TennCare members satisfied with program; gubernatorial candidates seek reform

By Megan R. Harrell
STAR STAFF
mharrell@starhq.com

   According to a survey completed by the University of Tennessee, TennCare enrollees are more satisfied than ever with the state's health insurance program. The annual survey concluded that enrollees have an 85 percent satisfaction rate and they have more confidence on the quality of care they receive.
   The study shows that TennCare patients are going to their physicians more often and visiting emergency departments less. The ratio of TennCare recipients initially seeking care for their children at emergency rooms is at the lowest rate, five percent, since the program's inception in 1994, while adult use of hospital emergency rooms for initial care is at seven percent.
   "I am pleased that TennCare members continue to be satisfied with the high quality of care provided by physicians, hospitals, insurers and state agencies," said TennCare Director Manny Martins. "Member satisfaction is a direct reflection of the cooperative nature of the health care sector in Tennessee."
   Although studies show that TennCare members are satisfied with the care they receive under the program, enrollees may need to get used to the idea of drastic changes in the system's future. Politicians have made bold statements about reforming the system and any attempts to reform it could be met with resistance from the large number of Tennesseans fully contented with TennCare.
   Both Republican and Democratic gubernatorial candidates have made promises to reform TennCare if elected. "TennCare has grown out of control. Even though it has done some good things for some good people, structurally it's flawed," gubernatorial candidate Van Hilleary said. Hilleary stated that TennCare has grown in cost to the state by over 50 percent in the last three years. "I know of no program in Washington or in Nashville, or at any level of government, that can sustain that kind of growth every year," Hilleary said.
   Democrat Phil Bredesen is seeking a less drastic approach to reforming the state's health care system that has made Tennessee one of the most insured states in the nation. Tennessee has only 3.9 percent under the age of 18 and 6.94 percent of adults that are uninsured. "TennCare is a fundamentally sound program that is off track and must be fixed," Gubernatorial Candidate Phil Bredesen said.
   Bredesen has outlined three areas where he believes reform would help to improve the state's health care system. He believes eligibility, benefits and regulation are the keys to making the system more efficient and financially sound.
   TennCare recipients locally have already had to adjust to some changes in the system. As of July 1 the TennCare Bureau moved from the Carter County Health Department to the Department of Human Services where counselors screen applicants for all of the state's Medicare programs including food stamps, disability and Family First.
   Since July 1, Jack Hensley, Area Manager for Carter and Johnson counties, has overseen helping more than 4,000 Carter Countians receive state Medicare at one lever or another. "I think that the ones that are getting TennCare are very satisfied with the service that they are getting, and we have not had any real complaints about people not being able to get the service," Hensley said.
   If local TennCare recipients have any complaints with the system their concerns are with the new re-verification process. Workers at the Department of Human Services are working endlessly to make sure that all of those receiving the state's health insurance meet the new guidelines referred to as the TennCare standard. Hensley stated if individuals already receiving TennCare have no other way of receiving medical insurance, and their incomes are in the 100 percent poverty level, they will be approved by the TennCare standard and will continue to receive state benefits. TennCare members that do not meet the guidelines in the re-verification process are referred back to the state in order to determine their eligibility for other services.
   Hensley believes the re-verification process will help to make the entire health care system more effective. "TennCare needed some improvements. There was a lot of people that came on TennCare that could have gotten insurance some other way," Hensley said. He also noted that politicians are warranted in their concerns about the number of individuals coming into Tennessee from its seven neighboring states in order to have surgeries covered by TennCare. "We do know that this happens and it should not," Hensley said.
   As someone working with TennCare recipients on a daily basis, Hensley is able to see first hand how the program works. "I think TennCare just needs to be cleaned up to give service to the people that really need it. Years ago we had very little medical care for our people who could not afford it, and I think our people are more healthy now because they are able to get health care," Hensley said.
   TennCare has come under a lot of criticism for the amount of money it costs the state, and individuals that have been denied coverage have complaints.
   However, political candidates planning on reforming the program may want to note that a majority of those who benefit from TennCare are satisfied with it the way it is.