March 14, 2003

Vanderbilt responds to state budget proposal

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Aleksandar Stanic and Jang-June Park, both graduate students in Immunology & Microbiology, are primarily responsible for the reported genetic and biochemical findings. (photo by Dana Johnson)

Vanderbilt responds to state budget proposal

Tennessee Governor Phil Bredesen has proposed $328 million in additional spending for TennCare, the $6 billion health care program for poor, uninsured and uninsurable Tennesseans.

The TennCare spending proposal was included in Bredesen’s $21.5 billion state budget proposal, which he outlined in a brief speech before a March 10 joint session of the state House and Senate. The overall proposal comes to $132 million less than last year’s state budget. This would be the first reduction in state spending in 10 years.

“I am proposing cuts that no one likes — including me,” Bredesen said. The proposal includes 9 percent cuts across the board; it eliminates 845 job positions, 207 of which are currently filled.

Bredesen said that to control TennCare costs prescription benefits will be reduced before the end of the fiscal year in June, and more changes will be forthcoming.

“By this summer, we will begin making fundamental changes in the structure of TennCare,” Bredesen said. “This program is innovative and it is helping hundreds of thousands of Tennesseans. It is also deeply troubled and it is one of the most significant sources of our fiscal woes. Its problems are structural, not superficial. It requires major surgery, not Band Aids.”

Meanwhile, Tennessee hospitals and physicians have been forced to subsidize a woefully under-funded program. Payments are in many cases inadequate to cover the cost of care and providers sometimes receive no payment at all. The state’s academic health care centers are reeling, as are physicians and hospitals that operate in rural areas of the state. Distrust and financial loss have caused doctors to flee the program, increasing the strain on the remaining doctors and hospitals.

“The fact that the governor is apparently willing to increase spending for TennCare may be cause for optimism, but without more specific information it’s hard to form any particular expectations,” said Norman B. Urmy, executive vice president for Clinical Affairs and CEO of Vanderbilt University Hospital. “We’re looking forward to hearing details of the governor’s proposal.”

Urmy added that Vanderbilt agrees with the governor’s announced intention of reducing TennCare pharmacy expenses. “We hope that any savings realized will be kept in the program to help meet the costs of care.”

Betty Nixon, director of Community, Neighborhood and Government Relations, said Bredesen will be revealing more of his plan for TennCare within the next two or three weeks.

In an Op-Ed piece in the March 12 Tennessean, Vice Chancellor for Health Affairs Dr. Harry Jacobson wrote that, “It is neither legitimate nor responsible to under-pay for actual services provided and to claim that the program is a success. … It is about time that the state’s leadership and our legislature showed some responsibility to the doctors and hospitals that have kept faith with a TennCare program that hurts them so severely financially. We cannot continue the status quo indefinitely.”

As a candidate, Bredesen promised continuation of special TennCare funding for the state’s six safety net hospitals and for other designated essential access providers. Funding for these payments has varied widely from year to year, and last year payments were dropped completely. This year lawmakers had agreed to spend $100 million in payments to essential access providers, with Vanderbilt’s portion coming to $10.4 million; today, nearly three-quarters of the way through the fiscal year, Vanderbilt has received only the first of four quarterly essential access payments. The TennCare Bureau has frozen these payments and Bredesen made no further comment about his intent to fund the payments.

TennCare accounts for more than half of the $629 million in new spending proposed by Bredesen. Other new spending includes $107 million for state employee health benefits and $21 million for teachers’ salaries in rural areas of the state.