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State Seeking Input on Affordable Care Act Health Coverage Mandates

Press release from the Department of Commerce & Insurance; July 26, 2012:

NASHVILLE, TN – This is a reminder that Commerce and Insurance Commissioner Julie Mix McPeak will be conducting outreach meetings across the state to gather input about the health conditions that should be covered under essential health benefit categories.

These public meetings are geared toward gathering public opinion on the determination of an essential health benefits package for health insurance coverage under the federal Patient Protection and Affordable Care Act or PPACA. For more information, visit http://tn.gov/commerce/insurance/ehb/health_essentials.shtml.

The July 17 Nashville meeting yielded informative questions and comments from residents and advocates alike. Infertility, hearing aids, HIV/AIDS testing and counseling – these were but a few of the topics raised. A list to sign up as a speaker at the meetings is at http://tn.gov/commerce/insurance/ehb/ehb-hearings-signup.shtml. The remaining dates are:

  • July 31, 2012, 9 a.m. to 11 a.m. – Kingsport Renaissance Center, 1200 E. Center Street, Kingsport, TN 37660
  • July 31, 2012, 4 p.m. to 6 p.m. – UT-Knoxville Conference Center Building, 600 Henley Street, Knoxville, TN 37902
  • August 1, 2012, 10 a.m. to noon – Lee University Dixon Center, 1053 Church Street NE, Cleveland, TN 37311
  • August 3, 2012, 10 a.m. to noon – Hamilton Eye Institute, Freeman Auditorium, 930 Madison, 3rd Floor, Memphis, TN 38103
  • August 3, 2012, 2 p.m. to 4 p.m. – Jackson State Community College’s McWherter Center: Ayers Auditorium, 2046 North Parkway, Jackson, TN 38301

All interested parties are invited to indicate which of 10 potential benchmark plans designated by the U.S. Department of Health and Human Services should be selected by the state as a benchmark or reference plan. Interested parties may also indicate how any of the plans might be modified, either to ensure the benchmark covers each of the 10 PPACA-required benefit categories, or for other reasons.

After she considers the public input provided at the meetings and through written comments,

Commissioner McPeak will recommend an essential health benefits benchmark to Tennessee Governor Bill Haslam. Within 30 days of an approval by the Governor, the Insurance Commissioner will enact an administrative rule, based on his recommendation, that will designate the benchmark plan and the essential health benefit package to be included in individual and small-employer group health insurance plans offered on or after January 1, 2014.

At the meetings, following brief introductory comments reviewing the purpose of the hearing, interested parties will be invited to take up to five minutes to offer comments. Written comments and related materials may also be submitted by email both during the meeting and through August 10, 2012, at PubComm.HRF@tn.gov, or by mailing them to:

Chlora A. Lindley-Myers
Tenn. Dept. of Commerce and Insurance
500 James Robertson Parkway, 12th Floor
Nashville, TN 37243.

Public comments on Essential Health Benefits that are recorded at the meetings or are sent in to Commerce and Insurance may be viewed and/or left at http://tn.gov/commerce/insurance/ehb/ehb-public-comments-form.shtml. Posted on the Commerce and Insurance Essential Health Benefits page are documents related to the discussion of an essential health benefits package:

  1. Slides summarizing the determination of an essential health benefits package, including:
    • required coverage categories and allowed variations;
    • what the U.S. Secretary of Health and Human Services intends to propose as federal rules; and
    • related matters.
  2. Slides outlining the benefits covered by the nine Tennessee essential health benefit benchmark options.
  3. A bulletin by a U.S. Department of Health and Human Services agency on how it proposes to define essential health benefits.
  4. Frequently Asked Questions related to the bulletin.
  5. A related list produced by HHS identifying the three federal employee plans that may qualify as benchmark options and the three largest, small-employer group products from which a benchmark may be selected. The Tennessee Department of Commerce & Insurance is in the process of confirming the accuracy of the small employer product designations.

