INFORMATIONAL WEBSITE OF
STATE SENATOR RAYMOND FINNEY,
who proudly represents the beautiful Great Smoky Mountains region of Tennessee--
the Eighth Senatorial District (Blount and Sevier Counties)...

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E-NEWSLETTER OF CURRENT EVENTS
Posted on May 10, May 11, and June 12, 2006

NOTE: This health insurance plan is under development. Conditions and provisions may change in the future. Any person interested in coverage should call the toll-free number listed below and seek to be advised in a timely manner of changing conditions.

COVER TENNESSEE-- A WORK IN PROGRESS (NOW SIGNED INTO LAW):

STATUS ON MAY 10, 2006:

INTRODUCTION: The 104th General Assembly has been marked by turmoil in healthcare delivery to indigent, uninsured, and unisurable Tennesseans. The first controversy was disenrollment of TennCare recipients to balance the budget. Seemingly as an afterthought, a healthcare Safety Net program was proposed. Now, there is proposed a Cover Tennessee program.

Cover Tennessee was suggested in Governor Bredesen's State of the Health speech in February of 2006. This program, a bundling of several different programs (some tested and some new), is proposed to provide slight to more comprehensive healthcare coverage for Tennesseans, especially uninsured and uninsurable patients.

At this date, the governor's proposal seems longer on promise than on on details. For every question answered, other questions seem to appear. All legislators are anxious to provide healthcare coverage for Tennesseans in need, but we do not want a second TennCare fiasco.

On May 10, 2006, Commissioner of Finance and Administration Dave Goetz addressed the State Senate. He provided the following table that summarizes the administration's thoughts on the COVER TENNESSEE program as of this date:

NAME OF PROGRAM AND BRIEF DESCRIPTION REQUIRED FUNDS SOURCE OF FUNDS
CoverKids: a program to insure at least some of Tennessee's 150,000 uninsured children Year 1: $6.9-million
Year 2: $21.2-million
Year 3: $35-million
TOTAL (three years): $63.1-million		 Funding comes from recurring TennCare savings
AccessTN: re-establishes and modernizes the old T-CHIP program; provides insurance for uninsurable Tennesseans Funding comes from premiums from the patient, State appropriations, and insurance companies' assessment. Total cost to the State is estimated to be $3.8-million for the first year and, then, $10-million each following year. The administration propposes providing a recurring subsidy of $5-million dollars for a premium assistance program.
TOTAL (three years): $23.8-million		 Funding comes from recurring Safety Net funds
CoverTN: a new program provides uninsured Tennesseans with affordable and portable insurance, but with limited benefits Year 1: $9-million
Year 2: $34-million
Year 3: $57-million
TOTAL (three years): $100-million		 Funding comes from TennCare clawback savings-- $34-million in recurring funds
CoverRx: a continuation of the present Safety Net drug assistance program Up to $23-million for the first year; then, $16.8-million for each following year
TOTAL (three years): $56.6-million		 Funding comes from Safety Net recurring funds
ProjectDiabetes: a program designed at education, prevention, and treatment of diabetes mellitus, consisting of two parts: (1) Seed money for at least ten Tennessee high schools to participate in a national clinical trial being conducted by the National Institutes of Health on promoting better health; and (2) Creation of a grant program, wherein clinics and healthcare service providers throughout the State can apply for State grants for the treatment of pre-diabetes and diabetes mellitus. $15-million each year
TOTAL (three years): $45-million		 Funding comes from Safety Net recurring funds
Coordinated School Health Program: utilization of the existing Coordinated School Health Program (CSHP) to develop programs to support healthy lifestyles and to expand diabetes mellitus programs currently operating through the CSHP. $15-million
TOTAL (three years): $15-million		 Funding comes from new, recurring revenues


STATUS ON MAY 11, 2006:

Read the text of the amendment which will rewrite the bill ("make the bill"), as follows:

  • GO TO the General Assembly's Website.
  • On the left margin of the home page, click on the LEGISLATION prompt.
  • On the page that then opens, type the Senate bill number in the TOP data entry box, and enter. The bill number is: SB3895.
  • On the page that then opens, there are several options. The primary amendment under consideration is SENATE AMENDMENT 15. Other amendments may be introduced and considered.

UPDATE:
  • Senate bill 3895 (SB3895) passed by a 30 - 1 vote on May 17, 2006. My vote: Aye.
  • The companion House bill 4011 (HB4011) passed by a 78 - 19 vote on May 23, 2006.
  • The governor signed the bill into law on June 5, 2006.



STATUS ON JUNE 12, 2006:

SB3895/HB4011 enacts the latest efforts of the Tennessee government-- Cover Tennessee-- to make healthcare more accessible and affordable for Tennesseans. A summary of this multi-part plan follows:

CoverKids:
Summary of program: CoverKids utilizes shared funding of the federal and state governments to extend healthcare coverage to uninsured Tennessee children.
Household income eligibility requirement: Below 250% of the federal poverty level,* with buy-in available for above 250% of the federal poverty level.*
Age requirement: 17 years of age and younger; pregnant women of any age.
Tennessee residency requirement: Yes.
"Go bare" requirement:* None.
Employment requirement: Not applicable.
Pre-existing condition clauses: None.
Pricing information: Reduced co-pays.
Benefits: Comprehensive coverage modeled after the State Employee Health Plan.

