Obamacare replace and repeal: Haslam concedes difficulty of getting 33 GOP governors to agree

March 01--NASHVILLE -- With President Donald Trump and Congressional Republicans set on repealing and replacing the Affordable Care Act, Tennessee Gov. Bill Haslam has become one of a group of GOP governors trying to develop a plan aimed at keeping states from getting financially gored.

After returning from a long weekend in Washington, Haslam told reporters his "read of the whole situation in Washington is it's pretty fluid. You have the House working on a plan, Senate the same discussion, the administration and then governors.

"What we're trying to do is have everybody be on the same page with something that can actually pass and will work in the states," Haslam said.

In play are several key aspects as Republicans seek to change the Affordable Care Act, also known as Obamacare, as well as the traditional Medicaid program for the poor, thereby saving billions for the federal government but potentially impacting millions of Americans.

One is ending the status of Medicaid as an open-ended entitlement Medicaid program with newcomers able to come in with the federal government picking up varying percentages of the tab with states covering a smaller percentage of costs.

Medicaid is operated in Tennessee as TennCare. The state's program covers an estimated 1.3 million people, basically low-income mothers and their children, as well as some disabled citizens and seniors.

Another facet of the problem involves states that chose to expand their Medicaid programs to single, low-income adults under then-President Barack Obama's ACA.

Tennessee never did. Haslam tried, but his own party in the General Assembly in 2015 revolted and rejected his proposed Insure Tennessee expansion to cover some 280,000 low-income single adults largely with federal funding.

Haslam acknowledged difficulty in getting everyone on the same page.

"Obviously, to get something passed you're going to have to do something that states that expanded and those who didn't can live with," said Haslam.

Haslam was appointed to the eight-person working group by Republican Governors Association Gov. Scott Walker of Wisconsin.

House Republicans' plan includes a proposal to turn federal Medicaid financing from an open-ended entitlement to a block grant or a per capita allotment to states. Haslam said he favors the latter.

He also thinks states like Tennessee, which didn't expand Medicaid, shouldn't be harmed financially because they didn't.

"No. 1, I don't think that a state should be penalized who didn't expand as we do that," the governor said. "No. 2, I think it has to be something, I'm more in favor of a per cap-type grant rather than a block grant."

A block grant provides a set amount of federal spending per year regardless of how many people enroll in a state's Medicaid program. According to the nonpartisan Kaiser Family Foundation, the per capita grant differs in that the federal government would set a limit on how much to reimburse states per enrollee.

Unlike a block grant approach, payments to states would reflect changes in enrollment, a feature Haslam believes necessary to handle economic downturns when more people come into Medicaid programs.

Still, it would not account for changes in costs per enrollee beyond the growth limit, according to Kaiser.

States like Tennessee would be given additional flexibility in controlling costs and Haslam said he welcomes that.

But there are other complications arising from the millions of Americans who are enrolled in the ACA's health care exchanges where they can find insurance with the help of federal subsidies.

The National Governors Association hired consultants to analyze how state budgets and residents in Medicaid expansion and non-expansion states like Tennessee would fare under congressional Republicans' proposal.

Modern Healthcare said the NGA-commissioned Avalere Health report examined the impact of changing Medicaid. If the proposals were implemented, Avalere found, up 51 percent of those who bought coverage through the ACA marketplace could lose coverage in non-Medicaid expansion states like Tennessee.

Those living in states that did expand Medicaid eligibility could see coverage slashed by 30 percent, Modern Healthcare reported.

Contact staff writer Andy Sher at asher@timesfreepress.com or 615-255-0550. Follow him on Twitter @AndySher1.

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