Committee rejects temporary TennCare expansion aimed at easing rural hospital strain

The Tennessee House Insurance Committee on March 25 voted 4-14 to reject House Bill 0018, a proposal from Representative Shimon Baum to authorize a waiver allowing a temporary expansion of TennCare eligibility to 38% of the federal poverty level.

Baum, the bill sponsor, told the committee the measure was designed to reduce uncompensated care that has contributed to rural hospital closures and would extend TennCare to an additional population on a temporary basis. “This is a bill that is designed to help rural hospitals really help all hospitals by increasing the number of patients that have insurance and they're for compensation for care,” Baum said. He described two time limits for the expanded population: benefits no more than 12 months in any 24-month period and no more than five years in a lifetime. Baum said the waiver would seek a 9-to-1 federal match (90% federal, 10% state) and compared the approach to rules used in earlier welfare reform legislation.

Supporters said the temporary design was intended to avoid creating a permanent entitlement while providing help after events such as natural disasters. Baum cited flooding in East Tennessee as an example of where temporary coverage could help residents who lost jobs and insurance.

Opponents, including Representative Hill, framed the bill as incompatible with Tennessee’s prior block-grant strategy for TennCare. “I would respectfully ... this is the antithesis of the block grant legislation,” Hill said, arguing the state’s prior approach sought to serve more people with existing resources rather than expand eligibility.

Committee members debated whether to send the bill to a summer study. Representative Spicke moved earlier to send the bill to summer study but the question of whether that motion remained on the floor became entangled with a subsequent procedural question; the clerk and members then moved to a direct vote on the bill. Representative Atkinson confirmed the committee was voting on the bill itself after the question was called.

A fiscal note discussed during the hearing estimated sizable federal dollars could be available under the waiver; a committee member cited a figure of roughly $2 billion in fiscal impact as noted in the fiscal analysis. Committee discussion also referenced TennCare reserve accounts and reversions from previous years as background to the fiscal debate.

Because a majority of committee members opposed the measure, HB 0018 did not advance. No formal amendment was adopted. The committee moved on to other agenda items after the vote.

Votes at a glance House Bill 0018 — Outcome: failed. Vote tally: 4 yes, 14 no.