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Tennessee health insurance

No Medicaid expansion in 2015, but coverage improves

A variety of factors influence the overall health of a state’s population, including socioeconomic indicators, access to primary care, the availability of affordable health insurance, and the prevalence of various illnesses. Here’s a summary of how Tennessee fares in these areas:

Tennessee health ratings

Tennessee ranked 40th out of the 50 states and the District of Columbia on The Commonwealth Fund’s Scorecard on State Health System Performance 2014 – a gain of three spots from 43rd in 2009. Tennessee’s Scorecard includes specific details to show how the rating was calculated.

The most recent edition of America’s Health Rankings (2014) placed Tennessee 45th among the 50 states. Despite the low ranking, Tennessee does have some strengths: ready availability of primary care physicians and low rates of binge drinking and pertussis. But the state has significant challenges to overcome as well, including high rates of obesity, inactivity and violent crime.

Trust for America’s Health has compiled 2015 Key Health Data about Tennessee, which includes the incidence of specific diseases and a variety of health factors and outcomes. You can also use this interactive map created by the Robert Wood Johnson Foundation to see how the individual counties in Tennessee compare with one another.

Tennessee and the Affordable Care Act

In 2010, Tennessee’s U.S. Sens., Lamar Alexander and Bob Corker (both Republicans), voted against the ACA. In the House, four Republican representatives voted no while five Democratic representatives voted yes. Alexander and Corker are both still in the Senate, and the U.S. House now has just two Democratic representatives from Tennessee, and seven Republicans.

The current congressional delegation from Tennessee is largely opposed to the ACA. This includes Rep. Marsha Blackburn, who has been very vocal in her opposition to the law.

Governor Bill Haslam has not been as outspoken against the ACA as many other Republican governors. The state opted to let HHS run the exchange and has not yet expanded Medicaid. Haslam has been working with HHS to try to gain approval for his modified version of Medicaid expansion, and he met with Secretary Burwell in July 2014 to continue the discussions he had been having with Secretary Sebelius.

Haslam has said he would like to expand Medicaid to cover another 161,000 low-income Tennessee residents, but he wants higher co-payments than HHS will allow, and no compromise has been reached yet.

How did Obamacare help Tennessee?

Prior to ACA implementation in January, the uninsured rate in Tennessee was 16.8 percent. In large part because the state has not yet expanded Medicaid, that number had only dropped by about 2.4 percentage points in the first half of 2014.

By the end of June 2015, the uninsured rate in Tennessee stood at 12.9 percent – lower than it was a year ago, but higher than it would be if the state had expanded Medicaid and taken a more hands-on approach to enrolling people in the exchange. In 2015, approximately 118,00 Tennessee residents fall into what is known as the coverage gap, meaning they are ineligible for Medicaid based on the state’s eligibility criteria and also ineligible for Obamacare subsidies because their incomes are below the federal poverty level.

Tennessee enrollment in qualified health plans

At the start of the first open enrollment period, the Kaiser Family Foundation estimated that 645,000 residents in Tennessee could potentially utilize the exchange to purchase qualified health plans, and that 387,000 of them would be eligible for premium subsidies. By mid-April 2014, when the first open enrollment period ended, 151,352 people had finalized their plan selections in the Tennessee exchange, and 78 percent of them received subsidies to lower their premiums.

As of June 2015, Tennessee’s total effectuated enrollment through its exchange was 177,453, with nearly 85 percent of those enrollees receiving tax credits to help lower their health insurance premiums and 63 percent receiving cost-sharing reductions to help reduce out-of-pocket spending on covered healthcare expenses.

The ACA included a provision to fund Consumer Oriented and Operated Plans (CO-OPs), and 22 states participated in the program, receiving a total of more than $2 billion in federal funding. In Tennessee, Community Health Alliance Mutual Insurance Company received $73,306,700. The CO-Op had been one of Tennessee’s five exchange carriers in 2015, but on Oct. 14 the Tennessee Department of Commerce and Insurance announced that Community Health Alliance would discontinue operation at the end of the year.

Assurant, another Tennessee exchange carrier announced its exit from the national individual market in 2015. Then, UnitedHealthcare announced that it would join Tennessee’s exchange for 2016. As such, Tennessee’s Obamacare exchange will include four carriers for 2016 open enrollment:

  • Blue Cross Blue Shield of Tennessee
  • Humana
  • Cigna
  • UnitedHealthcare

Tennessee Medicaid/CHIP enrollment

The ACA called for Medicaid for all Tennessee residents with incomes up to 138 percent of poverty. In 2012 however, the Supreme Court ruled that states could opt out of Medicaid expansion, which Tennessee has done so far.

Tennessee is currently one of 20 states that has not yet expanded Medicaid, although Governor Haslam is trying to reach a compromise with HHS that would allow the state to expand Medicaid the “Tennessee Way.” But for now, the state has 118,00 individuals in the coverage gap, with no realistic access to health insurance.

Exchange subsidies for private plans are not available if they earn less than poverty level, and non-disabled childless adults are not eligible for Medicaid in Tennessee, regardless of income (although parents with dependent children can get Medicaid in Tennessee if their household income is up to 105 percent of poverty – a more generous threshold than many of the other non-expansion states use).

The residents in Tennessee’s coverage gap would be eligible for Medicaid if the state accepted federal funds to expand Medicaid coverage. The federal government would pay the full cost of expansion through 2016, and then the state would gradually take on a small share of the cost, eventually paying 10 percent of the cost of Medicaid expansion by 2020.

The federal government will always cover at least 90 percent of the additional expense. But for now, there is no financial assistance available for people with incomes below the poverty level who do not qualify for Medicaid under the state’s existing guidelines.

During the first open enrollment period, which ran Oct. 2013 through April 2014, 83,591 Tennessee residents were still able to enroll in Medicaid under the existing guidelines, and the state’s Medicaid enrollment grew 8.1 percent from fall 2013 to July 2014. From 2013 to July 2015, Tennessee’s Medicaid enrollment increased 21 percent. Medicaid enrollment runs year round.

State-based health reform legislation

Tennessee’s legislature has been quite active in the arenas of healthcare and healthcare reform, but not all of their legislation has been beneficial to the state’s residents. They passed a law prohibiting the governor from implementing Medicaid expansion, and another that allows a new mother to be charged with criminal assault if she used narcotics while pregnant (critics point out that this can be discriminatory towards low income women in areas where health care and addiction treatment isn’t readily available).

The legislature even tried to pass a law that would have banned schools from notifying parents about TennCare (Medicaid) and CHIP availability.

Several of the state’s lawmakers supported banning subsidies in states with HHS-run exchanges, which include Tennessee. However, as a result of the King v. Burwell ruling on June 25, 2015, subsidies are safe and legal in every state, regardless of how their exchange is run.

Medicare in the state of Tennessee

Historically, Tennessee Medicare enrollment has been around 17.3 percent of its total population – overall Medicare enrollment is 16 percent of the U.S. population. Around 77 percent of Tennessee Medicare recipients are eligible based on age, while the other 23 percent qualify due to disability. The state spends about $10,024 per Medicare recipient and ranks 13th in the nation when it comes to total spending.

Medicare Advantage plans are available in Tennessee for those who want additional benefits beyond what Original Medicare offers. In 2014, 32 percent of Tennessee Medicare recipients selected a Medicare Advantage Plan. About 45 percent of all Tennessee Medicare beneficiaries also enrolled in Medicare Part D, compared with an average of 47 percent enrolled in stand-alone prescription drug plans nationwide.