TCA Opposes Bill Establishing Automatic Agreement to Insurance Policy Changes

Press Release from Tennessee Citizen Action, April 20, 2012:

Tennessee Citizen Action Asks the Haslam Administration and Their Department of Commerce and Insurance Why They Support a Bill That Will Erode Consumer Protections

Nashville, Tenn. (April 20, 2012) — Yesterday, the sponsor of a bill that would further erode consumer protection in Tennessee stated that the Department of Commerce and Insurance was aware of, and supported, the bill. The bill, SB2271 (HB2454) by Rep. Charles Sargent and Sen. Jim Tracy, states that a consumer or small business is bound to a change in their insurance policy by the simple act of paying their premium – either by check or by automatic bill payment. In other words, a consumer’s cashed check or automatic bill payment is enough to allow an insurance company to completely change their policy.

“The sponsor of HB2454/SB2271 said that the Department of Commerce and Insurance reviewed his bill ‘and they are very fine with this legislation…’” said Mary Mancini, Executive Director of Tennessee Citizen Action, “Since the mission of the Department is to protect “the interests of consumers while providing fair, efficient oversight” and this bill would create an unfair financial advantage for insurance companies over consumers and small businesses, we would like to know why they are “very fine” with it.”

A vote on SB2271/HB2454 was rolled in the House until Monday, 4/23.

Amendment Summary: (b) The payment of premium for an insurance contract, or amendment thereto, by an insured shall create a rebuttable presumption that the coverage provided has been accepted by all insureds under the contract.

Tennessee Citizen Action works in the public interest as Tennessee’s premier consumer rights organization. Our mission is to work to improve the overall health, well-being, and quality of life for all people who live and work in Tennessee

Lawmakers Consider Stronger Monitoring of Unemployment Recipients

After lots of talk last year about problems within the state unemployment system, Republicans in the Tennessee General Assembly are ready to push legislation requiring that people collecting benefits be more accountable for their work searches.

“When you’re on employment, you’re supposed to be looking for a job, and right now it’s more or less the honor system,” said Sen. Jack Johnson, R-Franklin. He is sponsoring a bill to make unemployment-benefits recipients keep track of where they submit applications each week and provide that information to the state online.

The proposal is meant to ensure people don’t draw unemployment any longer than necessary, he said.

“The burden should be on the applicant because that’s the condition upon receiving your benefits, is that you be looking for a job,” said Lt, Gov. Ron Ramsey. “Anecdotally, we’re pretty confident there’s a lot of folks who aren’t doing that. They’re just sitting at home collecting their benefits.”

Republicans met with Tennessee employers during a series of legislative jobs task force meetings in 2011, as well as part of Ramsey’s Red Tape Road Tour in 2011.

There are three overlapping proposals in the works, including the “Unemployment Insurance Accountability Act of 2012,” which would require people collecting benefits to submit on a weekly basis the names of three employers where he or she sought work.

Gov. Bill Haslam told reporters he’s a fan of the unemployment insurance reforms, although admitted his staff still needs to research the price tax first.

“I think the direction that Lt. Gov. Ramsey is going is 100 percent right,“ Haslam said after commemorating Andrew Jackson’s 245th birthday at the Hermitage Thursday. “I told him I would do our homework with our departments to try to understand cost to state government, impact and we’d be back to weigh in on that probably next week.”

The central piece of legislation, HB3431, would also charge the Department of Labor and Workforce Development with auditing 1,000 submissions a week and kick anyone submitting fraudulent job search reports off the rolls for at least eight weeks, redefine “misconduct” that disqualifies workers from benefits and ban people who are incarcerated from collecting unemployment while behind bars.

A yet-to-be-added amendment would further change the unemployment law to set wage standards for jobs that are deemed “suitable” for unemployed workers to accept.

The measure passed a House subcommittee Wednesday, and heads to the Consumer Affairs committee Tuesday, March 20. The bill stands now with a $122,000 price tag, but would save an extra $100,000 annually for the Unemployment Trust Fund, according to state officials.

Unemployment changes didn’t make the cut in a House Republican jobs task force that met last fall, but task force chair and bill sponsor Rep. Jimmy Matlock, R-Lenoir, said those meetings contributed to his desire to edit the system.

“We understand there are people who do need this. We’re not taking this away,” Matlock said about unemployment benefits. “We’re looking for legitimate folks who need it.”

