Real facts more complex, less scary
You've surely heard by now that TennCare is going to bankrupt the state. That nothing can be done to salvage it. That it's fraught with fraud. That enrollees are lazy bums who are taking advantage of "us." That one attorney, more powerful than the governor and more diabolical than Dr. No, is about to demolish the State. Puhlease! Are you really swallowing what's being deep fried, slung undrained, and served up cold?
Here are facts that need to be delved into and understood.
Tennessee's Problems Aren't Worse. The Proposed Solution Is.
Every state in the nation is struggling with its Medicaid program due to several factors, including runaway pharmaceutical costs, massive federal cuts, record numbers of Americans losing healthcare due to job loss, and employees eliminating and/or reducing healthcare benefits. None of these facts should come as news to Tennessee's governor and lawmakers.
Most states have been forced to contain Medicaid costs while putting a priority on protecting people's health care by implementing smart improvements like nursing home reforms, drug pooling, and disease management. Few states have cut eligibility or benefits and none close to the $2 billion in eligibility and service cuts Governor Bredesen is proposing.
Smart Reforms Rather than Senseless Harm
Now into the third year of his term, Governor Bredesen hasn't masterfully reformed TennCare as promised when he ran for governor. Instead, he's calling for cuts that cannot solve the core problems, but can create a ripple effect of harm. The instant harm would come from denying hundreds of thousands of sick people needed care. They would quickly seek local assistance, if it exists, and would overwhelm already overburdened local health services and hospitals that aren't financially or structurally equipped to handle TennCare overflow.
The costs driving health care wouldn't go away under the governor's proposal. The burdens would simply be shifted off State unto Local (much like other Bredesen budget cuts). The result would trigger increases in local health care costs, higher insurance premiums, and increases in local taxes.
Apples and Oranges: Tennessee -v- Other States' Healthcare Spending
Do you know what politicians and pundits aren't telling you when they say that TennCare costs more than other states' Medicaid programs? They're not telling you that when comparing Tennessee with other states the numbers are skewed higher for our state because they don't take into account other states' higher expenditures for non-Medicaid health programs that Tennessee lacks. In other words, direct comparisons between TennCare (Tennessee's Medicaid program) and other states' Medicaid programs are misleading.
For example, Tennessee is one of only two states that doesn't require responsibility by state or local government for indigent care. There aren't separate programs for particular disease populations, like HIV or mentally ill, either. In fact, Tennessee is the only state in which Medicaid covers adult mentally ill patients. So when looking at total costs remember that TennCare figures are pretty much total costs of all types of care, but the figures for other state's Medicaid programs (used for comparison) are not.
Calling TennCare "platinum" or "frills" coverage is erroneous for many of the same reasons that make it hard to draw direct comparisons to other states' Medicaid programs.
According to McKinsey & Company, compared to most states, Tennessee's old Medicaid program was conservative. In fact, no state has a bare bones Medicaid program that only covers mandatory groups required by federal law or eliminates essential needs like prescription drugs from basic coverage.
We need to understand that there are legitimate reasons why TennCare (Medicaid) covers more than most commercial and government insurance plans do. TennCare covers what these plans won't touch. Medicaid is designed as a safety net to serve populations that private insurance plans won't, such as nursing home and other long term care, treatments for severely emotionally disturbed children, and drugs for intense/chronic illnesses (like hemophilia). It provides mental health services, enabling the state to use federal matching funds to relieve burden on state-funded psychiatric facilities. TennCare's drug benefits aren't more generous than many private plans for sheer greed or waste. The benefits are broader because Medicaid covers a much sicker population (primarily elderly) than private plans.
1 TennCare program cumulatively saved the state over $2 billion in state tax dollars [from 1993 through 2001]". Tennessee Comptroller of the Treasury, TennCare: A Closer Look, p. 1 (October 2001), available at www.comptroller.state.tn.us/orea/reports/tenncarebrief.pdf.; The Role of TennCare in Health Policy for Low-Income People in Tennessee, p. 9 (Urban Institute, 2000) www.urban.org/uploadedPDF/occa33.pdf ; "Covering the Uninsured through TennCare: Does it make a difference?" 20 Health Affairs 231 (Feb. 2001); American Medical Association, Physician Socioeconomic Statistics
2 The Fiscal Survey of States (Dec. 2004)
3 The Continuing Medicaid Budget Challenge: State Medicaid Spending Growth and Cost Containment in Fiscal Years 2004 and 2005, Kaiser Commission on Medicaid and the Uninsured, (Oct. 2004)
4 2000-2001 State Health Care Expenditure Report, Milbank Memorial Fund, (April 2003)
5 McKinsey & Co., Achieving a Critical Mission in Difficult Times-TennCare's Viability www.sitemason.com/files/user/l/lucfK0/mckinsey.report.pdf.
every 20 hours
if 323,000
people are removed
from TennCare
-University of Tennessee Center for Health Services Research, March 2002
Over 200,000 people have chronic and/or life-threatening medical conditions like diabetes, kidney disease (dialysis patients), cancer, heart conditions, severe physical disability, and severe mental illness. Thousands more have medical conditions that they cannot afford to get care for if they’re cut from TennCare.
Who is slated to be cut?
- 97,000 medically needy poor adults (elderly, disabled, caregivers who are medically bankrupt and have no way to pay their medical bills);
- 67,000 uninsurable adults certified by doctors as having serious medical conditions;
- 38,000 Medicare enrollees needing prescription drugs and certified by doctors as having serious medical conditions;
- 121,000 poor adults (earning less than $776/mo.), many with serious mental health conditions.
Working-age Americans without health insurance are more likely to:
- Receive too little medical care and receive it too late;
- Be sicker and die sooner;
- Receive poorer care when they are in the hospital even for acute situations like a motor vehicle crash.
-Institute of Health, "Care without Coverage: Too Little Too Late"
May 2002.