The 2010 U. S. health care reform law, better known as the Patient Protection and Affordable Care Act (PPACA) gave states until Jan.1, 2013, to create “insurance exchanges” in which individuals and small businesses could shop for insurance policies. If the states don’t set up the exchanges, the federal government will step in and operate the exchanges for them. In states with conservative Republican leadership, such as Georgia and Tennessee, the deadline has put state leaders in a Catch 22: They hope the U.S. Supreme Court will overturn the Affordable Care Act this spring or summer or that the election of a new Republican-controlled Congress and White House would pave the way for the repeal or defunding of the law because the Republicans don’t want to implement health care exchanges under the Obama law. With less than a year before state legislation must be in place to implement this critical part of national healthcare reform, Tennessee And Georgia, along with 18 other states, have not made substantial progress toward meeting federal deadlines, according to reports from several nonpartisan organizations.
According to a recent editorial which appeared in the Los Angeles Times, “Each state should set up an exchange regardless of how its lawmakers feel about ‘Obamacare’ because it would help ameliorate the very real problems consumers face in the health insurance market.” One of the main goals of the Affordable care Act is to extend coverage to millions of Americans who can’t obtain insurance today. These are typically people with pre-existing medical conditions or limited incomes whose employers don’t offer health benefits. They may be unable to afford the individual policies sold in their states, or insurers may refuse to cover them because of their history of health problems.
Starting in Jan. 2013, the law provides subsidies to help lower-income families buy policies, and it prohibits insurers from excluding applicants with pre-existing conditions or charging them higher rates. To deter people from buying coverage only after they get sick, the law will also require all American adults to carry insurance or pay a penalty to the IRS. The subsidies and the mandate to buy insurance are two of the most hotly disputed elements of the Affordable Care Act. Less controversial are the efforts to slow the growth in health care costs by making the system more efficient and effective, to shift the incentives in health care from treating sickness to promoting wellness, and to help consumers be smarter shoppers for insurance.
That’s where the health insurance exchanges come in: Insurers offer standardized policies in formats that make them easy to compare with other companies’ offerings. The exchanges can be run potentially by the government, private for profit insurance companies or by private nonprofit companies. The main value for the consumers is in the convenience and transparency the exchanges provide. No longer would the consumer have to wander from agent to agent or website to website to find out what their options were. Nor would they have to transfer each insurer’s fine print to measure the total value of its policies. Enabling consumers to compare services and prices should remove some of the artificial barriers to competition in insurance as well as make it harder for companies to raise premiums. The exchanges’ role in promoting competition helps explain why the concept has long drawn support from health care reformers on both sides of the aisle. One of the first proposals for exchanges was in the Bill Senate Republicans offered in 1993 as an alternative to President Clinton’s ill-fated health care initiative. House Budget Committee Chairman Paul Ryan, R-Wisconsin, has made insurance exchanges a key feature in his proposed overhaul of Medicare.
Nevertheless, the political fight over the Affordable Care Act has deterred numerous states from trying to establish an exchange. According to research by the Urban Institute, California and 13 other states have created exchanges by law or executive order; 20 states have made little, if any, progress; and the rest of the states fall somewhere in between. As I previously mentioned, if the states don’t make significant headway in less than a year or by Jan.2013, the act authorizes the federal government to set up and operate the exchanges for them—probably the least desireable outcome for critics of the Affordable care Act.
In my opinion, Tennessee has adopted a schizophrenic “come here, go away” approach to health care reform and is, in essence, resisting the Affordable Care Act. “The overwhelming consensus among lawmakers is that no one wants to see the federal government step in and set up an exchange,” said Bo Watson, super conservative Republican State Senator and also Speaker Pro Tem of the Senate. “The general sense is how much time and finances do we want to put into the effort, only to have it overturned by the Supreme Court?” Watson asked.
The exchanges and other changes to health care will provide coverage to about half the people in Tennessee who are currently uninsured or some ½ million people. There are approximately 982,000 uninsured Tennesseeans under the current health care “system.” Georgians will benefit the most, with more than a million additional people covered under the Affordable Care Act. It’s important to note that Tennessee lawmakers have not introduced any legislation on the exchanges. Legislators in Georgia and Alabama introduced bills in 2011 that failed to pass. A Georgia lawmaker has introduced a bill this year, but there is little chance it will become law.
“It’s disappointing that we are just sort of hanging back, “said Cindy Zeldin, executive director of Georgians for a healthy Future, a health care advocacy group. “I worry that if we don’t move forward on this, that 5 to 10 years from now we will look across the country and see disparities in health care access. Those differences will be exacerbated, largely because of partisan politics.”
As I’ve said, Tennessee has not introduced any bills on the insurance exchange but has done a study on its feasibility. States must pass laws to implement the exchange’s operation by Jan. 2013 so the Department of Health and Human Services can certify the states to begin operating them. Public enrollment is set to begin in October 2013. An Associated Press report in Jan. 2012 found the outlook to be unclear in how Tennessee plans to move forward with the process. The report states, “Conservative legislature hostile to health care law.”
State Senator Bo Watson said that he thinks the individual mandate on the health care law is unconstitutional and should be overturned. However, on the other hand, that, he says, does not mean that he thinks the state should do nothing on exchanges. Recently, lawmakers discussed the possibility of meeting in a Special Session later this year after the Supreme Court returns its ruling, Watson said. If that sounds like the Tennessee Legislature is hedging their bets on whether or not the Supreme Court will overturn the law—that’s because they are (hedging their bets).
The state has done much groundwork for the exchange and has TennCare in place, so it will be able to move quickly once the law is in place, says Watson. To further muddy the picture, Tony Garr, the executive director at Tennessee Health Care Campaign, provides a strong assessment of Tennessee’s status: “I’d say we are up to speed, sort of in the middle of the pack. We continue to move forward on planning initiatives,” Garr said. “I don’t know what it will look like but I fully believe we will have a plan in place before the legislature goes home, “ he said.
Therefore, as you can clearly see, Tennessee is maintaining a schizophrenic “one step forward, two steps backward approach toward President Obama’s health care reform law. Whereas most news media and nonpartisan research organizations see Tennessee as going “nowhere” with the Affordable Care Act, Bo Watson and other Republican conservatives say we are headed “somewhere.” I’ll let you decide for yourself.