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State Freezes Federal Marketplace Enrollment for Community Health Alliance

Press release from the Tennessee Department of Commerce & Insurance; January 15, 2015:

NASHVILLE – Enrollment has been frozen today on the Federally Facilitated Marketplace (FFM) for Tennessee consumers seeking to purchase insurance plans through Community Health Alliance (CHA).

This suspension of enrollment is a preventative measure to support the long-term viability of CHA and the protection of Tennessee consumers. CHA plans to resume general enrollment later this year when the 2016 open enrollment period begins.

“Freezing enrollment in CHA was a decision we made after lengthy discussions with CHA leadership, the Department of Health and Human Services and an analysis of CHA’s financial conditions and projections,” said Tennessee Department of Commerce and Insurance Commissioner Julie Mix McPeak. “This course of action is the best one for CHA and for Tennessee consumers.”

While the freeze removes CHA from the Marketplace, there are still four insurance carriers offering coverage on the FFM – the same number of carriers on the exchange in 2014 – where Tennessee consumers can choose from a range of insurance plans, depending on their location.

In early January, CHA reported to TDCI that their enrollment had grown exponentially from 2014 to 2015 and had significantly outpaced expectations. At the request of CHA, TDCI sought and received federal approval to suspend CHA’s enrollment. The enrollment freeze is currently set to last for 180 days, pursuant to federal statutes and regulations.

Commissioner McPeak and her staff in the Division of Insurance will continue to closely monitor CHA and will remain in regular communication with CHA leadership.

Frequently Asked Questions

If I bought insurance through CHA, will the freeze change my coverage?

  • No.  The coverage you bought will remain in effect.

Can I continue to buy insurance through CHA?

  • No.  The company will not be enrolling new individual applicants or groups.

Will I be paying more for my premiums after the freeze?

  • No.  Premiums will remain the same for calendar year 2015.

What does this freeze mean to providers?

  • The freeze does not affect providers. The freeze only has an impact on CHA enrollment.

Does the freeze mean CHA is still financially solvent?

  • The company remains licensed to do business in Tennessee and is able to pay claims. The Department has not taken legal action against the company.

What if I have a qualifying event, such as getting married or having a child?

  • Individuals with qualifying events will be able to modify their existing coverage with CHA. For the time being, modifications to coverage must be done by Marketplace officials.

Where else can I enroll for insurance in the Federally Facilitated Marketplace?

  • Visit www.healthcare.gov for access to insurers participating in the FFM or call 1-800-318-2596. There will be up to four carrier options on the FFM, depending on your geographic location.

Who should I contact at TDCI if I have questions?

  • TDCI Director of Consumer Insurance Services Vickie Trice can be reached at (615) 741-2218 or 1-800-342-4029 or by email at cis.complaints@tn.gov. Consumers may also contact Community Health Alliance.

Kelsey Files Bill to Block TN From ‘Operating Any Obamacare Exchanges’

Press release from the Tennessee Senate Republican Caucus; January 15, 2015:

(NASHVILLE), January 15, 2015 – Senator Brian Kelsey (R-Germantown) and Representative Jeremy Durham (R-Franklin) today filed legislation that would prevent individuals and businesses in Tennessee from being assessed fees under Obamacare if the U.S. Supreme Court rules in favor of the plaintiffs in the case of King v. Burwell.  The Supreme Court is expected to hear oral arguments on the case in March which, in effect, challenges the administration’s regulations on citizens in states which did not set up state healthcare exchanges in conjunction with the federal act.

“This bill will stop the IRS from penalizing Tennesseans for not signing up for Obamacare,” said Senator Kelsey.  “It also prevents Tennessee from operating any Obamacare exchanges in the future.”

Plaintiffs in the lawsuit claim that the section of the law authorizing the government to distribute tax credits and assess penalties applies only when states choose to run their healthcare exchanges.  The law does not explicitly state that the tax credits and penalties apply when the federal government runs the exchange.  Tennessee is one of the 25 states that have chosen to force the federal government to run its exchange.  Senate bill 72 would prohibit Tennessee from running the exchange in the future if the plaintiffs receive a favorable ruling the case.  A decision on the case is expected by in June after the Tennessee General Assembly has adjourned.

“The Supreme Court could overturn half of Obamacare, and this bill will prepare our citizens for that,” Durham concluded.

