The expansion of Medicaid would provide health insurance to all adults who earn income below 138 percent of the federal poverty level, which equates to about $34,638 for a family of four. Experts predict that 250,000 uninsured Tennesseans would become newly eligible for heath insurance if Tennessee expanded Medicaid.

Under the Affordable Care Act, the federal government would pay for 90 percent of costs associated with expansion, while the states pay 10 percent.

Term-limited Gov. Bill Haslam attempted to expand TennCare, Tennessee’s Medicaid program, in 2015, but the General Assembly rejected the two-year pilot program, called Insure Tennessee. Under his plan, Tennessee hospitals actually agreed to pay for the state’s share, but lawmakers were nonetheless concerned about its cost.

With a new governor set to be elected in November, the top six candidates’ support or opposition falls along party lines, with the four Republicans opposing Medicaid expansion and the two Democrats supporting it. 

Here are the Republicans’ thoughts: 

Randy Boyd: “Obamacare has failed us, and as governor, I will go to D.C. to negotiate a Tennessee-based solution, such as block grants. Washington is broken, and it is clear that the answer to making Tennessee healthcare stronger is not going to come from the federal government.

“Returning power to the state is the critical first step in allowing us to create the best system that ensures quality care for the most people, with the broadest coverage, while keeping costs low. As things stand now, Tennessee can’t afford the health we have. I believes we have to focus on making all of Tennessee healthier.”

Diane Black: Black’s campaign did not immediately respond to a request for comment on Medicaid expansion, but the congresswoman has previously expressed opposition to the idea. 

When asked about the proposal by the USA TODAY NETWORK, Black said, “Federal dollars used to fund Medicaid in states, especially those that expanded under a previous administration, will decrease over time. These states are not going to get the Medicaid funding they were promised. Our state has been in that position before, and we are not going down that road again. 

“The answer to problems with Medicaid is block grants from the federal government to the states. The Founding Fathers included the 10th Amendment to the Constitution so states could find their own answers to difficult issues. Prior to Obamacare, Tennessee had programs such as CoverTN and AccessTN designed to provide coverage to different populations. Other solutions include the use of high-risk pools, reinsurance or invisible risk sharing, which was included in the American Health Care Act passed by the U.S. House of Representatives in 2017.” 

Bill Lee: “Expanding Medicaid is not the solution. Federal dollars with strings attached is not free money, and expanding a government program without first addressing rising costs is not the right approach for our state.

“Instead, we should be working with the administration to address the rising costs in our existing TennCare program, and supporting the provider community to help patients make the right choices to address the rising rate of preventable lifestyle diseases.”

Beth Harwell: “TennCare, the state’s Medicaid program, amounts to one-third of the state’s budget, and I’ve been active in the process which keeps it from ballooning. At the General Assembly, the people of Tennessee made it known they wanted to reject Medicaid expansion under Obamacare.

“While serving as Speaker of the House, I have asked President Trump to give states greater flexibility as to how funds can be spent by requesting block grants. With those grants, we can tailor the program to the specific needs of Tennesseans. A tailored solution is the Tennessee way, not the Washington way.”

Here are the Democrats’ thoughts: 

Karl Dean: “As governor, my top healthcare priority will be working across the aisle to expand Medicaid. I believe the decision not to expand in Tennessee was highly political and not in the best interest of Tennessee families. We are now seeing the tangible consequences. Tennessee has seen 10 hospitals close, largely in rural areas. They are closing, at least partly, because the hospitals are not receiving the reimbursements they need to keep operating.

“When a hospital closes in a small town or rural community, the entire area suffers. Without a hospital it becomes more difficult to retain residents and attract new ones. Without a hospital, it is more difficult to attract business. When a hospital closes, it means that families are 30 to 45 minutes away from receiving needed medical care.

“I also believe that expanding Medicaid will make a huge difference in the fight against the opioid crisis. We need the resources to be able to get folks the treatment they need. Virginia came together to approve Medicaid expansion in May; we can do it too. It is not too late.”

Craig Fitzhugh: During the 2018 legislative session, as House minority leader, Fitzhugh proposed an amendment that would have allowed Haslam to expand TennCare, but the measure was shot down by the Republican super majority in the House.

On his campaign website, Fitzhugh said, “When our governor failed to expand Medicaid coverage to cover more Tennessee families, our state lost out on $3.5 billion. It’s past time for the Senate to keep a path open for Tennessee’s next governor to ensure our families have access to life-saving care, and bring our tax dollars back.

“Helping families and businesses thrive means making sure every Tennessean has access to quality healthcare they can afford, and that when the federal government offers to help pay for it for our most vulnerable citizens, we take them up on the offer rather than letting hundreds of millions of dollars go to other states.”

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Here’s where the governor candidates stand on expanding Medicaid in Tennessee