NASHVILLE — Though he will no doubt fill in some gaps during his forthcoming State of the State address, due next month, Tennessee Governor Bill Haslam chose to be brief and general during his second inaugural address Saturday, a sunny day but one sporadically whipped by blasts of wintry wind out on War Memorial Plaza.
Backed by a platform full of state dignitaries, past and present, and by the soaring boxy spire of the state capitol building, Haslam faced a well-disposed crowd of several hundred, telling them that, during the first term of his administration, the state had made progress toward "a more effective and efficient state government," "better education opportunities and outcomes," and "high quality, good paying Tennessee jobs."
Much of that had earlier been disputed by a group of protesters, including several from Memphis, who had shadowed the inauguration preliminaries all the way from a Saturday-morning prayer breakfast at the legendary Ryman Auditorium to the Union Street fringe of the plaza, where state troopers made sure they kept their distance behind a modest barricade.
The demonstrators flashed a variety of signs behind a large banner demanding, "PUT THE PEOPLE FIRST," and chanted things like "Can't take it no more! Get fired up!" and "Haslam, step off it. Put people over profit!"
All things considered, the protests that serenaded Haslam on Saturday were probably easier to shrug off than those that are likely to greet him from the ranks of his own Republican majority in the legislature when the General Assembly reconvenes on February 2nd.
This will be for a special session preceding the regularly scheduled one. The subject will be the Governor's proposal for "Insure Tennessee," his own home-grown variant of a Medicaid-expansion plan that would begin availing the state of between $1 and $2 billion annually under the Affordable Care Act (ACA).
Haslam's resolve to address the issue, after a year or two of procrastination, may have been the primary matter hinted at in a key paragraph of the address: "But despite our accomplishments and momentum, one of the things that I've realized during my time in office is that we haven't had nearly high enough expectations of ourselves. In many ways, we've settled and haven't lived up to our full potential. So one thing I can guarantee you that we are not going to do in the next four years is coast to the finish line."
The governor's plan — a two-track system allowing insurees to participate either via vouchers for private health insurance or through TennCare, the state's version of Medicaid — is fairly certain to be approved by the General Assembly's Democrats, but they are but a speck in the ocean of the GOP super-majority in both legislative chambers.
The question is whether — or to what degree — the members of Haslam's own party will support a plan that operates in tandem with what Republicans disdainfully call Obamacare.
There have been surprise endorsements, including last week's 12-0 bipartisan vote of the Shelby County Commission, urging legislators to support Insure Tennessee. That resolution was sponsored by Terry Roland, the highly vocal Millington Republican whose conservative views are well known and who claims strong ties with GOP members of the General Assembly, including Lieutenant Governor/Senate Speaker Ron Ramsey, who was sounding uncommonly open-minded himself.
Clearly, there will be other Republicans willing to support the plan, either out of solidarity with the governor or, like state Representative Jimmy Eldridge (R-Jackson), out of a sense that, as Eldridge told a reporter during the course of Saturday night's inaugural ball at the Omni Nashville, "Our hospitals have to have it!"
Indeed, representatives of the state's hospitals have, along with the state Chamber of Commerce and other business groups, been lobbying hard for Medicaid expansion since funds first became available under the ACA two years ago. But many Republican legislators in the General Assembly are either openly scornful of Insure Tennessee or are holding back from it. That was made obvious when six GOP legislators from Shelby County addressed the Republican Women of Purpose group the week before last — criticizing the governor's plan as an unwanted expansion of government power and suggesting, in the words of state Representative Curry Todd of Collierville, that "bloodletting" on the matter would be a feature of the special session.
Absent from that gathering was the single most influential legislator from Shelby County, state Senate Majority Leader Mark Norris of Collierville.
In a sit-down interview with the Flyer last week, Norris expounded on his views. Insisting that his primary mission, prior to advising the members of his caucus, was "to understand what Governor Haslam proposes and how it is governed by existing laws, not only the Tennessee Code but the Social Security Act, the Affordable Care Act, and the Internal Revenue Code." All of these, Norris said, are "involved or implicated in one way or another."
Norris noted that the state was currently being sued in federal court "for its alleged inability to determine the proper eligibility and enroll people in TennCare." He continued, "My caucus asks, 'if you can't handle the enrollment you've got, how are you going to handle the additional enrollees?'" These, said Norris, are likely to add up to some number between 200,000 and 400,000.
Moreover, he contended, they are "a different segment, not the TennCare population." Instead, he said, a University of Tennessee study suggests that a substantial number of the likely new beneficiaries will be "healthy young white males."
Like such other Republicans as state Senator Brian Kelsey of Germantown, Norris has expressed concerns that the federal government, after a two-year fully funded period, might default on its promise to supply 90 percent of funding thereafter. (The Tennessee Hospital Association has pledged to fill out the balance.)
To the argument that even two years of coverage would be better than none at all for the currently uninsured, Norris contends that those two years of what he calls a "pilot program" might be fully occupied with just getting the newly insured TennCare population processed, all the while making them responsible for various co-pays and premiums.
An additional issue for Norris is the fact that on March 4th, the U.S. Supreme Court will begin hearing arguments in King v. Burwell, a case which will test the validity of the federal exchanges now managing Medicaid expansion in states, like Tennessee, that have opted not to operate their own exchanges. The outcome of that case, said Norris, could make the Affordable Care Act itself untenable.
Even if not, expansion of TennCare under the ACA could incur another peril, Norris said. "We are now within a percentage point or two of the point at which Governor [Phil] Bredesen had to cut 170,000 people from the rolls in 2007. When TennCare hits 33 percent of the state budget, Draconian cuts could again be called for. We're almost there.
"I have carried the budget for the last three years. TennCare is about to consume a disproportionate share of the state budget once again. My question is, how does this [Insure Tennessee] help stem the rising cost of TennCare? The answer has been, unfortunately, [it doesn't]."
Norris said further that, with the special session now less than two weeks away, the governor and his administration have not begun to address concerns of this sort in any real sense. "My duty is to keep my caucus informed and to advise them. As a whole, the caucus has been pretty good about keeping an open mind. But there's so much they don't know."
Sometime between now and the opening of the special session, Norris said, he may well suggest some "alternatives" to the governor's approach.
Norris, who, up to now, has been Haslam's point man for most legislation, has been depicted here and there as on a collision course with Haslam over Insure Tennessee, and there has even been speculation that a public break with the governor over the issue could serve the Majority Leader's own future political purposes.
"There is no kerfuffle between me and Governor Haslam," Norris insists. "I appreciate his heart, I really do. But the state will be around for long after his tenure ends. We need to be attentive to details."