A state run health exchange

Posted: Friday, December 14, 2012 7:00 pm

A new Tennessee General Assembly is just a few weeks from convening. Among the many challenges awaiting it have been whether to move forward with a state-run health insurance exchange, and whether to expand Medicaid to Tennessee’s uninsured population.
Gov. Bill Haslam wisely sought input from stakeholders over the past two years and previously indicated his preference for Tennessee to move forward on both counts.
It’s the best course for our state.
Instead, he’s done a 180 and decided to let the federal government run Tennessee’s exchange, no doubt buckling under intense pressure from the tea party wing of his party. If the governor doesn’t have the votes for exchanges, expanding Medicaid doesn’t stand a chance.
There are plenty of good reasons why a state-run exchange and Medicaid expansion are in our state’s best interest.
First, we would have more control over an exchange we established than one handed over to the federal government. This is a major reason why Republicans in Alabama have sponsored exchange legislation for the past two years.
Second, expanding Medicaid protects rural hospitals. By receiving payments for previously uninsured individuals, rural hospitals could more easily protect themselves from bad debts. Without expansion, 24 Tennessee hospitals in rural counties are at risk of closure, leaving 21 rural counties without a hospital.
Third, as federal dollars cover the uninsured, states expanding Medicaid would spend less on uninsured care.
I asked a hospital administrator to explain exactly how all of this would happen. His simple response: “We’ll be better able to manage the costs we face.” The big problem with the current medical system is the out-of-control cost of care for the uninsured. Simply getting them coverage will allow physicians and providers to manage a patient’s health care costs.
We see it all the time in our relationships with private insurance: higher deductibles here, a copay there, this plan covering such-and-such, that plan with various exclusions. It’s those outside of this system, the uninsured, who are the cost drivers. Covering them through Medicaid expansion is the first large step to our state managing those costs.
Until Monday, Gov. Haslam consistently said that a state-run exchange is the lesser of two evils, but while the exchanges like the one Gov. Mitt Romney implemented in Massachusetts have the support of top Republicans like Sen. Bill Frist, they’ve drawn the ire of the Republican “supermajority” and the tea party movement.
Unfortunately, they have forgotten their decades-old cadence of “local control” and “let the states have flexibility.” They are leading us to a more expensive, less accountable program run by Washington bureaucrats.
This health care law was tailor-made for their values, for each state to “captain its own ship.” Our governor once thought that’s what we should do. But a tea-party supermajority stands in the way.
My grandfather had his own take on an old saying: “You can lead a horse to water, but you can’t make him drink; but you can make him wish he had.”
Gov. Haslam was right to lead the state toward setting up our exchange and expanding Medicaid. But after yesterday’s turnaround, I’m afraid that if his caucus keeps dragging him away from the opportunity to provide an accountable, cost-efficient health care system, the hopes of charting our own path are fading.
While forfeiting to the federal government, we’ll watch other states drink from the wells of healthier — and more employable — populations. And we’ll be thirsty.
State Sen. Lowe Finney serves as chairman of the Senate Democratic Caucus. He represents Madison, Crockett, Dyer, Lake and Lauderdale Counties.
Published in The WCP 12.13.12