TennCare advocates outline changes for Bredesen
NASHVILLE — When Gov. Phil Bredesen outlined his reform plan for TennCare last February, he said he wanted input from groups that advocate for the needs of enrollees. Tuesday, he got it.
A coalition of groups representing the 1.3 million Tennesseans who use TennCare released a 27-page summary of it recommendations for reforming the program, its concerns over what Bredesen’s plan might do, and questions to be considered in making these decisions.
Tony Garr, executive director of the Tennessee Health Care Campaign, said the coalition supports reforming TennCare and saving the state money, but said it fears some of the governor’s plans could be needlessly harmful to the enrollees.
The coalition’s proposals have been forwarded to the governor’s office, and members met last week with administration officials to go over their plan.
Among the coalition’s biggest concerns are Bredesen’s proposals to limit drugs to six prescriptions per month in most instances, eliminate some categories of drugs from coverage and force the use of generics whenever possible.
Garr acknowledged the costs of the $7.8 billion program cannot be reined in without doing something about drug costs but said the coalition believes the six-prescription limit will be a false economy.
“Good medicine can save you money,” Garr said. “The six script limit is unnecessary and we believe it will cost the state money in the long run. There is no study we could find that says limiting medications saves money.”
The coalition’s proposals also raise concerns about the definition of “disabled,” which will determine for a lot of people whether they are eligible; services for children; safety net provisions; disease management; and the operation of the managed care organizations, known as MCOs.
Coalition members said there is no reason to reinvent the wheel with regard to the definition of disabled, that there are several functional definitions already worked out.
They said the safety net should be in place before any cuts in TennCare benefits or increases in cost-sharing are implemented.
Disease management should focus on the quality of life of the patient and not just the cost, they said.
And the MCOs should be put back at risk for managing care, which they have not been for two years now.
“Often we are characterized as anti-reform,” said Carol Westlake of the Tennessee Disabilities Coalition. “We want to lay that to rest. We absolutely believe it needs to be reformed, but we also believe it needs to be reformed in ways that protect Tennessee’s citizens.”
Bredesen sketched out his TennCare reform plans in February in an address to the General Assembly. Since then the Legislature has passed two laws giving the governor broad discretion to change the program, but the details of exactly what is to be done have yet to be specified.
The coalition hopes its recommendations will be considered as those details are mapped out.
“There are ways to reform TennCare and save money without hurting people,” Garr said.