Should the state of Tennessee establish its own health insurance exchange or tap into the national, federal exchange? That is the question being considered by the State of Tennessee under a $1 million grant from the federal government.
I attended the "kick-off" meeting on October 22, 2010 for Tennessee's evaluation of the whole health insurance exchange issue. About 200 of us gathered in the central Nashville library to hear about the proposal TN had made for planning grant funds from the Feds to evaluate the health insurance exchange issue in more detail.
I came away with a few thoughts and observations:
Most likely, if the State of TN moves forward to establish its own exchange, it will do so in an incremental manner. At first, I thought this was unnecessarily cautious. However, there can be a multitude of "unintended consequences" of establishing exchanges. For example, insurance companies could decide to "exit" TN if our requirements in exchanges are too rigorous.If many insurance companies exit, we would only be left with a few choices, and that may not be a good thing. So caution may be good.
The exchange will have more sweeping responsibilities than I realized. In addition to the more well-known responsibilities of defining and certifying qualified health plans for the exchange and offering web portals for both individual and small group plans, responsibilities also include:
- Determining eligibility and enrolling applicants in TennCare, CHIP, and Federal health insurance subsidies/tax credit programs for insurance through the exchange;
- Verifying exchange and subsidy eligibility for those whose employer-sponsored health insurance is "unaffordable";
- Administering the exemption process for the individual mandate requirements;
- Operating a navigator service offering consumer assistance programs.responsibilities.
Tennessee is looking for experts to help guide them through this process. They are establishing at least two "Technical Advisory Groups" or "TAGs" -- one for underwriters, actuaries and the like and one for brokers/agents. More TAGs will be established if the decision is to move forward to establish an exchange.
Of course, all of this gets complicated in TN because we will have a new Governor in January 2011. Both leading candidates for Governor have been briefed on these issues and are kept up to date on developments. I assume that State staff will be briefing the newly elected Governor in January. However, TN does not need to make a decision on whether or not to establish an exchange until next summer.
To keep up with the evaluation of exchanges in TN, go to www.tn.gov/nationalhealthreform. All documents will be posted at this site. In addition, MBGH will integrate these documents and TN exchange developments on our members Healthcare Reform Resource Center. So check our website regularly for updates.
Read the discussion paper on establishing an exchange in TN.
View the powerpoint presentation for the October 22, 2010 kickoff meeting.
Learn about exchanges in MA, UT, & CA to understand what might happen in TN