Cooper: BlueCross BlueShield of Tennessee's Obamacare diet

The headquarters of BlueCross BlueShield of Tennessee is on Cameron Hill in downtown Chattanooga.
The headquarters of BlueCross BlueShield of Tennessee is on Cameron Hill in downtown Chattanooga.

The withdrawal of BlueCross BlueShield of Tennessee from the Obamacare exchange insurance market in Knoxville, Nashville and Memphis last week gives voters an additional opportunity to ponder on Election Day how much longer they want this damaging health care system to continue.

Because while the insurer's move was a state decision, it is part and parcel the kind of decision insurers are being forced to make about their association with the Affordable Care Act (ACA) across the country in order to remain solvent.

Thus, it turns out not only could you not keep your doctor or your insurance plan, as President Barack Obama promised, you couldn't even keep the plan his exchange program had yet to create.

Democrat presidential nominee Hillary Clinton doesn't talk a lot about Obamacare, but her announced plans only include expanding it. She would, for instance, give a tax credit of up to $2,500 for individuals whose out-of-pocket medical spending exceeds 5 percent of their income. She further would lower the maximum amount people would have to pay toward insurance plans bought on the rapidly dwindling Obamacare exchanges. For individuals who earn about $47,000 or less, for instance, they would pay a maximum of 8.5 percent of their income, down from 9.7 percent. And she's also dangling a public option - a completely government-run agency that would compete with other insurers.

An analysis by the Rand Corp. and the Commonwealth Fund calculated that her plan would add about $90.5 billion to the deficit. In other words, her plan would use $90.5 billion more of money the country doesn't have to pay for a system that has been plagued with problems from the outset.

After eight years of the country's slowest economic growth following a recession since the Great Depression, is this the kind of policy we can stand for four or eight years?

BlueCross's decision, while understandable, seemed surprising since the Chattanooga-based insurer had been given approval by the state last month for an average 62 percent rate increase for 2017 - all that it asked for.

"We thought about it for a long time," Roy Vaughn, the company's chief communication officer, told Times Free Press editorial writers in a conference call. "It's a difficult but necessary decision as we looked toward the future of the ACA marketplace."

He said the insurer already is looking at nearly $500 million in losses over three years - through 2016 - on the exchanges market. But Vaughn said "there were uncertainties at the federal level that could put us in a loss position again even after getting a rate increase to cover those [medical] costs."

Those uncertainties, he said, include resolution of legal challenges to the ACA's cost-sharing provision - an appeals court still must rule - and the prospect for more legislative action that could affect how the program is executed.

Either or both of those changes in 2017, Vaughn said, have the potential to reverse the gap between premiums and medical costs that was partially closed with the recent permitted rate increase, which still needs federal approval.

It is also incumbent upon the company, he said, "to limit our risk as we move forward." The first three years of losses under the ACA marketplace exchange required the company to draw down its reserves and maintain "less of a safety net" than it is comfortable with, he said.

The decision, Vaughn said, was not a political calculation two months before the presidential election but a desire to do "what's in the best interest of the other 3 million [clients] we serve. Our responsibility is to maintain financial stability."

With that in mind, the company will drop nearly 130,000 people - who will have to find an alternate plan for next year - from its market exchange rolls and keep around 80,000, many of those in rural areas. The new insurance seekers will number 71,495 people in the Nashville area, 30,326 in Memphis and 29,246 in Knoxville.

The decision also will increase to 73 of the state's 95 counties in which there is only one insurer from which to choose on the exchange.

Vaughn said the population and relative health of individuals in urban areas vs. rural areas had no affect on how the cuts were made. Instead, it was a matter of leaving markets where there were more options available and choosing to stay in markets where BlueCross was likely to be the only option, he said.

United Health Care, which once sold market exchange plans in every county, has left the state exchange market altogether. Cigna and Humana, which offer exchange options in part of the state, had considered leaving before being allowed to refile their 2017 rate requests last month.

Tennessee is not the only state where all this is happening. BlueCross BlueShield insurers in Arizona and Minnesota are not selling exchange plans statewide, and the company in Nebraska is only selling plans off the exchange (which means purchasers won't be eligible for tax credits.)

The near collapse of the Obamacare marketplace, as part of the bloated Affordable Care Act, should be reason enough not to support the presidential candidacy of one who believes such a system is still a perfectly viable option.

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