Updated at 7:38 p.m. on Monday, Feb. 11, 2019.

NASHVILLE — In a state where nine rural hospitals have already shut their doors and a 10th one plans to close March 1, Tennessee House Democrats said Monday "it's time now" for Gov. Bill Lee and his fellow Republicans in the Legislature to expand Medicaid to some 280,000 low-income people.

Democrats brushed aside as a waste of time a GOP-sponsored bill that would launch the state on an effort to secure a federal block grant for its Medicaid program, operated here as TennCare.

Senate Republican leaders, who have consistently opposed Medicaid expansion under the 2010 federal Affordable Care Act, said last week their block grant effort might eventually lead to a program to help some working poor with insurance premiums under their employers' health plans.

"I think it's an idea that's being bandied about on their side to make it look like they actually care," charged Rep. John Ray Clemmons, D-Nashville, of one of about a half dozen Democrats who held a news conference to call yet again for Medicaid expansion.

Lee ran for governor last year saying he wouldn't expand Medicaid and was looking for other ways to address lack of health coverage, including addressing costs of care.

But Clemmons and other Democrats urged him and legislative Republicans to follow the lead of 36 other states, including Arkansas and Kentucky, and agree to expand Medicaid under the federal law. Similar efforts by former Gov. Bill Haslam, a Republican, met with failure in the GOP-led General Assembly in 2011 and subsequent efforts to revive it died.

"This is an issue that an overwhelming number of Tennessee families support," Clemmons said. "It's long overdue and they [Republicans] want to look like they're doing something or talking about something. Because all these years they've not provided an alternative or justifiable response of any substance."

Lt. Gov. Randy McNally, R-Oak Ridge, the Senate speaker, took issue with Clemmons' characterization.

"We're looking at some different options that wouldn't put the state at risk as much as a normal expansion," said McNally. He noted he is concerned the current federal share of financial support for the expansion population's coverage — the federal match is 90 percent with states paying the remaining 10 percent — could be cut substantially by Washington in the future.

That could harm state finances, McNally said, adding, "we hope we could find something that limits our future risk. I think a block grant might be a good way to do it."

Rep. Gloria Johnson, D-Knoxville, said GOP Senate leaders' idea is "just a block grant" for a TennCare program the state already has.

"It's not about expanding any further," Johnson said. "What we're talking about is a vote we could take tomorrow and make it happen instead of a plan we don't know how long it's going to take to execute or develop. It's time now, and [Medicaid expansion] is proven and tested."

But McNally said what's being discussed by Republican senators is a two-fold approach. There's the original bill, sponsored by Sen. Paul Bailey, R-Sparta, which seeks a waiver for a block grant for the current TennCare enrollees, totalling 1.34 million people. Federal officials would have to approve that.

Republican leaders would like to follow up on that with a second waiver seeking expansion money in the form of a block grant proposal helping some in the estimated 280,000 in the expansion population. A number of them are already working but may not be able to afford premiums for their employers' insurance. The idea is to provide them vouchers.

Nine rural Tennessee hospitals have closed since 2010. A tenth hospital, Cumberland River Hospital in Celina, announced last month it would shut its doors on March 1. The state has the second highest number of rural hospital closures in the nation.

Lee has consistently called Medicaid a "flawed system."

Contact Andy Sher at asher@timesfreepress.com or 615-255-0550. Follow on Twitter @AndySher1.