I n late April of this year, the dilemma facing “Insure Tennessee,” Governor Bill Haslam’s signature piece of healthcare legislation, was dramatized when the Governor, along with Republican leaders of the General Assembly, met with members of the Tennessee media in the Old Supreme Court Room of the Capitol for the customary press conference to sum up a just-concluded legislative session.
Sitting behind a conference table on a raised platform, along with Haslam, were Lt. Governor Ron Ramsey of Blountville; Speaker of the state Senate, Mark Norris of Collierville; the Senate Majority Leader, Beth Harwell of Nashville, Speaker of the House; and Gerald McCormick of Chattanooga, House Majority Leader. All the Gov’s people, so to speak; all fellow Republicans. And they all had one other thing in common: Every single one of them, save McCormick, had either bailed out on Haslam’s Medicaid expansion proposal or worked to defeat it, actively or behind the scenes.
The Governor tried to brazen it out, claiming, as he began his summary, “The primary constitutional obligation of the General Assembly and the Governor is to present a budget that balances. This actually was an extraordinary year; not only did we do that, but if you think about it, the hardest time to govern is when you actually have extra money.” An empty claim, perhaps, as Craig Fitzhugh (D-Ripley), Minority Leader of the House Democratic mini-minority (only 26 of the House’s 99 members are Democrats), indicated an hour later in his own summary: “We legislated quickly, and we passed a budget. That’s about it.”
Another statement by the Governor had been even more extraordinary. Haslam actually made a claim about “what you would call Governor’s bills”: that “every one of those bills was passed this year.” To be sure, he had added the qualifying phrase, “in the regular session.”
But even that nit was picked too fine: to be sure, the Insure Tennessee plan had been presented in the form of a resolution, not as a bill per se, and in a truncated special session held just before the regular one. Intended to last a week, the special session sputtered out on the second day of deliberations with a kill vote of 7-4 by a reconstituted version of the regular Senate health committee. But the proposal had in fact been brought back in the regular session, only to be smothered again in committee.
Both outcomes were misleading, as will be seen a few paragraphs hence.
In the Q&A session following the opening statements by Haslam and the others, reporters’ attention inevitably returned to the matter of Insure Tennessee. Might it live and breathe again?
“I still think Insure Tennessee is the right thing to do,” Haslam, anything but a rabble rouser, would say mildly. “I think we have the right approach ... but big, tough legislation like this often doesn’t happen in a one-year period.”
Senate Speaker Ramsey dosed this tentative optimism with cold water almost immediately.
“I hope we have a Republican president after 2016,” Ramsey ventured, after which “we’ll get the money back in block grants.” With a perfunctory verbal nod toward Haslam, the arch-conservative Lieutenant Governor, entitled by the constitution to the honorific title “Governor” in his own right, said, “We’re both Republicans, and we’re great friends. We have philosophical differences ... We’ll deal with this somewhere down the road.”
The math was simple enough to do. “So you’re talking about a two-year delay in bringing it back,” a reporter ventured. “Could be,” Ramsey agreed. Would be, was the message. Clearly, he was the elephant in this room.
“We’re both Republicans, and we’re great friends. We have philosophical differences ... We’ll deal with this somewhere down the road.”— Ron Ramsey
This was not the first time the Lieutenant Governor had exercised de facto veto power over his titular superior. Back in 2011, during Haslam’s first turn at the helm, the Governor proposed a several-tiered program of education reform that made allowance for teachers to continue having the right of collective bargaining on economic matters. But Ramsey had organized the Senate into an unyielding “No” on collective bargaining, a la Scott Walker in Wisconsin, and made it clear to his great friend Haslam, and to House Speaker Harwell, who also supported collective bargaining, that the choice was between no bargaining or no bill.
They chose to have the bill, sans collective bargaining, and on that pivot, philosophical differences were disposed of and the direction of state government altered to run henceforth through the Ramsey wheelhouse. Through Haslam’s first two legislative sessions in 2011 and 2012, House Speaker Harwell remained in alliance with the Governor, more or less, but a standoff between her and Ramsey at the close of the 2013 session (which resulted in her losing a charter school start-up which she had promised to Nashville Mayor Karl Dean) had lessoned her on bucking heads with the Lt. Governor.
She had never been totally forthcoming on the reasons for her refusal in 2015 to push for Insure Tennessee, even as GOP House Majority Leader McCormick insisted the votes were there for it. Perhaps she harbored, with Ramsey, some of the aforesaid philosophical disagreements with the Governor on the measure, or thought — McCormick notwithstanding — that her members did. Or maybe she was not of a mind for another wrangle with Ramsey. In any case, she declined either to support Insure Tennessee publicly, or to let the House initiate voting on the matter. So in the 2015 session, it would be up to Ramsey’s Senate to decide.
