TennCare

Alexander, Corker refrain from embracing Senate plan for Obamacare repeal and replacement

Tennessee U.S. Sens. Lamar Alexander and Bob Corker both stopped well short of embracing the Senate plan for repealing and replacing Obamacare – they label it a “discussion draft” – in official statements.

Alexander, who was involved early in drafting the plan, does list “benefits for Tennesseans” in the proposal, but says he’s going to continue reviewing the matter, see how cost estimates develop and watch for amendments. His statement is HERE.

Corker just says he will be reviewing the proposal, seeking input from a “wide range of stakeholders” and “make a final decision based on whether this legislation, on the whole, is better than what is in place today.” His statement is HERE.

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All TN counties will be covered by Obamacare next year, but only one provider in many areas

Filings with the state Department of Commerce and Insurance released Wednesday show Chattanooga, Knoxville and two-thirds of Tennessee’s 95 counties will have only one insurance provider offering individual health insurance plans under the health exchange markets next year, reports the Times Free Press.

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With Trump ‘shouting death spiral’ for Obamacare, TN insurance commissioner wonders who’s in charge

Tennessee’s commissioner of commerce and insurance and Sen. Lamar Alexander are both quoted in a New York Times article bearing the headline, “Trump, Shouting ‘Death Spiral,’ Has Nudged Affordable Care Act Downward.” An excerpt:

Frustrated state officials have ideas for stabilizing the individual insurance market, but they say they cannot figure out where to make their case because they have been bounced from one agency to another in the Trump administration.

“We have trouble discerning who has decision-making authority,” said Julie Mix McPeak, the Tennessee insurance commissioner and president-elect of the National Association of Insurance Commissioners, which represents state officials. “We reached out to the Department of Health and Human Services. They referred us to the Office of Management and Budget, which referred us to the Department of Justice. We reached out to the White House Office of Intergovernmental Affairs.”

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AG sues operator of 18 TN ‘pain management clinics,’ alleging TennCare fraud

News release from Office of the Attorney General

Attorney General Herbert H. Slatery III today announced the filing of a lawsuit against an organization of pain management clinics owned and operated by Michael Kestner and his business partner, Dr. Lisabeth Williams. Kestner is the primary owner of MMi, which operated at least 18 pain management clinics throughout Tennessee.

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Democrats urge Insure TN be reconsidered; Haslam says not now

With the Republican plan for repealing and replacing Obamacare dead in Washington for now, at least four states that previously rejected Medicaid expansion – Kansas, Maine, North Carolina and Virginia – have moves afoot to reconsider the idea.

Tennessee Democrats would like to see the Volunteer State become the fifth, reports WPLN, but Gov. Bill Haslam says it’s too early. In 2015, Haslam proposed a Medicaid expansion plan, dubbed Insure Tennessee, that was killed by the Legislature.

Gov. Bill Haslam said Tuesday he is not currently considering another legislative special session to expand the state’s Medicaid program under the federal Affordable Care Act, also called Obamacare.

“The sooner the better, so we can begin collecting and allowing up to 300- or 400-hundred thousand people to be covered under Medicaid,” says House Minority Leader Craig Fitzhugh, D-Ripley.

Fitzhugh proposes repealing a state law that requires the legislature to sign off on Medicaid expansion. That would free up Governor Bill Haslam to negotiate a plan with the Trump administration. (Note: It’s HB846, on notice for the House Insurance and Banking Subcommittee next week.)

Haslam says he’s instructed TennCare officials to review their options. But it’s too soon to come up with a plan.

“I think it’s early. I mean, we literally just had, Friday, the country took a change of direction no one was expecting,” he says.

Haslam adds it’s probably too late in the legislative session to propose an expansion plan this year. Lawmakers are likely to adjourn around the end of April, and the administration has focused on passing the state budget and a road-funding plan.

