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Capitol Hill Conversation: To Expand Medicaid, Or Not To Expand

The Supreme Court decision on the Affordable Care Act left Governor Bill Haslam with a big decision—expand Medicaid to include more low-income Tennesseans, or don’t. The governor is not exactly saying “yes” to expanding the state’s Medicaid program, known as TennCare. But he is not saying “no” either.

Haslam made his announcement last week to a joint assembly of the state Legislature, telling lawmakers he’s been working toward a “third option.”

“To leverage the federal dollars available to our state to transform health care in Tennessee without expanding our TennCare rolls," said the Republican governor.

Had Haslam agreed to expand TennCare, the federal government would have foot the entire bill for three years. Then, after three years, the federal government pledged to pay for 90 percent of the expanded coverage.

However, Haslam has expressed doubts that the federal government can live up to that financial commitment. So instead of using federal money to expand the state’s TennCare program, Haslam said he’d like to use the money to buy private health insurance for Tennesseans who have no other way to get it.

“Let’s say the federal money is cut, it’s Congress folks will be mad at and not the governor,” said Blake Farmer who covers the state Capitol for WPLN. “That’s helpful, at least politically.”

Haslam still hasn’t gotten approval from the federal government for his plan, so he told lawmakers he won’t be figuring the money into his annual budget.

Republican states have increasingly come around to expanding their Medicaid programs. Last week Arkansas also announced a kind of hybrid plan.

“A spokesperson for the federal Department of Health and Human Services tells me they welcome individualized state plans to expanding Medicaid. You know, the Obama administration really wants to find some way to get states on board and do this expansion,” said Farmer. “The question is whether Haslam is being a little bit too greedy.”