Meanwhile, Haslam had come, in an odd way, to resemble Barack Obama, the titular leader of another party in another capital, in the way he chose to deal with opposition (most of which, for the Tennessee governor, was in his own ranks). Instead of the big stick, he would brandish the olive branch and attempt to conciliate, not to conquer. This predisposition owed much to Haslam’s seemingly innate amiability and much, too, to the peculiar nature of his background.
A widely circulated item published in Forbes magazine during January of 2015, just before this year’s special session on Insure Tennessee would be getting under way, noted that Governor Bill Haslam of Tennessee, with confirmed holdings worth at least $2 billion, was now, since the retirement of New York City Mayor Michael Bloomberg, the richest politician in the United States. Haslam’s good fortune derived initially from birth, as the second son of Jim Haslam, a starting lineman on UT’s 1951 national championship team. Dad turned down a job coaching high-school football to go into the fledgling business of operating truck stops. The Haslam family is now owner of the vastly profitable Pilot Travel Centers, operating a national network of truck stops, with over 550 locations in every corner of the country and Canada. The chain boasts of being the largest purveyor of diesel fuel in the United States.
As Pilot grew and prospered, Jim Haslam became increasingly involved with his three great passions: the University of Tennessee, Republican politics, and the successful education of his three children. His older son Jimmy, who became Pilot CEO in 1994 and still holds that position, was Bob Corker’s college roommate (at UT, of course); in 2012, Jimmy Haslam bought a majority interest in the NFL Cleveland Browns for $1 billion. As a student at Emory University, Bill Haslam was making preparations to become a minister but eventually joined the family business, becoming president of Pilot (also in 1994) and later an executive with Saks Fifth Avenue.
The younger Haslam entered politics in 2003, winning a close race for mayor of Knoxville; he was easily reelected in 2007. Though a Republican, the Knoxville mayor had significant crossover support from Democrats and independents, and, as a candidate for Governor in 2010, was considered the relative moderate in a three-way Republican primary contest with Senate Speaker Ramsey and Chattanooga congressman Zach Wamp.
Fueled by campaign resources of more than $5 million, Haslam defeated Ramsey and Wamp, and won easily in 2010 over Democratic nominee Mike McWherter. He entered office with pledges of fiscal conservatism and a professed desire for unity in government, but at a time when a tide of new Tea Party Republicans in the state legislature had upset an equilibrium between Republicans and Democrats that had persisted for decades. As a result, the Governor often found himself walking gingerly on eggs, as he pursued a moderately conservative reform agenda.
An acceptance of Medicaid expansion in Tennessee in 2013, when it first became available, was a matter for Haslam to dispose of, since it would have been processed through TennCare, an agency operating within his administration and answerable to it.
At the time, the legislature’s fiscal review committee estimated that expansion would make 144,500 new Tennesseans eligible for healthcare coverage and bring some $1 billion in federal funding into the state, enough to reduce the fiscal strain on the state’s hospitals, which were having to provide free coverage for indigent patients in overburdened hospitals across the state. Within a year, those estimates would rise to 280,000 new coverages and $1.7 billion in annual federal funding. The Tennessee Hospital Association, the Tennessee Health Care Coalition, and the Tennessee Chamber of Commerce and Industry all lobbied hard for acceptance of federal funds.
State senator Brian Kelsey (R-Germantown) pushed through the legislature a bill prohibiting the Governor from acting on his own with regard to Medicaid expansion, as up until then he could have.
Initially, polls indicated that Tennesseans wanted the federal plan (as indeed they apparently still do). The major problem was that the 2009 Affordable Care Act, under which the Medicaid expansion was available, was still under siege by Republicans in Washington as “Obamacare,” a term which easily became a rallying point for GOP opposition in red-state Tennessee, as well.
Perhaps to propitiate such feeling, the Governor had already rejected the premise of a state-operated healthcare exchange in Tennessee, leaving it to the feds to provide a clearinghouse between insurance companies and customers. On March 27, 2013, Haslam rejected Medicaid expansion under wholly federal auspices, promising instead to seek federal waiver for a “Tennessee Plan” that would allow a voucher option for use with private insurance companies. This is what, a year and a half later, in December 2014, would come forth as “Insure Tennessee,” a plan designed to channel the federal funding either into TennCare or into private vouchers.
The eventual Insure Tennessee plan would have secured the same amount of federal funding — at 100 percent of federal funding for three years, and 90 percent thereafter. The grateful institutions that made up the Tennessee Hospital Association guaranteed to pay the state share of 10 percent after the third year — meaning that there would be no additional cost to Tennessee taxpayers, ever.
