The words of “We Shall Overcome” and “Wade in the Water” resonate through the halls as Insure Tennessee supporters descend on the Legislative Plaza for a key vote on the plan to provide coverage to 280,000 working Tennesseans.

Ministers from across the state hand out Bibles highlighting the responsibility to care for the poor, hoping to draw support for the use of Affordable Care funds for state residents who fall into a coverage gap.

“It is absolutely a moral question. To me it’s a moral question if you’ve got money that’s sitting there,” says the Rev. Matt Steinhauer, a Hendersonville resident who pastors Faith Lutheran in Lebanon.

People fill the halls wearing purple T-shirts with the words “Insure Tennessee Now.”

They say they have momentum with members of the Senate Health Committee recently backing the bill. The Senate Commerce Committee even moves the matter to the front of its agenda, though Steinhauer speculates, “That may be so they can get rid of us early so they don’t have to put up with us speaking on behalf of the poor and especially the working poor, people who are working lots of jobs and cannot get health insurance.”

He turns out to be right, as their efforts fall mostly on deaf ears.

Despite the governor’s urgent backing, support by TennCare Director Darin Gordon, a push by Republican Sens. Doug Overbey and Richard Briggs, and guarantees Tennessee can opt out if the deal goes awry, the Senate Commerce Committee kills it in a 2-6-1 vote with little comment.

Sen. Dolores Gresham is the only committee member to ask a question, and hers is designed to raise questions about the difficulty of removing people from coverage if Tennessee ends the plan. Under former Gov. Phil Bredesen’s leadership, the state removed 272,000 from TennCare rolls about a decade ago because of escalating costs.

TennCare helped some of those residents shift into other coverage for breast and cervical cancer, according to Gordon, but others had to be dropped.

“I was around at that time and remember that very well,” says Gresham, R-Somerville, who votes against the measure.

Likewise, Sen. Jim Tracy says in a statement later after voting against the resolution, although he didn’t take the vote “lightly,” the Legislature “worked hard” to cut Medicaid rolls under Bredesen so health care would take up no more than 25 percent of the state budget so education and public safety could be funded.

“That was a very difficult disenrollment process and we do not want to go through that again,” the Bedford County Republican states.

The Affordable Care Act pushed that percentage to 32 percent, Tracy says, adding “I could not in good faith vote to continue to increase the Medicaid rolls and its percentage of our state budget and affirm the financially unsustainable actions taken by Congress when they voted to approve the federal act.”

Battle will continue

Freshman Sen. Jeff Yarbro, a Nashville Democrat who initiated the resolution after Insure Tennessee failed during a February special session called by Gov. Bill Haslam, says he is disgusted, but not giving up.

“I think it’s disappointing to see a committee of the Legislature fail to act on Insure Tennessee after giving it as little consideration as it did and without considering any alternative whatsoever. I think the people of Tennessee deserve better than that,” Yarbro says.

“There was almost no discussion in there. And I think the people of Tennessee deserve better and people of Tennessee will demand better than that.

“We haven’t solved this problem, so I think that we’re going to continue to see work on providing affordable coverage to the people of Tennessee until we do. There’s no question we’re going to see a continued push.”

State Rep. Larry Miller, D-Memphis, drops his resolution in the House the day afterward, despite telling reporters he had the support of Republican Rep. Mike Harrison, chairman of the House Finance Subcommittee.

Meanwhile, Gov. Haslam is “disappointed” with the vote’s results but glad the matter could be heard in two Senate committees during the regular session, according to spokesman David Smith.

“As he has said, the issue has not gone away, and he will continue to work to find a way to cover more Tennesseans and address growing health care costs in the state,” Smith says.

Compelling argument

Using a waiver approved the U.S. Department of Health and Human Services, Tennessee would gain access to $1.2 billion in taxes paid as part of the Affordable Care Act. Tennesseans in a coverage gap would receive help with vouchers through employers or healthy incentive arrangements.

Briggs presents three new developments for the proposal:

• A written agreement by the governor it would not take effect until after a U.S. Supreme Court decision in King v. Burwell dealing with the legitimacy of federally-run exchanges

• A provision locking out members who don’t pay premiums

• A memorandum from the Center for Medicaid and Medicare Services stating Tennessee can opt out if it costs more than federal funding and hospital assessment funds, which will help pay for it.

In addition, the state attorney general opines Tennessee is taking on no financial risk. U.S. Health and Human Services Secretary Kathleen Sebelius and TennCare’s Gordon say Tennessee can drop out if excess costs come in.

“We may not trust the federal government, but I think we can trust our governor,” Briggs says.

Insure Tennessee would create 15,000 jobs statewide, equal to three Volkswagen plants, without state funding, he notes, and prevent the job loss at hospitals caused by uncompensated care. He points out Vanderbilt University Medical Center has lost 2,500 jobs already while rural hospitals are closing because of funding shortfalls.

He quotes Tennessee Economic and Community Development Commissioner Randy Boyd, who says Tennesseans’ physical health is poor and the shuddering of rural hospitals would be devastating to rural hospitals, many of which are the largest employer in their counties.

While 60 percent of Republicans in his Knoxville district oppose Obamacare, 62 percent support Insure Tennessee, Briggs notes, adding House Speaker Beth Harwell found the same support in her district.

Maury Regional Hospital System CEO Alan Watson tells senators his emergency departments had 65,000 visits in fiscal 2014, and 19 percent of those patients were uninsured.

In 2013, Tennessee hospitals provided $2 billion in uncompensated care. Meanwhile, federal cuts stemming from the Affordable Care Act will cost hospitals $118 million over the next decade, $12 million annually.

“This figure will consume almost all of our annual operating bottom line,” he says, adding Maury Regional had to close its open heart care unit because of costs and funding cuts.

Not only do rural hospitals provide care closer to home, they are vital economic engines, Watson says, noting Maury Regional employed 22,700 with a payroll of $137 million in fiscal 2014 and contributed $900,000 in lieu of taxes.

Overbey urges senators to keep the debate going this session. Sens. Ken Yager, R-Kingston, and Reginald Tate, D-Memphis, are the only two to go for it.

The others refuse, leaving Insure Tennessee supporters crying and screaming to boot them out of office.

“It’s disheartening. My husband has diabetes. I suffer with severe migraines and other issues. I have a daughter that has a severe anxiety disorder, and none of us can get coverage, so we fall in that gray area where there’s nothing that can be done,” says Diane Ballard, a McMinnville resident who falls into the gap.

“Recently they found a lump in my breast, and I told my husband, it’s sad that we almost hope that it is cancer so we have insurance to cover the bills.”

Maybe next year.

Sam Stockard can be reached at [email protected].