Tennessee Governor Hesitates on Medicaid Expansion, Frustrating Many - In Tennessee, opposition to expanding Medicaid has come largely from Republican officeholders and conservative groups. Arrayed on the other side are the Tennessee Hospital Association and other medical groups, the Tennessee Chamber of Commerce and Industry and local chambers across the state, several antipoverty organizations and the Democratic opposition.

From The New York Times:

Gov. Bill Haslam of Tennessee describes it as “trying to thread a needle from 80 yards.”

Mr. Haslam is only the latest Republican tailor trying to figure out whether to expand the state’s Medicaid rolls as prescribed by President Obama’s Affordable Care Act. In his case, it involves trying — so far unsuccessfully — to balance some sharply conflicting concerns: struggling hospitals, local business groups, dwindling state resources and fierce conservative opposition to the new health care law.

Though Mr. Haslam has said he felt under no time pressure, the state faces a Jan. 1 deadline to qualify for the first $300 million in Medicaid money for the coming year.
      

The National Conference of State Legislatures says that as of this month, 21 states, all of them with Republican governors or Republican-dominated legislatures, have announced that they would not expand Medicaid, while 27 others, plus the District of Columbia, have already approved an expansion or indicated that they would do so. The election this month of Terry McAuliffe, a Democrat and a supporter of the health care act, as governor of Virginia makes it likely that the state will join the expanders.

      

That leaves just Tennessee and Pennsylvania, where Gov. Tom Corbett has also asked the Obama administration for permission to use federal funds to buy private health insurance for the uninsured poor, on the fence.

 

In Tennessee, opposition to expanding Medicaid has come largely from Republican officeholders and conservative groups. Arrayed on the other side are the Tennessee Hospital Association and other medical groups, the Tennessee Chamber of Commerce and Industry and local chambers across the state, several antipoverty organizations and the Democratic opposition.

      

Recent layoffs at a few Tennessee hospitals have focused attention on their plight — and complicated Mr. Haslam’s decision.

      

David McClure, senior vice president for finance at the state hospital association, said that failing to expand Medicaid would have a devastating effect on the state’s 165 hospitals, leading to layoffs and the closing of some facilities.

      

“In every community that has a hospital, we are typically the biggest or one of the biggest employers,” Mr. McClure said. “I don’t want to be Chicken Little and say the sky is falling, but there will be some hospitals that will close.”

      

Since hospitals are required to treat patients who show up in their emergency rooms, whether or not they can pay, hospital officials had hoped that adding more poor people to Medicaid rolls would absorb some of those costs, Mr. McClure said.

      

Without an expansion of Medicaid, hundreds of thousands of Tennessee residents would fall into a gap, making too little money to get subsidized health coverage under the act and too much to qualify for Medicaid. The authors of the Affordable Care Act had assumed that states would expand their Medicaid rolls — which they had been required to do until the Supreme Court struck down that provision — providing coverage for these working poor families who fell into the gap.

 

Even though the federal government is promising to pay 100 percent of the new Medicaid costs for the first three years and most of the costs after that, Mr. Haslam said he was worried that later administrations might renege on that promise.