Senator Mark Green proposes market-driven alternative to Obamacare expansion

I detest Obamacare as much as the next conservative, but one thing we must admit is that the pre-Obamacare healthcare system was also seriously flawed.  Cost were rapidly increasing and too many people were uninsured. There really was not a "market" for health care.  When a third party pays the bill, no one cares what the cost of an item is.  It does not matter if the third party is an insurance company or the government, the effect is the same. The only exception is that you may care if the third party is your parents or your local church congregation. If you would be judged negatively for overindulging you may still care what something really cost, but when the party paying the bill is a distant impersonal entity, who cares? 

Assume we could join a food co-op and and assume that now we all spend about $400 a month on groceries, so we all put in $400 a month and go to the grocery store and buy what ever we want. I would eat more steak and shrimp and lobster. I really don't care if I buy Coke or Pepsi and I can switch between the two depending which is on sale. If someone else was paying the bill I would not even look at the price. Soon the cost of groceries would climb form $400 per month to $600 to $800 per month. Also, the merchant, who previously had an incentive to keep his groceries affordable, will realize he can constantly raise prices since no one really cares what something cost. That is much like were we are with health care.

Obamacare not only did nothing to address the problems with health care cost, but made the problems worst.  When Governor Haslam introduced his Insure Tennessee plan, I was opposed, but not adamantly opposed. I thought Insure Tennessee was better than the standard expansion of medicaid under Obamacare. I opposed it primarily because I think Obamacare is a terrible policy and I thought we should hold off on any expansion of Obamacare and focus on trying to defeat it, not acquiescence for something only slightly less offensive than the standard Obamacare expansion. I am glad  Insure Tennessee was defeated.

There is normally not much a State legislator can do to counter a nation policy other than refuse to acquiesce and to reject federal dollars. While I realize that Federal dollars come from the same pocket of the taxpayer as local or state dollars, there is still a compelling reason to get our share of federal money. If we don't, we still pay for it and someone else gets the money.

While it is difficult for a State legislature to do more than say "no" to a federal policy, State Senator Mark Green has proposed a couple of bills that do more.  He has proposed two bills that would incorporate changes to health care that incorporate market principles. Below is the report from his news letter explaining what he is proposing: 

Senator Mark Green

In the area of health care, there are two issues I'm working to address.

Unanimously passing Tennessee's Senate Commerce Committee last week, my bill to reform our state's Medicaid program - a federally-mandated program for which our state has a waiver - or TennCare.  

The Tennessean summed this legislation up in that it would "radically alter how health insurance is delivered to Tennessee's Medicaid (TennCare) recipients" and addresses the working poor that would have been covered by the expansion through the Affordable Care Act.

Simply, Senate Joint Resolution 88 allows patients in our state's health care program for the indigent and poor to participate in flexible savings accounts that reward healthy behavior and choices while incentivizing selective consumer choices and price-shopping.  In essence, the proposal makes the system patient-centric and not "3rd-party payer-centric."  This will create competition and reduce prices in an open-market environment.

In the TN Senate Commerce Committee, I requested that Commissioner of Insurance and Commerce, Julie McPeak, appear to provide an explanation for the double-digit increases in premiums by individual health-insurance plan holders.

From Commissioner McPeak's presentation it was clear that the consequences of Obamacare continue to cost hard-working Tennesseans. As healthy individuals left the healthcare exchange, prices covering the sicker patients have skyrocketed.  The point was obvious, prior to Obamacare, Tennessee had a competitive market that drove the price of insurance down.  In the wake of Obamacare, competition is gone and Tennesseans are paying the price.

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Vanderbilt Poll on Insure Tennessee Seriously Flawed

Beacon Center Press Release - In what can only be considered an affront to legitimate pollsters everywhere, Vanderbilt University released its latest poll showing that 64% of Tennesseans support Insure Tennessee, Gov. Haslam’s proposal to extend Medicaid benefits to upwards of 450,000 people. The poll is seriously flawed for a number of reasons, including the fact that Vanderbilt refused to release the topline results publicly, contrary to the practices of reputable polling outlets across the country. 

A look at the National Council of Public Polls shows that the Vanderbilt poll doesn’t even meet some of its level one disclosure principles, including complete wording and ordering of questions mentioned in the release. Only due to reporting by the Tennessean can the public even know what question was asked relative to support for Medicaid expansion.

