GOP rolls out health care plans

House proposals address costs, choices

NASHVILLE — State House Republican leaders on Thursday unveiled a multi-pronged plan they say will transform Tennessee health care through a “patient-centered,” free market approach that includes price transparency for consumers to help lower costs.

But legislative Democrats quickly pounced on Republicans’ “CARE” proposal, calling it an effort to camouflage the GOP’s refusal to expand Medicaid coverage for hundreds of thousands of low-income adult Tennesseans with the federal government picking up 90 percent of the tab.

Earlier, top Republicans rolled out their plan, which is comprised of 11 bills. In an acronym-loving legislature, CARE stands for consumerism, access, improving rural health systems and “empowering” patients.

Proposals range from a previously announced effort to obtain a federal block grant for Medicaid, known as TennCare here, to a “reform” of pharmacy benefits manager programs, which are third-party administrators of prescription drug programs for commercial health plans, self-insured employer plans and government programs.

“All Tennesseans are struggling to understand the complexity of health care as well as the unaffordable cost,” said GOP Caucus Chairman Cameron Sexton, R-Crossville, as he and other Republicans sketched out their proposals.

The major issue, Sexton said, is “how can informed decisions be made when there’s little to no transparency in the marketplace and limited competition.”

Some of the proposals are a work in progress.

Sexton, a former House Health Committee chairman, also said “these issues have been in the making for decades, so it’s unrealistic to say we can fix this overnight. It will take time. It’ll take time to dismantle the current insurance-centered approach and move to a patient-centered approach.”

Senate Minority Leader Jeff Yarbro, D-Nashville, called the CARE plan a “fig leaf to hide the failure to expand Medicaid in this state” through the federal Affordable Care Act.

Legislative Republicans have resisted expansion of TennCare, the state’s version of Medicaid, which currently serves low-income pregnant women and mothers along with their children. The 1.34 million enrollees also include a number of impoverished elderly Tennesseans and disabled people.

GOP lawmakers dealt former Republican Gov. Bill Haslam a rare defeat in 2011 when he proposed extending Medicaid to an estimated 300,000 lowincome Tennesseans under the ACA, widely known as Obamacare.

“Even by the standards of the Republicans in the Tennessee legislature, the current health care proposal rolled out by members of the House today is remarkable for its dishonesty and its complete unwillingness to do anything about the health care that Tennesseans need,” House Democratic Caucus Chairman Mike Stewart, D-Nashville, told reporters.

Among Republicans’ bills is a measure sponsored by Rep. Robin Smith, R-Hixson, who worked for years as a nurse, that she calls her “Tennessee Right to Shop Act.”

It would require insurers to implement a program to provide incentives for enrollees to seek out service from a network provider that is paid less than the average amount the insurer covers for the service.

“We’re trying to break down the barriers,” Sexton said.

Smith said earlier this year she is interested in “trying to inject a little more consumer power” and “reconstruct the market” to encourage more knowledgeable, less expensive choices by Tennesseans.

As for the pharmacy benefit manager program proposal, Sexton acknowledged “we’re still in conversations about what that legislation will look like. What I will tell you is PBMs are starting to be owned by insurance companies. The rebates are getting bigger, but the drug prices for consumers are not going down.”

Yet another proposal deals with all-payer claims databases, which are large state databases that include medical claims, pharmacy claims, dental claims, and eligibility and provider files collected from private and public payers. The data is reported by insurers to states.

Lt. Gov. Randy McNally, R-Oak Ridge, the Senate speaker, said he planned to discuss the proposals and bills with House Speaker Glen Casada, R-Franklin, and other House leadership.

“I think it will be further refined in committees and possibly on the floor of the House and working with the administration,” McNally told reporters. “It’s a good start.”

Asked whether the average person could figure out how to navigate through databases, McNally, a retired pharmacist, said “folks more technically savvy can probably do it.”

“It might give people some sense of what to do and where to go,” McNally said, but also noted, “it could be a little bit cumbersome.”

He also noted some states have had problems with all-payer claims databases.

“[The plan is a] fig leaf to hide the failure to expand Medicaid in this state [through the federal Affordable Care Act.]”

– JEFF YARBRO,

SENATE MINORITY LEADER