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Weeds in the Wild: Tennessee's Healthcare Bald Spot


Sarah Kliff travels to Tennessee to see what it looks like when Obamacare explodes.Links!Sarah's piece about her trip to Tennessee More details about the Missouri bald spotAn interactive map of the counties most at risk of losing all their insurers Our lovely Weeds Facebook groupEmail us at weeds@vox.com

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This is an unofficial transcript meant for reference. Accuracy is not guaranteed.
Welcome to another episode of weeds and the wild, our Papa podcast about how policy affects real live people. We are going to get started with the episode in just a moment, but a quick programming note we have a awesome new job opening on weeds in the wild. We are looking for an editor to join us for the next few months and really help us kind of take our narrative podcasting skills to the next level. If that is you, if you are someone who's interested, look at vocs media dot com, slash careers for more information, that is vocs, media dot, com, slash careers, okay, now to the actual episode last month, my producer, and I went to Knoxville Tennessee. So I just indicate to meet like, would you be able to use in other people s eyes? This looking carry reed is walking us through a grocery store and she's making this list of all the things she can't eat. This,
how do you mean no less cause? I'm not exactly sure what kind of flour it is, and it's not just specific flowers that she's allergic to I've got us epicenter, vinegar, onions, react me. Tomatoes react to me she's a course must lactose, even water carry actually allergic to nearly every kind of water she can only drink. This really expensive, super filtered kind are list, is growing really fast nets. I can't you a lot and that's bad at first carry as all these jokes and wearing fund in the supermarket, but fifteen minutes in its clear she's, really slowing down you needed on may be water.
I know I can't tell me I'm starting to get pain. Curry is smiling, but the back of her neck is just soaked with sweat. Part of it is like bumblebees things. It's like the lumps pressing on my nerves and my muscles are like certain shake so nice, it's fine! No, I mean. I know this is reality. This is reality for carry because she has for really rare diseases that interact with each other in all sorts of ways they cause all these, Allergies, they cause intense pain. The diseases have changed her life, they changed our kids life, they ve even changed or job, but until oh she's been able to manage them because she has health insurance through of Amr CARE. I happily costly shield in two thousand and fourteen thing in two thousand fifty, which means that in twenty four ten and twenty fifteen carry went on healthcare, talk of- and you chose Blue Cross plan, but then going into twenty six ten Picassos she'll, let the market place. So I switch to United, but then United left the marketplace to so carry switch to the
last remaining insurance, company, humanity and, of course you man is pulling out of this area next year and I've talked to insurance companies and nobody's offering something for someone like me, and so right now, there's no insurance choices for me, this was a huge problem for carry when we visited her in April and it was starting to get way way bigger than Tennessee. Here's Paul Ryan The republican speaker of the house, Justice we learned of another state Iowa or the like asked remaining healthcare plan is pulling out of ninety four of their ninety nine counties. How do you look in the faces of ninety four counties?
and I know that is majority leader, Kevin Mccarthy republican Legislators- keep talking about these coverage problem areas to explain why they had to pass a healthcare bell through the house. What kind of protection is your bombing here? If there are no plans to choose from how do you care for pre existing conditions when there's no care at all? The truth? Is this law This failed in is collapsing on this episode of weeds and the wild. We are in Tennessee to understand what is happening to the Obama car market places if they are in fact collapsing and what that means for the country's healthcare. Let's start with the really big confusing question here: how did Tennessee get this giant bald spot in the middle of its insurance market. When you look at what makes the market work forces, not work, there's no one answer to that. Unfortunately,
this Sabrina correlate? She's studies, the american health insurance market at Georgetown University, and she agreed to get super nerdy with me. You can, Sarah, like I, can honestly think of boot, literally nothing. I rather deal- then talk health care policy. With you see, I can't see after policy, so Sabrina has been studying Tennessee and she identified three big causes for that bald spot. There is the policy on the state level, the policy on the federal level, and then there is plain boring geography. The truth is rural areas of always had problems attracting competition. Rural areas tend to be sparsely pot, late at the people that live there aren't especially healthy. So it's really hard to get a health insurance company jazzed about covering those parts of the country Tennessee. Meanwhile, wasn't really helping the situation. The state leadership sort of took very anti Asia stance so that sort of general public Of the law was probably not very pause.
