Governor Haslam's logic -- such as it is -- runs that he should today deny several hundred thousand of his own poorest citizens basic health benefits -- even though they desperately need them, because at some potential future date, under some future new Presidential administration, he might not be able to keep them fully-covered, for free, in his state. So. . . don't ever give them coverage?! Deny all of them a minimum of three years' worth of very basic health care benefits?
Governor Haslam, your fellow Tennesseeans are quite literally dying, right now, in their homes, of advanced untreated heart conditions (of painful heart attacks and strokes), advanced untreated diabetes (going blind, and losing limbs -- before dying in agonizing pain), and cancers -- also wracked by unspeakable pain.
And the Governor Haslam answer is "I don't care that there is TODAY federal money to treat them." I don't care that they will die. I just don't want to face the politics of some distant future potential (not actual) retrenching of the subsidy for Medicaid, in my state. So let the poor die, today. Here is the salient bit of a longish New York Times article, tonight, pointedly concluding that Gov. Haslam has missed yet another deadline to elect either the federal exchange system, or build his own state system. Instead, Haslam is trying to craft a "hybrid" solution -- one that is very likely a windfall for a select sub-set of his Republican political base: the private insururers in Tennessee. He is negotiating with HHS -- to use the Tennessee allotment of the Medicaid expansion funding available under the ACA of 2010 to "privatize" this low end care -- by allowing for profit insurers to exclusively provide the added coverage/eligibility, and likely on terms they themselves primarily set. Take a program of basic care for the poor, and make it a new profits generator, for entrenched wealth. Nice. Quoting the Gray Lady, then:
. . . .Deepening the angst over this decision is the state’s own history with managed health care. Tennessee’s homegrown health care system, TennCare, went through a wrenching downsizing in 2005, when the program was totally state sponsored. More than 170,000 people [were] thrown off the TennCare rolls. . . .
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.
“If at some point we’re going to have to cut people off the rolls,” he said, “I’m not sure we’d want to go through that again. Our history makes us a little wary. . . .”
Here are three prior background pieces, on the sad, twisted and unneeded path Tennessee's Governor Haslam has chosen, to put (his potential) political gains ahead of crying, dying human needs. Just a few of my prior backgrounders -- here (we learned that -- if he'd tackle waste at for profit hospital systems operating in his state, like HCA and Anderson, he'd have plenty to cover these folks!). Here (on his endless waffling), and here (on other alternatives available -- all while he missed deadline after deadline).
In fairness, a part of this Tennessee mess -- is HHS Secretary Sebelius' fault -- for not holding his feet to the fire, sooner, after he missed numerous earlier deadlines (but HHS's main weapon, the cutoff of federal funding for existing medicaid patients, would simply punish Tennessee's poorest citizens, yet again, for Haslam's failure of leadership). We are now about 45 business days from when the system is to go live, and he won't decide what to do. Meanwhile, Tennessee's poorest citizens go without care, and many will die, all while he waffles for political gain. Disgusting.
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