The link above is a report by a volunteer for the Tennessee Justice Center on the first two meetings of Speaker Harwell’s task force and it is excellent. It gives you the best sense of where the task force members are coming from I have seen. And perhaps it gives you a preliminary sense of where they are going.
I have also listened to several people talk about meetings they have had with various task force members.
Here are some of my reactions.
1. I believe they would like to do something about the issue of the uninsured in Tennessee but only if they are firmly and ultimately in control of that process.
2. The task force is ultimately about asserting control. I think two things happened. First of all Governor Haslam have them a finished product they had little or no ability to modify or change.
3. More importantly I think they underestimated greatly the passion, the staying power and the appeal of the movement in favor of closing the coverage gap. I think they are surprised that even with the failure of Insure Tennessee it didn’t go away and got even louder and more passionate. I think the campaign against Beth Harwell scared a lot more people than Beth Harwell.
4. I think the consensus was something had to be done. Apart from the ethics of the issue many legislators in an election year were facing challenges from opponents that intended to use Insure Tennessee against them.
5. The task force members know that in order to get federal money they must meet federal expectations. CMS must approve their proposals.
6. There is some doubt whether or not CMS will approve some of what their expected proposals might look like. They have been very insistent for example that they want to phase a program in gradually and many people think that will be a poison pill CMS will not accept.
7. If CMS turns them down the task force is prepared to walk away, blame the federal government and use that as election year coverage to deflect blame.
8. If they do that there is not a clear path to health care expansion in the next legislature.
9. They do not believe the 280,000 figure often given. They believe the actual number is closed to 400,000.
10. This is part of the reason they question the idea that the hospital tax will be enough to pay what the federal government does not pay.
11. The ghost of Phil Bredesen comes into play here. They remember the experience of taking away the insurance of large groups of people and don’t want to relive it. They want the program to start small so if expense is an issue they can pull the plug before all 400,000 people get enrolled.
12. They do not trust the Tenn Care people. They see that as a bloated program with a lot of inefficiency that takes up far more than its share of the state budget.
13. They do not trust many of the hospital executives.
14. Whether or not anything happens depends I think in their mind on several variables:
A. They must feel like they regain control of the process and by doing that manage what they feel is the political risk the issue carries for them.
B. They must feel like the federal government will work with them. They can’t see it as a one way bend.
C. The issue of financial risk must be settled. Many of them have a lot of issue with the budget bite of TennCare and will not be okay with the risk of a second big ticket program.
D. The risk of reliving the Phil Bredesen experience must be dealt with. None of them will be okay with the possibility of having to remove large amounts of people from their insurance again. They would rather have them go without.
To put it mildly it is an uphill battle. If CMS refuses their proposal they still have ways to spin that loss as a political victory. They will not move quickly. They can’t do in 2 months what it took Haslam 18 months to do. I don’t think it is in their best interest to have a finished product that might be attacked in the election anyway. That way they can accuse their opponents of not knowing what they are talking about and trying to mess up sensitive negotiations.
I don’t think anyone knows for sure how to navigate this process. I know I don’t. My hope is that in all the calculation of political gain bottom lines don’t get lost. There are no acceptable casualties. Whether it is 280,000 or 400,000 no one can be left behind and a solution that doesn’t recognize that is not a solution. Regardless of political tactics or plans this is a moral issue, an urgent and fundamental issue, an issue that in some sense defines the kind of people we are and the possibility of a real justice for so many people and if we ever lose that we gave all lost regardless of what what the Task Force does.