ever widespread. We visited some of those rural counties in Tennessee that had no Obamacare insurance companies signed up to sell coverage next year and through Is there were not exactly positive? I don't like Obama, Karen, I think it's working the big we got loud through from the very first Eureka wouldn't go. You can keep your doctor. I was happy enough without a hand. It will apply in on itself. The page slight account when I looked into it it look like
will the commission put in place for every single more? I want to take a closer look at a few these answers because they actually help explain why Tennessee has such a problem. First, let's look at David Walker he's the guy who said I was happy enough with what I have David had health insurance plan that he bought way before Abominate took effect, and he was able to keep that plan because of a now very infamous promise that Obama made to voters like David. If you like your current plan, you will be able to keep it from your people. If you like your plan, you'll, be able to keep it before a bomb care insurance companies could do all sorts of things to keep their premiums really cheap. They could simply not offer coverage to sick people are not cover expensive benefits like maternity care or mental health services. Obamacare included a provision that grandfathered in those plans for people who already had them. That meant a healthy person like David just kept his cheap nano bomber care plan
and there were other healthy people that weren't even buying health insurance at all. That includes Damon Archer. You also heard him a little bit earlier saying it was wage cheaper to pay the penalty rather than by a health insurance plan with it the risk of it was one hundred and twenty move, the cheapest health insurance planning, a fine cost, a hundred twenty dollars each man woman. Twelve under knowledge versus the signal in building the Bob Administration made a choice years ago to keep the penalty for not buying insurance really low, and this was mostly a political decision and they already knew that the individual mandate was really unpopular. They didn't want to make. for even more angry with a giant fine, healthy people, a demon they did the man, and they decided it- was cheaper to go without insurance on non actuary. But that's got to have an effect on the overall risk pool, that's inside the exchange, and that would make it a less desirable place for other insurers
I can't imagine that it makes it a more desirable place. Imbalances put it that way, the beer reason. Insurance companies are quitting. Obamacare is because they have too many sick carries and not enough healthy demons and David joining the marketplace. Part of that is what we ve talked about already. The real flaws that exist and oh Mamma care, but part of it is also a story about Republicans obstructing
on a care making. It work a lot less well and we're going to dive into that right after the break. If you are a policy geek who also eggs to binge watch networks, we have a great podcast. You should check out my colleague, Todd Vander were opposed to the show. I think your interesting, where he just interview Decode Creator of Master of Non Ellen Yang. It's a super interesting interview. If you are someone like me who recently binge watched master of None Ellen talks a lot about how they made the series gives this fascinating behind the scenes. Look at how they use a lot of non actors on the show and kind of what it's like having people really act for the first time on this kind of show, with a pretty big audience at this point. So if you are looking for a break from policy coverage, definitely check out Hutch podcast. I think your interesting check out the interview with Helen. I think you will really enjoy it.
This is not the first time all the health insurance plans have threatened to pull out of an Obamacare market. It actually happened in twenty. Sixteen during the Obama administration, health insurance company at now has announced that it is pulling out of Arizona starting next year. If follows the excess of United Healthcare and humanity, leaving one Arizona County near Phoenix without
Any ensures offering Obama care, but the federal government it used to have a guy. My name is cavern Koona him. I was CEO of Healthcare, DOT govern oversaw the Federalist state exchanges in the abominable restriction and cabin. He made this promise. We will not have been colleagues going at the two thousand seventeen, and so I was asked. How are you going to assure that- and I said I don't know yet, but I will tell you that we will find a way I covered this last year and I remembered being like really dramatic, like this fight to keep a bombing here alive or that's how I pictured at and Kevin tells me it actually really was like that he had ended up becoming very much on the ground. I literally went to every market where we were at risk. Kevin ended up doing some serious negotiating. I felt I was
look. I gotTa Henry Kissinger risk type of Mideast strategy because there were three plans that were at risk and none of them are gonna stay if one of the other two were out Kellerman go to these places and you'd make the case for selling Obamacare, but he was negotiating from this really awkward position, because and this will get a little more weeds, but stick with me, the Obama administration had made these promises at the beginning of the law that they weren't able to keep. So in the beginning, Obamacare was this huge wacky policies? Paramount it was just full of risks. Nobody knew who is going to sign up for the market places if people would show up how sick or healthy they would be, and health insurance companies. If you knew-
one thing about them: they hate risk. The business is tough enough because her setting rates, essentially eighteen months in advance it very hard to deal with uncertainty. The people who wrote Obamacare. They were really aware of this problem. They were talking to health insurance companies all the time, so they basically said we get it. This is risky, but will put in some programmes that will make sure things don't go totally off the rails. You won't lose your short selling Obamacare. They created this program called risk corridors and for the first three years of the roll out. If an insurance company was losing a lot of money, the government were simply come in and backstop some of those losses. They would guarantee that insurance companies could only lose so much money selling
about a care when they passed a bomb care. They put a bail out fund anabolic here that Senator Marco Rubio. He was one of many Republicans who described the risk corridors as this slush fund, one by the big insurance lobby, and we lead the effort and wiped out that bail out fund Republicans put this provision in the twenty fourteen budget that really gutted the risk corridor programme. I remember getting a phone call from my deputy who said that we would be paying sixty cents on the dollar took a deep gulp. So in twenty six teen Kevin is on this, like cross country, road trip telling insurance companies. Why about care is great and there like. Why should we trust you? You didn't even give us those risk court or payments. You promised our credibility as the government took a hip when those payments were not realised, Kevin just remembers being full of anxiety. There's this one moment he told me about after a meeting with a really important and
