Gov. Bill Haslam: At some point ahead, Tennessee can 'come out ahead' in expanding Medicaid

Joel Ebert | The Tennessean

As the candidates for Tennessee governor have made their case to voters ahead of the Aug. 2 primary, Gov. Bill Haslam has rarely weighed in on the campaign.

He's made cracks about how his time in office is limited.

"This is an interesting job to lose because you not only lose your job, you lose your house and your car and your driver," he told a group of educators at a recent event in Nashville.

Tennessee governor's race candidates weigh in on health care. The forum featured five gubernatorial candidates who discussed various aspects of health care in Tennessee.

He's joked about how the candidates have been critical of him.

"There are people who are applying for your job very publicly and in the process of that they have really clear ideas of how you should have been doing your job for the last seven and a half years," he said at the same event.

Haslam has only offered an occasional reminder about what issues the next governor will likely need to address.

In a letter written to his eventual successor and published by the USA TODAY NETWORK-Tennessee, Haslam said the next governor will need to figure out how to keep the cost of TennCare low while providing coverage to Tennesseans.

Haslam's open letter to his successor: 'I hope you will love this job as much as I have'

Complete coverage: Tennessee's 2018 campaign for governor

More recently, Haslam said he would not be surprised if the next governor will face the prospect of having to expand Medicaid under the Affordable Care Act.

In a wide-ranging interview with the USA TODAY NETWORK - Tennessee's Grand Divisions policy and politics podcast, Haslam said the nation is down to a small number of states that have not expanded Medicaid under the Affordable Care Act.

Across the nation, 34 states and Washington, D.C. have expanded Medicaid, three states are considering it and 14 have not taken action, according to the Kaiser Family Foundation.

Subscribe and listen: Grand Divisions: A Tennessee politics podcast

Haslam said there were "a lot of mistakes" with the Affordable Care Act, including cost controls.

But, he said, "At some point in time we're going to say, can we put the right cost controls in there, whether it be everything from work requirements to some sort of user engagement to where we come out ahead having expanded."

"At some point in time, I think those states that haven't (expanded) will look around and say, we're all 50 states paying for it and 40 states are getting the benefit," he said.

Haslam said he still considers the failure of his 2015 proposal, known as Insure Tennessee, which would have provided hundreds of thousands of low-income residents access to health care, to be one of his biggest regrets.

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"I still think our plan was a good plan that would have saved the state money, covered people, been the right thing to do and would have long term been good for the country too," he said.

Earlier this year, Haslam briefly floated the idea of revisiting Medicaid expansion but it was batted down when he met with legislative leaders.

Haslam on Medicaid in 2018: Behind closed doors, Haslam asks again: Can Tennessee expand health care for working poor?

The four Republican candidates — U.S. Rep. Diane Black, House Speaker Beth Harwell, Knoxville entrepreneur Randy Boyd and Williamson County businessman Bill Lee — have said expansion is unaffordable and the state’s next governor should instead negotiate block grants from the federal government.

Although the issue remains significant for the thousands of Tennesseans without health insurance, Haslam said he was not surprised by the fact that many of his potential Republican replacements have focused on topics like immigration and the Second Amendment.

"The blunt answer is that's what people in the primaries care about," he said.

Former Nashville Mayor Karl Dean and House Minority Leader Craig Fitzhugh, the two Democrats in the race, have said they would support expansion under the Affordable Care Act.

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Reach Joel Ebert at jebert@tennessean.com or 615-772-1681 and on Twitter @joelebert29.