By Eric Schelzig, Associated Press
NASHVILLE, Tenn. — The growing demand for medical care that is expected to accompany the full implementation of the federal health care law in January is adding urgency to a Tennessee debate over whether nurses should be allowed to provide more independent care to patients.
Nurses currently see patients in a variety of settings ranging from private practices to retail clinics, but they want to remove a layer of supervision from physicians. Doctors’ groups oppose giving nurses more independence. A legislative fight is on the horizon.
“We’re in the ring,” said Gary Zelizer, who lobbies on behalf of doctors for the Tennessee Medical Association. “We’re warming up, but it’s coming.”
Sharon Adkins, the executive director of the Tennessee Nurses Association, said in an email that her group is “in full support of removing practice barriers and support full practice authority for all health care professionals.”
Adkins said advance practice registered nurses, or APRNs, “give as good or in some cases better care than physicians.”
After winning approval in a House committee, legislation to prohibit Tennessee insurance companies from participating in health care exchanges set under the Affordable Care Act has failed in the Senate.
The bill (SB666) got only one vote in the Senate Commerce Committee — that of the sponsor, Sen. Dolores Gresham, R-Somerville — after critical commentary from insurance company representatives and state officials. Gov. Bill Haslam said after the House vote that he opposes the bill.
The measure earlier won 6-2 approval in a House panel where sponsor Rep. Vance Dennis, R-Savannah, said it would exploit “the Achilles’ heel of Obamacare.” Since states control insurance companies, sponsors argued legislators can block the federal law by prohibiting state-licensed insurance firms from participating in the program.
Critics said that the result would likely be authorization from the federal government for out-of-state companies to sell insurance within Tennessee instead.
The two Democratic senators on the Commerce Committee voted against the bill. All Republicans on the panel — except Gresham — either abstained or were not present when the vote was taken.
Republican Gov. Bill Haslam has washed his hands of choosing what benefits will be required in basic health insurance plans sold to individual Tennesseans and small businesses under the federal health care law, reports Andy Sher. In deciding not to act, Haslam has turned over to the Obama administration a decision that will affect hundreds of thousands of people and small companies.
A number of Republican and some Democratic governors in other states have done the same. Unlike many, Haslam hasn’t shared anything with the general public, instead serving notice of his decision in a letter dated Sunday to U.S. Health and Human Services Secretary Katherine Sebelius.
In it, the governor criticizes the 2010 Affordable Care Act and says that after months of reviewing what he complained was vague federal guidance, “I have decided not to select such a plan for Tennessee.”
The deadline for states on how they will define “essential health benefits” was Monday. But some observers question how hard a deadline that actually is.
A copy of Haslam’s letter to Sebelius and other HHS officials was obtained by the Times Free Press.
In its efforts to extend health coverage to most Americans, the law requires private health insurers selling policies to individuals and smaller businesses to begin offering in 2014 the “essential health benefits” package comprising 10 categories.
The list includes hospitalization, emergency care, maternal care and prescription drugs.
Federal officials limited choice of so-called “benchmark” benefit plans to one of several options. They include selecting one of the three largest plans covering small businesses, state employee plans, in-state federal employee plans or the largest health maintenance plan serving commercial customers.
According to a list of “frequently asked questions,” HHS last year said if states don’t select an essential health benefits plan, the “default” benchmark plan “would be the largest small group market product in the State’s small group market.”
That would appear to be in Tennessee the small group plan benefits offered by Chattanooga-based BlueCross BlueShield of Tennessee, although HHS qualifies that by saying anything lacking could be picked up from the next largest plan. (Note: See also The Tennessean, which says the BlueCross plan will probably be the benchmark.)
Haslam spokesman David Smith and state Commerce and Insurance Department spokesman Christopher Garrett refused to comment directly on BlueCross, saying only the decision is now up to the federal government.
Smith said Haslam still hasn’t decided whether to participate in creating the law’s anticipated health care exchanges that will give hundreds of thousands of uninsured Tennesseans the opportunity to find coverage. The deadline for that, which could be left to the federal government too, is Nov. 17.
Haslam also hasn’t decided on another provision that would extend Medicaid coverage to as many as 300,000 or so low-income Tennesseans. The Medicaid program in Tennessee is operated as TennCare. The essential health benefits plan would control what type of plans any would-be new enrollees see.
Republican Brad Staats hopes to channel public discontent with the federal health care reform law into a voter uprising to defeat Democratic Congressman Jim Cooper, who supported it. But The Tennessean reports he “could have a hard time” in one of the state’s last Democratic strongholds.” “People seem to be in a better mood than they were two years ago,” said Cooper, who survived the 2010 midterm elections that gave Republicans control of the House of Representatives and a 7-2 edge in the state’s congressional delegation.
Staats, who owns two security businesses, has never run for office before, while Cooper has served 11 terms in two different stints in Congress. The challenger’s campaign war chest, which he estimated at $55,000, is a small fraction of Cooper’s, which held more than $800,000 in July, the last time they filed reports.