AccessTN:
Summary of program: AccessTN provides a comprehensive health insurance plan for seriously ill adults who can afford health insurance coverage but who have been refused coverage by insurance providers (persons labeled "uninsurable"). A premium assistance plan will assist low-income uninsurable Tennesseans to participate in AccessTN.
Household income eligibility requirement: No restriction.
Age requirement: Not applicable.
Tennessee residency requirement: Yes.
"Go bare" requirement:* Six months.
Employment requirement: Not applicable.
Pre-existing condition clauses: May include temporary exclusion for pre-existing conditions; exclusion may be waived for TennCare disenrollees.
Pricing information: Premiums capped at 150% to 200% of standard market rates; premium subsidies may be available for low-income uninsurable Tennesseans.
Benefits: Comprehensive coverage modeled after the State Employee Health Plan with HSA option.

CoverTN:
Summary of program: CoverTN utilizes shared funding between the state government, private employers, and employees (individuals) to offer guaranteed, affordable, basic healthcare coverage to uninsured Tennesseans. An option permits small business participation.
Household income eligibility requirement: Below 250% of federal poverty level*; small employer exception for businesses with fewer than 25 employees.
Age requirement: 18 years of age and older.
Tennessee residency requirement: Yes.
"Go bare" requirement:* Six months.
Employment requirement: Required at time of enrollment.
Pre-existing condition clauses: May include temporary exclusion for pre-existing conditions.
Pricing information: Premium target price of $150 per month, to be shared equally between employee, employer, and state government; policy is portable (follows the employee), and the employee may pay the employer's share, if an employer fails to offer the plan; premium varies (will be higher), if the enrollee is older, and/or overweight, and/or uses tobacco.
Benefits: Targeted coverage of most needed services (for example, physician, hospital, and pharmacy benefits).

CoverRx:
Summary of program: CoverRx expands the safety net pharmacy program instituted after TennCare disenrollments, to make prescription drugs more affordable for low-income, uninsured Tennesseans.
Household income eligibility requirement: Below 250% of federal poverty level.*
Age requirement: 18 years of age and older.
Tennessee residency requirement: Yes.
"Go bare" requirement:* No current pharmacy coverage.
Employment requirement: Not applicable.
Pre-existing condition clauses: Not applicable.
Pricing information: Affordable co-pays for medications dispensed from a base formulary; discounted price for all other medications.
Benefits: Affordable access to base formulary of generic and selected brand name drugs; discounted pricing for all other drugs.

Project Diabetes and Coordinated School Health Program:
Summary of programs: These programs expand educational pilot projects in K-8 school grades throughout Tennessee to teach healthy lifestyle and eating habits; establish a program to expand treatment options, focusing on reducing type II diabetes mellitus and obesity in Tennessee.

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*NOTES:
"250% of federal poverty level" is an annual income of approximately $24,500 for an individual or $50,000 for a family of four.
"Go bare" requirement is the time a beneficiary must be uninsured prior to enrollment in the insurance component.

Additional comments about CoverTN:

  • CoverTN is intended for working people who are uninsured. Because the monthly premiums are relatively low (as compared to commercial insurance policies available from other sources), CoverTN is a basic health insurance plan.
  • The lowest premium will start at $150 per month. Higher premiums will be charged for older persons, tobacco users, and overweight persons. The state will pay $50 per month. The other $100 will come from the employer and the employee or the employee alone (if the employer will not offer the plan to employees).
  • The employee-- not the employer-- owns the policy, and the policy is portable (may be carried to the next job, if the employee changes employment).
  • To be eligible, a person must live in Tennessee, cannot have an income that exceeds 250% of the federal poverty level, must be employed and uninsured at the time of enrollment, and must work at a company with 25 or fewer employees.
  • Estimated co-pays are $25 for a visit to a physician and $10 for a prescription. Deductibles are intended to be low. Some basic emergency and hospital coverage may be provided. Preventive care will be covered and encouraged.
  • A small business option is available to permit coverage of employees, even if few of them meet the federal poverty level requirement.

Additional comments about AccessTN:

  • Tennessee becomes the thirty-fourth state to create this type of high-risk insurance pool for uninsurable individuals.
  • This plan, modeled after the State Employee Health Plan, will be comprehensive and include physician visits, prescription drug purchases, hospital stays, acute and catastrophic care, and disease management for chronic conditions.
  • Because this coverage is intended for uninsurable persons, the premium is higher than that charged for persons with no health risks but lower than HIPAA policy rates. By way of comparison:
    • A single person might pay $238/month for an average policy, $715/month for a HIPAA policy, or $358 - $477/month for an AccessTN policy.
    • A family of four might pay $428/month for an average policy, $1,238/month for a HIPAA policy, or $641 - $855/month for an AccessTN policy.
  • The state budget sets aside up to 38-million dollars to assist low-income, uninsurable Tennesseans and to try to obtain federal matching dollars, if possible, through the Health Insurance Flexibility Act.

Because the major parts of Cover Tennessee do not requires federal government participation (with its detrimental rules as a condition of receiving federal funds) and because other safeguards are being put in place, it is felt that Cover Tennessee will not experience the rampant out-of-control expenses incurred by Tenncare.

Cover Tennessee health insurance options are scheduled to be announced in the fall of 2006 and benefits are scheduled to begin in early 2007.

To sign up for updates:

As always, my office will try to assist you in any way possible: call 1.800.449.8366, extension 12427; or, email sen.raymond.finney@legislature.state.tn.us. Also, see CONTACT INFORMATION elsewhere in this Website.



FUTURE DEVELOPMENTS:

Future Cover Tennessee developments will be posted in this e-newsletter.