Sunday, October 25, 2009

Obama Health Plan Another TennCare Fiasco

by Ron Spangler

TennCare in Tennessee has been hitting the news more today than at anytime since its conception. Critics of the proposed Government Option for all Americans point to the failure of TennCare to provide a government run program that would insure everyone that did not or could not not be covered by a private insurance company in the state of Tennessee. As a resident of Tennessee I believe the nation as a whole should listen to what people with experience in these government run programs have to say before they accept the proposed government option at face value. Trust but verify should not only apply to your enemies it should apply to all politicians.

Everyone must understand what TennCare is in order to understand how it failed in the past and continues to fail today, yes I said fail today. Tennessee was looking for a way to cut the high cost of heath care and decided to get out from under the Medicaid program. TennCare is basically Tennessee’s version of Medicaid. Contrary to what some people around the country may think, TennCare is still alive in Tennessee. It’s biggest private insurance company that is propping it up is Blue Cross Blue Shield. With the influx of new money being provided by the American Recovery and Reinvestment Act the American taxpayer and Federal Government is the biggest public entity that is keeping the program afloat.

According to Darin Gordon, Tennessee Deputy Commissioner the $1.1 billion in additional federal Medicaid matching aid will help TennCare avoid immediate budget reductions and allow the state to continue the program through December 2010. Another blessing for the state was the change in federal reimbursements. Before the act was passed for every dollar TennCare and ultimately the private insurers spent the federal government spent 65-cents and the state spent 35-cents. Now the federal government spends 75-cents and the state spends 25-cents. This has helped Tennessee since we are no longer facing a mandatory statewide agency reduction of 15% budget cuts for FY 2010. This does not mean TennCare can add any new services to its program, instead they must continue to cut cost by reducing the numbers of people currently covered that the state suspects or can prove are being fraudulently covered under the TennCare Program.

What all of this means is if the Federal Government and past actions of the Tennessee Democratic Governor and State Legislators had not come to the aid of TennCare, the program and the state would have been bankrupt back in 2005. Back then Governor Bredesen removed 170,000 Tennesseans from the TennCare program and reduced benefits and reimbursements to doctors and hospitals to save the program and keep the state from going into bankruptcy. While the efforts of Governor Bredesen, with help from the Federal Government, have succeeded in keeping the program alive fewer and fewer doctors and hospitals will accept TennCare patients. Under the Act, TennCare cannot expand the eligibility for coverage which means fewer Tennesseans can be covered by TennCare. As a result the governor has come up with another government insurance option called Cover Tennessee. This program relies on voluntary partnerships between the state, individuals and employers where each commit to pay one-third of the monthly premium of the low-cost product. With unemployment at 10.5% the program is running into trouble and the state may be facing another 2005 TennCare like crisis. Under both programs very few doctors will accept new patients so most people that are covered by these programs continue to use the emergency rooms for their primary care. By law the emergency rooms cannot turn people away but all they have to do is provide minimal care to stabilize the patient until other care can be found. This often means the patient is released immediately after they have been stabilized or transferred to a substandard medical facility like a nursing home, sometimes referred to as a rehab facility.

The bottom line is Tennessee’s government run experiment has been a dismal failure and if the President’s new Health Care Czar Nancy DeParle refuses to speak out against the public option she will be doing the President and her country a disservice. It is possible that due to the current outbreak of swine flu in Tennessee, both the TennCare and Cover Tennessee programs may go broke by the spring of 2010. It is also possible that if the unemployment rate continues to rise and the pandemic gets worse, Tennessee and other states may be facing another crisis similar to the 2005 budget crisis we faced in Tennessee.

It is unclear what will happen to TennCare if the federal government passes a national government option health care plan. It is clear that Nancy DeParle is going to have a large impact on what the government option looks like. DeParle served as Human Services Commissioner in Tennessee and should be well aware of the TennCare fiasco. Since the President has gone after the private insurance companies it is uncertain they will be part of a plan that is similar to TennCare. In all likelihood the federal government will have to design the program after Medicare. This in fact will be nothing more than a single payer plan. With Medicare already over 30 Trillion Dollars in debt I cannot see how the country can afford it, especially with the economy on the brink of disaster. DeParle knows that TennCare is nothing more than a huge albatross hanging around the necks of Tennesseans and it may get passed on to the rest of the country. If it does heaven help us all.

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