TennCare Vs. The Wal-Mart Low Road
In what could become a landmark case, the state of Tennessee is going to federal court today seeking approval to cut back on coverage offered by the state-paid TennCare health program.
Gov. Phil Bredesen (D) says the cut-backs will save the state some $100 million, enough to save 97,000 low-income enrollees from getting moved off the rolls entirely (which would reduce the number forced off TennCare under Bredesen's plan from 320,000 to 226,000).
The court will hear whether Bredesen's plan -- which include limiting drug prescriptions, restricting appeals by enrollees, and allowing TennCare officials to decide which procedures are "medically necessary" -- violate the TennCare law. The AARP, Children's Defense Fund, and Tennesse Justice Center all think so, and also think it will be a disaster for citizens using TennCare:
Fully 25% of Wal-Mart employees in Tennessee make wages so low -- and are unable to secure other health insurance -- that they depend on TennCare for coverage. Wal-Mart is the state's largest private employer.
Instead of stripping away health coverage for a quarter million people and families, maybe Tennessee could take a page from the Maryland legislature and its bill -- unfortunately sabatoged by Gov. Ehrlich and other corporate-backed politicians -- that called on big employers like Wal-Mart to spend at least 8% of their revenues on providing health coverage.
Other states are watching closely to see which way the case will go. Unfortunately, Gov. Bredesen is taking Tennessee health policy in the wrong direction.
Gov. Phil Bredesen (D) says the cut-backs will save the state some $100 million, enough to save 97,000 low-income enrollees from getting moved off the rolls entirely (which would reduce the number forced off TennCare under Bredesen's plan from 320,000 to 226,000).
The court will hear whether Bredesen's plan -- which include limiting drug prescriptions, restricting appeals by enrollees, and allowing TennCare officials to decide which procedures are "medically necessary" -- violate the TennCare law. The AARP, Children's Defense Fund, and Tennesse Justice Center all think so, and also think it will be a disaster for citizens using TennCare:
The state's attempt to redefine medical necessity, for example, is "putting a gag on doctors and they're kicking the doctors out of the role of decision-maker in what health-care enrollees get," said Michele Johnson, Tennessee Justice Center co-founder. Her organization has long said doctors should practice cost-effective medicine, "but this replaces the doctors with HMO bean counters."Largely left out of the debate is why TennCare is cash-strapped in the first place. Health costs are surely going up, but a report by the Memphis Commercial Appeal and Chattanooga Times Free Press in January 2005 found that 9,617 of those using TennCare for health coverage are employees of Wal-Mart.
Fully 25% of Wal-Mart employees in Tennessee make wages so low -- and are unable to secure other health insurance -- that they depend on TennCare for coverage. Wal-Mart is the state's largest private employer.
Instead of stripping away health coverage for a quarter million people and families, maybe Tennessee could take a page from the Maryland legislature and its bill -- unfortunately sabatoged by Gov. Ehrlich and other corporate-backed politicians -- that called on big employers like Wal-Mart to spend at least 8% of their revenues on providing health coverage.
Other states are watching closely to see which way the case will go. Unfortunately, Gov. Bredesen is taking Tennessee health policy in the wrong direction.
3 Comments:
You should read the piece on WalMart on the Becker-Posner blog.
J.S.
I worked for a health insurance company - a big one. Trained administrative professionals took the calls and claims, but I remember many a meeting where the general directives to the staff included, "Deny, deny, deny!"
This forces the person with the denied claim to appeal it, which most folks don't want to bother to do. That's where the doctors in Medical management came in. They would review the case at that point.
Health insurance companies can be such evil freaking entities - if you're submitting a claim, you or your loved one is already sick in some way, and the process of submitting and appealing claims just makes the stress worse.
Changes to TennCare won't make that any better, I'm sure.
Ehrlich vetoed the Maryland bill, but the legislature may well override that veto when they're back in session. I believe that will be in the late fall, maybe December.
Post a Comment
Return to Facing South's main page