Last week's Supreme Court decision to uphold the Affordable Care Act left Tennessee and other states with a choice—expand Medicaid, or don’t. If Tennessee chooses to expand TennCare, the federal government will foot the entire bill for three years. Then, after three years, the federal government will pay for 90 percent of the expanded coverage.
“It’s a very good deal,” said Dr. Cyril Chang of the University of Memphis. If the state accepts the deal, Chang estimates more than 200,00 uninsured people, more than 25 percent of the uninsured people in the state, will gain coverage. But funding even 10 percent of that expanded coverage could be difficult for the state which has had trouble funding TennCare in the past. In 2008 Governor Phil Bredsen took a scalpel to the TennCare rolls in order to balance his budget.
“Some good deals are unaffordable,” said Vanderbilt University legal health scholar James Blumstein.
University of Tennessee Health Science Professor David Mirvis says there are also costs to not expanding TennCare. When a person without health insurance goes to the emergency room, “That care is not really uncompensated. Somebody pays for it. We pay for it,” Mirvis said.
The Republican governors of Florida and Texas have said they may, indeed, walk away from this deal and not expand Medicaid. Tennessee Governor Bill Haslam says he’s weighing his options.