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Tennessee health insurance exchange

151,000 in Tennessee enroll in QHPs; state still faces challenges

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The 2014 Obamacare open enrollment period ended in April, but enrollment in the Tennessee exchange has continued to grow as a result of qualifying events that trigger special open enrollment periods.  HHS will release updated enrollment numbers again in November, and general open enrollment for 2015 will begin on November 15.

151,352 Tennessee residents had completed their Obamacare enrollment in private plans through the exchange by April 19.  This includes people who enrolled after the March 31 deadline, either during special open enrollments triggered by qualifying events, or during the special open enrollment that Healthcare.gov extended to people who tried to enroll by March 31 but were unable to complete their application by that date.  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.

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 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, 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.

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 its fate was uncertain.

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.

Four companies are selling individual health insurance through the marketplace: Blue Cross Blue Shield of Tennessee, Cigna, Community Health Alliance, and Humana.  After the first three months of open enrollment, the vast majority – 86% – of 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 is $184 — well below the national average of $249 a month.  Early numbers from Blue Cross Blue Shield of Tennessee, released in late November, indicate that the vast majority of enrollees so far are selecting plans with low (or zero) deductibles.  Only 20% have chosen bronze plans.

The Tennessee Department of Commerce and Insurance drew attention for emergency rules issued shortly before the Oct. 1 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.

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.

According to HHS, nearly 900,000 people in Tennessee were uninsured prior to the 2014 open enrollment and were eligible to use the marketplace to purchase insurance. HHS estimates that more than 834,000 of those people will either qualify for a subsidy to purchase insurance through the exchange or for Medicaid if the state were to expand its Medicaid program as allowed under the Affordable Care Act.  The issue of Medicaid expansion will be taken up again with the legislature in 2014.  Regardless of whether Tennessee expands Medicaid, the exchange was expected to direct up to 52,000 people to TennCare who are already eligible for Medicaid but not enrolled (that number had actually exceeded 83,000 by mid-April, and enrollment in Medicaid is year-round).  In mid-November, TennCare requested an additional $180 million for its budget as a result.

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.