NASHVILLE -- Republican Gov. Bill Haslam put a top Obama administration official on notice Monday that if he doesn't get his way on a Medicaid expansion, an estimated 181,000 Tennesseans won't get coverage under the federal health care law.

The governor said in his letter to U.S. Health and Human Services Secretary Kathleen Sebelius that he must have federal approval of the special conditions he wants for his "Tennessee Plan," unveiled with great fanfare to state lawmakers eight months ago.

If they aren't, he warned, "We do not see a path forward in the current environment that will allow us to extend coverage to the Medicaid Expansion population until the aforementioned issues have been resolved and flexibility is given to allow us to address health outcomes and cost in a way that the traditional program does not."

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