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.