Keeping Tennessee Nourished

As we all prepare for the Thanksgiving holiday, we invite you to read this blog post and take a simple action (see below) to keep your community healthy and keep “the least among us” nourished.

Nearly one in six Tennesseans is unsure of where their next meal will come from. The faces of hunger include new widows suddenly scraping by with a single Social Security check, families with parents working two jobs and still struggling to make ends meet, and the brave men and women who have served our country. If you have helped out at a soup kitchen, donated food to a food drive, or delivered meals on wheels, you get it.

What you might not know is that Federal programs – SNAP (formerly Food Stamps), school meals, and more – make up 95% of food assistance in our nation. Don’t get us wrong, charities are incredibly important. The point is that they can only do their job because of effective and efficient (though underfunded) publicly-funded nutrition program infrastructure that we have built up over the last five decades through strong bipartisan support.  If we didn’t have SNAP, the meal gap charities already struggle to fill would increase to four times what it is now.

These federal programs don’t just serve the hungry and bolster the work of charities. They deliver a nearly $2.5 billion stimulus to the state economy every year, create jobs in rural communities, and help keep our farmers growing.  And they save money and prevent unnecessary suffering.  According to a Bread for the World report, poverty-related hunger leads to $160 billion per year in avoidable healthcare costs and lost productivity.  Without federal nutrition programs, this amount would almost surely skyrocket.

Perhaps the most important point to drive home is that during the recession, people who had worked hard their whole lives and never dreamed of using Federal nutrition programs, like SNAP, suddenly found themselves doing just that.  It could happen to any of us.  If we had capped the funding for SNAP at 2007 levels, the program would have been able to meet half the need during the height of the recession.  Our Federal nutrition program infrastructure is our collective assurance that not one American should know the scourge of hunger.  We must keep it strong.

That brings us to our request.  You have probably seen in the news that Congress is debating tax reform.  You may have heard that these reforms include tax cuts that will increase our national deficit by $1.5 trillion over the next decade.  There are a lot of reasons that increasing our national debt is a short-sighted policy.  One of those is that it will force us to make impossible decisions down the road.  Without exaggeration, we could find ourselves as a nation having to choose whether seniors or children will get to eat.  Tax policy is complex, but choosing to keep our nation fiscally sound and able to ensure every person is ableto meet basic needs is a simple choice.

Now is the time to contact Senators Alexander and Corker to share your own story.  Share from the heart.  As these things apply to your experience, share about hunger in your community and the importance of Federal nutrition programs (and other Federal programs) to people you know.  Share about how we cannot afford to increase the deficit when we know there is still so much need and that anyone of us could fall on hard times.

An email is good, a phone call is great, setting up a call or meeting with a district staffer is SPECTACULAR!  The Senate will be talking taxes right after Thanksgiving weekend so the sooner you reach out the better.  Give us a call if you have questions – Keith Barnes, 615-846-4716.  We are thankful for your commitment to keeping our nation strong and fiscally sound.

Senator Alexander Contact Info

Senator Corker Contact Info

Join the Tennessee Justice Center at Our Table

This has been a year of tremendous challenge and almost unfathomable hope. You have certainly read about the challenges: lawmakers repeatedly and relentlessly threatened vital programs for our most vulnerable neighbors, showing disregard for the financial security and health of families, the dignity of older adults, and the nutritional needs of low-income children. And I hope you have also seen what I have seen: that in the midst of these challenges, this year’s countless miracles stand out. Love, compassion, and courage have won again and again. In my 24-year career, I can say with all honesty that I have never been more hopeful about what is possible.

Friends ask us how we refuse to fall into despair. Lord knows we at TJC have been tempted during these chaotic and long days. But we do not despair – not because we are naïve or even particularly optimistic, but because every day we have the privilege of witnessing the power of real human stories. These brave and honest stories break down barriers, inspire hope, and tap into the compassion for our neighbors that nearly all of us share.

Joe Manes is an Iraq war veteran, President Trump supporter, and father of 22 year-old Ashley, who has been quadriplegic since a terrible automobile accident when she was two. When Joe learned about a bill in Congress that would gut Medicaid and put millions of people like Ashley at risk, TJC helped him share his story in a moving Father’s Day op-ed. Joe wrote that Medicaid had saved his daughter’s life by covering services no private insurance company would. He concluded, “Protecting Medicaid is not a Republican or Democratic thing. It’s about American values and being able to count on each other. In combat, we pledge to never leave a comrade behind. Please don’t leave behind people like Ashley.”

