By Ronald W. Weathersby
Whether or not we agree with the Patient Protection and Affordable Care Act (Obamacare), it is on its way to Tennessee beginning Oct. 1.
Although there has been stringent opposition to the program since it was approved in 2010, and the Supreme Court upheld its constitutionality last year, many political opponents of the President have fought tirelessly to defund and discredit it. After collecting over $9 million in grants for research, planning, information technology development, and implementation of its Health Insurance Marketplace, Tennessee chose to opt out of a state-based health care exchange. Therefore the federal government will operate the exchange.
834,204 (94%) of Tennessee’s uninsured and eligible population may have qualified for Medicaid if Tennessee had taken advantage of the new opportunity. Therefore the federal government plans to open the Federally Facilitated Marketplace on Oct. 1 in Tennessee and across the country, which will begin an open enrollment period for coverage that will be effective next Jan. 1.
Beginning Oct 1, the Health Insurance Marketplace will enable Tennesseans to compare qualified health plans, get answers to questions, and out if they are eligible for lower costs for private insurance or health programs like Medicaid and the Children’s Health Insurance Program (CHIP), and enroll in health coverage.
This year, Tennessee will spend forty-two percent of the state’s budget, $24.4 billion, on health care including Medicaid. Several estimates say that Tennessee’s current program of providing health care, TennCare is not sustainable. The governor recently warned that of the projected $369 million in new revenues for his 2013-14 budget, TennCare will swallow $350 million or 95 percent of the money.
Part of Obamacare encourages states to enroll more people in their Medicaid programs and the federal government has promised to pay the full cost of expansion for the first three years and 90 percent thereafter. Tennessee would get $418 million extra in the first year and $1 billion in the second year. The state’s cost would be about $100 million a year when the government share drops to 90 percent.
That being said, the following is information about the new plan set to open in Tennessee on Oct. 1 as prescribed by federal law: Starting Oct. 1, individuals will be able to file a Marketplace application online at www.healthcare.gov, by phone at 1-800-318-2596, by mail or in person.
Coverage starts as soon as Jan. 1, 2014.
Open enrollment in the Health Insurance Marketplace begins Oct. 1 and will run through March 31. Right now, families and small business owners can visit these websites to start getting ready for open enrollment. The Marketplace will automatically tell those inquiring if they qualify for discounts or participation in state programs based on income. Health plans will be available to view online and will include a comparison tool.
If businesses have fewer than 50 full-time equivalent employees, they are not subject to the Employer Shared Responsibility parts of the law. They may use SHOP to offer coverage for employees. If businesses have 50 or more FTEs, they may have to make an Employer Shared Responsibility Payment if at least one of those full-time employees gets lower costs on their monthly premiums when buying insurance in the Marketplace.
More Obamacare facts: New coverage options for young adults. Under Obamacare, if your plan covers children, you can now add or keep your children on your health insurance policy until they turn 26 years old..
Ending discrimination for pre-existing conditions: As many as 2,764,651 non-elderly Tennesseans have some type of pre-existing health condition, including 352,794 children. Today, insurers can no longer deny coverage to children because of pre-existing conditions. In 2014, health insurers will no longer be able to charge more or deny coverage to anyone because of a pre-existing condition.
Providing better value for your premium dollar through the 80/20 Rule: Health insurance companies now have to spend at least 80 of your premium dollar on health care or improvements to care, or provide you a refund. Tennessee residents with private insurance coverage received $5,618,993 in refunds this year.
Scrutinizing unreasonable premium increases: Insurance companies are required to publicly justify their actions if they want to raise rates by 10 percent or more.
Removing lifetime limits on health benefits: The law bans insurance companies from imposing lifetime dollar limits on health benefits. 2,042,000 people in Tennessee are free from worrying about lifetime limits on coverage. The law also restricts the use of annual limits and bans them completely in 2014.
Covering preventive services with no deductible or co-pay: Obamacare requires many insurance plans to provide coverage without cost sharing to enrollees for a variety of preventive health services. Already 1.4 million Tennesseans with private health insurance gained preventive service coverage with no cost-sharing.
Increasing support for community health centers: Obamacare increases the funding available to community health centers in Tennessee where 26 health centers operate 190 sites, providing preventive and primary health care services to 372,360 people.
Investing in the primary care workforce: The numbers of clinicians in the National Health Service Corps are at all-time highs last year there were 175 Corps clinicians providing primary care services in Tennessee, compared to 94 in 2008.
Preventing illness and promoting health: As of March 2012, Tennessee had received $15,100,000 in grants from the Prevention and Public Health Fund created by Obamacare.
Making prescription drugs affordable for seniors: In Tennessee, people with Medicare saved nearly $148 million on prescription drugs because of Obamacare. In 2012 alone, 80,991 individuals in Tennessee saved over $50 million, or an average of $617 per beneficiary.
Covering preventive services with no deductible or co-pay with no deductibles or co-pays, cost is no longer a barrier for seniors and people with disabilities who want to stay healthy by detecting and treating health problems early.