|Volume 1 Issue 2 "Helping to Educate Tennessee Voters about Important Political Issues." March-April 2013|
MEDICAID / TENNCARE EXPANSION
Governor Haslam's Decision To Refuse Medicaid Expansion Will Cost More Money To Almost Everyone Needing Healthcare
Tennessee Governor Haslam has made, what many people consider, a wrong and politically driven decision about refusing the federal Medicaid Expansion for Tennessee's Medicaid program, TennCare. He wants to replace it with something called the Tennessee Plan which hopes to purchase expanded coverage on the Exchange.
His plan has these serious economic, financial, and social problems:
1) For 2014-2016, his 2014 TN Plan costs everyone but the State more money than 100% federally funded TennCare expansion. Poor enrollees, Federal Government, Hospitals & other providers, penalized small businesses, and enrollees in exchanges pay more with his TN Plan than they would pay with the 2014-2016 federally funded expansion.
2) His 2014 TN Plan fails to serve, childless adults aged 19-64 under 100% of federal poverty level.
Because the 175,000 dropped from the TennCare roles were those with pre-existing illnesses, they will have ACA 2014 ‘no exclusion nor premium rating for pre-existing illness’ insurance opportunities that will elevate premiums for all in 2014 exchanges. Some of these could be covered by 100% federal subsidy for three (3) years blunting the premium rise for others in 2014 exchanges. The Governor's plan will cost exchange purchasers more money. This hits hardest with the working poor and small businesses.
Because TennCare is a cost effective managed care plan, TennCare, estimated to cost $5016/enrollee in 2014 will cost less than a private exchange plan, which the Congressional Budget Office estimates will cost $9000. ACA will pay 98% of an exchange plan for someone with income 100-133% of Federal Poverty Line (FPL). 100% of TennCare in 2014, $5016, is less than 98% of $9000, $8820, so the TN Plan will cost the federal government more per enrollee than TennCare expansion in 2014.
Three years of TennCare expansion is superior to zero years of health insurance. The Governor's 2014 TN Plan sentences childless adults earning under 100% FPL, who have no work place insurance, to the status of zero health insurance. The TN Plan sentences to zero insurance many of those with incomes are 100-138% of FPL and who will be unable to afford offered exchange insurance.
Because small businesses with over 50 FTE employees must pay penalties for low wage workers who receive exchange insurance subsidies, the 2014 TN Plan places extra penalties upon small businesses in TN. This means the small business gets less for its health care dollar.
Because bringing new folks with unmet healthcare needs into the system causes higher than average costs in the first three years, the 2014 TN Plan gives up at least one of three expensive year 100% subsidies. (See the Massachusetts experience with costs and the actuarial results of the 175,000 dropped from TennCare). The TN Plan refuses payment for a high cost year.
Because the ACA Medicaid expansion encourages primary care by 2014-2015 Medicare rates for TennCare primary care service, the TN Plan gives up a primary care incentive for 2014. The hopes were that ‘medical homes’ would help reduce health care cost inflation. The TN Plan thwarts this effort. The plan thwarts efforts to lower health care costs using medical homes and outcomes data.
Because hospitals will experience much lower DSH payments in 2014, the TN Plan exposes many hospitals to unnecessary burdens for uncompensated care and may reduce health care availability in our poorest, neediest communities. 53 Tennessee Hospitals are at risk of closing because of this.
Because TennCare expansion would create new jobs and protect current health care jobs, the TN Plan will increase the unemployment rate in our poorest and neediest communities rather than increase employment as projected with the TennCare expansion.
Included in this issue of the TN Independent Thinker News are 5 tables showing Tennessee data that supports TennCare expansion:
1. Urban & Rural counties have poor and low income folks who would benefit from expanding TennCare. Table 1: Poverty by County.
2. Health jobs are the leading job category in many counties and the jobs pay well. Without them the unemployment rates will rise. Health/Social jobs are the #1 employing job sector in the state and #1, 2 or 3 in 12 of the 18 counties listed, 322,244 jobs state-wide. Expanding TennCare is estimated to create 18,000 new jobs, statewide. Table 2: Jobs, Health Jobs.
3. Counties meet some health care needs and health ranks that reflect unmet needs. Hospitals losing DSH payments are at risk. DSH payments are the disproportionate share payments given to hospitals for high volume charity care. DSH dollars lower in 2014 meaning either closed ER, hospital or reduced services in some hospital areas. Table 3. Health Needs, Hospitals at Risk.
