19 2 LINKEDIN 1 COMMENTMORE

This being Sunday, imagine that as you sit in the pew of your favored house of worship a stranger walks in, asks to address the congregation and offers $6.2 million a day to help the church provide health insurance for Tennessee's neediest citizens.

Not only that, the stranger says, she's willing to let church leaders determine how the program should be managed and who should run it. As long as it looks as if it will work and give hard-up Tennesseans coverage they currently don't have, the church gets the money.

Essentially, that is the deal the state of Tennessee has yet to embrace under the Affordable Care Act.

More than a year ago, Gov. Bill Haslam stood before a joint session of the legislature and announced his intention to come up with his own plan to expand TennCare for the uninsured, one that he said would rely more heavily on private businesses than on government bureaucrats. Now, a year later, the Republican governor's plan has yet to emerge.

This isn't an endorsement of President Barack Obama's signature legislative accomplishment, as complicated a piece of public policy as I've ever considered. It's an imperfect law, and it will likely be another 10 years, maybe longer, before the law's overall impact on American life can truly be assessed.

But the decision facing the governor seems less complicated. And if smartly managing financial affairs is the measure of success for a politician who sees himself as fiscally conservative, Haslam has taken an odd tack.

Last week, the governor withdrew a proposal to raise teacher and state employee salaries and to provide $12.9 million in new funding for the state's public colleges and universities because state revenues didn't come in as projected.

So times are hard, and tough choices must be made — which makes you wonder how the state can pass on $6.2 million a day to give more than 175,000 more people health insurance.

Arguing that the money should be given back to taxpayers doesn't work because of the way things happen in Washington. It ends up in other programs, or in other states, while hospitals and taxpayers in Tennessee bear the burden when the uninsured show up in emergency rooms.

Haslam said through a spokesman Saturday that the expansion discussions are ongoing, and that he is waiting for a proposal from the federal government to give Tennessee the flexibility it needs. The spokesman, Dave Smith, insisted that the governor still wants to expand TennCare.

U.S. Secretary of Health and Human Services Kathleen Sebelius, on a recent visit to Nashville, didn't comment on negotiations with the state. She did say that the $6.2 million would provide thousands of needy Tennesseans with health insurance every day.

A spokesman in her office later said she was open to flexible terms but made no reference to whose turn it might be to counteroffer. Neither side's version of where things stand conveyed much of a sense of urgency.

In a smart essay in this week's New Yorker, legal analyst Jeffrey Toobin notes that the folks who would benefit most from the expansion of health care nationwide aren't exactly a prized political constituency.

That was partly true of Medicare and Medicaid when they were created in 1965. Medicare had an instant constituency in elderly Americans, Medicaid not so much. It wasn't until 1982 that all 50 states had come on board.

Obama's health care law is flawed, yes, but the terms of this deal aren't so murky. No money down, $6.2 million a day, you draw up the plan. The rest of the federal law will be debated in this year's elections and beyond, but meanwhile a lot of money is going elsewhere.

So no, health care for the poor isn't a big winner politically, but it might be the right thing to do.

Something to think about as you sit in church this morning.

Scott Stroud is the politics and government editor. Reach him at 615-726-8930. and on Twitter @scottstroud1.

19 2 LINKEDIN 1 COMMENTMORE
Read or Share this story: http://on.wbir.com/1gAd8AB