Casada: Leaving Exchange to Governor “Viable Option”

Tennessee’s legislature could take a hands-off approach to setting up a state insurance exchange, as part of the federal healthcare law. A conservative lawmaker says his peers might simply leave the details to the governor.

Franklin Republican Glen Casada says many of his colleagues find it “unpalatable” to switch on part of the federal healthcare overhaul. Casada says in talks with constituents, he lays it out as a choice between the lesser of two evils:


“I think some Tennesseans think that if the state rejects the health insurance exchange, then we have effectively stopped Obamacare, and that couldn’t be further from the truth. The health insurance exchange – it’s federal law, it will be implemented. So now the question is: Does Tennessee do it, with our policy and procedures, or do the feds do it with their policies and procedures?”

Officials say it’s not yet clear what a state exchange would look like, or what exactly the governor would need lawmakers to sign off on, if anything. So Casada says the legislature could simply hand over the power to set up an exchange, and leave it at that. But he says it’s too soon to know which way members are leaning.

A state official says setting up a health insurance exchange could cost between $40 and $120 million. Governor Bill Haslam wants to meet a June deadline to make sure the federal government foots that bill, not the state.

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“A lot of constituents at home say ‘Glen, stop that health exchange and then you’ll kill Obamacare in Tennessee.’ And that’s when I have to stop and say ‘No… No. If we don’t implement it, the feds will. Which is the lesser of two evils?’ And then when I have that conversation with folks at home, in Franklin, and Brentwood, and Spring Hill, they begin to understand that maybe the state implementing it is more palatable than the feds coming in and implementing it.”

Casada chairs the House Health and Human and Resources committee, where state exchange planners gave an update today. After a quick slideshow Casada said there wouldn’t be time for questions from lawmakers, drawing some flack from Nashville Democrat Mike Turner:

“I think this is something we have to move forward with, and I think we need to make some decisions here. As I understand it there’s millions of dollars at stake here that we could lose by just dawdling a little bit. So I think if we have to make a decision this year on this, I think we need to be getting on with this. This is probably the most important decision before this committee this year.”

Casada says he’d try to have the speakers back soon, and also noted the health committee might not be the one taking up legislation to create an exchange, if such a bill is called for.

And that’s an open question, says TennCare Director Darin Gordon, because receiving federal guidelines to help steer the exchange setup process has been hurry-up-and-wait:

“We’re trying to solve a puzzle with a lot of moving pieces, and I think so far we’ve done a very thoughtful process in trying to gather appropriate input and being prepared to answer those questions. But now we need to see some of that (federal) guidance come out so we can figure out where we need to go from here.”

Gordon’s point-man on insurance exchanges, Brian Haile, got some lawmakers’ attention when he mentioned one possible effect of the healthcare overhaul, if the law isn’t scuttled in court or this fall’s presidential election: Haile pointed to a slide of “huge” tax credits for people below certain income levels who buy insurance through the exchange.


Under federal rules Haile said a hypothetical family of three making $55,590 a year – 300 percent of the poverty level – would only pay 9.5 percent of that amount for coverage.

“Roughly 10 percent of that number is $5500. However, an individual insurance policy for that family in Tennessee will likely cost between $12,500 and $14,500 in 2014. So who pays the difference?”

The federal government will, Haile says, through tax credits totaling more than what the family actually pays for insurance.

“I point that out because when we look at the average salary in Tennessee, it’s certainly a little bit below this, and so you can see hundreds of thousands of Tennesseans may qualify for these tax credits, which would mean hundreds of millions of dollars in new federal inflows to our state – again, potentially.”

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