Tennessee’s uninsured rate would climb under Senate bill
The health reform legislation proposed by the U.S. Senate is projected to raise the number of uninsured people in Tennessee, reversing a downward trend in recent years.
Broad changes to insurance subsidies and Medicaid funding, combined with the proposed removal of the mandate to buy insurance, could leave more than 1 million Tennesseans without some sort of coverage by 2022, according to the Urban Institute.
It estimates 1.07 million nonelderly Tennesseans would be uninsured by that year. That’s 48.6 percent more people, including children, without some type of coverage than under the Affordable Care Act. Under the current law, 726,000 non-elderly Tennesseans would be uninsured in 2022, according to the report.
The number of Tennesseans who were uninsured in 2016 fell to the lowest point in a decade.
The reductions to the number of people who have coverage would range from people who are removed from Medicaid — called TennCare in Tennessee — under more frequent eligibility reviews, potential changes to Medicaid eligibility or people who put off buying insurance until they need it under relaxed regulations, said
John Graves, assistant professor of health policy at Vanderbilt University School of Medicine, and who is not affiliated with the Urban report.
Still others, particularly older people shopping for individual plans, could be priced out of high premiums coupled with high deductibles.
Insurers are preparing for fewer people to buy insurance on the individual market if Congress eliminates the individual mandate, or if the federal government decides to not enforce the existing law. Seven percent of BlueCross BlueShield of Tennessee’s average 21 percent premium increase is due to expected changes in how many people buy insurance if the mandate goes away.
The mandate to buy insurance — and the essential health benefits required under those plans — are a sticking point for people who say they don’t need, or want, certain types of care.
But the option to buy insurance when it’s needed will lead to higher premiums on the individual market, said Graves, because insurers will be covering people when they need care rather than a better mix of healthy people as well as those who need services.
After years of losses on the individual market, BCBST was on track to request only a nominal increase in premiums for 2018 — compared to the average 63 percent it requested, and received, for 2017. But ambiguity about what will happen at the federal level, and who will be buying coverage, drove the insurer’s request upward.
SUPPORT GROWS FOR ACA
There’s been a softening of public opinion on the ACA in recent months as Congress has taken up repeal-and-replace bills, said John Geer, professor and co-director of Vanderbilt University’s Center for the Study of Democratic Institutions.
The existing legislation, often called Obamacare and panned across the state for its connection to Barack Obama, is “a little more popular than it has been.”
People who accessed coverage, some for the first time in many years, are outraged over the possibility of seeing benefits change or being priced out of the market. Meanwhile, other aspects of the ACA, such as protections for those with pre-existing conditions, are wildly popular, Geer said.
A recent poll from the American Medical Association conducted by Public Opinion Strategies of 500 Tennesseans who are registered voters found 56 percent oppose letting insurers charge more to people with pre-existing conditions who let coverage lapse. Thirty-seven percent support such a change.
Regarding the ACA, 47 percent believe it’s a bad idea; 35 percent think it’s a good idea; and 17 percent don’t have an opinion.
The poll found 42 percent believe the U.S. House’s American Health Care Act is a bad idea; 22 percent think it’s a good idea; and 33 percent don’t have an opinion.
The AMA opposes the Senate’s bill. The poll found Tennesseans are divided on whether the government should offset deductibles and outof-pocket costs for lower-income buyers. Of the respondents, 46 percent oppose elimination of those components while 44 percent support elimination.
“Republicans in general, including our own two senators, have to be careful with how this bill proceeds,” Geer said. “Obamacare is not all that popular but some of its components are popular. You’re like a cat on a hot tin roof in that way.”