Real facts more complex, less scary
Governor Bredesen tells you that he must cut 323,000 sick and uninsurable adults from TennCare to save $575 million (estimates range from $650 million to $535 million). Human costs aside, he insists it must be done in the name of fiscal responsibility. If this is his model for sound economics, someone ring for Nurse Ratchet. If he is allowed to impose these cuts, Tennessee will lose at least $1.2 billion in federal funding. Now, this sounds like fuzzy math until you view the facts.
Tennessee has the sweetest deal with the feds of all states. For every dollar the State spends on TennCare, it draws down two (2) dollars in matching federal funds. Imagine you're a health care provider with a backer willing to invest $2 for every $1 you put into your program. The program runs into problems with mismanagement and rising costs of materials. Do you gut the project rather than reform management and implement cost guards? Do you bail, knowing that the services you are currently providing will have to be absorbed by hospitals and local governments and ultimately by all Tennesseans via higher insurance premiums and more taxes? Or do you find creative, intelligent ways to restructure a necessary public service, knowing that if you don't the service will still be needed and will end up costing taxpayers much more in the long run?
Sinking Low: Villianizing the Sick and Destitute
Some folks will always be negative, unable to believe anything but the worst and judge people whom they know nothing about. The majority of us, however, should be highly offended any time anyone implies that the 323,000 TennCare enrollees slated to be cut are a bunch of nefarious beings, living large on TennCare.
Who are these "delinquents"? More than 200,000 have chronic and/or life-threatening medical conditions like diabetes, kidney disease (dialysis patients), cancer, heart conditions, severe physical disabilities, and severe mental illnesses. Thousands more have medical conditions that they cannot afford to get care for if they're cut from TennCare.
To break it down further:
- 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; and
- 121,000 poor adults (earning less than $776/month), many with serious mental health conditions.
If the Bredesen administration disputes these facts, they have not been forthcoming with numbers of their own.
What's Fishy About Fraud? It's a Red Herring
The myth that TennCare fraud and abuse, particularly among enrollees, is rampant and mostly to blame for the program's woes prevails despite facts to the contrary.
The national standard (average) for Medicaid eligibility payment error rate is three (3) percent. As the following data indicates, Tennessee's enrollee error rate is much lower and not a key factor driving program costs.
Fact: ChoicePoint, a Georgia-based data management company, reported in 2004 that its check of enrollees found about 18,000 or about 1.4% with possible inconsistencies that may make them ineligible. Put another way, 98.6% of enrollees are clean.
Fact: McKinsey & Company's December 2003 report stated that fraud and abuse were not major factors driving program costs; pharmaceuticals, professional services and outpatient services were. Most TennCare expenditures go to very ill: sickest 15% of enrollees account for 75% of the program's costs.
In sworn testimony to a Congressional Sub Committee in July 2003, Tom Mathis (Director of the TennCare Program Integrity Unit) cited enrollee fraud statistics for the year ending June 30, 2003: 21,638 cases closed with 6,487 terminations. You don't have to be a mathematician to see that these numbers are small percentages of a system that serves 1.3 million. 6,487 terminations is about 0.5% in other words, no problems with 99.5%.
Fact: TennCare Director Manny Martins testified before State Legislators in 2004 that there was no evidence of widespread fraud.
Fact: TennCare Fraud division has launched a "get tough with enrollees" publicity campaign,* notifying 9,000 enrollees that they will be looking into misuse of pharmaceuticals. Even if, against prevailing facts, all 9,000 enrollees have abused the system, they would still be less than 0.7% of 1.3 million-meaning 99.3% of enrollees are legally within guidelines.
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.
Section One Click Here
http://reform.house.gov/UploadedFiles/Mathis_Testimony.pdf
No Evidence Fraud Widespread, The Tennessean, Jan. 13, 2004, www.tennessean.com/government/archives/04/01/45433250.shtml
New Group of TennCare Fraud Investigators Up and Running, NewsChannel 5, Aired Feb. 11, 2005
TennCare Warning Letters Criticized, The Tennessean, Dec. 31. 2004, www.tennessean.com/government/archives/04/12/63524507.shtml
State Medicaid Fraud Control Units Annual Report Fiscal Year 2003, Dept. of Health and Human Services, Office of Inspector General