Editorials Question Sundquist’s Proposals for TennCare Reform

Tennessee's newspapers continue to respond to Gov. Don Sundquist's (R) proposal to revamp TennCare, the state's Medicaid managed care program. The proposal calls for restructuring TennCare into three parts, dropping coverage for about 180,000 beneficiaries and closing enrollment to individuals who are "uninsurable" in the private market (Kaiser Daily Health Policy Report, 10/1). The following summarizes recent editorials on TennCare reform:

• A Chattanooga Times & Free Press editorial calls Sundquist's efforts to reform the "horribly expensive TennCare" "commendabl[e]." The editorial says that although state officials want all people with "real medical needs to be taken care of," it is "obvious" that the program needs "substantial adjustments," especially considering that one-fourth of the state's population is covered by TennCare and that the program's costs have risen "beyond taxpayers' ability to bear the load." Although there is no "perfect plan" for reforming TennCare, Sundquist's proposals "offer a beginning," the editorial says. Pointing out that the state also faces other "financial problems," the editorial concludes that even after TennCare cost-cutting measures are implemented, "Tennesseans will still face a huge problem of finding enough money to fund all of our state's many important functions adequately" (Chattanooga Times & Free Press, 10/2).
• A second Times Free Press editorial, providing a counterpoint to the first, says that Sundquist's reform proposals "go too far toward damaging restrictions on enrollment, separation of enrollees and subsidies for private insurance costs that contravene the play-or-pay concept." Although the reforms were devised to save money, they "would do so only by shifting indigent costs back to other public bodies or private premium payers," the editorial states. The editorial adds that TennCare's problem is not coverage scope, but rather a "lack of resources" and lawmakers' "unwillingness" to mandate that insurers not participating in TennCare and employers that do not provide their employees insurance "carry their fair-share burden for public health-insurance costs." Other problems include the fact that some non-Medicaid-eligible individuals in TennCare "have been allowed to drop in and out of the program." Further, the program has allowed non-Tennessee residents to very easily "arriv[e] on TennCare rolls and extrac[t] expensive care at public expense," while many others have too easily received "uninsurable" status, the editorial says. The editorial recommends that the state solve those problems by "tightening eligibility, re-entry and status verification rules." Further, the editorial suggests the state ask for authority to impose "reasonable" copays and prescription drug limits for all TennCare beneficiaries (Chattanooga Times & Free Press, 10/2).
• A Nashville Tennessean editorial expresses concern about what will happen to the 180,000 people who would lose TennCare coverage under Sundquist's plan. The editorial says, "That not only raises immediate questions about the need for coverage for those people but what would happen once those people are off the rolls." Many advocates "rightly" believe that such people will rely on emergency rooms and hospitals for preventive care -- an "expensive proposition," the editorial states. In the debate about Tennessee's financial situation, TennCare has become a "scapegoat," the editorial says, adding that the program's critics fail to see that "TennCare has saved the state substantially when compared to the old Medicaid system." Although critics "blame" TennCare for the state's financial problems, they do not consider that two-thirds of the program's money comes from the federal government, the editorial states. The editorial adds that by proposing his changes to TennCare, "Sundquist is clearly making a political bow to those who want to blame TennCare for the state's budget woes." Sundquist in a televised address to the state said that the proposed changes would make the program "more efficient, leaner, streamlined and accountable to taxpayers." The editorial asks, "But will the changes be accountable to the health care needs of Tennesseans?" (Nashville Tennessean, 10/2).