TN TAX BATTLE: State's cuts could dump 400,000 on hospitals

State's cuts could dump 400,000 on hospitals ERs can't be last resort under TennCare changes

By Mary Powers powers@gomemphis.com June 7, 2002 The looming changes in TennCare could cost the Mid-South's key health providers millions and patients like Ed Brandon and Jacqueline WynnStitt reliable access to health care and medicine.

Brandon, 42, and WynnStitt, 57, both Memphians, are likely among the 400,000 to 500,000 Tennesseans who might lose health coverage when the state's experimental health program is overhauled beginning July 1. These are individuals who earn too much to qualify for Medicaid, the state-federal health program for the poorest Americans, but for various reasons lack private insurance.

For most, the state budget will determine whether they still qualify for TennCare. If it does, many will find their benefits, co-payments and premiums changed.

"I have no idea what I would do without" TennCare, said WynnStitt, who qualified for TennCare last year after being turned down for commercial insurance.

She said she doesn't earn enough operating a rooming house to pay for health care. In the last 10 months, she has undergone a series of diagnostic tests to identify what is causing her tremors, breathing difficulties and stuttering. She is also plagued by spinal degeneration, which makes walking or standing for long periods difficult.

Brandon also works but said he doesn't earn enough to pay for 16 medications prescribed to combat AIDS. He said his medications cost about $20,000 annually. He directs the medication adherence program of Friends For Life, a local AIDS social service organization.

"Half of my almost 400 clients are on TennCare and are not Medicaid eligible," he said. If they lost health insurance they would turn to hospital emergency departments for care. "That wouldn't be pretty," Brandon said.

The General Assembly must still pass a budget for the spending year that begins July 1. The state faces a budget shortfall and must raise an additional $800 million to maintain current funding levels.

One option under consideration would cut government programs rather than raise revenue. The approach, dubbed the DOGS budget for "downsizing ongoing government services," would trigger deep cuts in education, eliminate the state departments of tourism and economic development and fund only the Medicaid arm of TennCare.

Representatives of institutions and organizations ranging from the Regional Medical Center at Memphis and Methodist Healthcare to the AARP and AIDS advocates said they are working against such a budget.

Many are urging legislators to fund Gov. Don Sundquist's proposed budget. Even if that budget passes, an estimated 75,000 Tennesseans will lose TennCare coverage.

Key providers said if adequately funded, the planned TennCare overhaul will likely strengthen the program. "There are those who feel the program is finally getting the attention it deserves," said Cato Johnson, Methodist Healthcare senior vice president.

But Johnson and others said the community's medical safety net could not absorb a big influx of uninsured patients.

"We need to pray that God's wisdom will be in the minds of the legislature as they decide this," said Dr. Scott Morris, Church Health Center founder and executive director. The clinic is part of the Mid-South's medical safety net. It cares for about 35,000 individuals who work but lack public or private health insurance.

If the ranks of the uninsured grow dramatically, Morris predicted hospital ERs will be swamped.

A recent report from the National Academies' Institute of Medicine noted that Americans without health insurance were more likely to suffer poor health and die prematurely. The differences surface within a year of being uninsured.

Johnson said if TennCare becomes a program serving only Medicaid-eligible residents Methodist would likely see the amount of free care it provides jump $40 million to $45 million annually.

"Methodist doesn't have that kind of money," he said. Last year Methodist, which operates 14 hospitals in West Tennessee and North Mississippi, recorded $238 million in uncompensated care.

The Med estimated its TennCare revenue could drop $20 million. The Med currently provides about $70 million in uncompensated care and receives about $27.5 million annually from Shelby County to underwrite such care.

Dr. Bruce Steinhauer, The Med's president and chief executive officer, said if the ranks of the uninsured swell dramatically the hospital would have to reconsider programs and services. He predicted The Med would have plenty of company.

It would likely include Christ Community Medical Clinic and the 10 Health Loop clinics operated by the local Health Department and Med. Both are part of the community medical safety net where the uninsured typically turn for care.

"We aren't going to refuse to treat people," said Dr. Robert Stolarick, who oversees the Health Loop clinic system. But he said if the ranks of the uninsured swell there would be less time available to help patients manage chronic health problems like diabetes and high blood pressure. "That will make for sicker patients and they cost more," he said.

Burt Waller, Christ Community Medical Clinic executive director, estimated 5 percent of its current TennCare patients are at risk of losing coverage. "If they became self-pay, it would create a financial hardship for us," he said. The clinic serves about 12,000 patients.

ER's have become the subsitute primary care physician for a large portion of the "poor" especially illegals and TennCare recipents. MORE clinics would help. NOT every patient needs a doctor, Nurse Practioners could ease the shortage of doctors.

TN tax Serfs are supporting Mississippi trauma patients to the tune of $17M a year. Last time I went to the ER for severe prolonged abdominal pain it took me OVER 5 hours to be seen (turned out to be cysts on an ovary.) SOME ER treatment. A visit to the doctor could have been accomplished in under 2 hours.

It still boils down to Taxquist refusing so much as a hint of handling things in a conservative manner. Most of the Tenn Care roll could be eliminated through tax break incentives to persons and employers for private pay insurance. As well the state needs to cut the off insurance company's corporate welfare which is what Tenn Care is. No more patient dumping into Tenn Care or medicaid at the tax payers expense. There are many in Tenn Care who can indded be covered in the private sector. Parent Insurance companies of the HMO's are instead using Tenn care as a risk factor dumping ground. If 400,000 are without insurance I hope they choose a Columbia Hospital.

There are choices to make in life. Some will be hurt some that shoudn't be will be but priorities to be made. how many illegals are gonna suffer. maybe they will get disillusioned & go back to their wonderful care that Fox has for them.

Please! Why can't these people do the adult thing and take care of themselves? Who told them it was other people's job to provide for their health care? Health care is not that expensive. Get a high-deductible policy, and pay for preventative care out of pocket...you know, just like you do for your CAR!

So does Blue Cross and a number of other insurance companies. When I first went into the work force we were given "basic" health insurance. It mainly covered ER, hospitalization, the doctor's services when you were in the hospital, and medical test. Today insurance covers perscriptions and doctor visits besides all the above. Health care cost is rising so fast that NOT even the government can afford to cover it.

I'll be at the protest on the 19th if nothing goes wrong between now and then. Look for my sign with the boss hogg pig on it it has FR & Shelby CO on it. I've got a NEW noise maker that sounds like a siren it's about the size of a TV remote control. I'm short, blonde/grey and plump and will have my Neanderthal Horn Honker T shirt on.

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