Tuesday, March 28, 2006

TennCare, the Sequel??

From the folks who brought you TennCare, we now have the sequel . . . Cover Tennessee.

TennCare was unique in two ways. First, TennCare originally covered people who were not eligible under Medicaid. Traditionally, Medicaid provides health coverage to children, the aged, disabled, and families with very low incomes. The TennCare waiver offered coverage to families who either had no access to group insurance or individuals who had medical conditions that made them "uninsurable." The individuals who were covered through the TennCare waiver paid monthly premiums for their health coverage based on their incomes.

Sounds like a noble idea.

Only one problem . . . it failed miserably and in less than 10 years was on the ropes.

With TennCare, the health and productivity of Tennessee's citizens increased. Tennessee once boasted the lowest number of children without health coverage, and at the same time the lowest cost per enrollee of any state Medicaid program.
Unfortunately, the program fell into mismanagement as subsequent administrations failed to properly oversee the complex program and its many contractors. Advocates for the poor and disabled worked closely with various administrations to improve the program for the benefit of its recipients.

In 2005, the TennCare program was dealt a devastating blow by Governor Phil Bredesen, who had promised during his campaign to reform the program. Instead of reform that repaired the mismanagement of the program, Bredesen terminated coverage for all the adults enrolled in the TennCare waiver as well as for all the adults in the optional Medicaid categories that most states cover. Nearly 200,000 people in the state have lost health coverage, including people with life-threatening illnesses. Many have died. Their deaths are continually being reported by the media.

It get’s worse . . .

The State has also codified the narrowest definition of "medical necessity" in the nation. Medical necessity is the gateway to Medicaid-covered services since a service must be found to be medically necessary before a Medicaid agency will pay for it. Like most states, TennCare's former definition make medical necessity equal to that which the standards of good medical practice would require. The current definition says that a service is medically necessary only when it is the cheapest care that is adequate. The definition explicitly states that the cheapest care may be no care at all in some instances. The definition also give the power to determine medical necessity to State bureaucrats, not doctors.

Now we have Cover Tennessee.

Cover Tennessee is a plan with premiums shared by the state (via taxes), the employer and the employee.

"CoverTN will not require high deductibles on the front end," Bredesen said. "Participants will have modest co-pays -- about $25 for a doctor's visit and $10 for a generic prescription -- and can carry CoverTN with them regardless of where they work. Initially, the focus will be on workers earning $24,000 a year or less and small businesses such as restaurants, retail shops and landscaping firms...

If this plan gets off the ground, it remains to be seen if it will blossom or crash and burn like TennCare.
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