The Supreme Court decision on the Affordable Care left Governor Bill Haslam with a big decision—expand Medicaid to include more low-income Tennesseans, or don’t. If the governor chooses to expand coverage, 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. Haslam hasn’t made up his mind yet, but some Republican members of the state Legislature aim to pressure the governor not to increase coverage—the very first bill filed this legislative session “prohibits Tennessee from participating in the Medicaid expansion of the Patient Protection and Affordable Care Act.”
Whether or not Haslam expands Medicaid, which in Tennessee is known as TennCare, the Bureau of TennCare anticipates it will have more people on its roles next year.
“They call it the woodwork effect,” said Blake Farmer who covers the State Capitol for WPLN in Nashville. The Bureau of TennCare estimates that there are thousands of Tennesseans who qualify for TennCare, but haven’t enrolled. “So, starting next year when everyone has to carry health insurance [or pay a penalty],” Farmer explained, “the state figures they’ll go with the cheapest option—Medicaid.”
State Senator Brian Kelsey, a Republican from Germantown, says given this “woodwork effect” the governor shouldn’t expand TennCare, “We already know that there are going to be major expansions in Medicaid funding, regardless of whether or not we expand coverage … so with those additional costs, then we can’t possibly afford any new ones.”
Kelsey authored Senate Bill 0001 which aims to block the expansion of TennCare, but he says he’ll talk to Haslam before pushing the bill to a vote. “I do plan to re-file the legislation, and I look forward to speaking with the governor about it,” Kelsey said.
There are costs to not expanding TennCare, too. A study done by the University of Memphis found that in 2009 hospitals, clinics, and physicians’ offices in Tennessee provided $4.11 billion in services that they were never paid for. More than 90 percent the of people who did not pay their medical bills were uninsured.
“That care is not really uncompensated. Somebody pays for it. We pay for it,” said University of Tennessee Health Science Professor David Mirvis, a consultant on the study.
As a result, hospitals are lobbying the governor to expand TennCare, and Congressman Jim Cooper of Nashville, a Democrat, has said the state would be “crazy” not to take the federal money and expand coverage.