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Tennessee health insurance exchange

new carrier joins TN exchange; rates going up but still among the nation's lowest

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  • By
  • healthinsurance.org contributor
  • October 10, 2014

Tennessee exchange rates and carriers

Five companies will be selling selling individual health insurance through the marketplace during the 2015 open enrollment period.  Assurant is joining the four carriers that sold plans in 2014: Blue Cross Blue Shield of Tennessee, Cigna, Community Health Alliance, and Humana.

Blue Cross Blue Shield dominated the Tennessee exchange market in 2014, and was the only carrier that offered plans in every county in the state in 2014.  The vast majority – 88 percent- of 2014 private plan selections were for Blue Cross Blue Shield policies.

According to a report released by the U.S. Department of Health and Human Services (HHS), the average cost for a bronze plan —the lowest-cost option — in Tennessee in 2014 was $184 — well below the national average of $249 a month.

Final 2015 rates have not yet been released for Tennessee, but in July, Blue Cross Blue Shield of Tennessee filed rate proposals with an average increase of 19 percent for 2015.  Cigna was proposing a rate increase of 7.5 percent, while Humana’s came in at 14.4 percent.

A Kaiser Family Foundation report released in September found that Nashville residents would face an average rate increase of 8.7 percent for the second-lowest cost silver plan – the highest of the 16 cities they studied.  But even with the rate increases, Nashville will still have among the nation’s lowest health premiums next year.

Get Covered American-Tennessee announced in early June that Jacob Flowers would be their new director.  Flowers’ job will be to educate and enroll as many people as possible during the 2015 Obamacare open enrollment period, utilizing resources that have already been allocated to Tennessee.  The Tennessee Health Care Campaign is also gearing up for the 2015 open enrollment period, hoping to build on their success in the first round of open enrollment.

2014 enrollment stats

151,352 Tennessee residents had completed their Obamacare enrollment in private plans through the exchange by April 19 (HHS will release updated enrollment numbers again in November).  Total private plan enrollment in Tennessee’s exchange nearly doubled since the beginning of March, and the final total was 23% more than the original projected target for Tennessee.

Although Tennessee had a strong 2014 open enrollment period, there is still a long way to go.  Prior to the first open enrollment period, the Kaiser Family Foundation estimated that 645,000 Tennessee residents would be eligible to purchase policies in the exchange, and 387,000 of them would qualify for subsidies to do so.

But as in all states, the realities of getting people enrolled – especially people who have never had insurance before and are entirely unfamiliar with the system – have proved challenging in Tennessee.

No Medicaid expansion… yet

Although the state’s Medicaid enrollment system has been plagued with difficulties, an additional 83,591 exchange enrollees were eligible for Medicaid under the state’s existing rules, despite the fact that Tennessee has not expanded Medicaid.   In November 2013, TennCare requested an additional $180 million for its budget as a result of the influx of new applications.

In late March, Tennessee Democrats called on their state and their governor to move forward with Medicaid expansion, or at the very least, Governor Bill Haslam’s “Tennessee Plan,” noting that anything is better than nothing for the 161,000 residents who are currently in the “coverage gap” – not eligible for Medicaid, and not eligible for exchange subsidies.  

Haslam has not ruled out expanding Medicaid, and was still discussing options with the federal government and TennCare as recently as mid-September, but the general consensus is that public opinion would have to shift first and the upcoming midterm election will also play a role.  

US Rep. Steve Cohen has called out Gov. Haslam on his opposition to straight Medicaid expansion (Haslam’s plan involves private insurance for the Medicaid-eligible population), and wants Tennessee to move forward with Medicaid expansion – including accepting $1 billion in federal funds – as outlined under Obamacare.

Tennessee ACA legislation and regulations

Although enrollment surged in the final month of open enrollment and the ACA is obviously popular with the hundreds of thousands of Tennessee residents who have new coverage in place, GOP lawmakers in the state moved forward in mid-January with a bill that would prevent state and local government entities – and state contractors – from participating in the HHS-run exchange.  

By late March, the bill was still in committee in the senate, and no further action was taken during the 2014 legislative session.

The Tennessee Department of Commerce and Insurance drew attention for emergency rules issued shortly before the Oct. 2013 launch of the new marketplace. The emergency rules require individuals who will help others use the new health insurance marketplace be fingerprinted and undergo background checks, and would have forbidden lay people from assisting their friends and neighbors with health insurance applications.

Religious and community groups questioned the motivation behind the rules and sued to block the rules. A judge didn’t block the emergency rules, but did agree they were too broad and could be interpreted to apply to those giving informal advice, and a temporary restraining order against the rules was issued.  Two lawsuits were brought against the emergency rules, and by mid-October the state government had backed off of the rules, making it easier for people to assist others in Tennessee, both formally and informally.

History of the Tennessee exchange

In December 2012, Gov. Haslam announced Tennessee would not develop its own health insurance exchange, citing a lack of information from the federal government.

Prior to his 2012 announcement, Haslam had leaned toward a state-run exchange. He believed local state control was preferable and that the state could run the exchange more cost-effectively that the federal government.

However, Republican legislators opposed the exchange, Tea Party supporters staged repeated protests, and Tennessee eventually ended up with an exchange run by HHS.

Tennessee health insurance exchange links


Tennessee Insurance Exchange Planning Initiative

Health Assist Tennessee
Helps connect Tennesseans with public and private programs to meet health care needs and assists TennCare members with access to medical care.

State Exchange Profile: Tennessee
The Henry J. Kaiser Family Foundation overview of Tennessee’s progress toward creating a state health insurance exchange.