CBPP on tenncare

The CBPP has weighed in on the effects of Bredesen’s proposal to scrap Tenncare. Among the highlights:

  • Eliminating TennCare apparently would not produce the level of savings for the state budget that the Governor seeks, unless the replacement of TennCare by a smaller Medicaid program is accompanied by other substantial cuts in health care coverage, such as substantial reductions in health care services for those remaining eligible under Medicaid.
  • The reductions in state expenditures associated with the switch from TennCare to Medicaid would cause the loss of almost twice as much in federal funding, which would lead to a substantial reduction in business activity and employment in the state.
  • The loss of TennCare coverage would create serious financial problems for Tennessee health care providers.

What the report says is, essentially, that not just Tenncare is in danger: because of the accompanying loss of matching federal funds (which, if I’m not mistaken, was the reason McWherter originally came up with Tenncare in the first place), benefits for those remaining covered by Medicaid will be slashed as well. Bredesen is claiming this is in line with other states, but evidently that is not the case:

In discussing possible reductions in the scope of coverage under the Medicaid program that would replace TennCare, Governor Bredesen has said the state might limit coverage of prescription drugs to four prescriptions per month and limit physician visits to ten per year. He stated that Tennessee’s revamped program would “look much like other Medicaid programs. It would be consistent with the mid-range of benefits. Not Mississippi, but not Massachusetts, either.”

In fact, the limits mentioned by the governor are not consistent with the mid-range of benefits provided by state Medicaid programs. A survey of Medicaid benefits among all states shows such benefit limitations would be exceptionally harsh when compared to Medicaid programs in other states, including many states in the South. Only four states — Arkansas, Nevada, Oklahoma and South Carolina — impose a limit of four or fewer prescriptions per month. (Florida has a limitation of four brand name prescriptions per month, but additional generic drugs may be prescribed.) Tennessee would be among the bottom five states in this area. Only one state (New York) limits the number of physician visits to ten or fewer per year, and exemptions are frequently granted. Tennessee would be in the bottom two states here and possibly at the very bottom, depending on the exemptions it allowed.

And on the economic front, the ramifications are also frightening:

An estimate of the effect of the loss of federal matching funds on the Tennessee economy can be derived from an economic model developed by the U.S. Department of Commerce’s Bureau of Economic Analysis.[8] Such an analysis indicates that a loss of $1.2 billion in federal matching funds would lead to an overall loss of $1.6 billion in business activity in the state, along with the loss of about 14,500 jobs.[9]

Most of the loss in economic activity and employment would occur in the health care sector, as hospitals, clinics, pharmacies and other health care providers lost revenue and, in turn, were forced to reduce staff and payroll. But some losses would occur in other areas of the economy, such as the retail and real estate sectors, as workers who lost income or jobs as a result of the decrease in federal matching funds reduced their retail purchases or encountered difficulties meeting rent or mortgage payments.

In observing the debate on this, I think it should be obvious that placing the blame on one person or organization for problems with a $2.3 billion program is ludicrous. Bonnyman himself has relucantly agreed to step away which, as the Scene notes, puts the ball back in Bredesen’s court. Instead of playing pathetic blame-games, Bredesen should be asking more fundamental questions about Tenncare’s situation and the Grier case. Why isn’t Tenncare in line with federal law? Why is Tennessee so short on money? Why is the cost of prescription drugs bankrupting our healthcare system?

These are not easy questions to answer, but they certainly don’t reflect well on the current Republican leadership in this country. Bredesen is doing a disservice to this state as a leader and as a Democrat by not asking the tough questions.