in company, we were sitting on a curb waiting for an goober to take us back to the hotel and it was hot and we were perspiring and we looked at each other and said I don't know this is clear work but it worked. It worked out. It worked in large part because the Obama administration wanted it to work. They had Kevin, they had their guy, they people criss crossing the country, telling insurance companies. We are standing behind this law. You have our full support, has been saying for the last year and a half that the best we can do for literally speaking, is let a bomb slowed exploding right now. The trumpet ministration obviously has a very different take on a bomb care. It's not even clear that Kevin's role has been felt. We don't really know if they have a guy. And, as we mentioned earlier, insurers are notoriously risk averse that Sabrina again they're. Looking at an environment where we don't know, what's gonna happen, we still have a congress. This
repeal the ace yea. We don't have the time menstruation is gonna. Do anything on outrage, education, keeping the website functioning I spend a lot of time talking to insurance executives lately and they are really worried. They dont know if the Trump administration will enforce the individual mandate or keep paying me Obamacare subsidies. It looks like a very uncertain future oh knock on word. We won't have any bear county. In spite of the later we get near the more likely that gets her visit, my life saving kind, a bag, here. That's carry she's the woman with for rare diseases we met earlier. She is someone who, if nobody came, The Knoxville area would not have health insurance coverage in twenty eighteen. She showed us the zip log bag. She has it's one of those big court size ones, and it is full of medications through tax
then a jail, hydroxides, Inzana Tech. The bag also has her appy pens and are inhalers and her physical therapy tool the stick that she showed us. It's a wooden like thing and as these little balls on the outside of, though I put it up against my arm and push on it and it helps break up the fluid underneath some of this stuff is covered by insurance, some of it isn't, but the really expensive stuff like that Happy Panzer inhalers. That's what carry worries about paying for if she doesn't have health insurance or talking over a thousand dollars. You know just for those she's, also really worried about doktor visits like the trips to the emergency room she might have to take if she suddenly develops an allergy when our visit next year. What is going to cost me, thousands of dollars you now carry was preparing to lose her health insurance in a couple of really specific ways. First, she was running these experiments like chain and testing. Every four hang in upper allergic reactions, the different diet to help she can't go to college.
Because in a really terrible and ironic twist, she is actually allergic to the stuff in the shots they used to test or allergies. So carry came up with this plan. She would test foods all through twenty seventeen, while she stopped health insurance to figure out what cause allergic reactions and what didn't she figured if she needed and appy pan or your visit she might as well. Do it while she stud coverage so or playing around with hand. Corn were playing around with light. You know, like tortilla chip corn, the second week in April was corn. Weak I'm just trying to narrow down what in the corn is affecting me or Emily. Just done with corn. You take a corn, colonel, I'm aware, am adding some so my diet, but I try not to be hyper, focused on it because they don't want to psychologically psych myself out for it He has already done this with tomato sauce. It failed experiment and with pineapple verdict, was still out. She understands this sounds a little noddy, but she's just
not sure how else to prepare for life without health, insurance and just also done some things that are a lot harder than testing out corn and pineapple she's had to have some pretty difficult conversations with their kids about what would happen if something when really wrong, you do have the conversation. Who will you go to? What is the backup plan? You know what have and you know, and of life decisions. Her daughter Sidney, who is seventeen told us about these conversations, gets Phyllis scary, just cause. I don't want to think that that's gonna happen and so like I try I do everything that I can't help her. I'm just praying
that everything's gonna be ok. This is how we left the red family. Back in April we finished up, reporting went to the airport, came back to DC and then in May. The Tennessee insurance measure made this really important announcement. Today we were informed that Blue Cross and Blue Sheila Tennessee is willing to cover they Knoxville. Rating area for two thousand eighteen with individual health insurance policy, which means I have coverage now in two thousand and eighteen. We called carry up that afternoon and she told us about finding the Oh my god, I just started crying and nights made. My son- he came in deciding how much going on, and, unlike I told Ethan I still am- I guess I've cupboards and see that eighteen and he sat down in just started kind to ours.
I've seen a fifteen year old boy. Oh my gosh that happy tears dislike incredibly happy tears. Now blue Cross sent this letter about re entering the Tennessee market and they said yes therein, but they might back out of Congress changes things and they might bump up prices. Alot carry knows this, but she's. it's still a huge relief to have some hope. I've been really really scared. You now, knowing that I have they. Now I don't have to worry about the short term that I can fight for the long term. You know I'll have acts Although my medication, you know it's just the huge for carry. This is a happy ending. She finally has the security that she will have health insurance and twenty eighteen, but There are a lot of less happy endings happening across the country right now. We just
and last week that there will be twenty five counties in western Missouri that have zero health insurance companies signed up to sell Obamacare the local plan, their blue Cross of Kansas City, announced Wednesday it would quit the marketplace says we will. Likely see more problems like this too. It will be up to the Trump Administration to decide. Do they want to fix it or do they want to lack Obamacare explode? that was episode. Thank you so much to my producer, Bird Pinkerton to our editor and shot Croix. We had some engineering help on this episode from Peter Leonard. If you wanna come talk about, the episode you should Devlin join us in our Facebook group. You can find that at Facebook that come such groups flash the weeds as always, we love to hear your feedback on. If you email us at weeds at box, dot com bird will probably send you a delightful note in response. Thank you so much for the
and we will see you again soon.
Transcript generated on 2021-09-13.