By Louise Norris
January 25, 2014
36,250 people had finalized their private plan selections in the Tennessee exchange by December 28. More than 17,000 applicants were eligible for Medicaid under the state’s existing rules, despite the fact that Tennessee has not expanded Medicaid. Although enrollment surged in December and the ACA is obviously popular with the tens of thousands of Tennessee residents who have already selected their plan, 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.
In December 2012, Gov. Bill 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.
According to HHS, nearly 900,000 people in Tennessee are uninsured and 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. Haslam is trying to negotiate a deal with HHS to allow for a version of Medicaid expansion approved by the GOP lawmakers in Tennessee, but no deal had been reached as of the last week in January – and the results could mean millions of dollars in tax penalties for large employers in Tennessee. Haslam prefers his “Tennessee plan,” in which he has asked the federal government to allow the state to assist people in purchasing private insurance rather than covering them through TennCare, as Medicaid is called in the state. The issue of Medicaid expansion will be taken up again with the legislature in 2014. Regardless of whether Tennessee expands Medicaid, the exchange is expected to direct up to 52,000 people to TennCare who are already eligible for Medicaid but not enrolled. In mid-November, TennCare requested an additional $180 million for its budget as a result.
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.
Let your Tennessee governor and legislators know how you feel about the state’s proposed health insurance exchange.Tennessee Governor Bill Haslam