Chattanooga Times Free Press - - OPINION -

While the myths of the “you can keep your doctor,” “you can keep your health plan” and “your pre­mi­ums will go down” phrases have faded in the near decade since for­mer Pres­i­dent Barack Obama ut­tered them, this week brought good news to those who have Af­ford­able Care Act health cov­er­age.

Af­ter four con­sec­u­tive years of dou­ble-digit rate hikes, the 2019 pre­mi­ums for many cus­tomers will go down. In Ten­nessee, pend­ing ap­proval by state reg­u­la­tors, that will look like a 10.9 per­cent re­duc­tion for BlueCross BlueShield of Ten­nessee cus­tomers in the in­di­vid­ual mar­ket and a 4.8 per­cent cut for Cigna users.

The Vol­un­teer State orig­i­nally had some of the low­est rates in the coun­try when the health care ex­changes be­gan in 2014, but in­sur­ers lost hun­dreds of mil­lions of dol­lars on the plans when fewer peo­ple en­rolled than ex­pected and those who did were much less healthy — and thus re­quired more care — than ex­pected.

BlueCross BlueShield of Ten­nessee, for in­stance, raised rates 19 per­cent in 2015, 36.3 per­cent in 2016, 62 per­cent in 2017 and 21 per­cent this year, ac­cord­ing to Times Free Press ar­chives. Mean­while, sev­eral in­sur­ers left the field, un­will­ing to con­tinue ab­sorb­ing the losses.

How­ever, the Chat­tanooga-based in­sur­ance com­pany earned $117 mil­lion on its health care ex­change plans in 2017 and ex­pects to re­port a profit this year. The amount of that profit, how­ever, may be im­pacted by the Trump ad­min­is­tra­tion’s freez­ing of risk ad­just­ment pay­ments that in­sur­ers like BlueCross BlueShield re­ceive be­cause they take on a big­ger share of high-risk cus­tomers.

Lest any­one think the Af­ford­able Care Act, also known as Oba­macare, is on its way to be­com­ing the panacea it was promised to be, though, there’s this:

In the same week the pos­i­tive news of rate de­creases hit the pub­lic, new re­search from the Foun­da­tion for Govern­ment Ac­count­abil­ity has re­vealed that 55 per­cent of the 12.4 mil­lion able-bod­ied adults who re­ceive health care through the Af­ford­able Care Act in the states that ex­panded Med­i­caid are not work­ing.

To date, 31 states au­tho­rized ex­pan­sion, and that’s just ex­actly what many peo­ple in Ten­nessee would like to see oc­cur here. Ten­nessee Gov. Bill Haslam wanted to try it with a state-tai­lored pi­lot pro­gram — In­sure Ten­nessee — in 2015, but the leg­is­la­ture nixed it be­fore it ever reached the floor of the state House or state Se­nate.

To­day, the two ma­jor Demo­cratic can­di­dates for Ten­nessee gov­er­nor and many of the Demo­cratic leg­isla­tive can­di­dates want to see that Med­i­caid money flow into the state.

Among the states that ap­proved Med­i­caid ex­pan­sion, 70 per­cent of re­cip­i­ents in Illi­nois and 60 per­cent in Ne­vada do not work. Of the few states in the South that took the bait, 55 per­cent of Arkansas re­cip­i­ents and 52 per­cent of Ken­tucky re­cip­i­ents don’t work.

Thus, a pro­gram cre­ated more than 50 years ago to serve the el­derly and dis­abled has be­come, ac­cord­ing to Foun­da­tion for Govern­ment Ac­count­abil­ity, “a wel­fare trap” for many adults.

“Med­i­caid ex­pan­sion,” ac­cord­ing to Nic Hor­ton, di­rec­tor of re­search for the non­profit think tank, “has cre­ated a new wel­fare class of able-bod­ied adults, and with nearly 7 mil­lion of these in­di­vid­u­als not work­ing, some­thing has to give. Every dol­lar that goes to able-bod­ied adults on Med­i­caid is a dol­lar that can’t be spent on the truly needy.”

The an­swer, ac­cord­ing to the foun­da­tion, is com­mon-sense work re­quire­ments. To date, the vast ma­jor­ity of in­di­vid­u­als across the coun­try cov­ered un­der states that have ex­panded Med­i­caid are not re­quired to pay pre­mi­ums. Nei­ther do they have a work re­quire­ment, a vol­un­teer­ing re­quire­ment or a train­ing re­quire­ment.

Ear­lier this year, though, the Cen­ters for Medi­care and Med­i­caid Ser­vices is­sued new guid­ance on how states could in­cor­po­rate Med­i­caid work re­quire­ments for able-bod­ied adults. Since then, Ken­tucky, In­di­ana, Arkansas and New Hamp­shire have been ap­proved for work re­quire­ments, and Arkansas on June 1 was the first to take its re­quire­ment live.

Go­ing for­ward, with Med­i­caid con­sum­ing close to one of three dol­lars in state bud­gets, Congress should make Med­i­caid work re­quire­ments eas­ier to ob­tain and state pol­i­cy­mak­ers should act with ur­gency, the think tanks says.

Ten­nessee passed a sim­i­lar bill in May that would require able-bod­ied adults with­out chil­dren un­der the age of 65 who re­ceive Ten­nCare — the state’s Med­i­caid pass-through pro­gram — to spend 20 hours a week work­ing, vol­un­teer­ing or at­tend­ing school if they are not al­ready em­ployed.

As time passes, we’ll be in­ter­ested to hear how and if these re­quire­ments put peo­ple back to work or prompt them to at­tend school or vol­un­teer. While Amer­ica should al­ways take care of its most vul­ner­a­ble, it should never be­come a benef­i­cent host for the lazy, the unin­spired and the dis­sat­is­fied.

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