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Robert Houk

Opinion Page Editor
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Legislators could mess things up for sick, poor

June 17th, 2013 9:00 am by Robert Houk

Legislators could mess things up for sick, poor

I once heard the Rev. Will Campbell — the civil rights activist and colorful Baptist preacher, who died June 3 in Nashville  — say the prayer before a floor session of the Tennessee House of Representatives. I don’t recall the exact words of this prayer, but it went something like: “Oh Lord, please don’t let these legislators mess up Tennessee any more than it already is.”
We could certainly use a prayer like that today. Earlier this month, the Volunteer State was once again featured unflatteringly in a segment of “The Daily Show.” This time it was for what has been lampooned as a sadistic health care lottery for some of the sickest and poorest residents of this state. Twice a year, Tennessee offers eligibility to TennCare (which is where Medicaid dollars are spent in this state) to those who can get through on the telephone to request an application for the program.
The competition is fierce, so it’s extremely difficult to get through. The phone line shuts down after 2,500 calls, which the state usually receives within an hour or so of the lottery. Even if the caller gets through, there is no guarantee he or she will actually qualify for TennCare. Applicants must meet strict income, debt and medical requirements.
The fact that so many Tennesseans feel the1 need to participate in this kind of lottery is heartbreaking. Equally troubling is the fact that even more residents of this state could hear a busy signal from TennCare as a result of Gov. Bill Halsam’s decision to refuse acceptance of additional Medcaid dollars through the Affordable Care Act.
Among them could be the 5,000 Tennesseans who would be eligible for life-saving cancer treatment under an expanded TennCare program.

A key component of the Affordable Care Act allows the state to add 180,000 state residents to the TennCare program. These new enrollees would be mostly the working poor — Tennesseans who have no health insurance with their employer, who can’t afford to be in the state’s new health exchange and who make up to 138 percent of the poverty level.
 The federal government would cover the total cost of this coverage for the first three years and 90 percent thereafter. These funds are intended to soften the blow for as much as $7.8 billion in Medicare cuts to Tennessee hospitals.
In handing down its historic decision last year legitimizing the Affordable Care Act, the U.S. Supreme Court decided states should have a right to refuse an expansion of their Medicaid programs. Haslam passed on accepting these funds with the knowledge that he could have never gotten the expansion approved by the Republican-controlled state General Assembly.
 Many GOP lawmakers let the governor know quite sternly they did not want anything to do with what they call “Obamacare.”  
Haslam told a joint assembly of the House and Senate in March he would pursue a “third” option on the Medicaid expansion issue by requesting permission from the U.S. Department of Health and Human Services to “leverage” federal dollars meant to purchase private health insurance for uninsured Tennesseans.
 I met with officials from the American Cancer Society’s Cancer Action Network last week, who told me they are still holding out hope the Obama administration will approve Haslam’s alternative plan for securing additional Medicaid dollars. The details of this so-called Tennessee Plan have not been released, probably because state officials are currently in negotiations with the HHS.
Recently, HHS gave approval for an alternative Medicaid plan in Arkansas, where the Democratic governor and Republican-led Legislature reached an agreement to add even more residents to the state’s Medicaid rolls than the number called for under the Affordable Care Act. By rebranding the deal the Arkansas Plan, not Obamacare, Republicans there were more willing to accept the additional dollars.
Haslam is hoping the same thing can happen in Tennessee if the Obama administration approves the Tennessee Plan. He may be right, but I suspect it will be a battle no Republican wants with an election year coming up. It is also one the governor could lose in this the reddest of the Red states.
Many Tennessee Republicans believe accepting Medicaid dollars from Obamacare would be endorsing the president and socialized medicine. Some lawmakers will say it, but not because they truly believe it. They will say it out of fear that a well-financed far-right tea partier will challenge them in the GOP primary next year.
“Please, God, don’t let the General Assembly make things even worse for the sick and poor in this state.”

Robert Houk is Opinion  page editor for the Johnson City Press. He can be reached at

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