Lotteries are often competitions for something fun, like extra money or prizes. But for thousands of Tennessee residents who have escalating medical bills, their lives almost literally depend on a twice-yearly telephone lottery for people who need help paying medical bills, but while poor, do not quite qualify for TennCare, Tennessee's version of Medicaid. They must call a hotline so popular that its 2,500 call limit is reached in an hour or less. And that's only for requesting an application for the extra funding. Even if they get through, the hurdles only continue. Applicants have to be elderly, blind, disabled or the “caretaker relative” of a child who qualifies for TennCare. Their medical debt has to be sky high.
The Medicaid expansion part of the Patient Protection and Affordable Care Act would add 140,000 people to the TennCare rolls by 2019. This would capture many of the people with extreme medical debt that don't yet qualify, the thousands of people calling in twice a year. As of Thursday, however, Governor Bill Haslam has decided not to go through with the expansion, leaving open the question of what will happen to the 180,000 who do not qualify for TennCare, but remain uninsured.
This gamble may mean missing out on $1 billion in federal money, the Tennessean points out, that would have paid for coverage to people who make too much to qualify for TennCare now but still less than 138 percent of the federal poverty line, about $32,500 a year for a family of four.
Most of the people calling in for the lottery are aiming for what is known as a spend down, which already covers only a small sliver of Medicaid recipients in Tennessee, according to the New York Times, about a 1,000 people at a cost of $32 million. A Nashville Legal Aid Lawyer described the situation to the Times: "It’s like the Oklahoma land rush for an hour...We encourage people to use multiple phones and to dial and dial and dial."
So why is Haslam so opposed to expansion? No one believes the lottery is very efficient, but many state legislators, some of whom have Tea Party affiliations are hesitant to go back to the days when TennCare was one of the most generous in the country. By 2005, costs were rising, and Democratic Governor Phil Bredesen cut 170,000 people from its rolls. Others echo concerns echoed throughout the debate over the expansion, that despite the guarantee that the federal government will fund the program for the first few years, that somehow they won't be able to deliver.
It's also a stalling tactic, a way to delay the decision until 2014, and gain more time to negotiate for another recent way for governors looking to get around the Medicaid expansion, the private option. As writer Chas Sisk noted in the Tennesean, Governor Haslam "bought himself more time to work on a deal on Medicaid expansion, but he also borrowed future political problems." Haslam is betting that he'll be rewarded in the election year for getting a better deal from the federal government. If it doesn't work, however, he and his allies will be blamed for closing hospitals, escalating bills, and fewer services. Democrats in the state legislature believe “It’s a very chicken way to approach government."
While the results of the gamble remain to be seen, one comment from Tennessee's Republican Lieutenant Governor Ron Ramsey is less than comforting for those scrambling for more coverage. Ramsey told the Tennesean, “I know that there are some that are going to be hurting,” he said. “There will be some that close. ... Maybe there are some that need to be closed.” Meanwhile the hotline calls continue.