Another bill he and Johnson are sponsoring, SB3657, would allow employers to ask the department to classify them as seasonal employers. The measure would limit how much seasonal employees can collect in unemployment benefits, saving the state an estimated $2.2 million annually — although it would cost over $1 million in one-time startup costs. The measure has collected dust in House and Senate committees for weeks but is expected to move later this month.

SB3659 would require the state to build a portal for employers to send and receive information about employees who have quit, were laid off or fired. It would also allow employers to contest former workers’ benefits online.

However, the governor flagged that bill last month based on concerns about its price tag, $115,000. House lawmakers are sending this bill to the Finance Committee, although it awaits a vote in the Senate Commerce Committee.

Signing On to Obamacare Challenge Pointless for TN: AG Cooper

Joining with the 26 other states disputing the 2010 federal health care reform law simply isn’t a productive application of his office’s time or energies, Tennessee’s top government lawyer told a state legislative panel this week.

“It did not seem to be a wise use of scarce state resources when we have all these other cases that we’re working on to invest money in,” Attorney General Robert Cooper said before the Senate Judiciary Committee on Feb. 28. “Whatever happens, we will be equally bound by that whichever way the Supreme Court goes.”

Because some 140 briefs opposing provisions of Obamacare have already been filed with the Supreme Court, Cooper said there’s little reason for him or his attorneys to volunteer a legal opinion at this point. The high court is expected to hear arguments later this month about the constitutionality of the controversial “individual mandate” portion of the law.

Republicans in the Legislature tried unsuccessfully to convince Cooper to join other states in challenging the Patient Protection and Affordable Care Act after President Obama signed it into law March 23, 2010.

Cooper’s unwillingness to take on the Obama administration subsequently prompted on-again-off-again discussions amongst GOP lawmakers and conservative activists about making the state attorney general an elected official so as to ensure the office is more accountable to public opinion, which Republicans are confident in Tennessee runs decidedly in opposition to Obamacare.

Cooper shrugged off a suggestion by Judiciary Chairwoman Mae Beavers, R-Mt. Juliet, that “there is strength in numbers” when fighting the feds. “I really don’t think another brief would make a difference to the Supreme Court,” said Cooper, who worked as legal counsel to former Gov. Phil Bredesen prior to being appointed attorney general in 2006.

None on the Senate Judiciary Committee quizzed Cooper as to whether he believes the federal health care law is or is not constitutional. However, when asked by Sen. Mike Bell, R-Riceville, if his decision to sit out the heavyweight legal bout on the individual mandate was rooted in “monetary” concerns, Cooper said “yes.”

“It just did not seem to be a good use of our limited state resources,” said the attorney general.

Bell said  he believes there are few issues of more significant long-term financial concern to Tennessee than the Patient Protection and Affordable Care Act.

“If there is one piece of federal legislation or issue being discussed at the federal level that’s going to cost Tennessee more than anything, it is this Act,” said Bell, who serves also as the Senate Government Operations Committee chairman. “Hundreds of millions of dollars it is going to cost the taxpayers of this state.”

House Speaker Beth Harwell has appointed a legislative committee to focus on how the state will deal with the portion of the health care law dealing with  health insurance exchanges, which supporters say will act like “virtual marketplaces” to help consumers compare health-plan pricing. The federally imposed deadline for states to set up their exchanges is the end of the year.

Lt. Gov. Ron Ramsey has said he’s willing to call the Senate into a special session in December if the Supreme Court upholds the individual mandate portion of the health care law, or if President Obama wins re-election in November.

Gov. Bill Haslam avoided taking a formal legal stance on the issue his first year in office. However, last month his administration joined the Republican Public Policy Committee in filing a brief challenging the Act.

“The Obama administration’s approach is an unaffordable health care mandate that is a significant overstep of the federal government’s authority,” said Haslam. “I’m committed to controlling health care costs and finding meaningful ways to improve the health of Tennesseans by encouraging healthy choices, personal responsibility and accountability. Forcing mandates on states and individuals is the wrong approach, and if Obamacare is implemented, healthcare costs will rise significantly, putting a serious strain on state budgets across this country.”

Stable for Now, TennCare Demands Future Attention

Gov. Phil Bredesen has no illusions about the longterm manageability of TennCare, saying this week, “I think the stuff we did with TennCare bought the state a decade but not more than that.”

