Beth Harwell task force pitches TennCare expansion plan

TennCare would be expanded via a phase-in program that places priority on veterans and people with mental health or substance abuse disorders under a proposal from the health care task force commissioned by House Speaker Beth Harwell.

The proposal from the 3-Star Healthy Task Force outlines a two-step program that encourages people to develop relationships with physicians, get behavioral health treatment in tandem with physical health treatment and includes a work and education component to help people into positions lucrative enough to finance commercial coverage.

The plan, which takes an alternative approach to Medicaid expansion as compared to Gov. Bill Haslam's Insure Tennessee, is an effort to "move health care forward" using Republican principles that put an emphasis on motivation and achievement, the task force's chairman, Rep. Cameron Sexton, R-Crossville, told Tennessean reporters and editors during a Wednesday meeting.

Under the first phase, people would need either "a qualifying diagnosis of a mental illness" or proof of honorable discharge from the U.S. military in addition to making up to 138 percent of the federal poverty level — roughly $16,000 for an individual and $27,000 for a family of three.

Behavioral health emerged as a focus for the task force early in its tour of community meetings. Sexton said hospital administrators, health care advocates and other industry officials highlighted the costs that stem from people who suffer from mental illness and substance abuse using emergency rooms as primary care. He noted that those problems are an obstacle to holding a full-time job.

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The task force wants to help those who are "the most severe of the severe" and that a behavioral health pilot is one way to do that, Sexton said. The task force estimates up to 115,000 people could be eligible to enroll in the first phase.

The second phase would be open to anyone making up to 138 percent of the poverty level. Moving to the second phase would be contingent on the analysis of the first phase's success. It could include analysis of the costs per member, the number of enrollees and health outcomes, as well as the utilization of both emergency rooms and primary care physicians.

The task force met with officials from the U.S. Centers for Medicare and Medicaid Services on Tuesday along with Darin Gordon, the outgoing chief of TennCare, and his successor, Dr. Wendy Long. Sexton plans to follow up with CMS in a few weeks to see what the next step is. He estimated there will be six to seven more months of negotiations with federal and state officials before a plan is ready to present to the legislature.

Lawmakers head to DC to present health care plan to feds

When Harwell was asked what would happen if federal officials rejected the newly announced proposal, she told reporters during a Thursday morning press conference with members of the task force that it is more likely CMS would say which aspects of the plan they support and are against. 

"They’ll probably give suggestions on what we could change to reach approval," she said.

If federal officials approve the task force's approach, the plan would ultimately need an up-or-down vote from the Tennessee legislature, with no room for changes, Sexton said. The legislature previously failed to pass Insure Tennessee.

Sexton pointed out that one of the main concerns expressed by lawmakers during the debate over Insure Tennessee included the fact that the Medicaid expansion plan could be changed. For that reason, the task force's plan would not permit similar action.

"We want to do one vote for the whole package," said Sexton, without giving any assurances that he thought the plan could be approved by the legislature. He did say that he expected the task force's plan to have more support than Insure Tennessee given that it was a "conservative approach."

Sexton expects a vote on the proposal in the next session, assuming federal approval. If that happens, phase one enrollment could begin in 2017, with a targeted 2018 start date for phase two. He said there would need to be 12-18 months of data from the first phase.

Although last year some lawmakers, including Lt. Gov. Ron Ramsey, suggested the legislature wait until after the November presidential election to decide what steps to take in terms of health care expansion, Sexton said the task force's plan takes into account whoever may enter the White House in 2017.

"This plan gives us more flexibility in that scenario than what other states have, which I think is a benefit to Tennessee," Sexton said.

At one point during the Thursday press conference, Rep. Roger Kane, R-Knoxville, called the plan innovative, suggesting that Tennessee could be the "test case" of the other states that have not expanded health care coverage.

That point was seized upon by Rep. Mike Stewart, D-Nashville, who said, "What I heard today was we have an experimental plan that makes an experiment out of Tennesseans’ health care."

When pressed on whether he would support the plan, Stewart reiterated the need to pass Insure Tennessee, later adding, "If someone is expanding health care, I think we all know, common sense tells us, that Democrats are certainly not going to be the problem."

Exact details of the plan, ranging from which mental health diagnoses would lead to eligibility to the qualification process and how people would access treatment, need to be hammered out, Sexton said.

About 20 percent of all Tennessee adults in 2015 struggled with some form of mental health illness, ranging from depression and anxiety to schizophrenia and bipolar disorders, according to the Tennessee Department of Mental Health and Substance Abuse.

There are areas of the state that have few mental health providers, so, Sexton said, the program probably would use telehealth and telepsych programs to reach some people without local access.

The plan, while different from Insure Tennessee, would benefit many who need critical behavioral health care, said Anthony Fox, president and CEO of the Tennessee Mental Health Consumers' Association.

The work program would be in cooperation with the Tennessee Department of Labor and would help get people into training or other jobs that either pay enough to buy insurance on the federal marketplace or offer employer-sponsored coverage.

Because it's an extension of TennCare, the plan carries a greater financial obligation for the state.

Insure Tennessee included a 90 percent federal financing component and a 10 percent obligation from the state, which the Tennessee Hospital Association committed to paying from an assessment.

Under the task force's plan, federal funds would cover 65 percent. The state would be responsible for the other 35 percent, which Sexton expects could be covered with the same assessment funds.

The per-member cost of the task force is still being evaluated, Sexton said.

After the morning event, Michele Johnson, executive director of the Tennessee Justice Center, admitted that the plan is hardly perfect and “too conservative” for her organization but admitted, "We are thrilled that there’s finally movement on this important issue.

“I think what is hopeful about this is the politics of this issue are changing,” she concluded.

Reach Holly Fletcher at 615-259-8287 and on Twitter @hollyfletcher. Reach Joel Ebert at 615-772-1681 and on Twitter @joelebert29.