By Rep. Phil Roe
Across the country, states and individuals are dealing with the new regulations and costs being imposed by the Patient Protection and Affordable Care Act (PPACA), more commonly known as ObamaCare. Among the most burdensome regulations states face is making the decision of whether or not to set up state-based health insurance exchanges.
President Obama may be trying to rebrand these exchanges by referring to them as marketplaces, but the same truth still exists: these exchanges will strain states' budgets and could take resources from other programs, especially in states like Tennessee that require a balanced budget.
On Dec. 10, Tennessee Gov. Bill Haslam sent a letter to Health and Human Services Secretary Kathleen Sebelius informing her of the state's decision not to set up a state-based insurance exchange. Even after reviewing more than 800 pages of draft rules, the governor said there was still a lot of confusion as to how the exchange would actually work. Haslam chose not to set up the exchange because, despite all the uncertainty, one thing is clear: the law does not give state officials the flexibility needed to design an exchange to meet the needs of Tennesseans. Haslam's decision underscores the challenges emerging from the PPACA not just for Tennessee but nationwide.
Tennessee isn't the only state rejecting these insurance exchanges; more than half of the 50 states have decided not to set up state-run exchanges.
The PPACA also required states to expand Medicaid to cover more individuals beginning in 2014, but fortunately the Supreme Court's ruling made this expansion optional. Even though the federal government is supposed to pick up a significant percentage of states' expansion costs, the Obama administration is already seeking to limit its support to states that don't expand their programs as much as the law originally required. It sounds as though a bad deal has the potential to get worse -- and our state can offer some clues as to what will happen for states that choose to expand their program.
Because of our state's experience with TennCare, our state Medicaid program, Tennesseans know the dangers of simply expanding access to care without addressing costs. TennCare crippled the state budget and nearly 300,000 people were cut from the program in 2005 and 2006 just to keep it financially viable. TennCare is now one of the most restrictive heathcare plans in the country, limiting how many medications patients can receive, what brands they can purchase and what doctors they can see. Because TennCare's payments to physicians are even lower than the rates paid by Medicare and private insurance, many providers have opted out of the program and will no longer see TennCare patients. This is the model that the president is seeking to copy on a national scale.
We're seeing more and more states -- even those like Tennessee that have been committed to healthcare reform since the '90s -- opt out of these exchanges. According to the Tennessee Department of Health, a baby born in Tennessee today is expected to live approximately 28 percent longer, nearly 17 years more, than a baby born in 1923. We're making great strides in Tennessee to improve the overall health and wellness of our state, and I believe states can continue to make those strides without unnecessary federal government oversight.
As a physician, I am keenly aware that each state has unique healthcare needs and that trying a one-size-fits-all approach across the nation could be catastrophic. With that said, the PPACA leaves little room for flexibility, almost forcing states to surrender control of their healthcare systems to the federal government.
I remain committed to a full repeal of the PPACA, and I am proud to see governors across the United States standing up for their states. Healthcare reform is too important to get wrong again, and I will do everything in my power to address some of the worst parts of the legislation and to find ways to lower the cost of medical care, repeal the Independent Payment Advisory Board, implement meaningful medical malpractice reforms and fight fiercely to preserve the doctor-patient relationship.