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VOL. 40 | NO. 17 | Friday, April 22, 2016

Insure Tennessee: In like a lion, out with a committee

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What started with a roar is ending with a whimper. On the first day of the 2016 legislative session, dozens of Insure Tennessee supporters rallied, shouted and sang songs outside the House chamber.

In March, a group of proponents bought billboards statewide calling for House Speaker Beth Harwell to lead the measure to a floor vote.

Her answer in the waning days of the 109th General Assembly was the formation of a health care task force.

Harwell’s 3-Star Healthy Project is bringing a chorus of criticism from Democrats and pro-Insure Tennessee forces, while Republicans say they need to search for another answer with Gov. Bill Haslam’s plan stalling out.

“At some point, I think we have to come to the realization there’s not enough votes to pass Insure Tennessee for a variety of reasons. There’s not enough support,” says Rep. Cameron Sexton, a Crossville Republican who will serve on the panel.

“So we can continue looking at it and having the same discussions, or we can put it behind us and see what the task force can come up with on this approach and let’s see what happens from that point.”

The committee, which has only four Republican House members so far, will add senators and Democrats and hear from stakeholders, Sexton says, to come up with pilot insurance programs to be offered across the state and proposed to the federal Center for Medicaid Services.

Legislators need to get a better understanding of the TennCare population and the “dynamics” of those who fall in an insurance coverage gap between TennCare, the state’s expanded Medicaid program for low-income residents, and the federal marketplace, Sexton says. In addition, the panel could take a look at changes to TennCare.

All this is be completed sometime in June, he adds, a mere two months away.

“I think we want to take a more conservative approach in the aspect of let’s look at things that people have said work in the TennCare population, whether it’s a health savings account, some type of increased premiums and co-payments and such as income levels increase in that population and kind of look at everything that’s potentially being done out there,” notes Sexton, who chairs the House Health Committee.

The genesis for 3-Star began, Harwell says, when she started talking to Vanderbilt University School of Medicine more than a year after Haslam’s Insure Tennessee plan stumbled in the Senate and never started in the House.

“These informal, information-seeking discussions led to an even greater interest on the part of members to engage and determine the feasibility of these ideas,” Harwell says.

To put “structure” to the concepts, she started the task force, which is to use a staggered implementation based on “circuit breakers” once key benchmarks are reached.

In other words, when they see something working, they’ll use it with more people.

Three ideas are:

-- Encourage enrollees to take more responsibility for their health and use health care services.

-- Set up a health savings account funded by enrollees’ premiums to pay copayments for doctor visits and prescriptions.

-- Provide support for enrollees who want to go back to work.

When Harwell and Sexton introduced the plan, Haslam credited them for taking a “political risk” in the health care debate.

“I don’t agree with everything that’s been said here – nobody does,” the governor said. “What you have is some folks who are trying to find a solution, and we should encourage that and applaud that.”

Starting another “political argument” would only prove counterproductive, he contended.

Democrats are glad to oblige, of course, some calling creation of the task force a “joke” or “pathetic.”

Considering hospitals were willing to pay $74 million to cover the costs of Insure Tennessee and net some $2.8 billion from Medicaid in two years alone, many people across the state are wondering why the Legislature won’t give the go-ahead. Two polls show support statewide.

Incidentally, some of the concepts tossed out for 3-Star sound vaguely like Insure Tennessee, which would offer two options:

-- The Volunteer Plan: Members would get a set amount in vouchers to buy employer-sponsored insurance from a private provider and pay for out-of-pocket expenses. (That means they’d be working.)

-- Healthy Incentives Plan: Similar to TennCare, it would enroll adults starting at 21 in Healthy Incentives for Tennesseans where they would be able to earn contributions through healthy choices such as quitting smoking, passing health assessments and using the health-care system appropriately. They would also make small co-payments for health care.

Calling their hand

Democratic state Rep. John Ray Clemmons of Nashville points out any type of health care expansion will come with expenses, whether paid by the state or the taxes collected through the Affordable Care Act.

“I fail to see what good can come of this, other than delay, delay and refusal to implement Insure Tennessee. And what it signals is a complete killing of Insure Tennessee,” Clemmons says.

“This is the final nail in Insure Tennessee’s coffin, unfortunately. The governor stood there and smiled beside them as they bashed his own plan right in front of his face, on the same stage … . And then he has the gall to sit there and say what they’re going is a good idea.”