Beacon Communications Director Mark Cunningham noted, "This is one of the most poorly worded questions I have ever seen in my years of analyzing polls. It is no surprise that they got the result they did." The actual question posed was: "Do you strongly support, somewhat support, neither support nor oppose, somewhat oppose or strongly oppose expanding health care coverage for low-income people in the state?"

"Everyone at the Beacon Center would have answered 'support' to that question," Cunningham said, pointing to a quote from Beacon CEO Justin Owen echoing this sentiment when Insure Tennessee was defeated. Cunningham concluded that, "It seems that Vanderbilt is more interested in shaping public opinion than gauging it." 

My Comment: This is unbelievable that Vanderbilt University would ask such a question and then reach the conclusion that 64% of Tennesseans support Insure Tennessee. A majority of Tennesseans may support the Insure Tennessee plan of Medicaid expansion, but that is not what was asked. 

How about this: "Do you strongly support, somewhat support, neither support nor oppose, somewhat oppose or strongly oppose low-income people in the state having adequate food to eat?" After you compile the poll results then you could say, "Tennesseans support expanding Food Stamps in Tennessee." 

Or, how about this: Do you strongly support, somewhat support, neither support nor oppose, somewhat oppose or strongly oppose low-income people in the state having adequate shelter?" Then you could conclude the the poll result show, "Tennesseans support expanding public housing in Tennessee." 

Vanderbilt University should be ashamed. Based on who you ask, how you ask, and what you infer from the results, one can get a poll to produce almost any answer one wants. Advocacy groups do this all the time. I expected a little bit more from Vanderbilt.

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Statement from Bill Freeman on Insure Tennessee defeat

Press Release, NASHVILLE, Tenn. – By not even allowing Insure Tennessee to get out of committee recently, the Tennessee State Senate has once, again in the name of political grandstanding, refused to help the over 470,000 estimated individuals, working families and veterans across Tennessee in need of insurance. The state has already turned away over $1 billion dollars of tax dollars that rightfully belong to Tennesseans in need, including thousands right here in Nashville, and with the Senate’s lack of action yesterday means the state will continue sending those federal tax dollars paid in by Tennesseans, to help those in other states.

 

It is shameful that politics have gotten in the way of helping our fellow Tennesseans in need. While Insure Tennessee is still alive in the House, it is unlikely to escape a similar fate should it get back to the Senate. The hospitals and health facilities here in Nashville and across the state on the brink of closing deserved better than this, and the hundreds of thousands of Tennesseans suffering without the insurance their federal tax dollars have already paid for deserved better.

 

It is my hope that going forward, what is best for all the people of Tennessee will be the ultimate desire of our legislature. That is what voters expect when they elect those who represent them in government offices, and if privileged enough to become Nashville’s next mayor that is exactly what the citizens of Davidson County will get – A mayor not concerned about agendas, but concerned about how to make our beloved city a great place for them to work, play and be proud to call home.

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Haslam Announces Insure Tennessee Plan, Tennessee's proposed alternative to Medicaid expansion

Provides health care coverage to more Tennesseans while addressing health outcomes and cost

NASHVILLE – Tennessee Gov. Bill Haslam today unveiled his Insure Tennessee plan, a two year pilot program to provide health care coverage to Tennesseans who currently don’t have access to health insurance or have limited options.  Haslam has received verbal approval from the U.S. Department of Health and Human Services (HHS) on the plan.  The next steps are for the state to submit a waiver to HHS and for the governor to take the proposal to the legislature for consideration.

The program rewards healthy behaviors, prepares members to transition to private coverage, promotes personal responsibility and incentivizes choosing preventative and routine care instead of unnecessary use of emergency rooms.

The governor announced that he plans to call a special session to focus on the proposal after the 109^th General Assembly convenes in January.

“We made the decision in Tennessee nearly two years ago not to expand traditional Medicaid,” Haslam said.  “This is an alternative approach that forges a different path and is a unique Tennessee solution.  This plan leverages federal dollars to provide health care coverage to more Tennesseans, to give people a choice in their coverage, and to address the cost of health care, better health outcomes and personal responsibility.

“Our approach is responsible and reasonable, and I truly believe that it can be a catalyst to fundamentally changing health care in Tennessee.  It is our hope that this plan opens the door in the future for innovation within our existing Medicaid program.  I look forward to working with providers across the state to advance payment reform and with members of the General Assembly to make this plan a reality.”

Five key areas of the governor’s plan include:

• A fiscally sound and sustainable program;
• Providing two new private market choices for Tennesseans;
• Shifting the delivery model and payment of health care in Tennessee from fee-for-service to outcomes based;
• Incentivizing Tennesseans to be more engaged and to take more personal responsibility in their health;
• And preparing participants for eventual transition to commercial health coverage.

