Neighboring the nation's two biggest
Obamacare success stories has apparently made Republican Gov. Bill Haslam in Tennessee reconsider his refusal of Medicaid expansion under the law. Arkansas and Kentucky lead the nation in reducing the number of uninsured people in their states, largely because they accepted the expansion. Haslam appears to
want in on the action now.
This would be the first time for the governor to actually submit a plan. If approved by federal officials and the state legislature, the plan would help Tennesseans caught in the coverage gap of the Affordable Care Act, which has left 162,000 Tennesseans without health insurance, according to the Kaiser Family Foundation.
In March 2013, Haslam ruled out expansion of a traditional Medicaid model and said he favored a plan to leverage federal funds to, instead, help the poor buy private health insurance. Haslam said then that a "Tennessee Plan" should require copayments, which traditional Medicaid does not, so people would have "some skin in the game."
Now he's saying that the state could submit an application for a waiver in the program in the fall. It would follow the Arkansas model for expansion, using the public funds to subsidize purchase of private plans for the new enrollees.
Haslam is going to have to convince his Republican legislature to go along with the plan, and that could lead him to craft a program that the federal government would reject. A very recent example is Pennsylvania, which just announced a deal with the federal government to expand the program. There's only so far the administration will go to work with a Republican governor on Medicaid. In Gov. Tom Corbett's case, the administration refused to tie Medicaid enrollment to employment, restricting the program to people who have jobs or are actively looking for one. Haslam's idea to force copays from the newly eligible Medicaid recipients could be rejected, too. Iowa tried to impose premiums on people who earned more than 50 percent of the federal poverty line, and that was denied. The White House isn't going to be willing to create an unreasonable financial burden on low-income people.
Haslam is in the place a growing number of Republican governors—recognizing that Obamacare is increasingly less toxic, and that rejecting the money that is helping a lot of people and providing an economic boon to states is pretty politically damaging.