GOP seeks to use TennCare to influence insurance firms

Tennessee House Speaker Cameron Sexton, R-Crossville, is backing legislation to block TennCare and its contracted insurance companies, which distribute the state's Medicaid program, from covering or reimbursing any gender-transition health care treatments.

The legislation also aims to block any insurance company from contracting with TennCare if their parent companies cover any gender transition treatments anywhere in the country, Sexton said in a Thursday interview. TennCare contracts with insurance companies called managed care organizations, or MCOs,

"We don't want our MCOs, that are profiting off the TennCare program, to take that money and go to other states. They have to make a choice if they want to be one of our MCOs," or cover gender transition treatments, Sexton said.

"I don't feel like the Tennessee profits should be used to go to other states to cover services that Tennessee does not deem appropriate."

A leading House Democrat sharply criticized the bill on Thursday, calling it one of a series of attempts to marginalize an already vulnerable population.

"It appears they're using the heavy hand of the law to force MCOs into providing healthcare coverage aligned with an extreme ideology, which appears to be rooted in a dangerous form of discrimination," said House Democratic Caucus Chair John Ray Clemmons, D-Nashville. "I fail to understand how this type of legislation actually benefits or improves the quality of life of anyone in this state."

Though it wasn't immediately clear how the proposed bill, HB 1215, might be legally enforced, at least one TennCare MCO is a subsidiary of BlueCross BlueShield of Tennessee.

TennCare spokesperson Amy Lawrence said the agency serves 1.74 million people with more than half minors.

"We do not track the services you mention but surgeries are specifically excluded from TennCare coverage," she said in a statement.

Dalya Qualls White, a senior vice president and chief communications officer at BlueCross BlueShield of Tennessee, said in a statement Thursday the insurer will "continue to follow any applicable laws regulating our coverage."

"Like all insurers, BlueCross medical policies and coverage are based on medical consensus and aligned with state and federal laws," White said.

Bill latest targeting transgender health care

Sexton's bill has flown under the radar as the current legislative session has ramped up, while a high-profile bill to block Tennessee children and teenagers from accessing any surgeries, hormone treatments or puberty blockers has moved quickly through both chambers and could be up for floor votes this month.

House Majority Leader William Lamberth, R-Portland, and Senate Majority Jack Johnson, R-Franklin, have argued gender transition care is too risky for minors to consent to and should be a decision a person reaches as an adult.

Johnson is also sponsoring the Senate companion bill for the MCO bill, SB 1339.

"I believe in personal liberty at the age of 18," Johnson said of the trans youth bill, SB 1, this week. "You're free to do what you think is best.

Sexton's bill is up for its first hearing on Feb. 14 in the House Insurance Subcommittee.

When asked if he would support an effort to block all gender transition health care in Tennessee, Sexton said individuals can pursue it if they want and pay cash, but it should not be a covered insurance expense.

"I think it's a pretty straightforward bill. We're not telling them they can't cover it," Sexton said. "If they want to cover it in other states, that's fine. It just means we're going to go a different route for that company being an MCO on the state's biggest insurance plan."

Similar efforts have led to court challenges

If Sexton's push is successful, Tennessee could join a handful of other states that have attempted to block gender transition treatments in their Medicaid programs, the public health insurance program jointly funded by the federal government and states that serves low-income adults and children. TennCare is Tennessee's version of Medicaid.

Some similar policies have led to federal court battles.

"I don't see any real concern among my colleagues across the aisles about constitutionality," Clemmons said. "They're more interested in scoring a few political points to satisfy a far-right wing, extremist base than to pass good, sound policy that's well crafted and thoughtful for the benefit of every Tennessee family."

Henry Seaton, ACLU of Tennessee's transgender justice advocate, slammed the proposal.

"This discriminatory bill would take away access to safe, effective, medically necessary healthcare from trans Tennesseans, while allowing other Tennesseans to receive the same care," he said. "All trans people deserve access to this care, regardless of socioeconomic status. Gender-affirming healthcare is lifesaving, and this blatant attack on transgender Tennesseans clearly shows that legislators are actively working to harm trans people. We will continue to fight until all Tennesseans can access the care they need to thrive."

In Georgia, the American Civil Liberties Union successfully sued over a state policy blocking gender transition surgeries, arguing the policy violated the Affordable Care Act, and the federal Medicaid Act.

Florida authorities last summer moved to block its Medicaid program from covering gender transition treatments. A federal judge in October temporarily upheld the state's decision, allowing the policy to be implemented ahead of a pending lawsuit.

Reach Melissa Brown at mabrown@tennessean.com.