The Tennessean: Lamar Alexander: Trump trip to highlight urgency of Obamacare substitute

Tennesseans welcome President Trump to Nashville.  This is an opportunity for him to visit one of our country’s most vibrant cities and to honor one of our most important Presidents, Andrew Jackson.

It is also an opportunity for the president to learn more about the plight of 230,000 Tennesseans who will likely have zero health insurance options in 2018 if Congress does not act soon to replace and repeal major parts of the Affordable Care Act.

Tennessee’s state insurance commissioner has been warning since August that our state’s Obamacare insurance exchange is “very near collapse.”

Premiums in the individual market rose as much as 62 percent last year. Conditions are so bad that in three quarters of Tennessee’s counties, only one insurance company offers policies to those who buy on the exchange.

The same is true in one third of all counties in the United States.

In the Knoxville area, the one remaining insurance company on the exchange has pulled out for 2018, so it's a near certainty there will be zero insurance options for 40,000 Tennesseans who live there. There is a real prospect that unless Congress acts soon to stabilize the market, the same thing may happen to all 230,000 Tennesseans who buy insurance on the exchange.

In other words, in 2018, those with subsidies to help buy insurance on the Obamacare exchange will find the subsidies worth as much as bus tickets in a town with no buses running.

These 230,000 are about 4 percent of Tennesseans who have health insurance but they are some of the most vulnerable citizens in our state.

That is why Republicans’ top priority in Congress is to address this Obamacare emergency in our state and other states.

This week, the U.S. House of Representatives continues its work on legislation to begin the process of replacing and repealing major parts of the Affordable Care Act.

One thing I especially like about the proposed legislation is that it will provide options outside the exchange for the 40,000 Knoxville area residents who, under current law, are almost certain to have zero health insurance options next year because no one will sell them insurance on the exchange.

This will also help citizens in Nashville and other parts of the state. According to the Tennessean, this “change could also give people in the greater Nashville area the chance to access Vanderbilt University Medical Center through off-exchange plans, such as those offered by the Tennessee Farm Bureau.”

The proposal also takes steps to stabilize the individual insurance markets for three years so that insurance companies will be more likely to sell insurance to Americans who buy on the exchanges.

The House proposal will eliminate taxes and mandates that have driven up costs for employers and for the 60 percent of insured Americans who get their health insurance on the job.

The proposal would give states more flexibility over Medicaid (TennCare) to cover more Tennesseans more effectively and to bring costs under control. Partly because of federal mandates, Medicaid was 8 percent of our state budget in the 1980s; it is more than 31 percent today, taking state dollars that otherwise could be used for teachers’ salaries or for keeping college tuition down.

The House of Representatives’ proposal does not repeal everything in the Affordable Care Act. For example, it does not repeal the provision providing access to insurance for those with a pre-existing condition. And it does not repeal the provision offering children the opportunity to stay on their parents’ policies until age 26. And the proposal does not seek to change Medicare benefits, where most Americans over 65 obtain their health insurance.

Our health care system is complex but our goal should be simple: Give Americans more choices of lower-cost insurance by moving more health care decisions out of Washington, D.C., to states and patients.

Lamar Alexander, R-Maryville, is Tennessee's senior senator in the U.S. Senate.