TennCare bill crosses first hurdle in Legislature
NASHVILLE (AP) — Gov. Phil Bredesen’s TennCare legislation began moving through the General Assembly on Thursday with unanimous approval by a Senate committee, even as doctors expressed concerns it might hurt them and their patients.
The key stumbling block to the legislation was removed Wednesday evening when the administration reached agreement with pharmacists over a provision they feared would shut them out of future TennCare business.
The Senate Commerce Committee approved the governor’s two bills after agreeing to the change that will keep pharmacists involved, but allows Bredesen to do whatever he feels necessary to cut costs in the $7.3 billion health care program.
“This gives us the tools we need to fix TennCare,” said Senate sponsor and Speaker Pro Tem Jo Ann Graves, D-Gallatin. “I believe this is a step in the right direction.”
Bredesen hopes to save $2.5 billion during the next four years in TennCare, which will require $7.8 billion in state and federal funds next year. The overhaul has been the most significant initiative of his administration.
“I was very satisfied it came out in a sensible way,” the governor said Thursday afternoon.
“I definitely don’t want some estrangement from the pharmacists. … I’ve said a thousand times, you can’t do these things over the dead bodies of the providers, whether pharmacists or hospitals or physicians or anything else. You’ve got to find acceptable ways of working together,” Bredesen said.
The plan includes a limit on prescription drugs for about 450,000 of the 1.3 million TennCare enrollees and will require using cheaper generic and over-the-counter drugs wherever possible. It also limits the number of hospital stays, doctor visits and lab work, and sets up a tiered co-payment system with charges ranging from $1 to $40.
The proposal will include a limited safety net for people who need more treatment or medication than allowed and for those who cannot afford to pay for TennCare services.
However, TennCare enrollee advocates have expressed concerns the governor’s plan will deny needed treatment, resulting in more expensive care or even death.
They haven’t vigorously pursued changes to the legislation but are focused on new rules and regulations that must be enacted if the bills are approved and the federal government agrees to the governor’s plan.
“We’re meeting regularly with the administration to convey our questions,” said Stewart Clifton, who represents the Tennessee Health Care Campaign and National Association of Social Workers. He said the administration has committed to keeping enrollee advocates involved.
Two doctors told Commerce Committee members they fear the governor’s proposal would put them in a legal bind if they refuse to treat someone who can’t make the co-payments, and that patients will need more expensive treatments if denied prescriptions or services.
Also, they said the legislation’s definition of medical necessity will give the state too much authority in decisions that should be left to a doctor and patient.
“It tends to overvalue evidence and undervalue judgment,” said Dr. Bob Levine, a professor at Meharry Medical College in Nashville. “You’re issuing me a medical license but telling me I can’t use it on TennCare patients.”
Sen. Jeff Miller, R-Cleveland, said he doesn’t see how the state can control costs other than to tighten that definition and asked Levine to offer alternatives.
Levine said there should be a more balanced approach. Otherwise, he said, “Is it really ethical to practice in TennCare? You might say it’s cost-effective, but is it medicine?”
TennCare Director Manny Martins said Levine mischaracterized the issue.
“Doctors will still be able to practice medicine, but managed care needs to be a part of the TennCare system,” Martins said. “There’s no intent to take away any doctor’s judgment on good medical practices at all.”
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On the Net:
Read SB3394/HB3512 and SB3392/HB3513 at http://www.legislature.state.tn.us