The naysayers seem to have had their way with Governor Bill Haslam, who announced on Monday that his administration would not attempt to establish a state-run health exchange to administer the
Affordable Care Act in Tennessee.
The governor had been supposed beforehand, on the basis of his professed confidence in TennCare's experience in health-care matters, to favor creating a state exchange instead of leaving it to the federal government to set up its own. And the state's insurance agencies had made it clear that they, too, preferred such a solution, which would allow them to keep on dealing with familiar faces and procedures. Moreover, taking a hands-on approach to administering the act would clearly have given the state an opportunity to tailor-make a system to Tennessee's specific needs and hold down costs.
But the Tea Partiers and their sympathizers, in and out of the General Assembly, are still blindly raging against what they call "Obamacare" as amounting to a federal takeover of health care and have consistently made it clear they want as little as possible to do with it. Never mind that last summer's Supreme Court decision in favor of the act, followed up by President Obama's election victory, made implementation of the act inevitable, and, in those circumstances, a state's declining to fashion its own managerial agency ensures a maximum amount of federal control and minimizes the prospect of the state's ability to impose cost-control measures.
The foes of the Affordable Care Act, who mounted a noisy demonstration against it in Nashville just this past weekend, seemed not to understand that the act would be coming to Tennessee one way or another — and a state government default on managerial responsibility would be the very thing that would ensure the much-dreaded "federal takeover."
The bottom line, though, was that a state-run exchange would have had to be approved by the legislature, and Haslam clearly lacked any enthusiasm for the kind of wrangle that would have entailed. So he made what he insisted was not a political but a "business" decision — a business decision that may end up costing the state more money.
Haslam is the chief executive of Tennessee, and leadership is both his privilege and his duty. He was elected to provide it, and, much as we'd like to give the governor the benefit of the doubt about his choice in the Affordable Care matter, we can't shake the feeling that he has forfeited an opportunity.
There is one more health-related issue for him to decide on: whether to expand TennCare (Tennessee's version of Medicaid) some 38 percent beyond the currently recognized poverty line, a course of action originally mandated by the Affordable Care Act but one which the Supreme Court has rendered optional. To do so would invite something of a cornucopia in federal funding, though it would decrease percentage-wise at some point in the future.
We suspect there's profit for the state in that course and hope the governor will agree.