McPeak: 'Timing is critical' for Congress to stabilize individual health insurance

Tennessee Insurance Commissioner Julie Mix McPeak wants Congress to take action by the end of March to bring stability into the individual insurance market because Tennessee is on the cusp of having swaths of counties with no insurer.

McPeak is concerned that the repeal the Affordable Care Act without a replacement or clear transition process will push more insurers from the state. Seventy-three counties already have only one insurer selling individual plans.

Right now, the insurers on the exchange, BlueCross BlueShield of Tennessee, Cigna and Humana, are calculating whether they want to participate in 2018, McPeak said. Nationally, insurers are waffling about a presence in 2018, citing the lack of clarity about reform.

“Insurance markets do not respond well to uncertainty” and the individual market should be addressed separately from reforms to other types of coverage, such as employer sponsored or Medicaid, McPeak testified before the Senate health committee.

“That’s where the real need is and the timing is critical,” she said.

McPeak traveled to Washington D.C. at the request of Sen. Lamar Alexander, R-Tenn., on Feb. 1 alongside former Kentucky Governor Steve Beshear, Janet Trautwein, CEO of National Association of Health Underwriters, and Marilyn Tavenner, president and CEO of America’s Health Insurance Plans.

Alexander wants Democrats and Republicans — who he said fight like Hatfields and McCoys over Obamacare — to work on an immediate salve to the individual market so people are not left with no options in 2018. 

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“We may reach a place in 2018 where people have a subsidy but have no insurance to buy,” Alexander said.

Those testifying urged Congress to act expeditiously and transparently on ways to reassure insurers there would be stability in 2018.

McPeak said in an emailed comment after the testimony that Congress should “take immediate action on the common issues mentioned during testimony today by all witnesses in order to stabilize the market so there will be coverage next year – then discuss repeal/replace.”

Both Democrats and Republicans will have to “approve some things we might” typically support, Alexander said, stressing the importance of narrowing in on the ensuring stability in the individual market – where a sliver of Americans buy insurance. Most Tennesseans get insurance from employers – a scenario that is reflective of the most of the country.

“When people need help, we’re supposed to provide it,” Alexander said.

McPeak wants states to have greater flexibility and control of what type of plans are offered and when people can buy them. Specifically, states should be able to craft their own essential benefits and oversee grace periods and special enrollment periods.

Sen. Lisa Murkowski, R-Alaska, wants state commissioners to weigh in on what administrative actions would help them maintain an active, competitive market for 2018.

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State officials, Murkowski said, can tell Congress how to “be the rescue team they need to be more readily.”

Tennessee emerged as a flash point in the argument over Obamacare in the early fall when McPeak categorized the market as "very near collapse” because of tenuous competition in much of the state. About a month later, BlueCross BlueShield of Tennessee changed course and stopped selling individual plans in Knoxville, Memphis and Nashville – increasing the number of Tennesseans who have only one insurer option.

There is a steady stream of grassroots efforts to tell lawmakers in Washington, D.C. about the importance of sustaining the existing market while an ACA replacement, or a series of repairs, is considered.

There are a variety of citizen-led movements that have activated in last month or so that are trying to amplify the voices of people who want stability in health care reform, and keeping tenets of the ACA.

A group of protesters rallied outside of U.S. Rep. Scott DesJarlais’ office in Murfreesboro on Jan. 28, while a separate group gathered in front of Monroe Carell Jr. Children's Hospital at Vanderbilt on Jan. 31. 

Kathleen Ferris protested at DesJarlais’ office to raise awareness of those, such as her son, who have benefited from being able to buy plans.

While McPeak was in a two-and-a-half hour hearing in Washington, Tennesseans from four cities were livestreaming their testimony about how coverage under the ACA has impacted their lives via Protect My Care. The website, which is a tool used in Tennessee by local affiliates of the Alliance for Health Care Security, is led by a group of Tennesseans who are frustrated by efforts to get federal lawmakers to listen to ordinary voices, said Jackie Shrago, who works as a special projects coordinator for the Tennessee Health Care Campaign.

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McPeak said via email that there would need to be state and federal legislative action for Tennessee to establish a public insurance option on the individual market alongside commercial carriers – an idea proposed in the hearing by Sen. Sheldon Whitehouse, D-Rhode Island.

Reach Holly Fletcher at hfletcher@tennessean.com or 615-259-8287 and on Twitter @hollyfletcher.