The TennCare Diaries

BlueCross has reserves of over $1 billion, larger than the reserves of state government," says Tony Garr, executive director of the Tennessee Health Care Campaign. They only have those reserves because of what they have charged the employers, employees and taxpayers of Tennessee. The state needs to get its act together and work with BlueCross to become a better corporate citizen. (From a Chattanooga Times Free Press article by Dave Flessner, 16 April 2005, titled "BlueCross profits set new mark")

Flessner does a good job in the Times Free Press story of providing all sides to the health care debate. In a nutshell, though I would not say Flessner would characterize it this way, BlueCross/BlueShield--a nonprofit--is making out like a Mexican bandit. Yes, Mexican. Because so many of my fellow Chattanoogans worry about "Mexicans" or "Latinos" getting on TennCare, not to mention the worry about those "jerks and thieves" stealing from taxpayers. Ah, but BCBS could never be seen as rapacious or predatory. Here are some facts that might change your mind from the article:

1. BCBS boosted its earnings by more than 52% last year, but of course BCBS overcharged "consumers with rate increases three times the rate of inflation."

2. BCBS made $154.2 million last year, but of course group employer contracts grew by 25% and premiums by 3x the rate of inflation.

3. BCBS achieved a 90% retention rate, but of course 2.8 million Tennesseans are part of BCBS which continues to reduce its reimbursement to physicians.

4. BCBS claims it lost $1.7 million on TennCare in 2004, but of course that loss will be mitigated as Bredesen is going to cut 323,000 enrollees from TennCare this June 1.

5. Tennessee will lose millions in matching federal funds because of Bredesen's plan, but of course BCBS will continue to gain in profits as it did last year with $154.2 million.

Plante has it right. And let's see--do I understand this right?

We're giving Iraqis universal health care coverage (see Bush Gives Universal Health Care to All Iraqis), yet we're sending our soldiers and support troops to Iraq to accomplish this goal and sacrificing our own sick and dying to massive cuts in Tennessee (see TennCare Cuts Get Green Light).

A man without a vision, Bredesen blames "consent decrees" for lack of reform, and the Tennessee Justice Center now says it cannot fight the state any longer. Why? The federal courts have given Gov. Bredesen the green light. Bredesen says that on June 1, the state can begin its massive cuts of 323,000 TennCare enrollees. But why, if we are doing so much for others, can we not take care of ourselves? See Everybody in, Nobody out!

Friday, Federal Judge Haynes scolded both sides in the TennCare case before the U.S. District Court. He wanted to know why the two sides (the state versus Tennessee Justice Center) could not come to an agreement. The problem? They don't trust each other.



Gordon Bonnyman of the Tennessee Justice Center

So Haynes clarified one thing for the two sides: All parties [have] agreed that a reworking of TennCare drug policies would save money. Those savings could be big enough to spare some enrollee cuts, the judge said.

Haynes offered changes that would break the standoff--and guess what, the changes sound a lot like the some of the Bredesen reforms:

Those changes include: 1) ''Therapeutic substitution,'' or requiring cheaper versions of the same drugs. 2) Requiring doctors to prescribe from a more elaborate list of preferred drugs called a ''three-tiered drug formulary.'' 3) Implementing a process called ''prior authorization'' that requires doctors to get permission from TennCare before prescribing a drug not on the lists. [Source for quotes in this blog come from the Tennessean]

What did the two sides say? They still don't trust each other. Furthermore, the state continues to say it will disenroll hundreds of thousands, and Bonnyman of TJC continues to say that a settlement won't fix the problems of TennCare enrollees. But Nashville attorneys George Barrett and Ted Carey, who joined the case last fall to represent two TennCare enrollees, said they were willing to compromise.

