Amid ACA 'chaos,' Tennesseans push lawmakers to act
With Tennessee's healthcare.gov market for 2018 at a breaking point, some are ramping up calls on federal lawmakers to take action to make sure people aren't without health insurance options next year.
Since Humana’s decision last week to leave the federally run exchange, the Tri-Cities area is the only region of the state that will have two insurers from which residents can choose in 2018. The Greater Knoxville area will have none.
Yet, without progress on repeal-and-replace or repair of the Affordable Care Act in Washington, D.C., the exchange's existence in the state beyond 2017 will depend on business decisions by insurers BlueCross BlueShield of Tennessee and Cigna.
And there could come a point at which there is one insurer — or none.
If Cigna leaves, Memphis and Nashville will have no on-exchange option. If BCBST leaves, then dozens of counties will have no insurer on the exchange from which to buy.
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“They don’t even have to change legislation — they are creating chaos. They are playing games while real Tennesseans are sitting around their kitchen tables worried about their health care," said Michele Johnson, executive director of the Tennessee Justice Center, which advocates for health care and coverage. "It’s time for them to govern.”
The number of people who enrolled in 2017 plans on the federally run exchange — the market that offers tax subsidies to offset premiums for more than 80 percent of people — is about 3.5 percent of Tennesseans. The number that is eligible is roughly twice that.
It’s a small slice of the state — most people get employer-sponsored coverage — but many rely on the exchange and its tax credits to buy coverage. For some with pre-existing conditions, the Affordable Care Act gave them the opportunity to get coverage.
Even one decision from BCBST or Cigna will propel people into a situation similar to Christa Dansereau, a married mother of three in Knoxville who is wondering where she's going to buy insurance in 2018 since Humana left the exchange.
She works at a preschool and her husband is a real estate agent, and neither has access to employer-sponsored coverage. With three kids, one with a life-threatening nut allergy, going without coverage is not an option.
“I am seriously considering changing jobs and looking only at companies that offer health insurance. It is a big life decision," Dansereau said. "It is not one I want to do because I like to teach preschool, but I have to put my family first."
Her family has shopped for private insurance for years and the ACA brought some relief, she said, to the years of high deductibles and being concerned about pre-existing diseases. The increases in premiums and deductibles in recent years didn't impact Dansereau's family because the coverage was better than what the family had before the ACA.
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"It wasn’t until we were able to shop on the marketplace we didn’t have to be concerned every time we went to the doctor," she said.
As days turn to weeks without a repair or replacement plan from Republican lawmakers in Washington — who campaigned on repeal-and-replace — insurers are getting cold feet and shoppers are anxious about whether they will have insurance options next year. House Speaker Paul Ryan, R-Wis., said a proposal would emerge from congressional Republicans as early as this week.
Even action in the coming weeks might not keep insurers on the market. If lawmakers delay enacting a replacement plan until after midterm elections in 2018, people could be left with no options on the market, something many, including U.S. Sen. Lamar Alexander, R-Tenn., have repeatedly warned.
Alexander urged Congress to heed the developments in Tennessee as a reason to take swift action to keep insurers on the exchange through 2018.
Activists for the ACA will hold rallies or panels around the state this week as the impact of federal uncertainty begins to take hold.
More than two-thirds of Tennesseans oppose repealing the Affordable Care Act, according to a poll by Public Policy Polling in January commissioned by the Alliance of Healthcare Security, a group that supports the federal law.
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Proponents of the ACA are expected at an "alternative town hall" outside U.S. Rep. Marsha Blackburn's town hall in Fairview on Tuesday. Blackburn, R-Tenn., is expecting ACA questions at the one-hour event, according to a spokeswoman.
The "Save My Care" national bus tour will make a stop in Nashville on Wednesday at Centennial Park. Protesters are expected to walk to the Nashville offices of Alexander and U.S. Sen. Bob Corker.
Dr. Thomas Phelps is trying to get his concerns about the chaos in Tennessee heard by the state's federal lawmakers — deciding to give Twitter a shot.
“I’m worried for my patients because the chaos caused by the Republican rush to repeal the Affordable Care Act is already harming Tennesseans, like causing Humana to leave the market," Phelps said in a statement. “So I’m reaching out the only way President Trump, Sen. Alexander, and Sen. Corker seem inclined to communicate: via Twitter.”
On Thursday, there will be a town hall in Knoxville as well as a forum in Chattanooga.
Dansereau said she's very frustrated that she may have to resort to finding a new job.
"The two major problems: being able to have health care and also being afraid of pre-exiting conditions — having those be the most important of my job search feels ridiculous," Dansereau said. "It is a (situation) that is going to impact a lot more people than just me and my family.”
Reach Holly Fletcher at hfletcher@tennessean.com or 615-259-8287 and on Twitter @hollyfletcher.