Democratic governor in Tennessee oversees drastic Medicaid cuts

Before July 1, TennCare served 1.3 million poor Tennesseans, nearly half of whom were children. The majority of funding for the program’s $8.1 billion dollar annual budget has come from the federal government in a special arrangement through the Centers for Medicare and Medicaid Services, making the program less costly for the state than many, despite its large size.

Nationally, TennCare has enjoyed a reputation for being the most comprehensive of all Medicaid programs while boasting the lowest per-enrollee cost. However, it has consistently been described by the governor’s office as “a budget buster” requiring “necessary reductions in adult enrollment.”

The cut—the largest single reduction of enrollment in Medicaid history—is being justified by a budget crisis and need to balance the books. This is a familiar refrain echoing through state houses all across the US, where grants to public advocacy and social service programs are being sacrificed in favor of tax cuts for the wealthy and spending on war.

While oversight of Medicaid falls for the most part to the states, it is funded jointly by states and the federal government. States have been pressured to cut their programs in tandem with a $10 billion reduction in federal matching funds this year. Most states responded by cutting expanded coverage, shedding both adult and child beneficiaries who receive “optional” care according to the federal Medicaid law.

In many cases, treatments categorized as optional are actually necessary to maintain a patient’s health or life, but are based more on financial than medical considerations. The dis-enrollment in Tennessee will cut adult beneficiaries by half, and dramatically transform TennCare from the most inclusive to one of the most restrictive programs, offering the lowest level of adult coverage in the country.

Prominent nightly vigils at the Tennessee Capitol building and statewide Town Hall meetings have been organized by the public health community to protest the cuts. Tony Garr, the executive director of the Tennessee Health Care Campaign and one of the principal organizers of the protests, spoke with the World Socialist Web Site.

“The people whom the Governor is cutting are the most vulnerable,” Garr said. “People are being cut based on what category of eligibility they are in, not on their medical needs. There are over 67,000 people who have chronic medical conditions, who are part of the expansion population [unable to afford care but not mandatory recipients under federal law], verified by their doctor, and they are being cut, as well as a Medicaid category called ‘Medically Needy.’ The best description for this group is that they also had high medical bills and because of the bills, they are now financially bankrupt.”

Beyond the elimination from the program of 323,000 people, those remaining in TennCare will be limited to five prescriptions at any one time, hastening health complications for those suffering from multiple conditions and immune system deficiencies, including AIDS and organ transplant rehabilitation. According to Garr, “These cuts are already contributing to the preventable deaths of people. Thousands of lives are being put at risk and there is not a safety-net big enough to catch them all. TennCare was their safety net. Now...people are falling through and are being forgotten.”

The Knoxville News-Sentinel reported August 23 that many health care providers had been specially enlisted by Governor Bredesen shortly before the new fiscal year to maintain the “safety net” for four months in order to “soften the blow” of dis-enrollment for those requiring insulin injections and other critical forms of care.

In a separate statement, Bredesen described his “soft landing initiative” as “an example of how we can all work together to find solutions to help fill the gaps in services for people leaving TennCare.” Contrary to his self-congratulatory bluster, however, the governor’s promised $105 million transitional program has yet to be launched, non-profit clinics have seen no compensation, and social service providers complain that they are forced to turn people away.

Sherry Falkner, working in Lenoir City, in eastern Tennessee, for the National Alliance for the Mentally Ill (NAMI), expressed concern for the estimated 30,000 seriously mentally ill TennCare beneficiaries who were dropped from the rolls in July with limited options or ability to secure their own care without assistance. “As advocates in Tennessee we are most disturbed about these deep cuts to the most severely ill. It will be devastating and cost lives, I’m sure,” she told the WSWS. NAMI has predicted a marked increase in homelessness, accidents, and inappropriate incarceration of the mentally ill as a result of Medicaid cuts at both the state and federal level.

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http://wsws.org/articles/2005/aug2005/tenn-a30.shtml