As chronicled elsewhere, Governor Bill Haslam began this week of legislative special session in Nashville with the challenge of persuading reluctant members of his Republican Party to suspend their aversion
to what they call Obamacare and accept his home-grown version of Medicaid expansion called Insure Tennessee.
Prior discussions of the matter in the media have focused almost entirely on the mechanics of the plan or the political matters at stake or the financial incentives available to Tennessee (and its hard-pressed hospitals) should the General Assembly opt to give its statutorily necessary approval to the proposal. Those financial stakes are large indeed, amounting to somewhere between $1 billion and $2 billion annually. But the political obstacles are large, as well: GOP talking points against Obamacare (the vernacular name for the Affordable Care Act) are so well established that the governor's arguments for Insure Tennessee had to be couched in terms that drew the broadest possible distinctions between his Tennessee variant and the federal act.
Accordingly, Haslam made much of marketplace methodologies embedded in Insure Tennessee — including an alternative plan-within-the-plan for vouchers to pay for private insurance, as well as requirements for co-pays and modest premiums for those new insurees opting for coverage under TennCare (Tennessee's version of Medicaid). And the governor catered to home-state Republican sensitivities by adding an anecdote to his prepared speech involving his past entreaties to President Obama, along with those of other Republican governors, to allow Medicare funding to be dispensed to the states via block grants for the states to dispense as they wished.
But much of the governor's speech was taken up, too, with appeals to the legislators' hearts as well as to their heads. Opponents of Insure Tennessee have been shedding crocodile tears at the plan's provision for discontinuing Insure Tennessee after two years if either the federal government or the Tennessee Hospital Association default on promised funding. That would drop thousands of new insurees from coverage, the critics say. To this, Haslam offered the common-sense rebuttal that two years of coverage are significantly better than no health-care coverage at all.
And he offered his listeners a real-world anecdote about a Tennessean whose stroke, resulting from his inability to afford health insurance, had "landed him in the hospital, followed by rehabilitation" and taken him out of the workforce. "He was a hard-working Tennessean who wasn't able to get the care he needed on the front end and that has real consequences for him and his family. Having a stroke wasn't only devastating to him and his family, it could have been prevented, and not preventing it is costly to all of us."
The governor then, having argued facts and savings and marketplace models, laid the matter to rest on the bedrock issues of values and good will: "I think this is also an issue about who we are. My faith doesn't allow me to walk on the other side of the road and ignore a need that can be met — particularly in this case, when the need is Tennesseans who have life-threatening situations without access to health care."
Indeed. It's a matter of good faith and we agree with the Governor: That's the nub of the issue.