November 4, 2005

Panel probes impact of TennCare’s restructuring

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photo by Dana Johnson

Panel probes impact of TennCare’s restructuring

State finance commissioner Dave Goetz said Tuesday he looks to Vanderbilt University Medical Center for ideas for the continuing redesign of the state's health care program, TennCare.

During a panel discussion on TennCare at the Medical Center, Goetz said Gov. Phil Bredesen has three priorities: “everybody pays something, we pay for the most important things, and we pay for what works.”

“Vanderbilt is the place we're turning to for research on what really does work,” he continued. For example, the Medical Center is helping the state implement an electronic medical records system in three counties in southwest Tennessee based on its StarChart system.

Goetz noted that the debate over reforming TennCare has ignored the plight of 580,000 Tennesseans – a tenth of the state population – who are uninsured. More than 80 percent of them work full time.

“Expanding TennCare is not the … solution,” he said, particularly in light of pending federal cuts in government-run health programs. “We have to make private insurance work better. We have to focus on maintaining health status and we must focus on technology.

“This has been a bitter, bitter year for all of us,” Goetz said. “We've got to cooperate, we've got to innovate, we've got to do it together.”

About 50 people attended the two-hour-long discussion, sponsored by the Vanderbilt Center for Medicine, Health and Society. In introductory remarks, Vanderbilt Chancellor Gordon Gee said he hoped it would help stimulate public debate about the future of TennCare and health care in general.

Goetz was joined on the panel by James F. Blumstein, L.L.B., director of the Health Policy Center in the Vanderbilt Institute for Public Policy Studies; Robert F. Miller, M.D., assistant professor of Medicine; Joshua E. Perry, J.D., research fellow in the Vanderbilt Center for Biomedical Ethics and Society; and Bonnie Pilon, D.S.N., professor of Nursing and senior associate dean for Practice in the Vanderbilt School of Nursing.

TennCare was launched in 1994 to expand Medicaid coverage to the uninsured and uninsurable. Until Aug. 1, when the governor's plan to rein in costs took effect, the program covered nearly a quarter of the state's population and consumed a third of the state budget.

Blumstein, a member of Bredesen's legal team who played a role in implementing the reform plan, argued that to be financially viable, government-run plans must balance the expected health benefits of the services it covers with the cost of those services. Yet Miller and Pilon said the cuts, which included reducing enrollment by about 190,000 adults (14-percent) and limiting prescriptions for others, have gone too deep.

Many patients who have lost TennCare coverage or whose covered prescriptions have been cut to five each month have had to rely on free medications provided by Vanderbilt pharmacists, Miller said. “Where is the safety net?” he asked.

The problem of providing health coverage is not unique to Tennessee, Pilon noted. More than 45 million Americans lack health insurance. “There is no health care system in the United States if you are underinsured or uninsured,” she said.