Fatefully, however, after Haslam’s rejection of pure Medicaid expansion in March 2013, leading to largely pro-forma negotiations for a waiver between the Haslam Administration and the federal Centers for Medicare & Medicaid Services (CMS), state Senator Brian Kelsey (R-Germantown) pushed through the legislature a bill prohibiting the Governor from acting on his own with regard to Medicaid expansion, as up until then he could have. The Kelsey proposal passed through both houses in Nashville easily, a remarkable rebuke of the Governor, sponsored ironically by a representative from the one Tennessee county — our own Shelby — which would benefit most from Insure Tennessee.
In the special session, Brian Kelsey even suggested the whole thing amounted to nothing more than a bail-out for avaricious and inefficiently run hospitals.
Hence the need for a resolution to be approved by the General Assembly, and hence the gauntlet faced by Insure Tennessee during the special session of February 2015, where a home-grown measure desperately sought by the state’s healthcare community — including struggling hospitals in places like Jackson and Savannah — was savaged as “Obamacare” and subjected to doubts made out of pure whole cloth by determined opponents. The feds would renege on their long-range funding, those opponents argued, wholly without any precedent to reason from. In the special session, Brian Kelsey even suggested the whole thing amounted to nothing more than a bail-out for avaricious and inefficiently run hospitals.
So here we are in the summer of 2015. With demands for a revival of Insure Tennessee still arising from hospitals and Chambers of Commerce and newspaper editorial boards, from the minority Democrats and from an increasing number of moderate Republicans, and from legions of struggling patients themselves, with the polls showing unmistakably that the people of Tennessee want it, is there any way of getting it?
Or must the state abide by Ramsey’s formula and wait out a two-year ban until the hypothetical election of a Republican president, who would no doubt construct something vastly different upon the ruins of a program by then undermined by reams of cash from the Koch brothers (who famously funded red-shirted activists to flood the hearing rooms and galleries during the special session of February 2015), or sabotaged by a partisan Congress or perhaps even invalidated, this very month, by an unsympathetic Court?
Or will nice-guy Governor Haslam, who stands by his Insure Tennessee program, have something else to say and do about it before all that?
D oes Bill Haslam ever get mad? The question is predicated on what everybody acknowledges is the Governor’s uncommonly sweet and even-keeled disposition and his genuine likability in both public and private situations. He is the anti-Chris Christie, as it were.
Yet there are moments, behind closed doors, when he does let go. In a private session with Democratic leaders in 2011, early in his first legislative session, he accused them of playing hardball with some of his initiatives, raising his voice and expressing something akin to anger. Reports of that session indicate, however, that Haslam’s venting was confined to polite — if modestly agitated — English and that it fell far short of the level established by his gubernatorial predecessor, Nashville Democrat Phil Bredesen, who allegedly stormed into one meeting and jabbed a confrontational finger at GOP Senate Speaker Ron Ramsey, shouting, “You [bleeped] me!”
In any case, Haslam’s relationship with Democrats would ease, as both he and they came to realize how impotent the Democratic minority in the General Assembly actually was in the wake of the first GOP sweep election of 2010. The second one, in 2012, famously created a Republican super-majority in both Senate and House, forcing the once-dominant Democrats into so accommodating a mode that the grounds for tension virtually ceased to exist.
But as nature abhors a vacuum, so does politics, and Haslam would not be lacking a ready supply of antagonists within his own party ranks. Some of these were right-wing throwbacks, ideological eccentrics like state Senator Stacey Campfield from former Mayor Haslam’s own home environs of Knoxville. A Tea Party stalwart, Campfield had a penchant for bills that received national attention for their outlandishness, and became embarrassments to the state — like one to ban the word “gay” from use in Tennessee classrooms, and another to strip impoverished families of all state aid if their schoolchildren didn’t make their grades.
The governor practiced his customary forbearance until it became practical for him to do something about Campfield. That opportunity would come at the polls in August 2014, when Campfield came up for reelection to another four-year Senate term. And lo and behold, a Republican primary opponent had been found who was, coincidentally or not, a known Haslam friend. This was Dr. Richard Briggs, a respected physician and a former Knox County Commissioner.
At a press availability at Memphis in May that year, just as the primary season was about to heat up, Haslam was asked about Campfield’s latest extravagance, a tone-deaf comparison of Obamacare sign-ups to the Nazis’ forced evacuations of Jews to death camps in World War Two. The usually circumspect Governor found his tongue, as they say: “It was wrong and inappropriate and insensitive. When you’re in a public office, our words matter, and when you use words like that [which] are indefensible, it’s wrong. That’s not a statement you can defend.”
