Dems: State needs to help iron out individual health insurance kinks


The Tennessean, Oct. 27, 2016

By: Holly Fletcher

State government needs to take a leadership role in tackling the problems in the individual health insurance market, which leaves patients in a persistent state of uncertainty, according to state Democrats and patient advocates.

Sen. Jeff Yarbro and Rep. John Ray Clemmons, both Nashville Democrats, convened a forum Wednesday to look at why the state's individual health insurance premiums have grown and how to mitigate the impact of insurers' exit from metropolitan markets on consumers who have a dwindling number of options, particularly in three metro areas where some health systems are excluded from benefits.

The majority of Tennesseans have access to insurance through employer-sponsored coverage but those who are buying individual plans are beset by annual changes in available insurers, and rising premiums. The state has had among the highest premium increases in the past two years, in part because the people buying insurance are sicker than projected and using services more frequently than expected.

Yarbro and Chris Coleman, an attorney with the Tennessee Justice Center, agreed that legislative moves in the state — including anti-ACA legislation prior to the federal policy enactment and failure to expand Medicaid — have hindered the ability of the federally run exchange to take root and develop.

"From the outset we haven't done everything we could to implement the Affordable Care Act with fidelity and integrity," said Yarbro.

Michael Humphreys, assistant insurance commissioner at the Tennessee Department of Commerce and Insurance, was supposed to speak at the forum but canceled the night before at the request of the governor's staff, said Yarbro who added the meeting had been scheduled around Humphreys' availability.

"We always want to be available to legislators to answer their questions. This felt like a politically-motivated meeting," said Jennifer Donnals, spokeswoman for Gov. Bill Haslam.

The 2017 exchange is rocked by BCBST's late decision to cease selling individual plans in the three major metro areas. UnitedHealthcare will not sell insurance in 2017, leaving the state after one year.

The move left the remaining insurers, Cigna and Humana, as well as health systems in Nashville "scrambling like crazy" because now more than 70,000 people will need to move to new plans and potentially find new physicians, said Jackie Shrago, special projects coordinator for Tennessee Healthcare Campaign.

Jacob Kraft works as a senior software engineer for a small company that offers insurance to employees but not their families. He and his family have a BCBST plan, which has seen its premiums rise, but now will have to find another carrier. He explored off-exchange options — meaning plans that do not qualify for tax credits and may not be compliant with federal coverage regulations — but the benefits "sounded awful," he said.

The problems with the insurance market are complex and the result is high costs for insurers and potentially, without options to Nashville's three major health systems, overwhelming for the hospital system, TriStar Health, covered by both Cigna and Humana, Shrago said.

"Consumers bear the brunt of all the uncertainty" that comes with complexity, surprises and political volleying over the ACA, Shrago said.

A state public awareness campaign would be about the importance of buying insurance even at healthier stages of life would be central to reaching a wider variety of people to buy plans, and help balance the risk pools, Coleman said, referencing previous campaigns to get people to enroll in TennCare in the mid-1990s and anti-drunk driving campaigns.

 

"The most important thing we can do is a concerted state-run outreach effort to get people enrolled," said Coleman.

Shrago urged the state to act quickly to help the health systems, Saint Thomas Health and Vanderbilt University Medical Center, reach agreements with the remaining insurers about entering exchange networks for 2017.

There are concerns about the successful transition of care for patients who have to change providers in addition to questions about whether a single health system can absorb patients that were spread among all the Nashville-area health systems.

The state should be ensuring that patients have sufficient access to care, which was reshaped by BCBST's decision to exit the market.

Insurers, health system administrators and state officials should get in a room and figure something out, Shrago said.

"It’s not like none of these people know how to do contracts," Shrago said. “I still have hope that is a possibility.”