Gov. Bill Haslam of Tennessee said Wednesday that he would not expand Medicaid in his state as called for in the federal health care overhaul, joining 18 other Republican governors who have rejected expansion for now.
Governor Haslam said he wanted instead to use federal Medicaid money to buy private insurance for as many as 175,000 low-income residents of his state. But he said that plan was being held up because the Obama administration had put too many conditions on the money.
With his health care law, President Obama wanted to make Medicaid, the federal-state health program for poor people, available to many more Americans, covering those earning up to 138 percent of the federal poverty level (currently up to $15,856 a year for an individual). But when the Supreme Court upheld the law last year, it ruled that states could opt out of the Medicaid expansion.
For states that opt in, the federal government will pay the full cost of expansion from 2014 to 2016, with its share gradually decreasing to 90 percent in 2020. So far, about two dozen governors, most of them Democrats, have said they want to expand Medicaid.
Tennessee is not the first state to latch on to the idea of using the federal expansion money to buy private insurance for a portion of its low-income population. Arkansas and Ohio are seeking permission from the Obama administration to do so, and some lawmakers in other states, including Florida, Louisiana, Pennsylvania and Texas, have also expressed interest.
Under this option, a state would use the federal Medicaid expansion funds to pay premiums for commercial insurance that will be sold through new marketplaces known as insurance exchanges. But Governor Haslam said he had not received assurances from the Obama administration that he could do things the way he wanted. For example, he said, he wants beneficiaries to pay a portion of their health care costs if they can afford to. And he does not want the expansion population to have better benefits than others who get insurance through the exchange.
"Until we get those assurances," Governor Haslam said in a speech to state legislators, "I cannot recommend to you that we move forward on this plan."
Erin Shields Britt, a spokeswoman for the federal Department of Health and Human Services, said, "We welcome continued conversations with Tennessee about developing a state-based solution that meets both the state's unique needs and the requirements of the Medicaid program while providing much-needed coverage to thousands of Tennesseans."
Robert Pear contributed reporting from Washington.
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