When Ashley’s well-being, and that of millions like her, was under threat, it was not policy analysis that ultimately led to the unpopular bill’s defeat. It was a chorus of voices like Joe’s, showing the bill’s impact on real people. TJC was privileged to be there to help Joe and hundreds of others share that voice.

Instead of the fractured, frustrated world I often see when I turn on the news or scroll through my Facebook feed, my days at TJC are filled with people who overwhelmingly believe that Joe and Ashley and all of their neighbors deserve dignity and security, which means access to basic necessities like health, opportunity, and adequate nutrition. They are from every corner of Tennessee, from all political persuasions and walks of life – small business owners, religious leaders, moms. They are all moved by the needs of their neighbors to join with TJC in working for a system that reflects our shared values.

TJC has always lived at the intersection of individual need and complicated systems, and has made an incredible impact by doing so. Hard-pressed families in every part of Tennessee benefit from TJC’s work. Even at the highest levels of nerdy policy analysis or technical legal advocacy, all our work is grounded in our relationships with the families we serve. The more than 1,000 clients we served this year, the 130 trainings we conducted, the millions of people we reached through social media, and the thousands of calls we generated from real Tennesseans to their elected officials, all served to help empower and amplify the voices of real people and support systems that make us proud to be Americans.

TJC has been and always will be a fierce, committed defender of justice and a staunch advocate for our clients. At times, this means invoking the law and opposing systems and policies that are against our values and the needs of our clients. But we always do so by appealing to the light in everyone and recognizing that real power is not found in having the most resources or best legal minds or allies in high places – if that were the case, we would always lose. Real power is in stories like Joe’s that move hearts and minds toward compassion for our neighbors.

In a world of sound bites and tweets, where barriers are pronounced and people are too often reduced to their political persuasion or ideology, we see the universal power of people like Joe to make a difference. Your support allows us the immense privilege to amplify that miraculous power. Whatever happens in Washington, whatever the crisis of the moment in the media, whatever challenges and opportunities our clients and communities face, one thing is certain: with your help, TJC will be there to support families like Joe’s and work toward policies that are worthy of their courage and generosity.

Please support TJC as we champion those values and build a more just, humane, and inclusive community for all Tennessee families. We are grateful beyond words, and in spite of many challenges, we are full of hope.


Michele Johnson

Executive Director

P.S. Your dollar goes further with a gift to TJC. Over this year, we have secured $31,600 in life-changing services for Tennessee families for every $100 raised. Help us continue to change lives with a gift today.



Trump ending cost-sharing reductions and his executive order, explained

President Trump and his administration's singular effort to undermine the Affordable Care Act escalated quickly last Thursday with the announcement of an Executive Order regarding regulations affecting the health law and the announcement that he will end funding for cost-sharing reductions. Here's what you need to know:

Cost-sharing reductions

President Trump announced plans to end payments to insurers to reimburse them for cost-sharing reductions (CSRs), which total around $7-8 billion annually. This is a unilateral move to sabotage the Affordable Care Act. TJC wrote in August about the potential effects ending cost-sharing reductions could have. It will raise premiums for consumers, could cause people to lose coverage, and will raise the deficit by nearly $200 billion (source: Congressional Budget Office). Tennessee already accounted for the administration pulling funding for cost-sharing reductions so premium increases have already been factored in to 2018 individual plans.

Statement from Tennessee Department of Commerce & Insurance Commissioner & NAIC President Elect Julie Mix McPeak:

“In Tennessee, our carriers filed rates assuming CSR payments would not be paid in 2018.  The President’s decision will not impact those approved rates, and Tennessee consumers will continue to have marketplace options available for next year.  Tennessee insurance consumers will continue to see the CSR benefit in 2018; however, the carriers will not be reimbursed for the benefit that federal law requires them to provide.”   

BlueCross BlueShield of Tennessee Statement:

"BlueCross rates for Marketplace plans anticipated that CSR payments would not be made in 2018, so our members will still receive this benefit. We’ll continue to offer coverage options for Tennesseans in six of eight Marketplace regions as planned, including the Knoxville region, when the enrollment period begins on Nov. 1."

Oscar Health Statement:

"There will be no change to Oscar's plans in Tennessee and we are looking forward to delivering easy, guided health insurance to Nashville residents in 2018."

As Insurance Commissioner Julie Mix McPeak stated, Trump's announcement does not change the legal obligation of insurance to offer silver plans with cost-sharing subsidies. There are also no changes to eligibility for premium assistance.