Another problem arose, namely how to notify some 30,000 severely mentally ill about being booted off of TennCare and what they could do about it. Well, that does seem like a big problem. Pamela Womack, CEO of the Nashville-based Mental Health Cooperative agency, said that the notification should be made one-on-one rather than by mail. This is the old social work model fighting the entrenched bureacratic model. And in this case, as in most, I agree with Womack. And while I abhor the dropping of severe mental health cases first, person-to-person skills are going to be required for helping these enrollees know what to do next. No two ways about it. Strange as it may sound, putting people first actually makes better government sense--since the government is the people. Isn't it?

Other highlights of the week:

• 6th U.S. Court of Appeals in Cincinnati will hear the state's appeal of Haynes' decision to temporarily halt disenrolling TennCare recipients.
• Bonnyman plans on "pulling back the curtain" to reveal day-to-day mismanagement of TennCare.
• Bonnyman has produce evidence to show that TennCare's health management company allowed boxes of mail from enrollees to accumulate unopened.
• Haynes will rule on Monday concerning tens of thousands of documents that have been introduced despite objections by the state's lawyers. These documents evidently tell the story of the state's legal strategies. [See Raft of Docs]

That's what House Minority Leader Tre' Hargett (R-Bartlett) is saying. See the Nashville City Paper for more coverage.



Ultimate Bushite Tre' Hargett, 97th District State Representative

Today's Nashville City Paper: "Hargett said Bredesen, the third-year Democratic governor, was 'disingenuous' for appearing in area political advertisements that complimented Democratic legislators for passing TennCare reform. It was used as an issue in 2004 whenever … television commercials ran here in Middle Tennessee with the governor … saying he turned to a state senator to reform TennCare. Then, the week after the election we were called up here for an emergency leadership meeting to be told … people [were] going to be removed.”

I have to admit. That was weird. But aren't these kinds of issues always political fodder for either side?

But Hargett again: “If we knew we had a problem in October, really, wasn’t it disingenuous for anybody regardless of party to run around the state talking about how we reformed TennCare?”

Okay, he's got a point. As many of you know, I'm not a fan of the Bredesen TennCare Reform. So I wonder about the way reform turned so quickly into crisis back in October, with of course lots of blame on Bonnyman and the Tennessee Justice Center. And as we are finding out in the case before the U.S. District Court, TennCare's Hickey is up in his eyeballs with self-inflicting testimony.

If you haven't been following the courtroom revelations, you'll want to see The Tennessean online today, specifically an article titled Sickest enrollees would be among first off TennCare. The story carries some fascinating updates on a case before the U.S. District Court in Nashville.



It's amazing what being under oath can do to a man. TennCare Director J.D. Hickey was on the stand yesterday and had to acknowledge that . . . among the first in line for TennCare cuts are hundreds of terminally ill or debilitated sick people whose in-home nursing care will be eliminated under Gov. Phil Bredesen's plan for changes.

Who will be affected first, Mr. Hickey? The elderly? Of course, Hickey estimated that ''hundreds'' of those who rely on nursing care at their homes will be among the first wave to lose benefits, under the plan to phase in enrollment cuts and benefit limits.

Why these poor folks first, asked Tennessee Justice Center's Gordon Bonnyman, who suggested that many had severe or terminal illnesses, such as ALS, also known as Lou Gehrig's disease, and some relied on ventilators to survive. Hickey conceded that this is true, and that many would have few alternatives if the one-on-one private-duty nursing care they rely on to stay at home is eliminated.

Thank God for Bonnyman.

What about the hospitals, guys? How will they be affected? Well, earlier today, the CEO of the state's largest hospital system testified. That would be Dr. Bruce Steinhauer, president and CEO of The Regional Medical Center in Memphis. He testified that hospitals would lose millions of dollars under the governor's plan but would lose even more if TennCare's financial crisis, which state lawyers have dubbed a $650 million problem, led to the program's collapse.

Fortunately, we have lawyers to question such big wigs: Ryan Morettini, a lawyer for TennCare enrollees, asked Steinhauer if he was aware of a recent news report in which Tennessee Hospital Association chief Mike Huggins said the TennCare changes could cost the state's hospitals $660 million in revenue next year. Steinhauer said he was not.

The long and short? Bad news for everybody.