The governor’s take on the state’s version of the Medicaid program may come as a surprise to those who assumed TennCare’s major problems were over as a result of major reductions Bredesen made in the program that slowed what had become a runaway train.

But Bredesen, now nearing the end of his term, said the fundamental issues involving health coverage remain.

Apart from the cost pressures already involved in health care, another enormous storm is headed the state’s way with the expansion of Medicaid in the new federal Patient Protection and Affordable Care Act, the law that has become known, for better or worse, as ObamaCare.

Bredesen famously referred to the expansion of Medicaid as “the mother of all unfunded mandates” on states when the bill was being debated in Congress. Now that the bill has become law, Bredesen has taken a different tack, basically saying it’s the law and must be followed, somehow.

Yet through all the concern about what the future holds on the state health care program, for the moment a consensus appears to have formed that the current leadership at TennCare has adroitly managed the operation. Bredesen says so, and so do some people currently running for Bredesen’s job.

“I think one of the issues the new governor is going to have to deal with is basically how do you deal with Medicaid,” Bredesen said. “You know my feelings about using Medicaid as part of President Obama’s expansion. I don’t think it’s the right thing to do. I think it will put a huge amount of pressure on states in the future.

“But that’s something the governor’s got to do. It’s done. It’s the law. It’s over. It’s something the future governor is going to have to deal with.”

The new law calls for establishing health insurance “exchanges,” which will serve as a government-regulated marketplace for buying health insurance. While some aspects of the law have a more immediate impact — such as helping fill the “doughnut hole” in coverage of the Medicare prescription drug plan or extending coverage of children under their parents’ plans until age 26 (due to go into effect in September) — the bulk of the law is scheduled to kick in in 2014.

The time delay has given some who dislike the law an expectation that the law can be changed, so its full impact won’t be known for awhile. But as it stands, the burden will be falling on states to figure out how to follow through on the new law.

“This is not something the federal government can execute. They’re going to need the states to set up the exchanges,” Bredesen said. “Obviously a lot of new people will be coming into Medicaid, and that produces a whole bunch of issues, from rates we’re paying to physicians to other things. So I think there is a whole set of things to be dealt with in terms of implementing the act.”

Bredesen feels good about TennCare’s current leadership, which includes director Darin Gordon.

“We have some good expertise in the state right now, particularly in the form of Darin and his staff over there,” Bredesen said. “I think we’ll get through it but that’s going to take a lot of work.”

One of the candidates for governor, U.S. Rep. Zach Wamp, a Republican from Chattanooga, said this week he, too, is impressed with TennCare’s current leadership, and Wamp gives Bredesen credit for managing the state budget in broad terms, as well as specifically on TennCare.

“Darin Gordon has done an excellent job,” Wamp said. “In fact, the last 24 months at TennCare the program is trending better than it has at any time in its existence. When I had my full briefing with him and asked a slew of questions, I was highly impressed. I think they’re focusing now on more preventive care and wellness, which is something I’m really strong on.

“Frankly, short of the Obama mandate kicking in, I believe TennCare is going in a good direction, but if the Obama mandate kicks in without some relief, if we can’t change that, TennCare is going to get buried with federal mandates. We don’t have the money to pay for those mandates.”

The days of total upheaval at TennCare seem to have subsided, for now.

“We’ve got a good team at TennCare now. It’s been stable,” Bredesen said. “They know what they’re doing. They’re doing a good job. They’re making their budgets. In fact they’re helping us solve some of our other budgets. But that’s going to be a real issue.”

Bredesen was elected in 2002 in great part on his perceived management skills, just as TennCare was spiraling out of control. A key report by consultant McKinsey & Company showed TennCare putting the state on a path to financial ruin. Bredesen responded by cutting more than 170,000 people from the TennCare rolls in 2005. He also put limits on the amount of prescription medications that would be covered, a politically controversial move.

Now, the concern has become that with strides made over a number of years, Medicaid expansion in the new federal law threatens to wipe out previous gains.

Bredesen’s point, as he moves through his final year in office, is that while the state bought time with its changes, the problem of health care costs has not been solved. The new governor will find that waiting for him.

