NOXVILLE, Tenn. — The people in this Tennessee city might have good reason to agree with President Trump that Obamacare is an “imploding” disaster, given the recent collapse of the state’s individual marketplace. But you wouldn’t know it based on some residents’ pleas to save the Affordable Care Act.

On a rainy Tuesday, hours before Trump offered a joint session of Congress five principles for a replacement law, the organizers of Save My Care, a traveling, pro-ACA campaign, handed out “STOP REPEAL” signs to supporters in downtown Knoxville.

Knoxville is in trouble — for many, saving the ACA refers to saving the insurance marketplace — and this city of 183,000 is fresh out of options.


Two weeks ago, Humana became the latest insurer to pull out of Obamacare insurance exchanges by 2018. In Tennessee, Humana’s exit will affect nearly 80,000 people, including those who bought insurance from Humana after UnitedHealthcare and Blue Cross Blue Shield of Tennessee backed out of most of the state’s largest metro markets.

Metro Knoxville, with a population of more than 800,000, is bearing the brunt of Humana’s departure: 40,000 residents may have no other insurance option come 2018.

One of those residents is Rae Jones, who moved here for her dream job as a Montessori school teacher. She said Obamacare has had a life-altering impact — the care she needs after a kidney transplant costs $4,000 a month without insurance. She fears that losing Obamacare and possibly the provision that prevents denial of coverage for people with preexisting conditions might force her out of Tennessee to a state with better coverage options.

“Should I quit my job? Leave my students? Find a job based totally on health benefits again?” Jones said.

This east Tennessee city isn’t the first to be placed in such a bind. Last summer Aetna’s retreat almost left nearly 10,000 people in Pinal County, Ariz., without an insurer in its Obamacare exchange until Blue Cross Blue Shield stepped in at the last minute. But Knoxville may be the largest example of what an empty ACA exchange could look like.

Tennessee’s lawmakers are already fighting over repairing or replacing Obamacare. State officials now must figure out a stopgap for residents before the year’s end.

Tennessee Senator Lamar Alexander, chairman of the Committee on Health, Education, Labor, and Pensions, called last month to “rescue Americans trapped in the failing Obamacare exchanges.” He has suggested providing states more flexibility in defining health benefits. Unless something changes fast, Alexander worries Knoxville might be a harbinger of things to come elsewhere in Tennessee — a state where more than three-quarters of its 95 counties have only one insurer choice on the federal exchange.

“Tennesseans with Affordable Care Act subsidies are going to be like holders of a bus ticket in a town that has no buses,” Alexander recently said in a statement.

Save My Care
The Save My Care bus parks outside a small rally held in downtown Knoxville. Max Blau/STAT

At the Tuesday rally, other east Tennesseans, from a musician with a preexisting condition to a hair stylist getting insurance for the first time in years, agreed the good of Obamacare outweighed the bad. Rich Henighan, a longtime nurse practitioner, attributed the pullout of Humana and other insurers to political decisions by Tennessee lawmakers.

Tennessee Senator Bob Corker, who wants to see Obamacare repealed and replaced, said the “Trump administration has a process underway” to swiftly stabilize the individual insurance market, including in Tennessee. But if the Obamacare exchange goes into 2018, Tennessee Insurance Commissioner Julie Mix McPeak hopes to convince Humana to reconsider its exit from Knoxville.

In a emailed statement, Humana spokeswoman Kate Marx told STAT that they are working with the state’s insurance office to navigate the exit. She said the company pulled out of the Tennessee marketplace after they saw who had enrolled for 2017.

“The company is seeing further signs of an unbalanced risk pool and has decided that it cannot continue to offer this coverage for 2018,” Marx said.

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“We’re trying to look at every option to avoid having uncovered areas,” she recently told reporters.

Melissa Nance, a Maryville, Tenn., resident who stands to lose her Humana coverage, doesn’t have the luxury of debating health care plans. The 45-year-old nonprofit education advocate, who makes $62,000 a year without benefits, told STAT that without Obamacare, she couldn’t have afforded the costs of leukemia treatment after being diagnosed in 2014.

Doctors tell Nance that, despite her remission, her leukemia will likely return someday, at which point she may require an oral chemotherapy drug that runs $32,000 a month for someone who’s uninsured. Standing to lose stable coverage, Nance hopes lawmakers decide that health care’s future in this country includes people like her.

“I just want the privilege to purchase health insurance,” Nance said. “I don’t think that’s a handout. I think it’s a right, as a human, to buy insurance.”

This story has been updated to include comments from Humana.

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