Now that the Supreme Court has affirmed the constitutionality of the Affordable Care Act, Tennessee Gov. Bill Haslam and state lawmakers have a clear duty to begin planning for the state's nonprofit, flat-rate insurance exchanges that are required under the law. They also must decide whether to accept or reject the enormous benefit of federal funds to expand Medicaid to low-income Tennesseans, or possibly 200,000 to 300,000, who are now excluded from TennCare/Medicaid coverage because their incomes are just bit above the federal poverty level. The expansion would include those with incomes of 138 percent of the federal poverty level.
These crucial issues should be decided in the health interests of all Tennesseans, rather than on the basis of partisan political opposition to the ACA. Between the two programs, health care insurance for an estimated 930,000 Tennesseans, or roughly 15 percent of Tennesseans, hangs in the balance.
That number itself, to be sure, fails to suggest that a far higher percentage of working Tennesseans and their family members - about one out of four - now go without health care insurance. Why? Consider the larger picture.
Of the state's 6.2 million citizens, those over the age of 65 - or roughly 806,000 - are eligible for federal Medicare. Another 1.2 million residents, with incomes below the federal poverty level, are covered by Medicaid/TennCare, two-thirds of the cost of which is provided by the federal government, and one-third by the state. And another notable segment of military veterans qualify for Tri-Care, a federal health care program.
There is also a significant number of children in families above the poverty level who are covered by the federal- and state-funded Children's Health Insurance Program because their parents do not have employer-based health insurance for families. Another group of adult children who were uninsured are now covered under an ACA provision that allows those under 26 years of age to stay on their parents' family insurance - if they have it.
Subtracting these large segments of the state's insured population, and considering that less than 55 percent of employers still provide employee insurance programs, it turns out that around one out of four working Tennesseans between the ages of 18 and 65 goes without health insurance. Most are trapped in this circumstance because their relatively low wages - the sad norm in Tennessee - make meaningful private insurance plans unaffordable, or because insurers reject them over "pre-existing" conditions.
That one out of four working Tennesseans can't get or can't afford health insurance under this country's broken, status-quo health care system should prompt state officials to implement all the ACA provisions. Despite all the Republican myopic ranting about "Obamacare," it is clear that Tennessee's unmet health care needs stoke last-resort emergency care. That leaves hospitals overburdened with indigent emergency care cost - the most expensive, least efficient way to deal with health care demands. And those staggering costs, in turn, are shifted to the insured patients, causing their insurance costs to soar.
If the ACA isn't sabotaged by partisan lawmakers, it would help bring down the nation's mounting health care costs by dramatically raising the number of insured, by opening the door for them to preventive care and by sharply restraining this nation's horrendous indigent-care burden. The premium subsidies established by the ACA to help middle-class families purchase insurance on the regulated exchanges would further advance that goal.
Even with those subsidies, the non-partisan Congressional Budget Office has repeatedly shown that the ACA will dramatically slow the unaffordable cost curve of the current system, while greatly improving general health care for most Americans by eliminating the current insurance barriers (i.e, pre-existing conditions, limits on coverage, policy cancellations) to accessible, affordable and secure care.
Gov. Haslam and state lawmakers owe Tennesseans committed, nonpartisan help to make the ACA work for the state's uninsured workers and their family members - and for all Tennesseans vulnerable to the frightening loss of their employer-based health insurance. It would be a moral failure to do less.