Governor Haslam Announces Insure Tennessee Plan

Monday, December 15, 2014

Governor Bill Haslam on Monday 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. 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 109th General Assembly convenes in January.

“We made the decision in Tennessee nearly two years ago not to expand traditional Medicaid,” Governor 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.

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.

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. 

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.

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.

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.

In June 2012, the Supreme Court ruled that the federal government could not mandate that states expand their Medicaid programs under the Affordable Care Act.  In March 2013, Governor Haslam announced that Tennessee would not expand the traditional Medicaid program but that he would work with the federal government on a plan for Tennessee that would take into consideration program cost, patient engagement, payment reform and health outcomes.  Since that time, he has kept those principles as priorities in working toward the Insure Tennessee plan. Governor 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.

Governor Haslam was joined for the announcement in the Old Supreme Court Chamber of the State Capitol by representatives from a coalition of business, health care and civic organizations who applauded the plan and its impact on Tennessee.


Patten Towers Resident Charged In Wreck That Clogged U.S. 27 On Sunday

A Patten Towers resident is charged in a wreck that clogged the northbound lanes of U.S. 27 on Sunday. Melanie Evette Dobbs, 56, was charged with four counts of reckless endangerment, DUI, failure to maintain lane, violating the Implied Consent Law and failing to have insurance. Police responded to a collision at 9:45 p.m. in which a Dodge Caravan had struck a Kia sedan that ... (click for more)

Latest Hamilton County Jail Booking Report

Here is the latest jail booking report from Hamilton County: ALLEN, KENNETH EUGENE  2705 WOODSIDE DRIVE CHATTANOOGA, 37407  Age at Arrest: 49 years old Arresting Agency: Hamilton County AGGRAVATED ASSAULT/DOMESTIC --- BALLARD, DEANGELO DEMOND  3103 5TH AVE CHATTANOOGA, 37404  Age at Arrest: 34 years old Arresting Agency: Chattanooga AGGRAVATED ... (click for more)

White Coat Syndrome And The Medical System - And Response

Today I wish to share what I am feeling as a patient in our medical system. I am too old to put on airs at this point, and this is too pervasive of a problem for me to contain.   As I enter my AARP years, I am faced with so many medical encounters that evoke all kinds of uncomfortable feelings. I dread physician’s appointments riddled with government regulatory hypocrisy, ... (click for more)

Roy Exum: Knoxville’s Godsend

Back when we were uppity teenagers, the best put-down when a friend started acting crazy was to say to the heathen, “Quit acting like you are from Knoxville!” I don’t know how the term originated but I can say that back in the day it was pretty insulting to be told you were acting like you were from Knoxville. This week I wish that more of us acted like Knoxville. The Knox County ... (click for more)

Sales' Grand Slam Leads Lady Owls To 6-2 Comeback Win

Cheyenne Sales came close to hitting two home runs on Tuesday. She atoned for those close calls a day later with a grand slam in a five-run fourth inning and powered Ooltewah to a 6-2 victory over gritty East Hamilton in District 5-3A softball action at Jim Lovell Field. “That’s the first grand slam I’ve hit this season,” said Sales, who finished with five RBIs. “The pitch ... (click for more)

Red Bank's Kendall Farr Hurls No-Hitter Against Tyner

Kendall Farr was on the money Wednesday afternoon as she hurled a no-hitter and struck out seven as the Red Bank Lionettes blanked Tyner, 10-0, in six innings. Kelsey Peden and Destiny Painter both had two RBIs for the Lionettes while Hannah Wood had a triple and Sami Shrader a double.  Peden also had a double. With Farr improving to 3-2 on the season,, Red Bank finished ... (click for more)