Two hearings took place today in Nashville regarding the Medicaid Expansion. Those bills include Senate Bill 804 sponsored by Senator Kelsey and House Bill 937 sponsored by Representative Durham. Earlier this morning Governor Haslam had stated that he would not expand Medicaid this year.
During the hearings, the amendment was being distributed. It had been formulated this afternoon after the Governors speech. This amendment rewrites the bill by stating that if the Governor decides that he (or future Governor) would like to expand the Medicaid provision of the Affordable Care Act, he will need the legislatures approval first.
House Bill 937, by Representative Durham, was heard in the House Insurance and Banking Subcommittee. The chairman received the amendment and was asking if this was his plan for the affordable care act since they didn’t have the amendment this morning?
Representative Durham, didn’t have the answer. He knew that Governor Haslam “didn’t want to proceed at this time. When you get into budget amendments, an issue that is such importance, the entire legislature should get to hear that. When you are talking about a 33 billion dollar state budget, I just feel if it is of such importance like Medicaid expansion then we should be hearing just that. So the bill wouldn’t make expansion legal. But if we are going to do it we will do it by a joint resolution. I want everyone to be heard on that”
The chairman was confused by the amendment since the amendment deletes the bill and replaces it with how Representative Durham stated. He wanted the attorney to explain it for the record.
The Attorney stated (she had no prior notice of this amendment), “From looking upon it, it looks as though this with drafting code 5824 saying the Governor would not allow him to make any decision or obligate Tennessee with regards to the expansion of Medicaid Program without approval by a joint resolution from the general assembly. This is how I’m reading it. This (the amendment) would make up the new bill since it is deleting everything after the caption.”
The Chairman’s next question, “Is this something the administration is approving? It’s basically saying, Governor, you are going to have to have a joint resolution from the general assembly if you change your mind and to enact the Affordable Care Act.”
Representative Durham stated that he hasn’t spoken with Governor Haslam’s administration. He then stated, “If the amendment is adopted, I’m going to roll it to January because he said he would not expand it in the next year. So I’m not sure it’s entirely necessary this year. It is such an important topic that we should only be voting on that, instead of an entire notebook on medicaid.
The Chairman was worried that he does not want this bill to go onto the full committee if passed so that the subcommittee can do any work needed on it. He wanted to know the sponsor’s intent. The amendment is adopted and held over till January 2014.
Senator Kelsey, the sponsor of SB804 introduced his bill to the Senate Commerce and Labor committee. “Senate Bill 804 is the Tenncare Fiscal Responsibility Act, and as I said in here last time, those of use who are believers in principles of small government and federalism, this is an important piece of legislation.
Senator Kelsey continued after this minor interuption with, ” We all heard the statements from the govenor this morning. And, I applaud the governor rejecting medicaid expansion this year. That was the right decision. It was the right thing to do. His statements were unclear as to whether he will continue to reject medicaid expansion in the future. And it is for that purpose why I put for this bill to you.”
The Chairman stated, “We have amendment 5824 filed by Senator Green. Senator Green you are recognized on the amendment.”
Senator Green started by saying, “Thank you Mister Chairman, this amendment essentially…the governor and his remarks this morning stated that he was working with the administration (Obama Administration) to devise a plan that would be a Tennessee based plan. What I would like to do is continue to offer him that negotiating room, but as he promised in his speech that he would have us take a look at that once he had put that together. I would like to move this amendment to have an amendment to the amendment. I would like to make verbally. That is just striking 2 words. So I move the amendment with hope of amending the amendment.
The motion passed. Senator Green continued, “Thank you Chairman, the last sentence of section 1, verbally remove “Joint Resolution” and just reads “Authorized by the General Assembly.
The Chairman corrected him by saying it will strike out three words: “Joint Resolution of” to read “unless authorized by the General Assembly.” Senator Green affirmed. The amendment to the amendment was adopted.
Senator Kelsey was given time to make any remarks. “Just one last statement and that is, I will continue to be a watchdog on this issue. And, I fully plan to do everything I can to block Medicaid Expansion in Tennessee. And, I’m glad that we were successful this year. And, I plan to be a watchdog on this issue as we go forward. Thank you.”
Senator Burch was wondering if the legislature had the right to tell the Governor what to do since Tenncare was under the authority of the Executive.
Senator Kelsey responded, “The Tenncare program provides for a lot of discretion to the Governor, whoever that Governor may be, it allows for the Governor to negotiate a waiver with CMS, the National Medicare/Medicaid and Health Services organization. That is why this language directs particular expansion under CMS. A CMS waiver.
Senator Burch responded, “This also says the “…Governor shall not make any decision or obligate Tennessee…” It looks like we are telling him what to do as a Governor. I don’t think we can do that.
Senator Green said, “The intent of this isn’t to…if the Governor has a budget we still vote on it. And that is why the words Joint Resolution are amended out of it. So that in the appropriations bill arrangements that he makes to develop a Tennessee based plan would still be voted on by us in the appropriations bill. So we are not taking any powers away from the Governor in the wording of this amendment.
But it was corrected by another Senator saying that the statement is followed by the “…regard to the expansion of the medical assistance program. So it directly refers to this particular issue”
Senator Burch iterated, “and that issue has always been under the purview of the administration. We have never been able to regulate as the inter-workings of the medicaid program.”
Senator Kelsey responded, “The Senator is correct, but the reason why it is the legislature has never had the authority to make changes or have discretion over the medicaid program, the legislature volunteered, nearly gave that power away of a statute that is on the books. And so, we are controlled by statute of today. And this is the largest budget item over our entire state budget. And the legislature over the years has, as the Senator states correctly, has punted that decision to the executive. My intention, as a sponsor, is to say in this one small area we are going to say the legislature will retain power over this one small area.
Senator Green also responded, “What I’m trying to do with this…this bill 804 basically closes the door. It basically says were done. And while I’m no proponent of Obamacare, I at least know our Governor is negotiating with the administration, and they have not answered his questions. And, I want to at least keep the door open to him to those negotiations. That is the intent of this amendment. It provides, that after he reaches those negotiations and develops a Tennessee plan, we get to look at it as the voice of the people, as a legislative body. This is what the people say.”
Senator Green continued, “It also quantifies it with the Supreme Court decision that was heard. As you see there, it also includes the changes from those decisions.” The committee passed the amendment as amended. Senator Kelsey closed, “I applaud the Governor with rejecting medicaid expansion this year. I will use this bill as a vehicle to remain a watchdog and do not waste federal dollars or state tax dollars. With that, the committee voted 7-2. The bill now heads to the finance committee.
If these bills pass, Tennessee will have to remain vigilant in preventing the expansion of Medicaid under the Obamacare Provision. Without the bills, then Governor Haslam or any future Governor can accept the Medicaid expansion without the voice of the General Assembly.