Asked if he would be taking sides in Campfield’s reelection effort, Haslam contented himself with saying that, as Knoxville mayor, he had worked with Briggs who would bring “a really unique skills set” to the capital. As mild as that endorsement seemed, it sent the necessary signal to Knoxville GOP voters in Campfield’s Senate District 7, who turned out the previously undefeated Campfield by a two-to-one margin.
Bill Haslam, like all other self-respecting Republicans in the post-Reagan era, identifies himself as a “conservative,” though by today’s standards, especially when gauged against the current set of right-wing barn-burners in the Tennessee General Assembly, he would probably qualify for the now-lapsed and (in GOP circles) pejorative term of “moderate.” His efforts to move his party at least in the general direction of the political center are subtle, sometimes to the point of invisibility.
During the same primary season of 2014, other Republican officeholders besides Campfield were widely seen as problems for the Governor. Several of them were targeted for defeat in August (with mixed results) by a new Political Action Committee calling itself the Advance Tennessee PAC. The dean of Tennessee political reporters, Tom Humphrey, writing in the Knoxville News-Sentinel , noted the existence of the group, saying it was “funded by disclosed donors who all are Haslam supporters, although origin and leadership of the PAC are somewhat mysterious, with the governor denying direct ties.”
In any case, the Advance Tennessee PAC spent some $140,000 during the primary, either attacking conservative incumbent Republicans in the legislature or supporting their primary opponents.
Asked at a campaign stop by Chattanooga Times-Free Press reporter Andy Sher about the Advance Tennessee PAC’s efforts, Haslam blithely responded, “I can’t speak for the PAC. The PAC’s going to do what they’re going to do.” He acknowledged having connections to the PAC’s donors, but said, “[T]here’ve been people [involved in Advance Tennessee] who’ve supported me in the past who really understand having a governor is great. But it really matters that we have a Legislature that’s really going to make hard and good decisions going forward.”
The most important issue that would require “hard and good decisions” in the near future was, of course, Insure Tennessee, which the Governor was even then negotiating into final form with the federal Center for Medicare and Medicaid Services. We have seen the results of those efforts, however, and they weren’t pretty.
One problem for the Governor is that his remedial efforts are slow-motion, indirect, and future-oriented. Lt. Governor Ramsey’s obstructionist activity is present-tense, in place, and functioning.
During the run-up to last February’s special session, Lt. Governor Ramsey’s attitude toward Insure Tennessee was masked somewhat by a profession of open-mindedness, though, in his capacity as Senate Speaker, he had quite literally stacked the deck against the proposal by his restructuring of the Senate committees that would be in line to consider the Insure Tennessee issue. As an example, the regular nine-member Senate Health Committee, scheduled to have the first say on Insure Tennessee in that body, contained five members, a majority, known or presumed to favor the Governor’s proposal — including the Senate sponsor, Doug Overbey, a moderate Republican from Maryville.
Ramsey’s 11-member ad-hoc version of the committee — reshuffled, according to the Senate speaker, so as to insure that all 33 members of the Senate were evenly apportioned on the three committees that could potentially hear the measure — contained from the start a preponderance of add-on skeptics regarding Insure Tennessee, enough so that Republican Senator Rusty Crowe of Johnson City, thought to favor the proposal, chose not to waste a vote in bucking the trend. When the resolution came up again in regular session, Crowe was an enthusiastic yes, and the Senate Health Committee, its regular roster restored, voted 7-2 to advance the measure.
But, uh oh, Ramsey routed the resolution next to the Commerce Committee, a haven of arch-conservatives, who stomped out the insurrection before it could go further and be voted on in the full Senate. As was the case during the special session, when McCormick had confidently stated as much, there was believed to be a majority in the House in favor of the Insure Tennessee resolution, had the measure ever got that far.
The House that convenes for another run at Insure Tennessee in January 2016 will be the same House with the same members. That, however, will be an election year, and a full-fledged presidential-election year at that.
In some ways, Governor Haslam in his second term would seem to be in the same predicament as was faced by another Republican governor in recent times — Don Sundquist, whose attempts at revenue-enhancement and tax reform led him away from regressive forms like an ever-increasing sales tax and toward the concept, ultimately, of an income tax.
Sundquist would fail to achieve his objective, and would end his second term in 2003 as a pariah in his party. Haslam doesn’t mind hearing himself talked up as a possible GOP vice-presidential candidate in 2016, which many believe is why he skirted the all-powerful NRA’s wrath by signing a gun bill in 2015 that he had publicly deplored. Whatever lies in his future, Haslam surely wants to avoid Sundquist’s fate.
But he also genuinely believes in Insure Tennessee and its necessity for his people, and he knows that history will probably regard its fate as central to his legacy. Another legislative session awaits in the crucial year of 2016, and so does another chance for Haslam to define himself for posterity — or not.