Cooper said his opponent has been “almost invisible” so far, though he said he takes nothing for granted in a campaign. Political analyst Pat Nolan said he expects Cooper and everyone else in Tennessee’s delegation to be re-elected.
But Staats, while acknowledging his challenges, said the choice for voters in the5th Congressional District is clear. He said Cooper has tied himself to the health care reform law, which Staats describes as a vehicle that will drive the nation into a financial ditch.
“Any government that has ever reached 30 percent expenditure of their GDP (gross domestic product) has gone bankrupt,” he said. “With Obamacare, we will reach 30 percent expenditure within 18 months. That means America is bankrupt at that point. So, yes, I have a real problem with Obamacare, as all Americans, if they knew, should.”
The Diocese of Nashville and seven other local Catholic institutions filed suit against the federal government Wednesday, challenging a mandate that requires them to offer contraceptive coverage and morning-after pills as part of their employees’ health insurance.
Further from the Tennessean’s report: The suit claims the contraceptive mandate required by the nation’s health-care overhaul is “in violation of the centuries’ old teachings of the Catholic Church.”
“Plaintiff’s genuinely held religious beliefs dictate that it is unacceptable to support, pay for, provide, and/or facilitate abortion, sterilization, or the use of contraceptives as these services are contrary to Catholic Doctrine,” the suit said.
Joining the lawsuit are Father Ryan High School, Pope John Paul II High School, Catholic Charities and Aquinas College. Also included are Mary Queen of Angels, Villa Maria Manor and St. Mary Villa. Each is incorporated and operates independently.
The suit, filed in the U.S. District Court in Middle Tennessee, joins a growing list of similar legal actions challenging the reproductive health-care requirements of the Affordable Care Act since the rules were first written in August 2011. At least 28 suits have been filed so far on behalf of 88 religious schools, hospitals and other entities, according to the Washington, D.C.-based Becket Fund for Religious Liberty.
News release from U.S. Department of Health and Human Services:
As a result of the Affordable Care Act – the health care law enacted in 2010 – seniors and people with disabilities in Tennessee have saved $91.2 million on prescription drugs since the law was enacted, Health and Human Services (HHS) Secretary Kathleen Sebelius announced today.
Seniors in Tennessee saved an average of $550 in the Medicare prescription drug coverage gap known as the “donut hole” in 2012. Nationwide, nearly 5.4 million seniors and people with disabilities have saved over $4.1 billion on prescription drugs.
In addition, during the first seven months of 2012, the new health care law has helped 611,511 people with original Medicare in Tennessee get at least one preventive service at no cost to them.
“The health care law has saved people with Medicare over $4.1 billion on prescription drugs, and given millions access to cancer screenings, mammograms and other preventive services for free,” said Secretary Sebelius. “Medicare is stronger thanks to the health care law, saving people money and offering new benefits at no cost to seniors.”
Tennessee hospitals say they’re going to bleed if Gov. Bill Haslam and the General Assembly don’t agree to expand TennCare under the federal Affordable Care Act, reports Andy Sher. “We’re going to have to sit down with the administration to see what we can do about it,” said Craig Becker, Tennessee Hospital Association president. “It’s pretty clear that that is absolutely our Achilles’ heel right now.”
While the U.S. Supreme Court last week upheld most of the health care law, justices struck down a mandate for states to expand their Medicaid programs. The court gave states the choice whether to opt into the Medicaid expansion in 2014.
Haslam and Georgia Gov. Nathan Deal, both Republicans, said they haven’t decided whether to expand Medicaid under a law they oppose. Tennessee’s Medicaid program is called TennCare.
But Florida’s Republican governor, Rick Scott, told Fox News on Friday he won’t join the expansion. Republicans in at least three other states also are considering opting out, according to other news accounts.
Speaking to reporters on Friday, Haslam said, “We don’t really know what we’re going to do … but the cost impact to the state is very significant.”
Haslam and Finance Commissioner Mark Emkes have said the state has other pressing needs in areas like education. The governor said he hopes the GOP’s presumptive presidential nominee, Mitt Romney, is elected.
Romney has vowed to repeal the law, President Barack Obama’s signature legislative achievement.
But the hospital association and its members are a potent lobbying force at the state Capitol.
Becker said hospitals are worried because the Affordable Care Act dramatically would reduce special payments to hospitals that treat large numbers of Medicaid or uninsured patients.
The law assumes 30 million people nationwide will get coverage either through Medicaid or the individual mandate. The special payments will shrink $1 billion by 2019, Becker said.
“It would be pretty bad,” Becker said, noting many rural hospitals could be hard hit.
He noted that while hospitals are eager for the Medicaid expansion, “we’re obviously aware it has to be done within the restraints of the budget.”
