A One-Size-Fits-All Approach Won’t Achieve Health Care Reform

Last week, Governor Haslam announced that the state of Tennessee would not expand Medicaid as envisioned by President Obama under the Affordable Care Act. The federal government’s insistence on a one-size-fits-all approach under Medicaid is a poor solution for solving our health insurance access problems, especially given the access problems so many of our citizens already face under this program. The governor’s preferred approach – to use federal dollars to expand Tennesseans’ access to private coverage – seems like it may be a better solution for access to health insurance, and it seems to me he deserves an opportunity to put this plan to the test.

As you may know, the Affordable Care Act required states to expand Medicaid to cover more individuals beginning in 2014, but fortunately the Supreme Court’s ruling made this expansion optional. Even though the federal government is supposed to pick up a significant percentage of states’ expansion cost, the Obama administration is already seeking to limit its support to states that don’t expand their programs as much as the law originally required. It sounds as though a bad deal has the potential to get worse – and our state had a good idea of what would happen if we chose to simply expand Medicaid.

Because of our state’s experience with TennCare, the state’s Medicaid program, Tennesseans know first-hand that expanding a broken system would do more harm than good. TennCare crippled the state budget and nearly 300,000 people were cut from the program in 2005 and 2006 just to keep it financially viable. TennCare is now one of the most restrictive heath care plans in the country, limiting how many medications patients can receive, what brands they can purchase and what doctors they can see. Because TennCare’s payments to physicians are even lower than the rates paid by Medicare and private insurance, many providers have opted out of the program and will no longer see TennCare patients. Restricting what medications a patient can receive or what doctors they can see is not health care reform, and I know we can do better.

Obamacare was the wrong answer to our country’s health care problems, but Tennessee has an opportunity to do better. The governor has now challenged the administration to step up and help the poor and underserved to a far better health care plan than Medicaid, and I hope they will work with him to find a path forward.

Governor Haslam’s proposed plan would use federal dollars to purchase health insurance coverage for Tennesseans that are unemployed or that do not have the means to purchase their own plan. According to the governor’s calculations, this alone could provide coverage for more than 175,000 uninsured Tennesseans. The governor’s plan would reform the way TennCare pays doctors so they are compensated for patient outcomes, not simply services performed. The governor deserves a chance to see whether his approach could deliver care more efficiently and more cost effectively; but unfortunately, the Department of Health and Human Services won’t give states the flexibility they need to implement these potentially innovative reforms. The governor did not create this problem but he is offering market-based solutions, not failed government solutions, for Tennesseans.

The Affordable Care Act left states with a great set of challenges and I don’t envy the difficult decision the governor had to make. I have a great deal of respect for Governor Haslam, and I applaud last week’s decision. I look forward to continuing to work with him to find commonsense solutions to ensure Tennesseans have access to affordable health care.