A draft of the bill is available at: http://www.capitol.tn.gov/Bills/109/Bill/SB0072.pdf

Obamacare Adversary Calls for More Patient, Doctor Control

A prominent national free-market critic of the federal Affordable Care Act laid out his vision for “curing” America’s “health care crisis” during a private event in Nashville Wednesday hosted by the Beacon Center of Tennessee.

The event was closed to the media, but Goodman spoke with TNReport for a few minutes before the event.

“The biggest problem with the health care market, unlike other markets, is that we have completely suppressed normal market forces,” said John C. Goodman, who leads the National Center for Policy Analysis, a group that promotes private-sector alternatives to government programs and regulations. “As a consequence no one ever sees a real price for anything … and we have a bureaucratic, dysfunctional system.”

The way out, Goodman says, is to liberate the consumer and give patients more control over their own health care spending.

Goodman says changes to the healthcare landscape are possible and points to a recent innovation at Walmart as an example. Earlier this month Walmart announced a program that offers workers heart, spine, and transplant surgeries with no expenses for the worker — as long as the surgery is performed at one of six hospital systems across the U.S.

“That’s an example of an employer doing something pretty radical to step outside the normal, third-party payer system,” he said.

He also said that government requiring individuals to buy insurance opens the door for special interests to take advantage.

“Once you start specifying what the individual has to buy, then all the special interests come in, as they did in Massachusetts. Then you’ll get the acupuncturists, the in vitro fertilization folks and the naturopaths,” Goodman said. “Every special interest will want to be part of the insurance plan, and then it will be very expensive.”

Trent Seibert can be reached at trent@tnreport.com on Twitter at @trentseibert or at 615-669-9501.

Haslam Among Republican Governors Who Believe Block Grants Would Improve Obamacare

Gov. Bill Haslam was mentioned prominently in a Forbes piece Thursday, after he and four other GOP governors said they would consider an expansion of Medicaid under the federal health care reform law if the money were awarded as a block grant.

“Obviously, as a Republican, I’m with those folks who say, if you can block grant us Medicaid, we’d look at it differently,” Haslam said, according to Politico. The governors were at a weekend meeting of the National Governors Association in Virginia.

The block grant idea is dear to the hearts of conservatives, who say the setup would free states from onerous federal restrictions and give states the power to keep expenses in check. Governing magazine explains the history and criticism that such a plan would reduce the number of people covered, especially in times of economic strain.

The governors have the option of saying no to a Medicaid expansion in their states without losing existing Medicaid funding, based on the U.S. Supreme Court ruling last month that upheld the Affordable Care Act.

This week the state held a meeting at Vanderbilt to seek input on what insurers should be required to cover in plans offered in the state, according to the Tennessean:

These rules will apply to individual policies and small-employer group plans, including those offered through the state insurance exchange after Jan. 1, 2014. The federal law, often referred to as Obamacare, directs that these plans have the same level of coverage as those typically offered by a large employer. But the law leaves it up to the states to set those benchmarks. …

States have 10 basic plans currently offered by large employer groups from which to choose a benchmark, but they can modify whichever reference plan they choose.

The meeting attracted people with health complaints from loss of hearing to infertility, wanting to make sure the state’s standards would require their ailment be covered, WPLN reported.

Another component of the health care law got a boost from a Tennessean Wednesday. Former Sen. Bill Frist urged states to set up their own health insurance exchanges. The exchanges will foster competition and are “the most innovative, market-driven, and ultimately constructive part of the law,” Frist wrote in a column for The Week.

Opponents of the law have urged the opposite. The Cato Institute calls them “the new government bureaucracies” for forcing people “to purchase Obamacare’s overpriced and overregulated health insurance.”

In May, the Kaiser Family Foundation expressed doubt that Tennessee would meet a deadline to submit a plan for its exchange this fall. The state has accepted more than $9 million in federal tax dollars for planning and establishment efforts.

Montgomery Co. Employees’ Health Insurance Fund Floundering

The health insurance fund for schools and county employees in Montgomery County had a more than $1.6 million deficit at the end of fiscal year 2010, state auditors found in an annual check of county finances.

The red ink stemmed from a spike in claims in April, though officials have worked to address the issue, management with the county and the Clarksville-Montgomery County School Department wrote in their response to the audit’s finding.

“Premiums were increase by 11.89 percent for the current fiscal year, and adjustments to the health plan were implemented, which appear to have adequately addressed the problem at this time,” management wrote in its response.