Tennessee

Note: I decided that while the original headline accurately reflected my feelings about this WSJ Op-Ed, it was a bit over the top, so I've changed it to something less crude.

For years, the Patient Protection & Affordable Care Act, generally shorthanded as the ACA or, more colloquially known as "Obamacare," was the top policy target of Republicans and other conservatives.

It seemed as though not a day went by without some right-wing opinion piece being published attacking the ACA for one thing or another. Once in awhile these attacks had some validity, but the vast majority were either completely baseless or grossly exaggerated.

And yet, after the dust settled on the infamous 2017 ACA "repeal/replace" debacle, it seemed as though the GOP had pretty much tired of their relentless assault on the healthcare law. They had failed to repeal it even with control of the White House, Senate, House of Representatives and Supreme Court, and ended up settling for zeroing out of the federal Individual Mandate Penalty as a consolation prize.

Original story published 8/17/23.

Tennessee's preliminary 2024 individual & small group market health insurance rate filings are now available, including actual enrollment numbers, which allows me to run weighted averages for both markets.

For the most part they're fairly straightforward: The individual market is looking at average rate increases of around 4.8%, while the small group market averages around +7.8% overall.

The biggest news here is Humana dropping out of Tennessee's small group market, making Tennessee the 12th state where Humana is doing so in 2024. I'm embarrassed to say it took me taking note of this over a dozen times before remembering that I already wrote about Humana pulling out of the entire employer group market nationally back in February.

UPDATE 10/02/23: Well, all of Tennessee's filings appear to have been approved as is by the state regulatory department...they all say "approved" at the SERFF database and the newest filing versions all predate the original publication of this blog post from 8/17, so I'm concluding the preliminary rates are also the final rates.

Tennessee has posted their approved 2023 individual & small group market health insurance rate filings. For the most part they're fairly straightforward: The individual market is looking at average rate increases of around 8.5% (down a bit from the 9% average via preliminary filings), while the small group market averages around +3.0% overall.

The biggest news here is Bright Health is dropping out of Tennessee's markets. Bright's withdrawal will leave roughly 50,000 Tennessee residents to have to either manually pick a different plan from a different carrier or be automatically "mapped" to a similar plan to what they have now...via a different carrier.

I strongly urge them to do the former.

(Note: Most of this is a shortened version of my post from seven weeks ago...with a pretty important update at the end):

Just over a year ago, Bright HealthCare, which was only founded in 2016, announced that they were dramatically expanding their operations around the U.S.:

Bright HealthCare Expands Affordable Plans in 42 New Markets Next Year Including in Texas, Georgia, Utah and Virginia

Sherman, set the Wayback Machine to 2015:

MICHIGAN: Another One (Mostly) Bites The Dust; 12th CO-OP Drops Off Exchange, May Go Belly-Up

It appears that East Lansing-based Consumers Mutual Insurance of Michigan could wind down operations this year as it is not participating in the state health insurance exchange for 2016.

But officials of Consumers Mutual today are discussing several options that could determine its future status with the state Department of Insurance and Financial Services, said David Eich, marketing and public relations officer with Consumers Mutual.

Consumers Mutual CEO Dennis Litos said: "We are reviewing our situation (financial condition) with DIFS and should conclude on a future direction this week.”

While Eich said he could not disclose the options, he said one is “winding down” the company, which has 28,000 members, including about 6,000 on the exchange.

Tennessee has posted their preliminary 2023 individual & small group market health insurance rate filings. For the most part they're fairly straightforward: The individual market is looking at average rate increases of around 9%, assuming they're approved as is by state regulators, while the small group market averages around +2.9% overall.

A couple of noteworthy items, however:

via the Centers for Medicare & Medicaid Services:

Today, the Centers for Medicare & Medicaid Services (CMS) announced that Tennessee and South Carolina can begin offering Medicaid and Children’s Health Insurance Program (CHIP) coverage for 12 months postpartum to an estimated 22,000 and 16,000 pregnant and postpartum individuals, respectively, through a new state plan opportunity made available by the American Rescue Plan.

Tennessee and South Carolina join Louisiana, Michigan, Virginia, New Jersey, and Illinois in extending Medicaid and CHIP coverage from 60 days to 12 months postpartum. CMS is also working with another nine states and the District of Columbia to extend postpartum coverage for 12 months after pregnancy, including California, Indiana, Kentucky, Maine, Minnesota, Oregon, New Mexico, Pennsylvania, and West Virginia. As a result of these efforts, as many as 720,000 pregnant and postpartum individuals across the United States could be guaranteed Medicaid and CHIP coverage for 12 months after pregnancy. 

Tennessee's proposed 2022 rate filings are pretty straightforward...no new entrants or drop-outs among the carriers in either the individual or small group markets, and the SERFF filings actually include the enrollment totals for all of them in both markets (a rarity these days!).

The weighted average premium increase for unsubsidized enrollees is 4.4% for indy market enrollees and 8.9% on the small group market.

UPDATE 10/26/21: Well, it looks like all of the requested rates have been approved by the TN regulators without any changes on either market.

I'm presenting snippets of these stories without much comment because...really, there's not much more for me to add:

Via Brett Kelman of the Nashville Tennessean, two days ago:

Tennessee fires top vaccine official as COVID-19 shows signs of new spread

The Tennessee state government on Monday fired its top vaccination official, becoming the latest of about two dozen states to lose years of institutional knowledge about vaccines in the midst of the coronavirus pandemic.

The termination comes as the virus shows new signs of spread in Tennessee, and the more-transmissible delta variant surfaces in greater numbers.

Dr. Michelle Fiscus, the medical director for vaccine-preventable diseases and immunization programs at the Tennessee Department of Health, said she was fired on Monday afternoon and provided a copy of her termination letter. It provides no explanation for her termination.

I've once again relaunched my project from last fall to track Medicaid enrollment (both standard and expansion alike) on a monthly basis for every state dating back to the ACA being signed into law.

For the various enrollment data, I'm using data from Medicaid.gov's Medicaid Enrollment Data Collected Through MBES reports. Unfortunately, they've only published enrollment data through December 2020. In most states I've been able to get more recent enrollment data from state websites and other sources. For Tennessee, I'm using estimates based on raw data from the Tennessee Division of TennCare for January 2021 and beyond.

Tennessee is one of 12 states which still hasn't expanded Medicaid eligibility under the ACA (13 if you include Missouri, whose voters expanded the program last year...but which the state legislature refuses to fund).