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Haslam, other GOP govs, fret over lack of flexibility in health care bill

“Flexibility” has become a buzzword among 15 Republican governors raising concerns about U.S. House GOP’s health care bill, reports Politico, including Tennessee’s Bill Haslam on it list. No governors have publicly expressed strong support for the American Health Care Act.

Further from an AP report: The nonpartisan Congressional Budget Office estimates that GOP legislation would increase the ranks of the uninsured by 14 million people next year alone, and 24 million over a decade. Haslam says it’s not clear how many people would be affected in Tennessee, and that the legislation could still change in Congress.

The Republican governor said Tuesday that the main thing the state is looking for in the overhaul is more flexibility to deal with areas like increased enrollment during an economic downturn or escalating costs for medications. He says that flexibility was not included in the in the original version of the proposed overhaul.

Similar language was used by the director of TennCare in an appearance before the House Finance Committee on Tuesday, reports the Tennessean. She said the proposal is structured to reduce Medicaid funding without loosening up regulations for states to further tailor programs.

“We definitely have concerns at this point in time,” said Long, adding the agency would continue to be in touch with the state’s federal congressional delegation to monitor amendments.

Politico: TN is ‘Exhibit A’ for Republicans pushing Obamacare repeal

Under the headline ‘Tennessee becomes Exhibit A in GOP’s Obamacare repeal push,’ Politico reviews the state’s health care system troubles, most recently highlighted by Humana’s move to cease operations in 16 counties where it is now the only provider and Blue Cross Blue Shield closing in much of the state while announcing “some of the sharpest premium spikes in the nation.”

Republicans warn that other states could look just as dire unless they get rid of Obamacare and replace it with a market-driven system.

“The Affordable Care Act is too expensive to afford,” Rep. Marsha Blackburn (R-Tenn.) said during a town hall meeting over the Presidents Day break in Fairview, about 30 miles southwest of Nashville. “Our goal is that health care is going to be more flexible, more usable and more affordable to everyone.”

But even here, despite all the turbulence, resistance is mounting to Congress scrapping the law without a credible replacement plan, because it could unleash even more chaos. Obamacare defenders believe their message is starting to resonate, especially with the state’s Republican senators, Lamar Alexander and Bob Corker.

…The challenge, then as now, is insurers have struggled to get enough healthy people into the coverage pool to offset the cost of caring for older, sicker individuals. Some in the desirable cohort have flouted the health law’s mandate that most people be covered and instead paid penalties, happy not to deal with rising premiums.

“What happened is the people who are healthy paid the penalty and moved on,” said state Rep. Cameron Sexton, a Republican who chairs the House Health Committee. “And then, the people who were really sick picked up the insurance because they needed it, and the risk to the insurance companies was far greater than they ever expected.”

…Michele Johnson, executive director of the Tennessee Justice Center, said the problems have been exacerbated by the state’s failure to expand Medicaid eligibility under the health law. Johnson pointed to neighboring Kentucky, which opted in and dramatically lowered its uninsured rate, as evidence that such a move would have helped stabilize the individual market and reduce premiums.

“We chose not to do it and then they’re like ‘This thing is dying.’” Johnson said. “That’s because you have your hand around its neck killing it.”

Note: Alexander has an op-ed piece declaring there’s an ‘Obamacare emergency’ in Tennessee. His bottom line (as it appears in Jackson Sun version):  It’s time to stop fighting like the Hatfields and the McCoys over Obamacare. Tennesseans expect the new Congress and administration to work together to quickly fix the Obamacare emergency in our state.

House votes to expand checks of income for those on TennCare, welfare

Hundreds of thousands of Tennessee adults who are receive TennCare coverage, food stamps and/or welfare will face enhanced income-verification process that regularly checks their incomes against other state and federal databases under a bill that cleared the state House Monday night, reports the Times-Free Press.

The GOP-majority House approved the measure (HB227), sponsored by Rep. Dan Howell, R-Georgetown, on a largely partisan 73-21 vote.

Howell said the bill is intended to detect fraud and ensure benefits are going to those who truly need it while saving taxpayers money.