Tennessee Justice Center Executive Director Gordon Bonnyman said Tennessee’s not participating in the Medicaid expansion would lead to “the collapse of a good portion of the hospital industry” in rural areas. The center is an advocacy group that supports the health care law.
Not only that, he said, “but the dominoes would be really significant. You just look at rural communities where in many counties the largest employer, or one of the top two or three, [is] the hospital. And when that closes, obviously that has a huge economic impact.”
The law would extend health care coverage to 16 million Americans by expanding Medicaid to cover people with incomes of up to 138 percent of the federal poverty level — about $25,571 for a family of three last year. Other low- and middle-income people would fall under the individual mandate, which requires them to obtain private coverage and offers federal aid to help with the cost.
The law assumes the additional coverage will reduce the need for the special payments to hospitals.
A nod toward states rights within the U.S. Supreme Court’s health care decision Thursday raises the possibility that Tennessee’s state government may not need multiple millions of dollars stashed away in the state budget to cover potential costs of implementing the federal health care law.
While the court held that most of the Affordable Health Care Act constitutional, it declared that a provision requiring states to expand Medicaid coverage – known as TennCare in Tennessee – is invalid.
The $32 billion state budget for the fiscal year beginning July 1, enacted by the Legislature in May, leaves about $225 million in surplus revenue from the current year unspent. Gov. Bill Haslam and Finance Commissioner Mark Emkes said they wanted the money on standby in case it is needed to cover potentially increased costs for states because of the federal law.
Though cautioning that they still need to fully review the ramifications of the Supreme Court decision, Haslam and Emkes said Thursday that it appears the prospective mandate – which Emkes had estimated to run $200 million per year or more – will not materialize.
WASHINGTON (AP) — THE RULING:
The Supreme Court upheld the constitutionality of President Barack Obama’s health care law, including the most disputed part: the mandate that virtually all Americans have health insurance or pay a fine. The mandate was upheld under the federal government’s power to levy taxes.
The ruling put some limits on the law’s plan to expand the Medicaid insurance program for the poor, a joint effort of the federal government and states. It says the U.S. government cannot threaten to withhold a state’s entire Medicaid allotment if it doesn’t participate in the expansion.
Chief Justice John Roberts sided with the court’s four liberal justices — Stephen Breyer, Ruth Bader Ginsburg, Elena Kagan and Sonia Sotomayor — to form the 5-4 majority.
The decision affects nearly every American and marks a major milepost in a century of efforts to make health care available to all. The law is President Barack Obama’s signature legislative achievement and perhaps the most polarizing issue of his re-election campaign. His Republican rival Mitt Romney and GOP lawmakers have promised to repeal Obamacare.
The 2010 health care law will continue phasing in as planned. It’s expected to bring coverage to about 30 million uninsured people, so that more than 9 in 10 eligible Americans will be covered.
Some parts are already in effect: Young adults can stay on their parents’ insurance up to age 26. Insurers can’t deny coverage to children with health problems. Limits on how much policies will pay out to each person over a lifetime are eliminated. Hundreds of older people already are saving money through improved Medicare prescription benefits. And co-payments for preventive care for all ages have been eliminated.
Starting in 2014, almost everyone will be required to be insured or pay a fine. There are subsidies to help people who can’t afford coverage. Most employers will face fines if they don’t offer coverage for their workers. Newly created insurance markets will make it easier for individuals and small businesses to buy affordable coverage. And Medicaid will be expanded to cover more low-income people.
Insurers will be prohibited from denying coverage to people with medical problems or charging those people more. They won’t be able to charge women more, either. During the transition to 2014, a special program for people with pre-existing health problems helps these people get coverage.
An assortment of tax increases, health industry fees and Medicare cuts will help pay for the changes.
IS THE ISSUE SETTLED NOW?
Not necessarily. Although the court found it constitutional, the health care law still could be changed by Congress. Romney and Republican congressional candidates are campaigning on promises to repeal it if elected in November.
Some parts of the law are popular, but others — especially the mandate that virtually everyone have insurance coverage — are not.
Also, an estimated 26 million people will remain without health coverage once the law is fully implemented, including illegal immigrants, people who don’t sign up and elect to face the fine instead, and those who can’t afford it even with the subsidies.
Gov. Bill Haslam says Tennessee is ready for Thursday’s expected Supreme Court ruling on the federal healthcare overhaul, no matter what the Supreme Court decides, reports WPLN, beecause the state has been carefully keeping its options open for the last year. If the federal law stands, the state’s main responsibility would be setting up an insurance exchange. It’d be a state-run website like Expedia where people could comparison-shop for health insurance. The state’s been using federal grants to pay for planning its exchange, so Haslam says it’s ready, whichever way the Supreme Court decides.
“You know, if they don’t strike it down, we’re on that path. Obviously I’m hoping that they do, because I think it saves the state money long-term, and that’ll make things easier. But I think we’ve played this right in the sense of being ready either way it goes.”