4. Counties have many adults ages 19-64 for whom TennCare expansion may serve as a temporary safety net during job loss. Among the 809,000 Tennesseans uninsured 2009-2011, 23.8% are ages 19-64. Some of these may be childless and near poor. Table 4. Insure Near poor, poor ages 19-64.
5. 359,000 were uninsured and had incomes of 138% FPL or less. Table 5. Uninsured by Income Levels.
(Continued next column)
(Continued from column 1)
How Can You Help Make TennCare Expansion Happen:
You can help by sharing your concerns about this issue with your friends, neighbors and especially your representative in the Tennessee General Assembly and Governor. Share your views by sending a letter or an e-mail or calling your representatives in the General Assembly. Don’t know who your representative is? Just visit www.legislature.state.tn.us/legislators/ to find your representatives phone number, e-mail or office address. You may contact Governor Haslam by phone at 615-741-2001, by email at firstname.lastname@example.org, and by mail at Gov. Bill Haslam, 1st Floor, State Capitol, Nashville, TN 37243. You can read more about the Governor Haslam's Tennessee Plan for Health Reform at https://news.tn.gov/node/10458
The information provided in this article, including the Tables of information, came from a letter to Governor Bill Haslam from Mary M. Headrick, MD.
Read Dr. Headrick's entire letter to Gov. Haslam
Read Gov. Haslam's response to Headrick Letter
In case your eyes and mind glazed over reading so many facts and figures about the reasons to expand TennCare (Medicaid) in 2014. Here is a shorter version that was published in the League of Women Voter's newsletter.
Governor Haslam called the joint session of the General Assembly on March 28 and refused the 2014 Medicaid (TennCare) expansion.
According to the Governor, in order to insure that low income workers making less than $15,415 per year (that’s in 2012 dollars) have “'skin in the game,” he refused to accept $730.7 million from the federal government. Medicaid is a federal-state match program that has and will continue to be a 65% federal-35% state match for the historic program covering people already enrolled. The $730.7 million for Tennessee has been on the table to supply 100% coverage for Medicaid expansion through TennCare for 144,500 low-income newly eligible enrollees in 2014. The 100% federal dollars have been offered to all states for the first three years (2014-2016) of the expanded Medicaid program with a gradual reduction to a 90% federal rate through 2020. It’s a very good deal and eight states even adopted early after the 2010 passage of the Patient Protection and Affordable Care Act.
Using CBO estimates, a low earner at 100% to 133% of the federal poverty level (FPL) who puts “skin in the game” purchasing private “exchange” insurance in 2014, will pay 2% of premiums plus co-pays and deductibles (in excess of $180 per year). The federal government will pay 98% of the premium (approximately $8820 instead of under $6000 for TennCare). TennCare, with a 93% positive approval rating from its enrollees, cost $3183 per enrollee per year in FY2010 and will cost less than the $6000 U.S. Medicaid average in 2014.
Tennesseans can expect three years of accelerated costs while those newly insured “catch up” in obtaining health care because it’s not just the uninsured that are vulnerable in this battle over coverage. Governor Haslam has refused $730.7 million for one of those three expensive years. Low-income families, local governments, hospitals, and clinics will be hurt.
Meanwhile, Mr. Haslam leaves a new kind of “donut hole” for Tennessee citizens. Childless adults (aged 19-64) who earn under 100% of poverty get no help. Folks under 100% FPL are not eligible for subsidies. Reach the Governor at 615-741-2001 and share your opinion about his refusal to expand Medicaid (TennCare) as well as his new “Tennessee Plan” (https://news.tn.gov/node/10458).
Submitted by eyewitness: Mary Headrick, MD
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by Ralph Hubbard
Governor Haslam's Refusing Fed Dollars in 2014 Makes No Sense
I have read Governor Haslam's remarks to the General Assembly on March 27, 2013 and it makes me wonder whose side he is on in regards to the Medicaid (TennCare) expansion in 2014. First of all he appears to be merging the Medicaid cost figures for the existing TennCare enrollees with the cost for the new enrollees under the expansion to come up with a larger cost as if that were the cost of the expansion only and he uses the total cost for the next eight years to make it seem even bigger.
