Planning health care reform

Planning health care reform

December 29th, 2011 in Opinion Times

As in other Republican-controlled states, Tennessee's top officials are in a needless fret over whether to initiate planning for a state insurance exchange, the entities that states must have in place beginning in January 2014 to help uninsured citizens buy competitively priced, reasonably comprehensive health insurance.

Senate Speaker Ron Ramsey says he fears being seen as supporting "Obamacare" if he moves legislation to establish an exchange. Gov. Bill Haslam says he opposes the requirement for states to establish an exchange to promote transparent insurance competition. But he also fears losing millions in federal grants to help create an exchange, and possibly state control of the exchange, if the state doesn't move forward and defaults to a federally established exchange.

Given the huge number of adult Tennesseans who stand to benefit greatly from the insurance reform, the heartless irony of their partisan remarks, and their misplaced fear of health care reform, is reprehensible, to say the least.

Nearly half of Tennessee's employers do not provide employer-based health insurance. At least one out of every three Tennesseans under the age of 65 (or about 1.7 million of the 5.3 million Tennesseans under age 65), and probably half of Tennessee adults between the ages of 26 and 65, do not have health insurance. They need and deserve the benefits of health care reform in general, and the state exchange in particular.

These are citizens who are not poor enough to qualify for Medicaid/TennCare; who do not have access to, or cannot afford, employer-based health insurance; and who cannot afford to purchase individual health insurance.

In fact, given two other health insurance programs -- one for children below 18 in families above Medicaid-poverty levels, another for adult children up to age 26 -- the number of adults in Tennessee without health insurance may actually be above 50 percent.

Here's why. Tennessee children in uninsured families whose incomes are above Medicaid's poverty eligibility levels generally qualify for insurance coverage under the federally based Children's Health Insurance Program, known as CHIP, which helps families with incomes up to three or four times the official poverty level. That's high enough to cover virtually all of Tennessee's middle-to-upper-middle-income families.

And under a provision of the Affordable Health Act instituted in 2010, uninsured adult children whose parents have health insurance now qualify for coverage under their parents' insurance until they are 26, whether or not they are married, or working, or living away from home.

At least a quarter of Tennessee's 1.5 million children qualify for Medicaid, and most of the rest are covered by employer-based or CHIP coverage. That makes the number of Tennesseans under 65, and excluding children under 18, around 3.8 million. Take away the under-26 year-olds who can now stay on their family coverage for dependents, and the 3.8 million figure declines significantly. If 1.7 million Tennesseans are uninsured, that's probably half the number of people over 26 and under 65.

State officials should be scrambling to pin down the number of uninsured working adults between the ages of 26 and 65, the Medicare entry point. They should be eager to implement the wrongly maligned Affordable Care Act and the exchanges that will make it possible, and imminently affordable, for virtually all of Tennessee's uninsured adults to purchase health care.

Under the Affordable Health Care Act -- which Congress, not Obama, wrote -- the federal government will provide new regulations on health insurers to require more comprehensive insurance plans, and to ensure that 80-to-85 percent of their revenue from health insurance premiums is actually spent on delivery of health care. That will reduce the vast amounts spent on CEO's megamillion salaries, jets and perks and other lavish overhead, and it will help fund better, more comprehensive care.

Insurer plans on the state exchanges will have to provide level rates for all buyers; insurers cannot adjust rates upwards for higher-risk patients. Most individual purchasers and families, moreover, will qualify for substantial federal subsidies designed to make health insurance affordable.

The Affordable Care Act, to be sure, is not as good as it might have been. To address Republican concerns about federal mandates, President Obama recently decided -- wrongly in our view -- to allow states to set minimum comprehensive standards for policies to be offered on state exchanges. He also backed away from offering a public plan -- a Medicare-for-all type plan -- to put pressure on for-profit insurers' for competitive and fairly priced plans.

Even so, the ACA , if the Supreme Court does not unfairly undermine it, would vastly improve health care coverage and affordability. State officials who oppose it offer no alternative, and they are wrongly negligent of the great public need for such reform.