NASHVILLE (AP) — Republican Gov. Bill Haslam is putting his goals for a special Tennessee deal for Medicaid expansion into writing.
The governor said in a letter to Health and Human Services Secretary Kathleen Sebelius on Monday that unless a special agreement can be reached, "we do not see a path forward in the current environment that will allow us to extend coverage to the Medicaid Expansion population."
Haslam in March declined $1.4 billion in federal funds to cover about 140,000 uninsured Tennesseans under the terms the money was offered. He has instead sought to strike a deal with Sebelius and other federal officials on his proposal to use the federal money to subsidize private insurance and promote healthier lifestyles through a series of incentives.
Haslam wants to create a health provider payment system that stresses rewards for keeping patients healthy through preventative care and management of chronic illnesses.
"We think there's a lot more flexibility that they have under the law than what they've shown," Haslam told reporters. "So that's what we're trying to figure out."
On a trip to Memphis last month, Sebelius acknowledged several conversations with Haslam about his proposal, but said she had not received specifics.
Spokesman Fabien Levy said in an email Monday that the agency welcomes ongoing discussions aimed at "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."
The governor said he had not cleared the letter with fellow Republicans in the Legislature, such as Senate Speaker Ron Ramsey, who have said they would oppose expansion in any form.
Under President Barack Obama's health care law, the federal government will cover all costs of new Medicaid patients from 2014 to 2016. After that, states will pay up to 10 percent of the cost.
Democrats have heavily criticized Haslam's delay, arguing that his inaction has led to layoffs and hiring freezes at hospitals around the state.
"There has never been an easier way for the state of Tennessee to improve the lives of its citizens without having to spend a single dime in state funds for years to come," House Democratic Caucus Chairman Mike Turner of Nashville said in a statement last week.
Haslam told reporters the long-term ramifications of an expansion would range beyond his time as governor.
"There's a legitimate question: Can the United States government really afford to pay 90 percent of the Medicaid cost for this population forever," he said. "Think that's a big question mark."