Governor Haslam was a successful businessman so he knows how to manipulate the figures to prove whatever point he wants to prove. Now I am just a small businessman and I look at things a little simpler. Now if someone offers me 730.7 million dollars to pay 100% of the cost of expanded TennCare for year 2014 to cover 144,500 additional people who's yearly income puts them below or just above the federal poverty line, I'm going to take it. The federal offer also would allow me to opt out after three years if I decide I can't afford the small increasing percentage I have to pickup after three years until it reaches 10%. Now that 10% is a lot of money, maybe $200 million a year, but that is not a lot to cover the expected 181,700 working poor in Tennessee by 2020. With the expected job increases and the additional revenue, I would expect the HMO premium and the economic stimulation from the added employees to easily cover the added cost.
Since the federal government was expecting the working poor to have health care coverage in 2014 and beyond, the hospitals will no longer count on receiving DSH payments to cover charity care. Many small rural hospitals who serve large numbers of uninsured or underinsured people will loose so much income they will have to close or shut down Emergency Room service.
Perhaps the real agenda for the Governor refusing the TennCare expansion in 2014 is to have those hospitals close and then let the large corporate hospitals buy them for a song or maybe to help the health insurance companies make more money with his "Tennessee Plan". Of course only the Governor knows for sure.
Tennessee Independent Thinker
The Tennessee Independent Thinker News is a periodic publication to help educate the public about important political issues facing Tennessee and the nation. Your support and contributions to this publication will help to make it something that can help Tennesseans make informed decisions about the political issues in our future and how you can help.
Co-Editors - Dr. Mary M. Headrick & Ralph Hubbardmary@maryheadrick.com or email@example.com
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Read Past Issues: ( Click issue date to view )
January-February 2013 Articles on
1. Medicaid / TennCare Expansion that supports accepting federal dollars to obtain Health Care for the working poor;
2. TN Chapter of the American College of Physicians write letter to Governor in support of Medicaid Expansion;
3. Frequently asked questions about the Health Care and federal funds expansion impact on the State budget and Tennessee’s economy;
4. U.S. Senator Lamar Alexander introduces legislation to repeal individual mandate of the Affordable Care Act;
5. Knoxville News-Sentinel posts timeline for Affordable Care Act;
6. League of Women Voters of Tennessee submits Action Alert about proposed Constitutional Amendment to change our Judicial Selection Process; and
7. Medicaid Expansion Issues & Benefits By C. Wright Pinson, MBA, Vanderbilt University Medical Senate Health and Welfare Committee.
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Prison-based Gerrymandering: Unequal Representation
By Sunny J. Murray
In Tennessee, conviction of a felony leads to a forfeiture of the right to vote. Also, according to the Tennessee Annotated Code § 2-22-122 (a)(7):
“A person does not gain or lose residence solely by reason of the person’s presence or absence while employed in the service of the United States or of this state, or while a student at an institution of learning, or while kept in an institution at public expense, or while confined in a public prison or while living on a military reservation”.
Therefore, prison populations should not be counted during the redistricting process on any level, so as to avoid ballooning representation in areas that have prison(s) full of people who are not only ineligible to vote but also may consider home to be an area outside of the prison’s district.
You don’t have to imagine how these prison populations of non-voters can balloon the population count in an area when districts are being drawn. Just look at Table 1 here.
According to the Prison Policy Initiative website, www.prisonersofthecensus.org, the 1,799 prisoners in Northwest Correctional Complex enhanced the vote by 87.6% when County Commissioner districts were drawn based on the 2000 census. Further examples of these distortions are listed in the Table 1.
According to the Department of Justice, there were 27,451 prisoners under the jurisdiction of state and federal correctional authorities in Tennessee as of December 31, 2010.
Tennessee has 14 state prisons: 11 state prisons are operated by the Department of Corrections, and a private company, Correctional Corporation of America (CCA), manages the other three (3) state prisons. See Tables 2 and 3 for prisons operated by the TN Department of Corrections and by Corrections Corporation of America.
The good news is that this practice does not have to continue. In 2010, the Census Bureau provided an Advance Group Quarters Summary File for the first time. This new file allows counties to easily identify and exclude prison populations before they begin to draw new district lines.
The bad news is that despite uneven representation and the availability of the Census Bureau’s Advance Group Quarters Summary File in 2010, Tennessee opted to continue including prison populations in the redistricting process.
WE CAN’T LET DISTORTIONS CONTINUE WHEN THEY CAN BE EASILY AVOIDED.
You can help by sharing your concerns about this issue with your friends, neighbors and especially your representative in the Tennessee General Assembly. Help bring about equal representation in Tennessee for the 2020 Census by sending a letter or an e-mail or call to your representatives in the General Assembly. Don’t know who your representative is? Just visit
www.legislature.state.tn.us/legislators/ to find your representatives e-mail, office address, or phone number.
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