Tennessee Governor Hesitates on Medicaid Expansion, Frustrating Many

Gov. Bill Haslam of Tennessee describes it as “trying to thread a needle from 80 yards.”

Mr. Haslam is only the latest Republican tailor trying to figure out whether to expand the state’s Medicaid rolls as prescribed by President Obama’s Affordable Care Act. In his case, it involves trying — so far unsuccessfully — to balance some sharply conflicting concerns: struggling hospitals, local business groups, dwindling state resources and fierce conservative opposition to the new health care law.

And it has left him hanging out there, with no resolution in sight, while almost every other state has made a decision, and with many of his impatient constituents wondering how long it is going to take.

Rick Perry of Texas and Bobby Jindal of Louisiana, among many other Republican governors, have flatly rejected the expansion, even though it would provide billions of federal dollars to their states. Gov. Jan Brewer of Arizona and Gov. Rick Snyder of Michigan are among a small number who decided to accept it, coming under intense criticism from conservatives as a result. Gov. John R. Kasich had to do an end run around his own Republican-controlled Legislature to make it happen in Ohio.

But Mr. Haslam, who had once promised a decision by summer’s end, is still trying to negotiate a new plan of his own with federal officials, hoping it will satisfy the competing constituencies. It would involve using federal money to place many of the state’s poor on the federal health care exchange created by the act, rather than on Medicaid. But so far he has not persuaded federal officials, who have asked for more details, and said he expected no quick resolution.

Although he is not required to do so, Mr. Haslam has also promised not to enact anything without the approval of the Legislature, whose Republican majority, he said, was dead set against an expansion of Medicaid. Support for his alternative plan seems uncertain at best.

“We don’t want to expand a system that’s not doing a good job controlling costs,” the governor said, karate-chopping the air during an interview in his modest Statehouse office. “We want to end up with something that’s not just Medicaid with lipstick on it.”

More From The New York Times: