McPeak said during a post-hearing interview, the Patient Protection and Affordable Care Act is designed to make massive changes in the way health insurance has been structured.
“Historically, when a health plan was developed, it was done by the insurer to the extent the benefits were actuarially sound and the premium was fair. We could approve that product to be sold on the Tennessee market,” she said. “Under the federal law, we need to have a minimum level of benefits offered in all plans in Tennessee.
“That’s what we are trying to determine, what that floor should be, what those minimum benefits should be,” she said.
Ten plans were given to the state from which to choose. However, any plan the state chooses must include the 10 areas.
“This is designed to be the minimal level of benefits that will fill the requirement of individual needs. The requirement that individuals hold an insurance policy in the United States — that policy has to include this minimum level of benefits in order to qualify for the mandate. You can certainly buy more than that and we hope that insurers, particularly on the commercial side, which we are going to continue to regulate as opposed to the (insurance) exchange, will continue to offer many varieties of plans above this minimum level of benefits, because I think choice is best for consumers.”
Between 50 and 75 people were seated in the Dixon Center at Lee University as she explained the purpose was to gather public opinion on the determination of which of 10 potential benchmark plans designated by the U.S. Department of Health and Human Services should be selected by the state as a benchmark or reference plan.
The meeting lasted only about an hour instead of the two hours scheduled.
The input she receives will be used to recommend a basic plan to Gov. Bill Haslam, who will then forward the Tennessee plan to the U.S. Department of Health and Human Services by Sept. 30.
The essential health benefits provision is a narrow and specific piece of the Patient Protection and Affordable Care Act.
“We are not here to discuss TennCare, Medicaid expansion [or] health insurance exchanges either the state or federal government will run under the law as it stands today,” she said.
June Griffith of the Rhea County Tea Party was first to speak. She voiced her opinion that the law is unconstitutional and it is an abuse of power by the federal government to control states through grants. She was followed by Robert Main, Siskin Hospital president and CEO; Dr. B.W. Ruffner, past president, Tennessee Medical Association; Susan Fuchs, co-president, Chattanooga Academy of Nutrition and Dietetics; and Stacy Griffith.
Griffith said, “We are requesting there be a total resistance to any of these plans.” She also asked state legislators to prevent the Internal Revenue Service from enforcing fines and penalties.
“I am a Tennessean. I am an American. I resent force. I will not be forced and should this ever go to court, we will win because of our Tennessee Constitution,” she said. “It’s unconstitutional to force an individual to spend money to buy goods or merchandise.”
Main described Siskin Rehabilitation Hospital as the first and largest nonprofit rehabilitation hospital in Tennessee.
“The disabled population is our country’s largest minority. There are more than 47 million people who are disabled either through trauma or through disease,” he said.
He said the affordable care act ensures people have access to critical medical rehabilitation services as an essential benefit.
“It can’t stop there. It needs to move on to provide coverage for the individual in a rehabilitation facility to have that opportunity to reach a maximum level of independence so they can have a life that’s productive and satisfying,” he said.
Ruffner, a physician, said access to medicines is not real well defined in any of the 10 possible benchmarks.
“Patient access to appropriate pharmaceuticals is essential for adequate care,” he said. “At a minimum, we request the allowed drugs match or exceed those available for TennCare patients which includes two brand-name drugs and three generic drugs per month.”
He said TennCare patients have access to a fairly long list of mainly generic drugs for treating chronic illnesses that do not count against the five-drug limit.
He said it is critical that patients be aware if their physician is participating in the plan the patient is considering and if doctors are accepting new patients.
Fuchs, who is also the clinical nutrition manager at Erlanger Health Systems, stressed the importance of nutrition in preventive health care.
“We prefer not to see them there (in hospitals). We prefer to take care of them before they get there. I think it is very advantageous to keep them out and keep them healthier, so please include us or keep us in mind,” she said.
Written comments will be accepted until Aug. 10 by mail to: Chlora A. Lindley-Myers, Tenn. Dept. of Commerce and Insurance, 500 James Robertson Parkway 12th Floor , Nashville TN, 37243 or email to PubComm.HRF@tn.gov. Comments are posted on the Internet at http://tn.gov/commerce/health_essentials.shtml.
