billions for the federal government but potentially impacting millions of Americans.

One is ending the status of Medicaid as an open-ended entitlement Medicaid program with newcomers able to come in with the federal government picking up varying percentages of the tab with states covering a smaller percentage of costs.

…Haslam acknowledged difficulty in getting everyone on the same page.

“Obviously, to get something passed you’re going to have to do something that states that expanded and those who didn’t can live with,” said Haslam.

Haslam was appointed to the eight-person working group by Republican Governors Association Gov. Scott Walker of Wisconsin.

House Republicans’ plan includes a proposal to turn federal Medicaid financing from an open-ended entitlement to a block grant or a per capita allotment to states. Haslam said he favors the latter.

He also thinks states like Tennessee, which didn’t expand Medicaid, shouldn’t be harmed financially because they didn’t.

“No. 1, I don’t think that a state should be penalized who didn’t expand as we do that,” the governor said. “No. 2, I think it has to be something, I’m more in favor of a per cap-type grant rather than a block grant.”

A block grant provides a set amount of federal spending per year regardless of how many people enroll in a state’s Medicaid program. According to the nonpartisan Kaiser Family Foundation, the per capita grant differs in that the federal government would set a limit on how much to reimburse states per enrollee.

Haslam, other govs, meet with Trump on Obamacare

Tennessee’s Bill Haslam was among a group of governors meeting with President Trump Monday for a discussion of Obamacare, reports the Associated Press.

“It’s an unbelievably complex subject. Nobody knew that health care could be so complicated,” Trump told the governors.

Haslam unsuccessfully pushed a plan to expand health insurance access to hundreds of thousands of low-income Tennesseans. Haslam’s Insure Tennessee plan would have used funds made available through the Affordable Care Act.

“There was discussion around a couple of topics, including infrastructure, but the discussion was predominantly around health care, and Gov. Haslam was very encouraged by the amount of collaboration between the White House, Congress and governors on this issue,” Haslam spokeswoman Laura Herzog said by email Monday. “He has never seen the White House and Congress listen to governors as much as they are doing now.”

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New TennCare waiver could mean ‘whole new ballgame’ in fed funding

After six months of operating under temporary extensions, state and federal health care officials have reached a new long-term agreement on continuing federal funding of TennCare that will change the way money is distributed to hospitals in two years.

From a Modern Health Care article:

 Under the new agreement, the CMS will continue the uncompensated-care payments through June 30, 2017, at current levels, which have averaged around $500 million a year.

During a one-year transition period, the total possible payments will ramp up to $708 million.

After that, Tennessee must submit a revised methodology for distributing the money that limits the subsidies to care provided to people who wouldn’t be eligible for Medicaid if the state agreed to expand the program under the Affordable Care Act.

“Coverage is the best way to assure beneficiary access to healthcare for low income individuals, and uncompensated care pool funding should not pay for costs that would otherwise be covered in a Medicaid expansion,” Eliot Fishman, director of the CMS’ State Demonstrations Group wrote in a letter to the state in November 2015.

Tennessee hospitals are nervous about how the allocations will change. It’s “a whole new ballgame with a new distribution system of funding for hospitals,” said Craig Becker, CEO of the Tennessee Hospital Association. “We have some concerns about precisely how this will work, but we have a couple of years to work with state and federal officials to nail down details and secure needed funding for hospitals in the state.”

The CMS has increasingly resisted paying for healthcare for the uninsured now that most of them have access to coverage under the Affordable Care Act. That issue has been an obstacle to renewing waivers in other states, including California, Florida and Texas.

See also The Tennessean, HERE

Two legislators seek more ‘Healthy Task Force’ transparency

Two Knox County legislators say they’re concerned about a lack of transparency in dealings of the legislative task force studying options for Medicaid expansion in Tennessee, reports WSMV-TV.

Sen. Richard Briggs and Rep. Roger Kane, both Knoxville Republicans and members of the 3-Star Healthy Task Force set up by House Speaker Beth Harwell, made their concerns known in a letter to Rep. Cameron Sexton, R-Crossville, who chairs the panel. (Letter text, HERE.) In particular, they complain about task force members using cell phones to communicate with one another in a manner that would violate the state’s “sunshine law.”

Sexton, on the other hand, tells the station his group has been “more transparent and open than any task force that’s ever been created in the history of Tennessee.”

“In the spirit of transparency and accountability, we have real concerns about using personal cell phone devices to transmit  information back and forth on the Healthy Task Force. In addition, there needs to be a permanent record at the state level of all transactions that we are doing in order to be in compliance with the Open Records and Freedom of Information Acts,” says the letter. “Going forward, it is vital that we have documentation of our communication and procedures through the legislative email system.”

Excerpt from WSMV’s report:

In a phone interview, Briggs said he and Rep. Kane feel strongly about open government issues, which is why they contacted Sexton.

“We’re about to get into some serious areas of the Three-Star Health plan,” Briggs said. “I wanted to put everything out in the clear.”

Their letter made a reference to “Black Wednesday,” an event in 2007 when Knox County politicians struck backroom deals over appointments to the county commission.

“We realize the Tennessee Legislature is not bound by Sunshine rules, but in some cases like this, we should be,” Briggs and Kane wrote.

Note: State courts have repeatedly held that laws on open meetings of governmental bodies do not pply to the General Assembly. The Senate, however, has adopted the open meetings law as part of its official rules and is thus bound to follow the provisions. The House has not done so.

The court rulings are generally based on this provision in Article II, Section 22 of the Tennessee Constitution: “The doors of each House and of committees of the whole shall be kept open, unless when the business shall be such as ought to be kept secret.” In other words, the legislature is open to the public except when legislators decide it should not be open to the public.