TN Lt. Governor Ron Ramsey
By Paul C. Barton | Tennessean Washington Bureau | and The Associated Press
State Senate Speaker Ron Ramsey expects fellow Republican Gov. Bill Haslam to announce that Tennessee will move ahead with plans to create a state-run health insurance exchange.
But Rep. Scott DesJarlais, R-Jasper, said Thursday that implementation of the 2010 federal health care reform still can be blocked and urged Haslam to not create a state health insurance market.
Originally, Haslam faced a deadline today to notify the federal Department of Health and Human Services about whether Tennessee will create its own health insurance exchange or let the federal government create one for the state. But HHS announced Thursday evening that the deadline had been extended to Dec. 14.
Under Democratic President Barack Obama's federal health care law, the exchanges are intended to be a kind of clearinghouse through which insurance companies will compete for customers beginning in 2014.
Most observers interpret the law as allowing the federal government to create exchanges in states that decide not to create their own.
But DesJarlais, in an argument first raised earlier this year, contends there can be no health care exchanges, and thus no final implementation of the controversial health care law, if states refuse to create their own.
In a letter to Haslam dated Thursday, DesJarlais said his position has been bolstered by a recent Congressional Research Service report.
IRS officials, however, contend the clear intent of the law is to allow federally created exchanges in states where governors don't act. Many Southern governors have opposed setting up exchanges.
"In short, states that refuse to create and implement their own state health-insurance exchanges could potentially have the ability to block the law altogether," DesJarlais wrote.
Because of President Barack Obama's re-election and a changed makeup of Congress, he added, this may be one of the last options for stopping the law, at least until it can get further judicial review.
Key details lacking
Ramsey stressed that a final decision is still months away about whether the state or the federal government will ultimately run the health care marketplace.
If the state says it will create its own exchange, "All that really does is kick the can down the road -- as the federal government has done with this -- and leave our options open," Ramsey said.
Ramsey called it "arrogant" for the federal government to demand states make a decision when so many details about what the exchanges will entail are still lacking.
Key issues include how much flexibility would be granted to the states if they run their own exchanges.
"Why would we want to have a state-run authority when we only really get to run 10 to maybe 20 percent of it?" he said. "The federal government's still running 80 percent of it, yet we get 100 percent of the blame."
Ramsey said he expected the issue of how -- and at what level -- to comply with the federal health care law would be a major focus of lawmakers when they return in January.
Haslam is still reviewing his options, spokesman David Smith said.
" No decision has been made," he said.