Fiscally Sound and Sustainable Program
The program will not create any new taxes for Tennesseans and will not add any state cost to the budget.  The Tennessee Hospital Association has committed that the industry will cover any additional cost to the state.  The program will automatically terminate in the event that either federal funding or support from the hospitals is modified in any way.

New Private Market Choices for Tennesseans
Insure Tennessee offers several options of coverage for individuals below 138 percent of poverty ($16,100 for an individual and $27,300 for a family of three).  Tennesseans 21 to 64 years old will be offered a choice of the Healthy Incentives Plan or the Volunteer Plan.

The Volunteer Plan would provide a health insurance voucher to participants that would be used to participate in their employer’s health insurance plan.  The voucher, valued at slightly less than the average TennCare per-enrollee cost, can be used to pay for premiums and other out-of-pocket expenses associated with participation in an individual’s employer sponsored private market plan.
Participants in the Healthy Incentives Plan may choose to receive coverage through a redesigned component of the TennCare program, which would introduce Healthy Incentives for Tennesseans (HIT) accounts, modeled after Health Reimbursement Accounts (HRAs), which can be used to pay for a portion of required member cost-sharing.

Payment Reform Efforts
The governor’s Delivery System Reform Initiative lays the foundation for reform by addressing the underlying quality and outcome deficiencies that contribute to growing health care costs and unaffordable insurance coverage.  This initiative creates financial incentives for providers to provide high quality care in an efficient and appropriate manner so as to reduce costs and improve health outcomes. Insure Tennessee builds on this reform initiative by creating new participant incentives that align with the existing provider incentives.  Ultimately, bringing the health care consumer into the equation is critical to successfully controlling cost growth.

Personal Responsibility and Patient Engagement
The voucher program provides a fixed contribution that can be applied to the costs of a person’s private market plan.  All costs incurred in excess of the amount of the voucher are the responsibility of the participant.  This structure empowers individuals to make a choice about which plan is better for their needs and to manage their health care expenses to avoid additional costs.

Newly eligible individuals who choose to participate in the TennCare program and whose incomes are above 100 percent of poverty will be required to pay premiums and copays for services.  All enrollees, including those with incomes below poverty, will have modest pharmacy copays.  TennCare members “earn” contributions into their HIT accounts by performing healthy behaviors.  The account then can be used to cover copayment expenses.

Prepares Participants for Commercial Health Coverage
The design of Insure Tennessee is based on private market principles that provide incentives to participants to engage in their health care by actively managing their health care costs.  Through both programs, Insure Tennessee introduces a commercial health insurance experience which can help Tennesseans prepare for independence from public assistance.

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Marsha Blackburn: Allow insurance shopping across state lines.

I want health care reform. I want it because the system we have simply is not sustainable. The trajectory we are on will bankrupt the nation and leave more and more people without health care if something is not done.

I also want it because I want people to be free from being forced to work jobs they hate simply for the insurance. Too many people feel chained to their desk by the insurance their employer provides for them. For many people the most important aspect of a job is not the work they will do or the pay they will earn but the insurance. Your employer should no more provide your health insurance than they should your homeowners or auto insurance. Your employer should no more provide your health insurance than they should your housing or pay you in script that is only redeemable at the company store.

Most importantly, I want health care reform because someone very close to me who I love very dearly cannot get insurance due to having a preexisting condition. I see the anguish this situation causes and the worry and fear of living without coverage and the threat to the health of this good person.

I am not alone in wanting health care reform. I run in Republican, conservative, and libertarian circles and I have yet to meet a single person who does not want health care reform. We differ on what kind of reform we want. The other side wants to take over 17% of the economy and greatly expand government control; this side wants common-sense reform that will use market forces and empower the individual to achieve the same desirable results.

One of the things our side thinks will go a long way toward reforming health care is to allow individuals to purchase insurance across state lines. In this clip from the Blair House Health Care Summit, Representative Marsha Blackburn argues that robust competition will lower insurance cost. She argues that we should empower patients by giving them the ability to buy insurance products that fit their needs. She says people are tired of being forced to buy insurance they don’t want. She says to avoid the premium acceleration of the type we are seeing in California, Californians should be allowed to go to Oregon where they can buy a policy for 25% less. Watch the clip:


In this article, First Step: Allow shopping across state border, which appears in today’s Tennessean, Representative Blackburn further makes the case for empowering patients through expanding markets and increasing completion.

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