Tennessee suffered third-largest increase of uninsured people in the nation, Census reports

• Tennessee tied for the third-largest increase in the rate uninsured residents in 2018.
• Uninsured Americans rose for the first time since the passage of Obamacare.

About 46,000 more Tennesseans were without health insurance last year, one of the largest increases in the rate of uninsured residents in the nation, according to a new U.S. Census Bureau report.

Tennessee’s uninsured rate rose 0.6 percent in 2018, the Census report states. Although the percentage may seem small, it tied with Alabama and Arizona for the third-largest rate increase nationwide. Only Idaho and South Dakota had larger increases.

The Census Bureau now estimates than more than 675,000 Tennesseans — or about one in 10 state residents — have no insurance coverage.

This surge of uninsured Tennesseans is part of a nationwide shift threatening to reverse years of progress on access to health insurance. The bureau reported the number of Americans with no insurance rose for the first time since the passage of the Affordable Care Act, climbing by nearly 2 million to an estimated 27.5 million. The rising number of uninsured people is attributed to enrollment drops in state Medicaid programs, such as TennCare, impacting low-income families and children the most.

“What the census data shows us is that, unlike what the we’ve heard from some program administrators and government officials, it is not the economy that is driving people into employer insurance,” said Tricia Brooks, a Medicaid expert at Georgetown University. “In fact the data shows that employer insurance was flat and Medicaid enrollment was down.”

Medicaid enrollment also plunged in Tennessee. State data shows that TennCare’s total enrollment shrunk by more than 120,000 people since January 2017. Nearly all of these disenrollments occurred when the state government processed insurance renewals with an outdated system of paper forms and postal mail. TennCare officials often were unable to determine if families qualified for coverage, and many people faced disenrollment due to incomplete forms, not ineligibility, according to a Tennessean investigation published in July.

TennCare launched a modernized system for processing applications in March.

Tennessee leaders provided other explanations for disenrollment. Lt. Gov. Randy McNally credited Tennessee’s strong economy for lifting families out of poverty and off of TennCare. TennCare Director Gabe Roberts said some families let their coverage lapse because they knew they were no longer eligible.

After the Census report was released on Tuesday, a spokesman for the lieutenant governor, Adam Kleinheider, said McNally still believed that a least some families had been lifted out of TennCare by the economy, but that he was "obviously concerned by any drop in the insured population." 

TennCare spokeswoman Sarah Tanksley said it was possible that some of the people who were disenrolled from TennCare were now uninsured, but also said she believes a likely contributor is the end of the Affordable Care Act's individual mandate, which penalized anyone who chose not to have health insurance. 

Gov. Bill Lee suggested a similar theory on Thursday. During a brief press conference, the governor said he wanted to "dig in and find out" why the uninsured rate was rising.

When pressed for an explanation, Lee said he thought a possible scenario involved residents making more money so they no longer qualified for TennCare, then electing not get any health insurance from their employer.

“People being brought out of poverty because of the unemployment rates are lowered and therefore they don’t qualify, and others do qualify,” Lee said. “Some of the reasons for that would be that people choose not to tap into private insurance because the mandate was lifted and their requirement to do so was taken off. There could be a number of reasons that could happen but we need to find out why.”

Michele Johnson, founder of the Tennessee Justice Center, said the new census data effectively torpedoed the claim that families were leaving TennCare because they were obtaining private insurance.

Johnson said officials in the state and federal government had "played politics" with Medicaid programs, resulting in "catastrophic" losses of coverage.

“These kids are falling from Medicaid to no coverage,” Johnson said. “I know it doesn't work well for politics, but that is just the facts."

Politics reporter Natalie Allison contributed to this story.

Brett Kelman is the health care reporter for The Tennessean. He can be reached at 615-259-8287 or at brett.kelman@tennessean.com.