The Executive Order

President Trump issued an executive order that would destabilize health insurance markets and undermine protections for people with pre-existing conditions. The executive order allows the sale of junk insurance that doesn't have to cover essential health benefits and can charge higher premiums to people with pre-existing conditions. Tennessee is the only state with insurance rules like the ones President Trump proposed, and the TN experience shows how harmful these insurance rules are.

The components of this executive order include:

  • Expanding access to Associated Health Plans (AHPs)
    • It essentially would treat small-group coverage like large-group coverage, exempting it from most ACA regulations.
    • What does this mean?
      • A return to pre-ACA medical underwriting and segmentation of the risk pool that would cause the cost of ACA plans to rise.
      • These low-cost plans will be more attractive to healthier people, meaning sicker people could be stuck with higher cost, ACA-compliant plans.
      • AHPs have a long history of fraud and insolvency.
  • Expand time limits on short-term limited duration insurance
    • Not considered minimum essential coverage (MEC) under the ACA since they can underwrite and exclude essential health benefits.
    • Possibly exempting participants in these plans from the individual mandate and/or redefining what minimum essential coverage is.
    • What does this mean?
      • A return to the individual market before the ACA.
      • They will pull even more healthy individuals away from the individual marketplace.
      • More about short-term coverage
  • Expand health reimbursement arrangements (HRAs) to be used in the individual market
    • HRAs are employer-funded tax-advantaged health benefits for out-of-pocket costs.
    • Currently, HRAs must be used with a group plan and must comply with ACA rules.
    • There are currently exceptions for some small businesses to use these on non-group plans but there are boundaries.
    • What does this mean?
      • If large employers could use HRAs for their employees to get coverage in the individual market, they could shed sicker workers from their group plan and send them to the individual market.

For a more in-depth analysis of all aspects of the executive order, read this Health Affairs article by Tim Jost.

What will happen next?

On the cost-sharing reductions:

As you read above, Tennessee already accounted for the changes and business should continue as expected.

Seema Verma, CMS Administrator, stated Thursday “we will discontinue these payments immediately.”  However, federal law still requires insurers in the federal marketplace to provide the subsidies to consumers regardless of whether the insurers receive the expected payments from CMS. It's unclear how the insurance companies will respond in 2018.

On the executive order:

An executive order is a direction to draft rules, not a change of law. They are well into the drafting process for the actual regulations and the regulations will most likely be subject to notice and comment rulemaking, which will happen within 30 days of the release of the regulation. Once the comments have been considered, the regulation can take effect within 30 days of release. The process won't be done soon enough to affect plans by Jan. 1, but we could see some changes mid-year 2018. Health reimbursement arrangement (HRA) changes could take effect sooner.

Where does White House action leave Americans’ health coverage?

The President has made clear since his election that he is determined to end “Obamacare.” In recent months, his administration has taken a series of actions, such as cutting funding for outreach and enrollment assistance, to discourage enrollment and deter insurers from offering ACA-compliant health plans.  Since the recent failure of congressional efforts to repeal and replace the ACA, he has indicated he would proceed unilaterally to undermine the law and cause it to “implode.” The President’s actions this week have that purpose. But will they have that effect?

The President’s actions can have several possible types of effects, by:

  • Altering the scope, availability and affordability of health coverage for people in the individual insurance market;
  • Politically disrupting individual markets and the larger health insurance/health policy environment; and
  • Moving public perceptions of the ACA and the political parties’ handling of health policy.

First, the President’s actions will not immediately affect most consumers in Tennessee, but some higher-income consumers will see a sharp increase in premiums. Insurers must still provide cost sharing reductions to consumers who qualify for them by law. As the Tennessee Department of Commerce and Insurance announced, the state had already approved insurance rate increases based on an assumption that federal reimbursement of CSRs would not continue.  By making this assumption, Insurance Commissioner Julie Mix McPeak had the foresight to avoid the serious disruption that this announcement could have caused and helped mitigate the negative consequences of ending cost-sharing reductions. In effect, insurers will be reimbursed for CSRs through higher premiums. The 80% of consumers who get coverage through the marketplace and who qualify for premium tax credits will not feel the premium increase, because their tax credits will rise to cover it.

Insurers had already factored in the potential for disruption by the President before they decided to offer plans during the open enrollment period opening November 1. On October 13, both Blue Cross and Oscar announced affirmed that they would remain in the market in 2018.

