Something must be done to reform healthcare in Tennessee.

By Senator Steve Cohen

This Op Ed appeared in the Commercial Appeal in January of 2006. Steve Cohen of Memphis is a Democrat who represents District 30 in the Tennessee Senate.

Moved by the pleas of doctors, clergy, community leaders and the many families that have been devastated by cuts in the TennCare program, a bipartisan group of legislators will make TennCare reform a priority this year. The TennCare crisis poses a major challenge for Tennessee, and it demands the legislature’s urgent attention.

Until now, lawmakers have been reluctant to intervene in decisions about TennCare’s troubled finances. We accepted assurances from the current governor and his predecessors that the TennCare Bureau and its contractors would make needed reforms on their own, and have provided only limited oversight of the program.

But recent events show that lawmakers, as representatives of Tennessee’s taxpayers, can no longer wait for state agencies to put TennCare’s house in order. In spite of assurances that $1.7 billion in medical care for the sickest and poorest Tennesseans could be cut without serious harm, it is now painfully obvious that real suffering is occurring across the state.

The situation will only worsen if TennCare continues on its present course, with only limited improvements to a woefully inadequate “safety net.”

Make no mistake — the collapse of TennCare has created a true crisis. An analysis by the University of Tennessee Center for Health Services Research warned that TennCare terminations, which reached about 200,000 by the end of 2005, can be expected to result in a preventable death every 36 hours. For those who remain on TennCare and who suffer from complex chronic illnesses, doctors warn that cuts in the program have left them unable to provide effective treatment.

Reductions in treatment for the severely mentally ill have been devastating, with jails and homeless shelters reporting that they are already beginning to see the effects. The loss of funds has undermined public health programs that affect all Tennesseans.

The economic damage to our state is serious as well. Two-thirds of the dollars cut from TennCare came from federal funds. UT economists warn that the loss of $1.2 billion in federal funds will reach beyond the health sector to cost Tennessee’s economy some 7,000 jobs in 2005 and about 20,000 by 2008, according to the Center on Budget and Policy Priorities. No state’s health care infrastructure has ever before sustained such a large loss of funds; officials have warned that as many as 20 rural hospitals in Tennessee may close.

Rather than fix TennCare’s financial problems, the state has merely shifted them to the private sector and to local taxpayers, who will have to pay for emergency care for those who now lack coverage but remain seriously ill. And Shelby County taxpayers will be stuck with the highest health care tab in the state.

There is no single “magic bullet” to fix TennCare’s problems, but lawmakers of both parties must pursue a combination of reforms in the months ahead.

I expect that we will seek passage of laws requiring the TennCare Bureau, with effective oversight and technical support, to institute overdue management reforms that can save money and improve patient care. Such measures include computerized review of drug prescribing and use, and targeted disease management programs.

We also will seek ethics reforms that specifically address the cronyism that has undermined public confidence in TennCare and compromised its integrity.

We will ask to extend coverage to the sickest patients who have lost TennCare, and will do so on a basis that is financially sound. We will also call upon Tennessee’s congressional delegation for help in restoring federal funding.

Tennesseans have a long tradition of responding to their neighbors in need. I am confident that the legislature will honor that tradition this year by requiring management reforms that will put TennCare on a sound financial footing and restore coverage to those most in need.

TREAT- TennCare Reform
TennCare Reform, Ethics, Accountability, and Transparency Act of 2006

NO NEW REVENUE NECESSARY FOR TREAT BILL

With the current revenue stream and with better management of the program, no new taxes are necessary. The TREAT BILL includes the following:

• Re-Opens Enrollment for the Medically Eligible or Uninsurable.

• Would return approximately 67,000 Tennesseans back onto the roles. Some Uninsured (the working poor) of the 121,000 cut would become eligible.

• Restores Medically Needy or “spend-Down” Program. This would allow 97,000 sick patients to remain on TennCare as promised .

• Ensure that all children below 200% of Poverty receive healthcare. Currently Tennessee is the only state in the country that only covers the Federal Minimum number of Children (those 100% of Poverty or below).

• Lifts hard limits on 5 prescriptions per month for the sickest Tennesseans to what is medically necessary.

Disease Management $45 MILLION
Requires the state to improve how it manages care for the 51,000 TennCare enrollees (4%) who use 47% of TennCare resources, so that their health care is effective and less costly.

Drug Utilization Review Minimum savings: $50 MILLION
Control drug overuse and abuse by using academic institutions already capable of identifying overuse and educating doctors how to prescribe more effectively and economically.

Home Health Care Support Minimum savings: $45 MILLION
Allows consumers to use vouchers to obtain home care instead of going into nursing homes. Each person who chooses home care would save TennCare an average of $4,400 per year.

Therapeutic Substitution $100 MILLION
Requires the use of the least costly drugs that will effectively treat patients, not the cheapest and not only what is adequate.

Accountability of MCOs
Makes managed care contractors assume financial responsibility for managing patient care.

Corporate Accountability
Holds accountable large corporations that encourage workers to receive state health care instead of providing affordable health coverage.

Call To Maximize Federal Matching Funds $200 MILLION
Requires state to seek 2-for-1 federal matching funds for safety net services.