The GOP supermajority must decide whether a federal windfall is worth a politically toxic dose of ObamaCare 

Bitter Pills

Bitter Pills

House Speaker Beth Harwell calls it "a horrible situation" for Tennessee Republicans. By that, she means forcing the state's mighty new supermajority to make a politically difficult decision.

The choice? Whether to upset the state's business establishment, deny health insurance to more than 150,000 of the working poor, and body-slam Tennessee's economy; or to embrace ObamaCare and outrage the GOP's radical right — which in this fire-ant red state entails a huge chunk of the party.

When the U.S. Supreme Court made Medicaid expansion optional under the Affordable Care Act last summer, Republicans all across the country said they would just say no.

But in a remarkable flip-flop in the past few weeks, six of the party's governors — including right-wing firebrands like Ohio's John Kasich and Arizona Gov. Jan Brewer — have gotten with the program because of pressure from business interests and the enticement of federal dollars.

In Tennessee, businesses are lobbying aggressively for Medicaid expansion. The Nashville Chamber of Commerce joined Tennessee's hospitals last week in calling for it, pointing out the state would gain billions of federal dollars with little investment of its own.

With the Affordable Care Act, health care providers took deep cuts to reimbursements in return for the promise of new Medicaid patients. In Tennessee, hospitals would lose nearly $6 billion if the state balks at expanding Medicaid. That would cost the health care industry 90,000 jobs over the next decade, according to a Tennessee Hospital Association study released last week.

The association's president, Craig Becker, calls it "almost a recessionary impact on the economy." He predicts some hospitals, the linchpins of the economies in rural communities, would close.

On the other hand, a University of Memphis study predicted expansion would support more than 20,000 new jobs in Tennessee by 2019.

Even Phil Bredesen, who famously denounced ObamaCare as the "mother-of-all-unfunded mandates" when he was governor, now is urging Gov. Bill Haslam to accept it.

Beset, Haslam has reverted to his default mode — procrastination. Haslam as Hamlet wrings his hands, while hardliners in the legislature chomp at the bit to make a statement against ObamaCare.

Sen. Brian Kelsey has filed legislation to bar Tennessee from expanding Medicaid. In the session's opening days, his bill quickly gained 16 sponsors — only one short of a Senate majority. In deference to Haslam, Senate speaker Ron Ramsey had to intervene to stop Kelsey from moving his bill last week.

During a panel discussion on ObamaCare at last week's Tennessee Press Association winter convention, Kelsey basically said he couldn't care less whether hospitals close.

"My job is not to bail out the special interest hospital lobby," Kelsey said.

He also was forced to admit at one point that he's misleading the public when he says — as he does repeatedly — that expanding Medicaid would cost the state $200 million a year. In reality, it's free to the state for the first three years and might cost $200 million a year after five years, but enrollment projections are too uncertain to be sure.

If the state found the cost to be too high at any point in the future, officials could change their minds and opt out, removing all the new beneficiaries with no federal penalty. Even so, ObamaCare's foes argue that would create a messy political situation that they'd rather avoid.

Sick people probably see that as a crass argument, as patient advocate Gordon Bonnyman — founder of the Tennessee Justice Center — pointed out when it was his turn to talk at the TPA convention. Bonnyman said officials should go to someone with cancer and say to them:

" 'We know we would be able to cover you for three years totally at federal expense, but we may have to cut you off at the end of that. Are you willing for us to put you through the trauma of cutting you off after three years?' I think you can answer that question pretty clearly. The folks that I'm close to would say, 'I need help right now. We'll let three years from now take care of itself.' "

In his State of the State speech, Haslam seemed to plead with his party's lawmakers to set aside their partisan feelings about President Obama's signature law.

"Most of us in this room don't like the Affordable Care Act," he said, "but the decision to expand Medicaid isn't as basic as saying, 'No ObamaCare, no expansion.' "

Haslam says he'll make a decision before this year's session ends. But whatever he recommends is subject to legislative approval. It seems unlikely the governor has the stomach for a fight with his own party.



There were (at least) two errors in last week's cover story, "How We Became the Bomb." In 1874, the Fisk Jubilee Singers sang for Queen Victoria, not Queen Elizabeth. And the Nun Bun was stolen in 2005, not 1996. Our apologies to the Commonwealth and Bongo Java Roasting Company.

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