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The governor and the advocate both want to save TennCare

by Barry Henderson

The status of TennCare, the state’s bold and embattled healthcare “safety net” for the uninsured, remains up in the air until at least the end of this week and maybe for much longer.

The high-stakes poker being played by Gov. Phil Bredesen, who says the program must reform or die, and Gordon Bonnyman, a tireless advocate for TennCare patients, hasn’t concluded, although each made an important concession earlier this week.

Bonnyman took the recommendation of former Gov. Ned McWherter, who founded TennCare 10 years ago, by offering a two-year moratorium on legal action against the state on TennCare issues. Bredesen, who originally deflected McWherter’s suggestion, agreed to consider it in terms of negotiations that are underway and may be concluded in time for a Friday hearing in the Nashville federal courtroom of Judge John Nixon, who will have to approve any deal based on Bonnyman’s motions to hold off on four suits already on file.

Bredesen has been saying he’ll dump TennCare and return to the federal Medicaid program to save the state from the threat of bankrupting itself to pay the medical costs that TennCare continues to run up. That’s $7.8 billion this year, with an expected growth of almost 20 percent per year to serve the 1.3 million Tennesseans currently enrolled.

The governor’s reform proposals, which Bonnyman and his Tennessee Justice Center have adamantly opposed, would keep the enrollment intact, but would reduce benefits so that the growth rate could be cut to a manageable level. If the reforms don’t go through, and Medicaid resumes its coverage of the qualified poor, about 30 percent of those now covered by TennCare would have no medical protection whatever.

Both Bredesen and Bonnyman have been the recipients of hate mail over their positions on the matter, which is certainly an unfortunate development. Demonizing either of those figures, who have struggled mightily to make TennCare work, ignores those positive contributions.

In a nutshell, here are the governor’s priorities in TennCare reform as his office describes them:

Tightening eligibility—The state must improve the process for determining who is eligible for TennCare, while still working diligently to deter fraud by those who would take advantage of the system.

Reforming benefits—Government must do a better job of tailoring benefits based on the state’s ability to pay for them. Above all, TennCare’s benefits should not create an incentive for people to abandon private health insurance.

Toughening regulation—It’s vital for Tennessee to enlist the help of experienced regulators who know how to make sure that MCOs, the middlemen who work with the state to provide patient care, are doing a good job of controlling costs and paying patients’ bills on time.

Controlling costs is a huge trick in an environment in which medical care, across the board, is getting outrageously expensive, outstripping inflation by double-digit percentages every year. Something has to be done nationally to flatten out that growth curve or we’re going to bankrupt the whole nation to pay for ordinary healthcare.

Maintaining an adequate level of care for the uninsured is not, or should not, be in question. If Bredesen, whose background includes healthcare management, believes the state can afford his reformed version of TennCare, we have to believe it’s a reasonable alternative to breaking the state or dumping the issue back on the federal government’s more selective program.

A two-year moratorium on any legal actions to include more persons or increase benefits may be painful, but it’s as McWherter says, “a half-loaf is better than no loaf.” We can always hope that, inside that two years, some of the TennCare immigrants who came to the state only because of our liberal benefits and instant qualification feature will take the hint and move back home, where they’d probably really rather be anyway.

Over its decade of existence, TennCare has provided lots of legitimate care for people in dire need. It has also been abused by some care providers and some patients, particularly in the area of prescriptions, where bottle upon bottle of Schedule II narcotics such as morphine and Oxycontin have found their way into the hands of unscrupulous users and dealers.

There have been horror stories from eligible beneficiaries about the difficulty in obtaining treatment under TennCare, and, with more than a million people on its rolls, there always will be.

Look for a stream of such horror stories to arise in the wake of reform, or a deluge in the event of TennCare’s demise. Those personal accounts are heart-rending, but think about how we’d feel if there were no benefits available to any of us.

November 18, 2004 • Vol. 14, No. 47 © 2004 Metro Pulse