Clemmons and other Democrats contend legislative Republicans are merely trying to distance themselves further from Obamacare by giving it a new name, pulling a “political stunt” after the filing deadline for this year’s election and in the final two weeks of the General Assembly’s session.

Gov. Haslam’s administration took 18 months to come up with a plan the Center for Medicaid Services would approve, offering it in December 2014. It never received a vote in the House last year, though a proposal by Democratic state Rep. Craig Fitzhugh of Ripley to give voters an opportunity to hold a referendum failed in a House committee this year.

Insure Tennessee failed before a Senate committee in a 2015 special session then saw a glimmer of life during the regular session before falling in yet another committee last year.

“It’s going on 30-plus months of this hanging out there, working on it, that people across the state of Tennessee have been suffering without access to quality, affordable health insurance and coverage and those individuals in the coverage gap,” Clemmons says. “And this task force, I hate to use hyperbole, but it is a complete joke.”

Not only does Clemmons knock the idea of setting up different pilot programs in separate parts of the state, still not knowing whether the feds will approve them, but he also points out the committee is made up of “four white guys, no women, no Democrats, nobody of color,” in addition to being void of health policy experts or physicians, some of whom serve in the Legislature.

Physician-lawmaker view

State Sen. Richard Briggs, R-Knoxville, points toward a report released last year by the University of Tennessee Baker Center showing only seven states have a worse work absentee rate than Tennessee, mainly for health reasons.

“I’m in favor of trying to get health insurance for as many people in Tennessee as we can, not only because they need the health care, that’s the right humanitarian thing to do, I also think it’s part of a good business model we’re trying to promote in this state,” says Briggs, a retired Army colonel and heart surgeon. “We have to have a healthy workforce.”

Briggs supported Insure Tennessee in 2015 and says he still believes it’s the state’s best method for covering people in the gap because it wouldn’t hurt taxpayers, allowing hospitals to pay the bill.

Details were lacking in Harwell’s announcement, and the Center for Medicaid Services can be “hard to deal with,” he says.

But conceding he’s “willing to look at anything,” Briggs is proffering an idea to take Insure Tennessee and, instead of making it “open-ended,” come up with a limited program to see how well it works before possibly expanding it.

Another physician lawmaker, Republican Sen. Mark Green of Clarksville, called immediately after the 3-Star Healthy rollout for passage of a resolution for a TennCare Opt Out pilot program enrolling low-income Medicaid-eligible participants in a health savings account pilot to give them incentives for better health and more patient control.

“Expanding an already-failing system through Obamacare is not an option and only a typical response of government bureaucrats,” Green says.

“Health care innovation must include the approach that places the paying customer, the patient, in control of their personal health care choices and care through incentives.”

The Fiscal Review Committee projects the Senate Joint Resolution 88 could save the state $6.8 million.

Tennessee Justice Center reacts

Michele Johnson, executive director of the Tennessee Justice Center, which advocates for low-income and indigent Tennesseans, is big on Insure Tennessee and helping those 280,000 people caught in the state’s coverage gap, about half of whom are working.

Noting Green’s resolution doesn’t add any people to coverage rolls, she points out two more rural hospitals, those in Scott and McNairy counties, are set to close because of budget constraints linked to uncompensated care, putting even more Tennesseans farther away from health care.

“These bills are not being paid,” Johnson says. “We are excited to work with any state officials who have a sense of urgency.”

People such as uninsured Old Hickory resident Steven Wall, who worked heavy construction for 30 years before he grew ill two and a half years ago, are a prime example of those who need a “safety net,” Johnson explains. I can’t believe they didn’t pass it or vote on the program,” Wall says.

“I wish the Legislature didn’t look at health care as a luxury.”

In fact, nearly every state legislator is covered by Tennessee’s health insurance, including some who could get coverage through an employer.

Sometimes it’s easy to sit back and criticize those who’ve fallen on hard times, people like Wall who worked hard for years but never made enough to buy health insurance or never could get it through an employer.

Maybe the state ought to drop the coverage of our part-time legislators and see how they feel.

Then, maybe we would see more than another study on expanding insurance for Tennessee’s most vulnerable people – more than likely we’d hear a roar rather than a whimper.

Sam Stockard can be reached at sstockard44@gmail.com.

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