Even as a pending expansion of Medicaid services for poorer Americans is being highlighted as a political issue by observers like columnist Paul Krugman, who writes about it this week, a Tennessee state senator from Shelby County is proposing legislation to prohibit expansion of the program in Tennessee.
Passage of such legislation would presumably bind the hands of Governor Bill Haslam, who has been non-committal about whether the state should accept add-on federal funds for Medicaid expansion under terms of the Affordable Care Act.
Senator Brian Kelsey (R-Germantown) said in a press release on Monday that on Wednesday, November 6, the day after next week’s election, he will introduce a bill to prevent the expansion of Medicaid called for by the Act. Kelsey’s co-sponsor in the House would be Jeremy Durham (R-Franklin), who has not been formally elected yet but it unopposed on next week’s ballot.
As Kelsey noted in his release, the same U.S. Supreme Court decision which upheld the Act last July struck down a provision of it which mandated such expansion and left it to the states to decide whether to revamp their Medicaid programs.
Under the Act’s provisions, the federal government would initially pay all the cost of expanding Medicaid to 133 percent of the poverty level. A state’s share would slowly rise to 10 percent of the cost by 2020. But Kelsey casts doubt on the reliability of the federal government’s commitment to its ultimate 90 percent share of additional expenses.
“Unlike Washington, Tennessee balances its budget every year,” Kelsey said. “Tennessee taxpayers cannot afford this expansion of spending. The federal government may be promising money today, but with sixteen trillion dollars of debt, those funds will not be there tomorrow.”
As GOP opponents of the Affordable Care Act often do, Kelsey quoted an initial reaction former Governor Phil Bredesen, a Democrat, when the Act was first being considered in 2009. Bredesen referred to it then as “the mother of all unfunded mandates,” and, according to Kelsey, estimated that it would impose a $1 billion burden on Tennessee taxpayers.
Proponents of the Act and of its Medicaid provisions see thingsdifferently. In his column on the subject this week, Krugman insists that Medicaid actually lowers overall costs by eans of greater efficiencies. “While costs grew rapidly in 2009-10, as a depressed economy made more Americans eligible for the program, the longer-term reality is that Medicaid is significantly better at controlling costs than the rest of our health care system.”
