According to the Governor, in order to insure that low income workers making less than $15,415 per year (that’s in 2012 dollars) have “'skin in the game,” he refused to accept $730.7 million from the federal government.  Medicaid is a federal-state match program that has and will continue to be a 65% federal-35% state match for the historic program covering people already enrolled. The $730.7 million for Tennessee has been on the table to supply 100% coverage for Medicaid expansion through TennCare for 144,500 low-income newly eligible enrollees in 2014.  The 100% federal dollars have been offered to all states for the first three years (2014-2016) of the expanded Medicaid program with a gradual reduction to a 90% federal rate through 2020.  It’s a very good deal and eight states even adopted early after the 2010 passage of the Patient Protection and Affordable Care Act.

Using CBO estimates, a low earner at 100% to 133% of the federal poverty level (FPL) who puts “skin in the game” purchasing private “exchange” insurance in 2014, will pay 2% of premiums plus co-pays and deductibles (in excess of $180 per year). The federal government will pay 98% of the premium (approximately $8820 instead of under $6000 for TennCare). TennCare, with a 93% positive approval rating from its enrollees, cost $3183 per enrollee per year in FY2010 and will cost less than the $6000 U.S. Medicaid average in 2014.

Tennesseans can expect three years of accelerated costs while those newly insured “catch up” in obtaining health care because it’s not just the uninsured that are vulnerable in this battle over coverage.  Governor Haslam has refused $730.7 million for one of those three expensive years.  Low-income families, local governments, hospitals, and clinics will be hurt.

Meanwhile, Mr. Haslam leaves a new kind of “donut hole” for Tennessee citizens. Childless adults (aged 19-64) who earn under 100% of poverty get no help.   Folks under 100% FPL are not eligible for subsidies.   Reach the Governor at 615-741-2001 and share your opinion about his refusal to expand Medicaid (TennCare) as well as his new “Tennessee Plan”                            (https://news.tn.gov/node/10458).
Submitted by eyewitness: Mary Headrick, MD

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                        by Ralph Hubbard

Governor Haslam's Refusing Fed Dollars in 2014 Makes No Sense

I have read Governor Haslam's remarks to the General Assembly on March 27, 2013 and it makes me wonder whose side he is on in regards to the Medicaid (TennCare) expansion in 2014.   First of all he appears to be merging the Medicaid cost figures for the existing TennCare enrollees with the cost for the new enrollees under the expansion to come up with a larger cost as if that were the cost of the expansion only and he uses the total cost for the next eight years to make it seem even bigger.

Governor Haslam was a successful businessman so he knows how to manipulate the figures to prove whatever point he wants to prove.   Now I am just a small businessman and I look at things a little simpler.  Now if someone offers me 730.7 million dollars to pay 100% of the cost of expanded TennCare for year 2014  to cover 144,500 additional people who's yearly income puts them below or just above the federal poverty line, I'm going to take it.  The federal offer also would allow me to opt out after three years if I decide I can't afford the small increasing percentage I have to pickup after three years until it reaches 10%.  Now that 10% is a lot of money, maybe $200 million a year, but that is not a lot to cover the expected 181,700 working poor in Tennessee by 2020.   With the expected job increases and the additional revenue, I would expect the   HMO premium and the economic stimulation from the added employees to easily cover the added cost.

Since the federal government was expecting the working poor to have health care coverage in 2014 and beyond, the hospitals will no longer count on receiving DSH payments to cover charity care.  Many small rural hospitals who serve large numbers of uninsured or underinsured people will loose so much income they will have to close or shut down Emergency Room service.

Perhaps the real agenda for the Governor refusing the TennCare expansion in 2014 is to have those hospitals close and then let the large corporate hospitals buy them for a song or  maybe to help the health insurance companies make more money with his "Tennessee Plan".   Of course only the Governor knows for sure.