The consumers who will be immediately harmed by the President’s actions are the 20% of households who get coverage on the marketplace and whose incomes are too high to receive premium tax credits. They will see sharp increases in premiums, and they will have to bear those increases without help from the federal government. The President’s apparent goal was to drive these higher income individuals out of the marketplace, leaving only those who have pre-existing conditions that are so serious that they will pay for coverage, regardless of the cost. Depending upon the new rules that will be issued under the executive order, insurers are likely to be encouraged to sell cheaper, less comprehensive plans off of the marketplace, with the goal of attracting healthy consumers who are more sensitive to price than to the value of the coverage. Departure of healthy consumers, and the concentration of sicker consumers in the marketplace are designed to make ACA plans non-viable and destabilize the individual insurance market.  These effects, if they do occur, are unlikely to occur in 2018, however.

In addition, the premiums of off-exchange products will also increase if the insurer offers individual coverage on both the federal marketplace and in the parallel market. This is because an insurer must use the same underlying risk pool to generate their premium rates.

Second, the President’s determination to disrupt insurance markets and cause the “implosion” of the ACA will have unforeseeable effects on the health insurance system affecting all Americans.

Although his target is the individual insurance market, which covers only 7% of Americans, damage to that market will have ripple effects on the larger insurance system and on health care providers. Blowing up the present system – even one part of it – will have effects that no one can predict, but are certain to be harmful to many Americans. Those most likely to be hurt are those who need coverage the most: people with pre-existing conditions.

Third, the President’s actions are out of sync with the views of 71% of Americans, who want the President and Congress to repair rather than destroy the ACA. Senator Alexander reflects the views of the great majority of Americans when he calls for Congress to find bipartisan solutions that will improve health care and lower costs for everyone.

What can you do?

  1. Keep spreading the word about Open Enrollment (Nov 1 - Dec 15). The Affordable Care Act has not been repealed. Also, in Tennessee, our insurance carriers assumed that the administration would end the CSR payments. This means that TN consumers will continue to have marketplace options available for next year, and they will continue to see the CSR benefit in 2018. It's vital for both Tennesseans' health and for the stability of our market that people still enroll in health coverage during Open Enrollment! But the administration has shortened Open Enrollment and cut funding for advertising. This means it’s vital that we all help spread the word! Share our graphic below and/or our Facebook post!

  1. Congress has the power to fix this. Call Senator Alexander on Monday, and tell him to continue bipartisan action to permanently fund the cost-sharing reduction payments.
  2. Call Governor Haslam and Insurance Commissioner Julie Mix McPeak and tell them to tell our congressional delegation how important cost-sharing reductions are for Tennesseans.

Hometown Healthcare Heroes

What a time to be alive!

Following the defeat of ACA repeal efforts in July, the Tennessee Justice Center asked Tennesseans across the state to nominate their friends, family, and neighbors who fought tooth and nail to preserve healthcare coverage.

We received so many inspiring submissions, I can’t help but feel so grateful to be surrounded by such passionate and dedicated Tennesseans who called, petitioned, marched, and prayed to protect health care for themselves, their families and their communities.

I heard from patients who nominated Dr. Terri Lewis, an advocate for those with chronic pain generating conditions, who has relentlessly advocated for access to care from her home in Putnam County to the national stage.

I heard from advocates in Knoxville about Molly Bryson, who publicly shared her story highlighting the importance of Medicaid in her daughter’s life to countless reporters and legislators. One of the nominators, Max Carwile, stated, “She's an incredible mom, advocate, and human being and I really believe she deserves to be honored for her work.”

I heard about Jessi Bohon, who made national news when she stood up in a town hall and defended the Affordable Care Act in front of hundreds, including Rep. Diane Black. A Slate reporter who covered the story said, “Bohon’s comments amounted to the kind of forceful, moral argument for universal health care we need to hear more often.”

I heard about the righteous Bedford County ladies who made countless trips while braving downpours, traffic and unwavering heat to stand outside Rep. Desjarlais’ and Senators Alexander and Corker’s offices demanding they vote no on any ACA repeal.

2017 has been a year for the books, but I have never been more hopeful knowing that we have these healthcare heroes who rose to the challenge and made history themselves. They wrote, called, prayed, told their stories, made signs, read policy blogs, became health policy experts, and told their terrified neighbors they weren't alone. TJC is so privileged to stand alongside each one of these hometown healthcare heroes.

Award winners will be announced on Monday, October 16th at the NALS Association for Legal Professionals Silent Auction benefiting the Tennessee Justice Center.