GOP Fears Bills ‘Behind Budget’ Will Die This Session

A key House subcommittee moved two high-profile bills to the back burner this week, a maneuver Lt. Gov. Ron Ramsey believes is an attempt to kill Senate Republicans’ high-priority legislation.

One of the signature bills, the Health Freedom Act, is a challenge to federal health care reforms. It contains provisions that direct the attorney general to defend Tennesseans who refuse to obtain insurance coverage as mandated by the federal government.

“I think it is a ploy to try to kill that bill before it goes to the full House,” said Ramsey, a Republican who serves as Senate speaker. “I’m concerned it might not pass the House.”

The other bill would clear up any vagueness in the Tennessee Constitution regarding the permissibility of an income tax in the state — by explicitly banning “any tax upon personal income or any tax measured by personal income, except…incomes derived from stocks and bonds that are not taxed ad valorem.” It would also prohibits payroll taxes.

Both pieces of legislation are now “behind the budget,” a term that means the bills will be taken up after the subcommittee has tackled the new fiscal year’s government spending plan. Bills typically held back have some sort of price tag or fiscal note.

Hammering out a budget can be a lengthy process, and Riceville Republican Rep. Mike Bell said bills put on hold until after that’s over often never see the light of day again.

Bell is carrying the Health Freedom Act, which was on its way to a full floor vote earlier this month but was then kicked back to the Budget Subcommittee by the House Calendar Committee.

“I wasn’t promised that (the Health Freedom Act)  would be pulled out and voted on, but I was given what I think was some pretty strong assurances that it would come out from behind the budget and be voted on,” said Bell.

“Not necessarily that it would pass out of committee,” he continued, “but I want to have my day to have it heard.”

Anti-federal health care legislation has dominated the spring legislative session, sparking rallies from Tea Party protesters who insisted the federal government not meddle with state business.

The Senate approved the Health Freedom Act in February, with one member — Chattanooga Democrat Andy Berke — voting against it.

But the act could have a price tag of $50,000 to cover costs if the attorney general actually ends up defending residents who choose not to obtain health insurance.

The budgetary impact on the income-tax constitutional amendment includes posting public notices about the amendment on the General Assembly and Secretary of State websites, and is “not a significant amount,” according to legislative fiscal analysts. However, there’s some debate whether that notice should be printed in newspapers across the state, which could cost $20,000.

“I think we all know that Budget-Sub has always been a committee over there formerly known as ‘the Black Hole’ — that you stick things in you don’t want to go to the House,” Ramsey said.

But Finance, Ways and Means Committee Chairman and Budget Subcommittee member Craig Fitzhugh, D-Ripley, said that’s not the whole story. “They just don’t get out of there because we can’t fund them. I guess in that sense, a bill will go in there and never come out,” she said.

He called the committee more of a “clearinghouse” that ensures the state has the money to support bills with a price tag.

But he said he expects that one or both those bills could ultimately emerge.

“Just because they’ve been sent behind the budget, doesn’t mean they’re dead,” he said.

Enrollment of Children in State Government Health Insurance Program to Resume

State of Tennessee Press Release, Feb. 11, 2010:

NASHVILLE – Governor Phil Bredesen today announced that CoverKids, Tennessee’s program for uninsured children, will reopen enrollment to new members on March 1, 2010. Enrollment in CoverKids was suspended late last year when membership reached the maximum that could be supported by the current budget.

Bredesen’s proposed budget for FY 2010-2011 includes an additional $13.1 million in recurring state dollars to continue the CoverKids program next fiscal year, which would support increased program enrollment. Reopening enrollment on March 1, however, means children will have access to this coverage four months earlier.

“For three years, children across Tennessee have benefited from the quality coverage provided through CoverKids,” Bredesen said in a speech to members of the Tennessee Press Association. “In light of the state’s budget situation, we had to make a tough decision to suspend enrollment last year. Fortunately, we’ve been able to dig deep and find additional funding to keep this option available to families in need.”

In addition to the new state appropriation, $41.5 million in federal funds will come to Tennessee as a result of the state’s increased contribution. Combined, this budget increase will allow for continued growth in CoverKids’ membership.

