November 1, 2002

Candidates’ stances on TennCare may affect VUMC

Featured Image

Candidates’ stances on TennCare may affect VUMC

With Election Day fast approaching, representatives of Republican and Democratic gubernatorial candidates spoke about health care finance issues at an Oct. 23 meeting in Nashville of the Tennessee Public and Teaching Hospital Association (TnPATH). The meeting agenda was dominated by TennCare, the $3.8 billion managed health care program serving 1.4 million of the state’s poor, disabled and uninsured.

Republican Van Hilleary and Democrat Phil Bredesen appear to hold similar positions on a number of key policy issues affecting Vanderbilt University Medical Center and other institutions that provide essential health care services in Tennessee. The discussion also pointed up some differences between the two candidates, represented at the meeting by Joby Fortson, policy director for the Hilleary campaign, and Paula Flowers, volunteer advisor to Bredesen.

• Fortson’s opening theme was that hospitals could count on a “provider friendly” Hilleary administration, including ready access to administrators who run TennCare.

• Bredesen’s theme is that Tenn-Care is a fundamentally sound program in need of experienced leadership. The campaign stresses Bredesen’s background as a former founding executive of a managed care company.

The availability of TennCare has inadvertently invited businesses to drop health care benefits for workers. Hilleary wants to move more people away from TennCare and back to private insurance. He would allow smaller businesses to band together in associated health plans, achieving lower health care benefits costs through the strength of mass purchasing. Fortson said 43 percent of Tennesseans are on government-based health care, compared to a 34 percent average in surrounding states. With government payments being inadequate to cover costs, providers shift these costs to commercial payers. Fortson said health care costs to private business in Tennessee are 29 percent higher than the Southeast average.

The Bredesen Web site includes a short recipe for fixing TennCare: improve oversight of TennCare managed care organizations, tighten eligibility, and “tailor” the benefits package, both to bring it in line with available funding and to lessen people’s incentive “to voluntarily leave private options.” The prospect of tightening eligibility and reducing benefits didn’t come up in the TnPATH meeting. In Flowers’ opening statement, however, it was made clear that Bredesen is especially aware that if TennCare shrinks, the financial burdens of safety net providers will increase. As for the managed care organizations, in addition to stepping up oversight, Bredesen would “get politics out of the regulation of the MCOs,” Flowers said.

• Hilleary views the current Tenn-Care enrollment reverification process as a positive step to ensure that only eligible citizens are included in the program; in fact, “reverification is the one thing that will save the program,” Fortson said.

• Bredesen views reverification as critical for preventing fraud, but Flowers said the candidate is also concerned that legitimate enrollees are not showing up at appointments to re-enroll in TennCare. Flowers warned that many people may not discover they’ve been inadvertently dropped from the roles until they show up sick or hurt in the ER or at their doctor’s office.

Both candidates would continue special TennCare funding for the state’s six safety net hospitals and for other so-called essential access providers. Funding for these payments has varied widely from year to year, and last year payments were dropped completely. This year Tennessee will spend $100 million in payments to essential access providers, with Vanderbilt’s portion coming to $10.4 million.

• Hilleary is committed to essential access funding at the current $100 million level or greater.

• Bredesen will review data before determining funding for essential access payments.

Both candidates would continue TennCare graduate medical education payments to the four hospitals associated with the state’s four medical schools. Tennessee will spend $50 million this year on these payments, with Vanderbilt’s portion coming to $14.2 million.

Both candidates would closely involve themselves with the TennCare program. Bredesen would take a “hands-on” approach to TennCare. Hilleary would meet daily with the TennCare director. Both candidates would establish collaborative ties with TnPATH. Neither candidate would replace the administrators currently running TennCare.

The candidates diverge on what if anything is to be done about rising medical malpractice insurance costs.

• Hilleary sees a malpractice insurance crisis in Tennessee, and would make medical malpractice tort reform a top priority.

• Bredesen perceives Tennessee juries as relatively disinclined to make exorbitant malpractice awards. He would monitor awards to ensure that they remain moderate and reasonable.

For more information, visit the candidates’ Web sites at and