By MICHAEL ACKLEY

At least three of four Williamson County state legislators directly oppose Gov. Haslam’s initiative to provide health care to more than 200,000 Tennesseans whose annual income is below the federal poverty level.

Gov. Bill Haslem

At least three of four Williamson County state legislators directly oppose Gov. Haslam’s initiative to provide health care to more than 200,000 Tennesseans whose annual income is below the federal poverty level.

But many in the healthcare industry say they support the proposal because it will decrease use of expensive emergency room treatment for routine illnesses.

“Insure Tennessee,” Haslam’s new plan, seeks to close the “coverage gap” created by the Affordable Care Act, which currently doesn’t extend to folks who earn below the poverty level — less than $16,000 a year for individuals, and less than $27,300 for a family of three.

Haslam says such Tennesseans in the current “coverage gap” need insurance because they don’t qualify for Medicaid coverage; they earn too little to qualify for tax credits to help buy coverage in the federal Health Insurance Marketplace; and they may be unable to afford coverage through the Marketplace even with tax credits.

Haslam calls the program “fiscally sound and sustainable.”

“We made the decision in Tennessee nearly two years ago not to expand traditional Medicaid. This is an alternative approach that forges a different path and is a unique Tennessee solution. This plan leverages federal dollars to provide health care coverage to more Tennesseans, to give people a choice in their coverage, and to address the cost of health care, better health outcomes and personal responsibility.”

State Sen. Jack Johnson

However, State Sen. Jack Johnson, and State Reps. Glen Casada and Jeremy Durham say they oppose increasing the level of government involvement in the health care industry because it will increase how much money the government must borrow to fund the program. Numerous attempts to contact State Rep. Charles Sargent for his stance were unsuccessful.

“I haven’t made up my mind as to how I will vote,” Johnson said. “I will honor the governor’s request to reserve judgment until I hear the testimony. I do, however, have grave concerns. This program will mean taking more federal money with strings attached. How long are we going to keep taking money from our children and our grandchildren?”

Johnson blames the Affordable Care Act for creating a “donut hole” of those Tennesseans who fall within the “coverage gap,” and therefore do not qualify for insurance under the ACA.

“I cannot help the fact that Obamacare is a failed law and has created this donut hole. I certainly applaud the governor for trying to work within this failed system.”

Casada also complimented Haslam for his efforts in “trying to bring market forces to health care,” but said that he cannot “overemphasize my grave concerns enough.”

“This will mean that more people are dependent on the government,” he said. “The program obligates $400 million to the state over the next few years.”

Casada said he recognizes America’s health care system needs repairs, “but not through government. There was a time when the marketplace was competitive.”

Durham, in a recent guest column in the Franklin Homepage, also expressed concerns about Insure Tennessee.

“Under the proposed funding formula, the federal government pays the entire cost for fiscal year 2015-2016 before the state share increases and eventually becomes about 10 percent in five years. According to the Urban Institute, the state share will represent about $400 million (and the federal share about $3.8 billion) by 2022.

“To cover the state share, Insure Tennessee seeks to increase an existing provider tax known as the ‘hospital assessment fee.’ Hospitals essentially give the state $1 and the state presents the $1 to the federal government, which then matches the $1 two-for-one. The state pockets 50-cents and gives hospitals the remaining $2.50 …

” … You don’t ever want to become a destination for entitlements,” Durham said. “I think it’s very important that we exercise fiscal restraint. We’re basically borrowing money from China and adjusting it to increase entitlements.”

However, many in the health care industry in Williamson County strongly favor Haslam’s approach.

“An increased volume of patients with insurance is great for all hospitals and providers,” Williamson Medical Center CFO Paul Bolin said. “We might see a slight decline in charity care and bad-debt expense, but we don’t expect significant volume changes related to Cover Tennessee.”

For Franklin-based clinic, Mercy Community Healthcare, the program makes a lot of sense. The clinic currently serves low-income residents of Williamson and surrounding counties.

“The uninsured and those reliant on Medicaid make up about 75 percent of our patients,” said David Winningham, Mercy’s CEO. “When Tenn Care was cut, it disenrolled a vast majority of adults. These people, for the most part, have remained uninsured. The whole idea of the ACA was to get these people insured. The federal government will cover the first two years of ACA; that’s where the political football comes in.”

Winningham said he is convinced that insuring those who cannot afford insurance is “the right thing to do.”

“From a legislative standpoint, they are asking if we will have to raise taxes. No. The hospitals have stepped in to cover the five percent needed to fund the expansion, so there is no loss. This is purely political. Right now, a TennCare patient can go to a doctor as often as he wants. Haslam wants to change that by giving them insurance and by requiring a $20 co-pay for doctor visits, they will have some skin in the game. It will not be free.”

The program will add an increase in accountability from the health care providers themselves, Winningham said:

“Haslam wants to require a place like mine to be accountable. If the state is paying me to treat a patient with high blood pressure, Haslam wants to ensure that in two or three years, that patient’s blood pressure is under control. He wants to know if these people are getting better. We have to move to a point where we are not treating illnesses but managing people’s health.

“These uninsured folks need access to basic care, so that we can keep them out of the hospital.”

The issue ultimately may be decided in February when Haslam asks the General Assembly for a vote.

Michael Ackley covers Franklin for Homepage Media Group. Contact him at michael@franklinhomepage.com.