Insure Tennessee’s Three-Ring Circus

The debate on Gov. Haslam’s proposal to expand health insurance coverage through the authorization provided by Obamacare began and ended this week. There seemed to be three primary themes to the debate, just as there are three rings under the big top. And just like the big top, one ring took center stage.

No doubt, for many the debate was about how to provide health care services to the working poor, determined to be those earning between 100 and 138 percent of the federal poverty level. Personally, I don’t think anyone in the legislature is unconcerned about access to deliver quality health care to those who struggle to afford it. But in the first “ring” were those who think the answer is civil government.

In the second ring were health care providers, hospitals in particular, who made a deal with the federal government in connection with the passage of Obamacare. The deal was that they would give up certain payments to care for the poor in exchange for more of those poor being covered by insurance through which they would then get paid.

The part of the Obamacare law that took away their money is still law. Unfortunately for them, the Supreme Court upset the applecart when it said states didn’t have to expand coverage. The combination was, for them, a lose-lose result. To be honest, for a number of those in this ring, the issue was, quite understandably, a matter of finding a way to get the money they’d made a deal to get and had lost.

The third ring was composed of those who were opposed to Insure Tennessee. But within this ring were all kinds of “performers.”

There were those who saw this as “Obamacare” and they weren’t going to be for anything that might come remotely close to making it look like they were somehow part of Obamacare. The political coattails from the President’s hospital gown flowed long and wide for them. And within this group were those who were never going to trust an oral promise from the you-can-keep-your-insurance-if-you-like-it administration that we could get out of the program if we wanted to.

Then there were those who thought we could get a “better deal” from the federal government than what the Governor had secured and those who wanted to wait to see whether Congress or the Supreme Court pulled up the Obamacare tracks on which Insure Tennessee was to run.

Others heard this as the second stanza of Governor Ned McWherter’s swan song in the early ‘90s, the original expansion of health insurance coverage beyond the Medicaid population known as TennCare. They had been there and gotten the “Axe the (income) Tax” T-shirt to prove it. Once was quite enough for them.

And lastly, there were those who simply didn’t think providing health insurance is within the function, scope, or competencies of civil government. For them, it was kicking the can down the road of needing to get civil government out of the health care business as much as possible.

In talking to those in this last group, I don’t think they failed to appreciate the immediate “pain” that some hospitals are experiencing or that some poorer individuals are feeling; they just thought Insure Tennessee was a short-term solution that would lead to greater pain down the road. Perhaps it was, for them, what I often heard during the TennCare-generated income tax battles toward the turn of the century, “When you’re in a hole, stop digging.”

In any event, at the end of the day, those in the third ring took center stage and closed down the show. Now the legislature will get back to its regularly scheduled business. In other words, the circus will be back in town again next week.

So don’t stop paying attention to what our legislators will be doing. And attending one of our State Legislative Issue Briefings over the next few weeks is a great way to do just that.


David Fowler served in the Tennessee state Senate for 12 years before joining FACT as President in 2006. Read David’s complete bio.

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