When CoverKids originally opened, officials estimated somewhere between 40,000 and 45,000 children in the state would qualify for the program. The program’s capped enrollment of 45,000 indicates the number of CoverKids-eligible children has increased, which is likely a result of the national economic downturn.

“CoverKids plays an important role in serving the needs of Tennessee’s uninsured children,” Bredesen said. “While the number of eligible children who have yet to enroll is relatively low, we hope to serve as many of them as possible through this increased funding.”

Looking forward, program administrators believe as many as 5,000 more children in Tennessee qualify for coverage through CoverKids.

In Tennessee, TennCare remains the primary provider of insurance for low-income uninsured children. TennCare currently has more than 750,000 children on its rolls.

As part of the State Children’s Health Insurance Program, CoverKids picks up where TennCare eligibility ends and provides comprehensive health and dental coverage to children in families who cannot otherwise afford or access private health insurance.

Tennessee families earning less than 250 percent of the federal poverty level, which is $55,125 per year for a family of four, qualify for CoverKids and pay no monthly premium for the plan. Income-based co-pays are required for most services, though preventive care, including well-child visits, teeth cleanings and vision screenings are fully covered.

CoverKids is a program of Cover Tennessee, Bredesen’s initiative to address the health care needs of Tennessee’s uninsured. Cover Tennessee offers three other programs including CoverTN, a limited benefit health plan for the working uninsured; AccessTN, which offers comprehensive health insurance for those who are uninsurable due to pre-existing medical conditions; and CoverRx, which provides access to affordable prescriptions for Tennesseans who lack pharmacy benefits.

For more information about any of the Cover Tennessee programs, visit www.CoverTN.gov or call 1-866-COVERTN.

AccessTN Expands Eligibility to Include Children

State of Tennessee Press Release: Dec 03, 2009

NASHVILLE – The AccessTN board of directors today approved a new policy to allow uninsurable children with chronic and acute medical conditions to enroll in the state-administered health insurance plan. The change will take effect immediately.

As Tennessee’s high risk health insurance plan, AccessTN has provided comprehensive coverage since 2007 for adults who have been denied insurance coverage due to pre-existing health conditions. Until recently, CoverKids had provided coverage to children in similar situations, but suspended new enrollment in November 2009 due to budget limitations.

“With enrollment for new members in CoverKids closed, uninsured children with chronic conditions have fewer options for coverage,” said David Hilley, director of AccessTN. “The AccessTN board voted to expand the program to include children to ensure viable options remain for families with sick children.”

With a current enrollment of more than 3,800 members, each of whom pays a monthly premium for coverage, AccessTN provides comprehensive health insurance to individuals younger than 19, while still managing within its set budget.

Premiums for children will be based on the lowest premium level charged to AccessTN enrollees and will range from $284 to $410 per month. Premium assistance is an option for some families earning less than $75,000. This aid can cover up to 60 percent of the monthly premium, depending on family income, and is subject to available funding.

“Prior to the CoverKids enrollment suspension, families with uninsurable children could buy into that program by paying monthly premiums because they exceeded the income limits to qualify for free coverage,” Hilley added. “Now that enrollment for CoverKids has closed, this keeps a buy-in option open for those families who still need coverage for their children.”

To qualify for AccessTN, an individual must be a Tennessee resident, U.S. citizen or qualified legal alien and be considered uninsurable due to pre-existing health conditions. In addition, applicants must be uninsured for at least three months, though special exclusions apply for those finishing COBRA or TennCare policies, or for those whose employer has cancelled group coverage.

AccessTN is a program of Cover Tennessee, Governor Phil Bredesen’s initiative to address the health care needs of Tennessee’s uninsured. Cover Tennessee offers three other programs, including CoverTN, a limited benefit health plan for the working uninsured. CoverKids provides free comprehensive health insurance for qualifying children 18-years-old and younger. CoverRx provides Tennesseans who lack pharmacy benefits with access to affordable prescriptions.

New enrollment in CoverKids suspended Dec. 1, 2009. The last day to pre-qualify for CoverTN was Nov. 30. Any businesses or individuals who prequalified for coverage have until Dec. 31, 2009, to enroll with BlueCross BlueShield of Tennessee. Both programs are temporarily closing enrollment as a result of limits in the state budget.