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Bonnyman goes ‘all in’

by Frank Cagle

So when did social justice crusader Gordon Bonnyman decide to start playing high-stakes poker? Since he is playing with your money, you ought to pay attention.

Gov. Phil Bredesen came into office pledging to reform TennCare, and he ordered up a study which said current trends would bankrupt the state. This comes as no surprise to anyone, but he at least had hard data, which he used to come up with a plan to get services and costs under control.

Bredesen and any number of powerful legislators have made it clear that the reforms will be enacted or the state will pull the plug on TennCare and return to the Medicaid system. This will eliminate benefits for 270,000 of the uninsured and uninsurable patients that have benefited from the TennCare experiment.

Bonnyman, a son of one of Knoxville’s oldest coal company families, heads the Tennessee Justice Center in Nashville and has sued on behalf of TennCare patients numerous times. All previous attempts to change the program have been derailed by lawsuits in the federal courts. The state has a string of losses.

Bredesen’s reforms have generally been regarded as a good compromise and sure to be enacted. As a Democratic governor he has the support in the legislature to back him up. He also has the support of Republican legislators who have been the program’s harshest critics during budget battles. The proposals need approval in Washington, but there you have Senate Majority Leader Bill Frist from Tennessee, who is familiar with the program, and the Bush administration is believed to be amenable to any plan that will reduce costs. Most of the money being spent in TennCare is federal funds.

But Bonnyman has set himself against Bredesen’s reform plan and headed back to court. What makes Bonnyman think he can call Bredesen’s bluff, keep TennCare as is, and not destroy the program?

There are any number of patient advocacy groups in Washington, and Bonnyman has warned them all that if Tennessee gets away with this plan they can expect similar trimming in other state programs. The advocacy groups have jumped into the Tennessee case and are bringing pressure to bear in Congress and at Health and Human Services. They could prevent Tennessee from following through on the threat to return to Medicaid. Or force the state into a protracted negotiation with Bonnyman and health care advocates. The picture could also totally change should Sen. John Kerry win the White House in November.

In this high stakes poker game Bonnyman also has an ace in the hole.

U.S. District Judge John Nixon, in Nashville, has been the court of choice for the Tennessee Justice Center, and Nixon has stopped most past efforts to change TennCare. Although he has retired, he has kept the major TennCare case under his supervision.

It may be that Bonnyman believes that if Bredesen tries to pull the plug on TennCare and go back to Medicaid, he can go to Nixon and have it stopped. He could argue that returning to Medicaid denies benefits the state has agreed to assume for the last 10 years and thus represents a denial of patients’ rights. It won’t take much of a case to win Nixon’s sympathy.

It is significant that Bredesen modified his proposals recently to exempt children and pregnant women from limitations on prescription drugs. Nixon has been especially draconian in past rulings on the issue of coverage for children. The Bredesen administration is also wary of judicial involvement.

The McKinsey study estimates that if present trends continue, TennCare will take 91 percent of all new state revenue by 2008. That means no money for any other department of government. Bredesen and the legislature cannot let it stand. If Nixon decides to order that the program continue as is, the state is faced with bankruptcy or enacting additional taxes.

During the Sundquist years Bonnyman could argue that the reforms that were proposed were ill-conceived and that the troubled TennCare agency, which has had 10 directors in 10 years, did not have a good enough grasp of the problem to be trusted to change it. It was an argument that had resonance even with TennCare critics.

But Bredesen has made a good faith effort to, as he puts it, change the TennCare benefits package for those not under Medicaid from “platinum” to “bronze”—a benefits package similar to what’s available in the private sector. He has widespread support for his efforts, and he is perceived to be a competent administrator who can carry through with the reforms.

In this poker game, Bonnyman is now dealing Texas Hold’em. He is going all in for the whole pot.

Unless, of course, he’s bluffing.

Frank Cagle is a political analyst and the host of Sound Off on WIVK FM107.7, WNOX AM990, FM99.1 and FM99.3 each Sunday 8-9:30 a.m.

August 26, 2004 • Vol. 14, No. 35 © 2004 Metro Pulse