As Gov. Bill Haslam remains undecided on whether to expand TennCare rolls under the Affordable Care Act, the decisions of his fellow Republican governors will likely weigh on his final choice.
The most recent GOP state executive to accept a federal offer to increase Medicaid coverage to those at 133 percent of the poverty line was Florida Gov. Rick Scott, who announced his decision Wednesday.
Like Haslam, Scott recently rejected an offer to create a state-run health insurance exchange. He is one of at least four Republican governors to decline operating an exchange while expanding Medicaid.
Although similar in scope and breadth, a major difference between governors' decisions on exchanges and the current choice on expansion is the role the federal government will play after the decision is made. With regards to exchanges, states that opted against operating their own online clearinghouse for health insurance were guaranteed the provision of an exchange by the federal government, regardless of their decision to decline.
There's no similar fallback regarding expansion.
If Haslam decides to expand TennCare—a move that would add tens of thousands of Tennesseans to a program that already covers approximately 1.2 million residents—the federal government would provide full funding for the first three years. After that period, funding would be reduced to 90 percent.
If Haslam opts against an expansion, the state would receive no additional federal assistance for TennCare, and fewer residents would be covered.
The predicament for Haslam becomes more complex in light of the GOP-dominated General Assembly. A decision to expand TennCare rolls would require approval in the Legislature, and Lt. Gov. Ron Ramsey has signaled it "won't be easy."
Haslam has committed to making a decision on expansion before the end of the current legislative session, which is expected to close before summer.
The topic will likely be discussed at length by Haslam and his colleagues, as he attends the National Governors Association winter meeting in Washington, D.C. this weekend.