It’s going to take a Christmas miracle for Insure Tennessee to make it into anyone’s stocking this year.

As the 2016 session of the General Assembly approaches in early January, Republicans are showing no support for the plan Gov. Bill Haslam offered for a special session in early 2015.

And Democrats are miffed at the governor’s inability to push his own proposal, which is designed to catch some 280,000 people who fall into a health insurance coverage gap.

It failed twice in committees and never reached floor debate in the House or Senate.

When pressed on the matter, Haslam consistently says even though the problem still exists and he thinks it’s the right thing to do, he says he believes “something will have to change for it to pass next session.”

So far, he doesn’t see that legislative opening.

Republican Sen. Doug Overbey, who carried the measure last session, says the resolution remains in the governor’s hands. They’ve had a couple of conversations “in passing” about what occurred in 2015 and what might happen in 2016, and the governor has it “under advisement,” Overbey explains.

“For it to have a chance to succeed, I think there would have to be a change of opinion among the members of the General Assembly. And so far I haven’t seen or heard about any change,” Overbey adds.

“In fact, it seems more and more folks are taking the attitude of let’s wait and see what happens in the November 2016 elections, the national election.”

Block grant idea popular

Some Republican presidential candidates are broaching the idea of repealing the Affordable Care Act, which has overcome about 40 congressional efforts to kill it and gotten backing from two U.S. Supreme Court decisions. Such a move could make Insure Tennessee a moot point and raise entirely new questions.

Two years ago, the Legislature asked Haslam – short of straight Medicaid expansion – to come up with a Tennessee plan for uninsured working people. The measure would net more than $1 billion in taxes Tennesseans have paid and use it to provide the coverage through a market-based plan.

Officials said it would require no new taxes or increased state spending.

Those in the coverage gap include people who don’t qualify for Medicaid, don’t make enough to obtain tax credits to purchase coverage on the federal Health Insurance Marketplace, or can’t afford Marketplace coverage, even with tax credits.

Those eligible would be able to choose from two options:

n The Volunteer Plan: Members would get a set amount in vouchers to buy employer-sponsored insurance from a private provider and pay for out-of-pocket expenses.

n Healthy Incentives Plan: Similar to TennCare, it would enroll adults starting at 21 in Healthy Incentives for Tennesseans where they would be able to earn contributions through healthy choices such as quitting smoking, passing health assessments and using the health-care system appropriately. They would also make small co-payments for health care.

Despite its market-based approach, Insure Tennessee couldn’t overcome general Republican disgust for its connection to Obamacare.

“I think those same hurdles are still there, still as high, if not higher at this point,” says Overbey, a Maryville Republican.

State Rep. Glen Casada, chairman of the House Republican Caucus, predicts Democrats will try to resuscitate Insure Tennessee in 2016, but he doesn’t see Republicans, who hold super-majorities in the House and Senate, supporting it.

“It’s just not a good economic decision,” explains Casada, a Franklin Republican. He points toward escalating insurance costs in Kentucky where Medicaid expanded and an increasing number of hospitals went out of business there, more than in Tennessee.

Republican legislators consistently bring up the Legislature’s move under Democratic Gov. Phil Bredesen to remove tens of thousands of people from TennCare rolls and the difficulty that caused.

They say they don’t want to do it again, and they predict Insure Tennessee costs would increase over time and fall into the state’s lap.

Casada believes the federal government should provide block grants of Medicaid funds to Tennessee and let it run the program. “We could do it where we could cover everybody, and they would have skin in the game because they would have to pay a little bit,” he says.

Some Republican presidential candidates are mentioning the idea of making Medicaid block grants to states, Casada adds.

“If they would do that, I tell you we could do a ten times better job, more efficiently, more economically for the taxpayers and cover more people. But … that’s a Washington, D.C. decision,” Casada says, noting he is speaking theoretically.

Democratic discontent

While that sounds vaguely similar to Haslam’s proposal, netting a big chunk of money from the federal government to help the uninsured, Tennessee Democratic Party Chairman Mary Mancini says she doesn’t think Republicans would spend block grants wisely.

“There’s nothing efficient about the way Republicans are running this government, so I don’t trust them to take that block grant and actually use it for what it was intended to be used for,” Mancini points out.

“The federal government has set up a system that’s working. It’s working in a lot of other states, and because the Republicans would rather play politics with this issue than actually help people of Tennessee, they’re just not responsible enough to take that money and use it well.”

State Rep. John Ray Clemmons says Insure Tennessee should be the state’s top priority this session, noting “at the very least” 280,000 Tennesseans fall in the coverage gap.

“And there’s just one reason they still don’t have access to quality affordable health care, and that is because of politics. And that’s because Republicans are scared of their own shadow,” says Clemmons, a Nashville Democrat.

Statewide polls show at least 60 percent of Tennesseans support Insure Tennessee. But Republican lawmakers are too afraid big money from out of state will “parachute” into their districts during an election year and knock them out in a primary vote.

“We find ourselves, as Democrats, pushing a Republican governor’s plan, because he won’t do it himself,” Clemmons says.

“We ask ourselves why he would come up with this plan that people generally support in large numbers and then not ask a single member for their vote.”

While some Republican legislators are calling it bad economics, Rutherford County Democrat Molly Mann says Insure Tennessee should pass because it’s “good business.”

“I think the Tennessee legislators should use all the resources they have coming from the federal government, or whatever, for the benefit of the citizens of Tennessee to help those citizens out and also help the hospitals out, help the medical community out, help all those people who work in the medical community and also help the patients,” Mann explains, speaking at a recent Democratic holiday gathering where purple Insure Tennessee stickers were handed out.

While Insure Tennessee won’t help her directly, she notes, if all Tennesseans are able to pay their bills when they go to the emergency room, for example, those costs won’t be shifted to other people who have coverage and can pay.

That is a reality nobody can ignore.

But as 2016 approaches, don’t expect to see Insure Tennessee in stockings or under the tree.

The Legislature is in no mood to play Santa with insurance.

Sam Stockard can be reached at [email protected].