The day before President Obama released his most comprehensive proposal for health care reform yet, Tennessee Gov. Phil Bredesen was out in front of the issue alongside several fellow governors, calling for more attention to be paid to states during health care negotiations that may end up requiring most citizens to carry health insurance in the midst of a slackened economy that’s already putting major pressure on state budgets.
Meanwhile, as the country gears up for what many expect to be a bazaar of political rhetoric Thursday night, when the president faces Republican and Democratic leaders to discuss the future of health care reform, Tennessee’s congressional cabal stands at the ready.
The occasion for Bredesen’s speech was the National Governors Association meeting in Washington on Sunday, and the group came out channeling some frustration over their exclusion from the decision-making process. The president’s proposal would require states to carry out many of the changes to health insurance law, including a major expansion of Medicaid that would cost states considerably.
“Governors have something unique to contribute,” Bredesen was quoted as saying by The New York Times. “Washington, D.C., is full of think tanks, theoreticians and advocacy groups. Governors are the ones whose feet are on the ground. We have a sense of what will work and what won’t work. Our perspective is not the only one. But we can bring some practicality to this discussion.”
Bredesen and three other governors — Republicans Jim Douglas (Vermont) and Michael Rounds (South Dakota), and Democrat Joe Manchin III (West Virginia) — were expected to meet with President Obama Monday to discuss their concerns over being left out.
Through his spokeswoman, Bredesen declined further comment on the matter Tuesday.
In another year of dramatic budget cuts, Bredesen has proposed slicing some $200 million from TennCare , the state’s version of Medicaid. That accounts for half the proposed cuts, although it only takes up about a quarter of the overall budget.
On the congressional side, Sen. Lamar Alexander, R-Tenn., penned an op-ed  Tuesday in Roll Call saying Republicans would work with the president on health care reform in a “step-by-step” approach — that is, scrapping the current plan and starting over, passing incremental changes rather than the sweeping legislation Democrats have proposed.
“If the United States were small like Denmark, Congress could enact comprehensive solutions all day long,” Alexander writes. “But it is arrogant to imagine that 100 U.S. senators are wise enough to reform comprehensively a health care system that constitutes 17 percent of the world’s largest economy and affects 300 million Americans of disparate backgrounds and circumstances.”
Neither Sen. Bob Corker, R-Tenn., nor Rep. Jim Cooper, D-Nashville, was prepared to offer comment as of this writing. Cooper will attend the summit Thursday.
Obama’s health care proposal would cost $950 billion over 10 years, and although the non-partisan Congressional Budget Office has yet to offer its analysis, the administration argues it would reduce the federal deficit by $100 billion in the first decade and $1 trillion over 20 years. It would require all but the most destitute Americans to carry some form of insurance, create state-based exchanges where consumers could compare prices and plans, and expand Medicare and Medicaid coverage.
It would also end any discrimination based on pre-existing conditions.
For seniors, the plan would cover the “donut hole” gap in coverage, which currently hangs many out to dry on a large portion of prescription drug reimbursements. The proposal also includes an excise tax that would begin in 2018.
It would also create the Health Insurance Rate Authority, a federal entity that would help states monitor for unfair rate increases and other unjust practices. Registration and background checks would be required of billing agencies and individuals in federal health care programs to eliminate those with a history of corrupt billing practices.
Tennessee Medical Association President Richard J. DePersio urged caution in moving forward.
“This new proposal appears to include a number of aspects of the previous bill that are positive for patients, such as eliminating the public option, setting caps on maximum out-of-pocket expenses, and banning insurance denials for pre-existing conditions,” he said. “But as we have seen in Tennessee, when you add more people and increase services, the cost will go up. The budgetary double-speak is something we will need to keep a close watch over.”