Bredesen gets Tri-Cities view on TennCare reform

By Jennifer Lassiter and Thomas Wilson
star staff

  JOHNSON CITY -- Gov. Phil Bredesen confirmed his plan to reinvent TennCare, the states $7.8 billion health care system in a public "round table" discussion at the James H. Quillen VA Medical Center campus on Thursday.
  The current system, if kept in place, will be forced to spend 80 percent of all new state revenue over the next four years.
  "We are trying real hard to keep people on the plan," said Bredesen. "But if the new plan doesn't work we will have no choice but to start cutting people off the list."
  In an effort to save the program, Bredesen has proposed what he described as "reasonable changes" to the health care system. The governor said trimming certain benefits of TennCare without cutting enrollees in the program was a top priority for his administration.
  Bredesen is proposing to amend the state's current TennCare waiver to redefine enrollee status, maximize expenditures, and hold down overall costs. Bredesen proposes moving some enrollees out of TennCare's core population, which will be called "TennCare Medicaid," and creating a new category called "TennCare Standard." The TennCare Standard would cover 30 percent of program enrollees who would be required to make co-payments for medical care. TennCare Medicaid enrollees - representing 70 percent of the program population - would not be required to pay co-payments and cannot be removed from the program.
  Bredesen described TennCare as "operationally, a mess". To address the problem, he heard comments from local enrollees, doctors and a few uninsured people to get a glimpse of TennCare needs in the Tri-Cities area.
   Dr. Deb Mills, a local pediatrician who spoke of her daily contact with TennCare patients and the importance of raising healthy children, stressed the significance of family needs and foster care.
  "The day these kids sign up, we need to be figuring out how to get them off," said Mills. "TennCare is our safety net; we can't lead them to grow up on TennCare."
  Lesley Mathes, a fifth-grade school teacher in Washington County, recounted a series of devastating events that left her without insurance or even TennCare coverage. Mathes said her husband passed away in July 2002, only one month after the couple learned she was pregnant with triplets. Her husband's death left her without health insurance. Mathes told the governor she was denied health insurance for her and her children even though she was a state employee.
  "Your circumstance is strange; we want to look specifically at your case," said Bredesen, underlinig the fact that she is a state employee and that this "should not be the case".
  Mathes has spent time fighting for the three children who were born prematurely and suffered from several physical problems. She said she maintained 24-hour nursing care for the triplets while she worked full time to support the family.
  "I've been in litigation with TennCare over approval," said an emotional Mathes.
  Roundtable contributor Peggy Oliver of Elizabethton told the governor she was forced to apply for TennCare two years ago after her husband died and she lost the health care benefits previously provided through her husband's job. She said she knew abuse of the program occurred, but added the system had been a life saver for her.
  "TennCare was a savior for my eyesight," said Oliver who had surgery to remove cataracts while on the program.
  She said she opposed the proposal limiting TennCare's pharmacy benefit to six prescriptions per month. "If you face paying insurance and buying groceries, you will have to choose," Oliver said.
  The draft TennCare waiver was submitted to the TennCare Oversight Committee of the General Assembly Aug. 19. The earliest any of these changes will take affect will be Jan. 1, 2005.
  The public can submit comments about the TennCare reform plan at the state's Web site, or by telephone (1-800-669-1851). Citizens can also mail comments to the governor at TennCare Open Discussion, c/o Governor Phil Bredesen, State Capitol, Nashville, Tenn. 37243.