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Tennessee health insurance

Support for ACA mixed in TN, but law improves coverage

  • By
  • contributor
  • August 7, 2014

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 (2013) gave the state a very similar score, placing Tennessee 42nd among the 50 states. Despite the low ranking, Tennessee does have some strengths: high immunization rates and correspondingly low rates of pertussis infection, as well as low rates of binge drinking. But the state has significant challenges to overcome as well, including high rates of smoking, violent crime, infant mortality and low birth weight.

Trust for America’s Health has compiled 2014 Key Health Data about Tennessee, which includes the incidence of specific diseases and a variety of health 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 Obamacare

In 2010, Tennessee’s U.S. Senators, 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 Representative 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, but 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 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 the ACA 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 has only dropped by about 2.4 percentage points in the first half of 2014.

As of the end of June, the uninsured rate in Tennessee stood at 14.4 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.

Tennessee enrollment in QHPs

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 coverage, and that 387,000 of them would qualify for premium subsidies. By mid-April, when the 2014 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.

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 is one of four carriers participating in the Tennessee exchange. The other three are Blue Cross Blue Shield of Tennessee, Humana, and Cigna.

Tennessee Medicaid/CHIP enrollment

Tennessee has come under fire from HHS this summer because the state’s new $35 million computer system for TennCare (Medicaid) application isn’t working correctly, and the state doesn’t have all of its federally mandated Medicaid application process up to par. TennCare chief Darin Gordon has countered the HHS criticisms, stating that many of the issues have already been fixed, and that the state is working as quickly as possible to get the computer problems resolved.

Tennessee is currently one of 22 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 161,650 people – nearly a quarter of the state’s uninsured population – 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.

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, and Tennessee has so far chosen to do so. But 83,591 Tennessee residents were still able to enroll in Medicaid under the existing guidelines by mid-April. Medicaid enrollment runs year round, so that number has continued to increase during the summer.

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. Here’s a summary of recent Tennessee bills related to healthcare reform: