NASHVILLE -- Tennessee insurers, hospitals, doctors and other providers want the state and not the federal government to run a state health care exchange mandated under the 2010 federal health care reform law.
In a recent "white paper," the state's Insurance Exchange Planning Initiative summarizes feedback from providers and businesses about the advantages of Tennessee running the exchange.
But the idea of Tennessee running its own exchange is generating uneasiness among some Republican legislative leaders.
Hundreds of thousands of Tennesseans would be eligible for the exchange, according to estimates, which would have to be up and running by Jan. 1, 2014, requiring extensive planning in 2012 and 2013.
The federal health care reform law directs the creation of the exchanges, which are intended to provide one-stop shopping at competitive, sometimes-subsidized expense, to people whose employers don't provide health insurance.
State Exchange Planning Initiative officials emphasized in their report that, while the "white paper does not consider the question of if Tennessee should operate an exchange or cede that responsibility to the federal government, it is worth noting that key Tennessee stakeholders have expressed [in writing] their preference that Tennessee operate the exchange instead of the federal government."
Among them are major state insurers such as Chattanooga-based BlueCross BlueShield of Tennessee as well as the Tennessee Medical Association, the Tennessee Nurses Association and the Tennessee Hospital Association.
"The state will obviously want any type of exchange environment created to serve the citizens," said BlueCross spokeswoman Mary Danielson, citing the state's experience in working with TennCare and insurers. "Obviously, regulation and oversight at the state level is important to ensure consumer protection."
The exchanges are part of Obama's strategy for expanding health coverage to more than 30 million uninsured people. While the middle-class uninsured will go through their state exchange, low-income people will be covered through an expanded Medicaid program.
Senate Speaker Ron Ramsey, R-Blountville, and House Speaker Beth Harwell, R-Nashville, have expressed worries about the state running the exchange. The concern is that, by voting to move ahead with the plan during the legislative session that begins Jan. 10, Republicans risk the wrath of Tennesseans opposed to what critics have dubbed "Obamacare."
"None of us want to sit there and push a button or green light that sets up these health care exchanges," Ramsey said. "Because if we do, then suddenly it's: 'Well, you voted for Obamacare.'"
Ramsey recently suggested a special legislative session could be held in December 2012 to create an exchange if Democratic President Barack Obama's health care reforms survive a U.S. Supreme Court challenge as well as the November 2012 presidential election.
Republican Gov. Bill Haslam said he is no fan of the federal health overhaul either, but the state risks losing millions in federal assistance if it doesn't move to set up its own exchange but later decides to take over from a federally run program.
"My feeling is that we ... need to keep planning," Haslam told the Times Free Press. "Who knows? Does the court overrule it? Is there a different president in 2013?
"But as the person responsible for the state delivering services, I feel like my responsibility has been to prepare as if it's going to happen -- I wish it wouldn't."
In its paper, the state's Insurance Exchange Planning Initiative said a state-run exchange could maintain "conservative fiscal management of Tennessee's resources" as well as "control of major cost drivers such as TennCare" and another program, CoverKids, which covers low-income children.
A state exchange also could minimize employer health care costs as well as keeping any increased federal tax burden on employers and employees as low as possible, the report said.