NASHVILLE -Perhaps it should come as no surprise that the five votes in the state Senate today against a new 3½ percent state assessment on hospitals - proposed and lobbied by the Tennessee Hospital Association itself as a means to leverage federal money and avoid $659 million in "devastating" TennCare cuts - included the Senate speaker who's running for governor, two senators running for Congress, and two facing potentially tough re-election challenges this year.
The "hospital coverage fee" won Senate approval on a 25-5 vote and now goes to the House of Representatives for debate Monday. The one-year assessment - 3½ percent on hospitals' patient revenues but which by law cannot be passed on to patients - is deemed essential by Tennessee's hospital industry to avoid $659 million in cuts to health care providers July 1. The fee would generate about $230 million that the state could use to draw down about $430 million in federal Medicaid money.
Hospitals large and small are in favor of the bill. Gov. Phil Bredesen said Wednesday the Regional Medical Center at Memphis cannot survive if the fee isn't passed. The bill has bipartisan sponsors in both the chambers. The lead Senate sponsor, Sen. Doug Overbey, R-Maryville, said it would attract federal Medicaid dollars at a better than 2-to-1 match. Tennessee would become the 27th state to use a hospital assessment for that purpose, and 12 states are considering similar legislation this year.
The Senate's "no" votes were:
* Speaker Ron Ramsey, R-Blountville, who is running for governor.
* Sens. Diane Black, and Jim Tracy, R-Shelbyville, who are both running for the 6th congressional district seat.
* Sens. Mae Beavers, R-Mt. Juliet, and Lowe Finney, D-Jackson, who are both facing tough re-election battles.
(Sens. Jack Johnson, R-Franklin, Bill Ketron of Murfreesboro and Jamie Woodson of Knoxville did not vote.)
The most striking "no" vote was Ramsey's, in light of his heightened position of responsibility AND his previous remarks about the proposal.
This is what he told reporters last month days after the THA asked the legislature to approve the fee in lieu of deep cuts in TennCare reimbursements to hospitals and other health care providers planned by the governor:
Ramsey: "They (the THA) presented it to the Republican leadership and I think we can see the need for that. There's nothing been put on paper by the Hospital Association so I'm reluctant to comment until we actually have a bill in front of us. But I understand that if these cuts go into affect that the governor has proposed, then it would be devastating to hospitals. And I understand that."
Reporter: "So you're open to that?"
Ramsey: "Um huh."
Reporter: "And it would not be viewed as a tax increase?"
Ramsey: "No because it's not a tax increase. It truly isn't. There are a couple of things that I wanted to make sure of if that happened: Number one, that this is a voluntary assessment by the hospitals -- that they agree to it -- and they did; they're coming to us with this plan. And the fact that this would not be passed on to patient bills, but would actually be eaten by the hospitals. They'd rather absorb a 3 percent cut instead of a 25 percent cut. And the last and maybe the most important to me right now is that this would not increase the federal deficit. Keep in mind the money has already been appropriated for the state of Tennessee in Washington DC. If we go through with these cuts, that money already appropriated to the state of Tennessee would stay in Washington, so this is really just figuring out a way of getting the money that's already been appropriated to us for our TennCare program."
This was what Ramsey had to say after the Senate vote today:
Reporter: "Did you vote against the hospital fee?"
Ramsey: "I did vote against that."
Reporter: "I thought you were okay with that. What happened?"
Ramsey: "I just don't think the timing was right for me to vote on that right now. And I'm not going to criticize others who did because I understand that within their specific districts, that that was a vote they needed to make."
Reporter: "What do you mean by 'the timing not being right'?"
Ramsey: (jokingly) "It came up at 11:30 and I wanted to wait 'till 11:35."
Reporter: "But as speaker you could have probably prevented that bill from coming to the floor, could you not?"
Ramsey: "There's a possibility."
Reporter: "Is it a coincidence that two others who voted against it are running for Congress?"
Ramsey: "Ask them."
Reporter: "Seriously, you've talked about how this is an important issue, that the hospitals could find this money to avoid drastic cuts. Is the political price so high to vote for this that it's not worth doing?"
Ramsey: "The timing wasn't right for me to do it right now, that's all I'll say."