How Is Haslam’s Medicaid Expansion Different From Regular TennCare?

Gov. Bill Haslam unveils his Medicaid expansion proposal, dubbed Insure Tennessee. Credit: Governor’s Office.

Gov. Bill Haslam’s proposal to expand Medicaid is expected to cover hundreds of thousands of uninsured Tennesseans, and it’s hoping to accomplish that by helping employees out with the cost of employer-provided insurance and expanding TennCare’s rolls.

Insure Tennessee, as it’s been dubbed, is aimed at those who make too much money to qualify for TennCare, but too little to get a subsidy under the Affordable Care Act.

For people who fall in this gap, there are two options available.

John Graves, a professor at Vanderbilt University’s School of Medicine who has studied the proposal, helped unpack some of the particulars.

“The question is how many of them are working in a job that offers them health insurance benefits that they’ve declined because they were unable to afford it,” Graves said.

The governor’s office thinks about half of the newly eligible population — around 100,000 people — fit into this category. Vouchers will be available to knock down monthly health bills.

The vouchers wouldn’t be used to shop for a plan on the Affordable Care Act marketplaces, but specifically meant to reduce the cost of insurance provided by an employer.

“This would be shopping for a specific plan. Their employer probably offers one or two plans to full-time employees, with some employee contribution. This would be used to offset that employee contribution. Whereas if they went into the TennCare option, they would have to find a doctor who provides services to the private claims that TennCare covers.”

For part-time workers who are uninsured and make under $16,000 a year, there would be a second option. It’s TennCare with a twist: part of the state’s subsidy would depend on life choices, bringing in rewards for healthy decisions in the form of credits to pay for out-of-pocket expenses.

“So the idea would be, for example, if you take part in a smoking cessation program, you might get a dollar credit to your account, which then you could use if you had a doctor payment that was a $3 co-payment, rather than pay it out of out of pocket,” Graves said.

Sticking with the hypothetical, that means there’s still a $2 co-payment, but Haslam would say that’s still cheaper than it was before.

Some other states that have accepted Medicaid expansion dollars have let patients use the money to buy coverage through an insurance exchange, or have added controversial work requirements, but Tennessee’s approach differs from both of those approaches.

For those without employer-provided insurance who fit into its narrow income requirements would basically be added to TennCare, which is administered through private insurance companies in Tennessee. The difference is essentially over “cost-sharing requirements.” In other words, nominal premiums and co-pay would be required.

“This program, if it gets implemented, would fill in the gaps,” Graves said. “People who are working and may not have access to coverage through their employers, prior to now, they could only be eligible for TennCare if they fell into certain categories, like if they’re pregnant or disabled. So for an adult who didn’t fall into a traditional TennCare category, they weren’t eligible for anything, and this would change that.”