On Monday, Governor Bill Haslam sent a letter to Health and Human Services Secretary Kathleen SebeliusKathleen SebeliusJerry Moran: 'I wouldn't be surprised' if Pompeo ran for Senate in Kansas Mark Halperin inks book deal 2020 Democrats fight to claim Obama's mantle on health care MORE informing her of Tennessee’s decision not to set up a state-based insurance exchange. Even after reviewing over 800 pages of draft rules, the governor said there was still a lot of confusion as to how the exchange would actually work. Governor Haslam chose not to set up the exchange because, despite all the uncertainty, one thing is clear: the law does not give state officials the flexibility needed to design an exchange to meet the needs of Tennesseans. Governor Haslam’s decision underscores the challenges not just for Tennessee, but nationwide, emerging from the Affordable Care Act.

The Affordable Care Act also required states to expand Medicaid to cover more individuals beginning in 2014, but fortunately the Supreme Court’s ruling made this expansion optional. Even though the federal government is supposed to pick up a significant percentage of states’ expansion cost, the Obama administration is already seeking to limit its support to states that don’t expand their programs as much as the law originally required. It sounds as though a bad deal has the potential to get worse – and our state can offer some clues as to what will happen for states that choose to expand their program.

Because of our state’s experience with TennCare, our state Medicaid program, Tennesseans know the dangers of simply expanding access to care without addressing costs. TennCare crippled the state budget and nearly 300,000 people were cut from the program in 2005 and 2006 just to keep it financially viable. TennCare is now one of the most restrictive heath care plans in the country, limiting how many medications patients can receive, what brands they can purchase and what doctors they can see. Because TennCare’s payments to physicians are even lower than the rates paid by Medicare and private insurance, many providers have opted out of the program and will no longer see TennCare patients. This is the model that President Obama is seeking to copy on a national scale.

My priority remains a full repeal of the Affordable Care Act because I don’t believe the program can simply be repaired. While we continue to work on achieving full repeal, we should also act to ensure the worst parts of the legislation that have the impact to dismantle people’s current health care now are repealed.  We can find ways to lower the cost of medical care, repeal the Independent Payment Advisory Board, implement meaningful medical malpractice reforms and fight fiercely to preserve the doctor-patient relationship.

Roe is a member of the House Education and Workforce Committee.