Having lost the fight against ObamaCare at the Supreme Court and the ballot box, Republicans in Tennessee this week stood against the president's signature legislation with one of the few weapons still available to them. On Monday, Gov. Bill Haslam announced that the state will not create and operate the online health insurance exchange required by the law.
What may look like a stiff-arm, though, is really a hand-off. Haslam's decision simply returns the responsibility for running the exchange to the federal government. In many ways, the more momentous decision Haslam faces under the law is whether to expand Medicaid in the state to as many as 330,000 low-income Tennesseans, saying "No" to which would be a truer show of the hand to the feds. On that, Haslam says he has not decided, but conservatives in the legislature and around the state are urging him to reject the expansion, and the federal dollars that would come with it.
On the matter of the exchange, the governor said his decision was not based in a desire to thumb his nose at the president. Instead, he pointed to a lack of information from the federal government on the particulars of how the exchange would work.
"This decision comes after months of consideration and analysis," Haslam said in a statement following the announcement. "It is a business decision based on what is best for Tennesseans with the information we have now that we've pressed hard to receive from Washington. If this were a political decision, it would've been easy, and I would've made it a long time ago."
That much appears to be true. Haslam's consideration of the issue lasted long enough for him to be among the governors who requested and received an extension of the initial deadline. On a strictly political basis, he did himself no favors by appearing to give even a moment's thought to getting into bed with ObamaCare — which is how those on his party's right wing would have framed the matter. (It's also worth noting that the idea Haslam would turn down a state-run exchange to protect himself against a primary challenge holds little weight. It's difficult to imagine any Republican prominent enough to present a challenge to Haslam being fool enough to go up against his money and popularity.)
Moreover, the governor's public statements leading up to the announcement were classic Haslam — that is, he seemed characteristically, yet perhaps genuinely, undecided. As recently as last month, he was telling reporters that he preferred the state-run option, and that Tennessee could run the exchange better than the federal government. Insurance companies in the state also said they would rather interact with the state as opposed to the federal government. Despite that, however, Haslam went the other way.
Asked if the governor had effectively chosen the option he apparently believes will result in a less efficient and less competent system, Haslam spokesman Dave Smith said the governor's statement spoke for itself. He referred the Scene to the letter Haslam wrote to U.S. Health and Human Services Secretary Kathleen Sebelius.
In it, Haslam tells Sebelius, "If given the proper latitude Tennessee could operate an exchange in a more efficient and cost effective manner than the federal government." However, he said, more than 800 pages of draft rules made it clear that "the federal government is calling all the shots and has important decisions still pending."
But whatever went into Haslam's personal calculation, his ultimate decision was, in all likelihood, moot. Politics and process are indeed the reason that this decision might as well have been made a long time ago.
The governor himself has acknowledged that getting the legislature to approve a state-run exchange looked close to impossible. As decision day drew near, top GOP legislators made it clear the governor would have a hard time summoning the Republican support he would have needed to go through with a state-run exchange. Perhaps Haslam saw the votes on the wall.
Given Tennessee's current political makeup, Haslam's power is arguably inferior to that of his party's supermajority in the legislature, many of whom consistently reside to the right of him politically. With a bit of discipline, they can pass legislation, override a veto, or reject a state-run insurance exchange or Medicaid expansion at will.
So while politics may not have been the primary basis of Haslam's decision, it is also the reason the choice was never really his.
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