TENN: TennCare's deficit could reach $259 million (SHILLARY CARE fiasco)

The Commercial Appeal ^ | 2/5/03 | AP

[GailA]

TennCare's deficit could reach $259 million

By The Associated Press February 5, 2003

NASHVILLE - Even if the state drains the $140 million in TennCare reserves this year, Tennessee's health care program for the poor and uninsured would still reach a deficit of $259 million, Finance Commissioner Dave Goetz said Tuesday.

Goetz told the Senate Finance Committee that the state already has withheld the second quarterly payment to hospitals that treat most of TennCare's patients rather than further tap TennCare reserves. Those supplemental payments were to total $100 million over the course of the year.

He said TennCare's problems result from faulty numbers used to estimate the trend in medical costs. The numbers were built into the program's budget and the state's new waiver with the federal government that defines how the state will use Medicaid and other federal funds for the program.

Gov. Phil Bred esen has said his background in health care management will help him make necessary changes to get TennCare spending under control, but it will take time.

TennCare is the state's $5.9 billion health care program for 1.4 million people who are Medicaid eligible, uninsurable due to medical conditions, disabled, or uninsured children. The federal government pays two-thirds of the cost.

Sen. John Ford (D-Memphis) questioned whether the administration has the authority to withhold the payments to hospitals. Ford argued they were part of the budget and amounted to a contract. "If we do this the state of Tennessee has no credibility," Ford said.

Comptroller John Morgan said the finance commissioner "has a lot of discretion over how money is disbursed."

Ford said: "If you call this discretion, it is very unwise discretion. These payments should be made. You're putting hospitals in jeopardy. You're putting TennCare in jeopardy."

Goetz said there was some confusion over whether the $100 million in supplemental payments to hospitals was supposed to come from TennCare reserves, or from payments made to the managed care organizations that serve TennCare patients. He said the administration hopes to draft a plan soon on how to resolve funding shortages.

[GailA]

TennCare covers 25% of Tennessee's population..and it is about to BANKRUPT the state. This is what National Health Care..i.e. shillary Care would do to our Federal budget.

[Blood of Tyrants]

To Bredesen's credit, he has identified the prescription plan as one of the most abused plans in the U.S. Some Tenncare patients are getting 65 prescriptions a month. I have seen people on their deathbed who didn't get 65 prescriptions a month. The problem is that there are absolutely NO restrictions on the system and that there is NO co-pay at all! If they would implement a $5 co-pay for generic and a $10 co-pay for brand name, the would cut the prescription drug cost in half.

[OldFriend]

I believe it was the sensible citizens of Oregon who voted against any socialized medical care for their state.

Slowly as the results of these 'experiments' are becoming clear, people are waking up to the disaster any such government run health care plan is to their health and well being.

[MainFrame65]

The other problem here is that the prescriptions for long-term (maintenance) medications are for only 30 days at a time, with only 2 refills. My own insurance plan provides a similar benefit for short-term drugs, but after that, and for all maintenance drugs, I am required to use a mail order plan, with prescriptions written for "90 days, with three refills." This reduces costs considerably, and should be adopted by TennCare.

Of course, I have a co-pay amount that depends on generic versus proprietary, and listed versus unlisted on the formulary. There is no excuse to continue this plan without these cost-saving measures.

[MainFrame65]

Actually, I have discovered that I lied (a little) in post 4. I stated there that Tenncare doctors could prescribe 30 days of medication, with two refills. NOT SO!

The actual limit is 30 days with NO refills, and a new trip to both the doctor and the pharmacist every month, which drives the costs through the roof!

This information comes from a family member on Tenncare who takes an expensive drug, and refuses to stay on a job long enough to lose his Tenncare eligibility.

Don't flame me, I have had that conversation with him.

[GailA]

Yep Bredesen to his credit called it a CADDY plan.

[GailA]

In Memphis the eye docs send vans into neighborhoods to gather up kiddies for WEEKLY eye exams and TennCare pays for the van ride, the exam, the glasses. Then you have the GYN's doing pelvics monthly on young girls. Welfare Queens are using the docs as VERY HIGH priced baby sitters.

[MainFrame65]

Yes, I know about that one. Actually, there is some kind of a federal program for children that makes this scam available in many parts of the country. Fortunately for them, there are a lot of taxpayers like us around to support them. Doesn't that make us proud?

[Timesink]

"If we do this the state of Tennessee has no credibility," Ford said.

Too late.