One feature of the legislation would require the Tennessee Education Lottery to send monthly data on all lottery players who win $5,000 or more jackpots to the state Human Services Department.

The department determines eligibility for TennCare (Medicaid), the Supplemental Nutrition Assistance Program (food stamps) and the Temporary Assistance to Needy Families (welfare) programs.

Democrats spent their time largely questioning the lottery-related impacts on families in which a parent or caretaker plays and wins larger lottery awards that could cost them their benefits.

Howell argued that lottery winners on state and federally-subsidized social programs are already supposed to self report and his bill simply ensures it’s properly done.

Speaking later with a reporter, Howell appeared a little surprised that no one got into the overall aspects of his bill, called the “Program Integrity Act of 2017.”

“That [cross checking lottery winner database] is just a small part of it,” Howell said. “What we’ve done is create enhanced verification.”

Haslam helping congressmen seek GOP Obamacare repeal deal

Republican congressmen are hoping four Republican governors – including Tennessee’s Bill Haslam – will help them draft a deal for replacing Obamacare, according to CNN.

The governors are Haslam and Scott Walker of Wisconsin, who serve in states where Medicaid was not expanded under the Affordable Care Act, along with the chief executives of two states that did expand Medicaid, John Kasich of Ohio and Brian Sandova of Nevada.

The discussions are likely to continue at the National Governors Association meeting in Washington this week, and as Kasich privately meets later this week with Trump at the White House.

The thinking is that if these four can cut a deal, it will help resolve an issue that GOP leaders say is currently the biggest hurdle in putting together a plan to repeal President Barack Obama’s Affordable Care Act. But they have a monumental task: resolving concerns from conservatives who want to turn Medicaid into a block grant program and alleviate fears from politicians who hail from states that accepted federal dollars to expand coverage for low-income adults under Obamacare.

“We’re going to have to find a solution that accommodates those concerns,” House Speaker Paul Ryan said last week.

Republicans are hoping to unveil a plan in March that could be voted on within the next several weeks. They are under a time constraint because they are using fast-track budget rules that will allow them to avoid a filibuster in the Senate and pass a repeal bill on a party-line vote.

The party is still divided over key issues — including how far to take the repeal bill. Conservatives in the House Freedom Caucus want to pass a full-blown repeal bill that mirrors a plan that Congress approved in 2015 — and Obama vetoed — which would also repeal the Medicaid expansion.

Yet top Senate Republicans privately say that such an approach would not pass their chamber.

New TennCare waiver could mean ‘whole new ballgame’ in fed funding

After six months of operating under temporary extensions, state and federal health care officials have reached a new long-term agreement on continuing federal funding of TennCare that will change the way money is distributed to hospitals in two years.

From a Modern Health Care article:

 Under the new agreement, the CMS will continue the uncompensated-care payments through June 30, 2017, at current levels, which have averaged around $500 million a year.

During a one-year transition period, the total possible payments will ramp up to $708 million.

After that, Tennessee must submit a revised methodology for distributing the money that limits the subsidies to care provided to people who wouldn’t be eligible for Medicaid if the state agreed to expand the program under the Affordable Care Act.

“Coverage is the best way to assure beneficiary access to healthcare for low income individuals, and uncompensated care pool funding should not pay for costs that would otherwise be covered in a Medicaid expansion,” Eliot Fishman, director of the CMS’ State Demonstrations Group wrote in a letter to the state in November 2015.

Tennessee hospitals are nervous about how the allocations will change. It’s “a whole new ballgame with a new distribution system of funding for hospitals,” said Craig Becker, CEO of the Tennessee Hospital Association. “We have some concerns about precisely how this will work, but we have a couple of years to work with state and federal officials to nail down details and secure needed funding for hospitals in the state.”

The CMS has increasingly resisted paying for healthcare for the uninsured now that most of them have access to coverage under the Affordable Care Act. That issue has been an obstacle to renewing waivers in other states, including California, Florida and Texas.

See also The Tennessean, HERE