Lawmakers will see TennCare legislation next week
NASHVILLE (AP) — Gov. Phil Bredesen is putting the final touches on legislation that would help him overhaul the state’s $7.8 billion TennCare program, and lawmakers will get their first look at it next week.
The governor aims to curb TennCare’s growth and save $2.5 billion over the next four years. The plan would cut benefits for many of the 1.3 million TennCare enrollees and require even the poorest “able-bodied adults” to help pay for their health care and drugs.
Most of the benefit reductions proposed by Bredesen in February wouldn’t apply to pregnant women, children and the disabled, but they would have to use generic drugs whenever possible and pay for over-the-counter antihistamines and gastric-acid reducers instead of getting free prescriptions.
Bredesen can do much of what he wants administratively but needs legislative authority for some aspects and federal approval for others. Part of the reason lawmakers haven’t seen his bill yet is that the staff is trying to determine just what laws need to be changed.
Administration officials declined to discuss details of the legislation on Friday.
Lawmakers generally have been supportive of Bredesen’s proposal but want to see the bill before committing themselves. The administration will brief legislative leaders about the bill Monday and it will be completed early in the week.
“It’s something I know they’re waiting for,” the governor said Thursday. “I think there’s a tremendous amount of support. I think it will be a fairly easy one for them to deal with.”
Among other things, legislators will be asked to approve the creation of a separate agency devoted to TennCare fraud and abuse investigations.
Bredesen said he wants it to be “a law enforcement unit, not a bureaucratic one” with the “authority and autonomy it needs to actively go after fraud and abuse, to recover money that has been stolen from the program, and to refer to the district attorneys the cases that warrant criminal prosecution.”
The governor’s proposal would not cut any enrollees off the program but would implement an insurance package more in line with commercial insurance.
He suggested limiting prescriptions to six per month for everyone except children, pregnant women and the disabled. TennCare also would pay for no more than 10 doctor visits, 45 inpatient hospital days and eight outpatient days per year.
Without changes, the governor says, TennCare will become too expensive to sustain. It already takes up more than a quarter of the state budget for next year, about $2.3 billion. The rest of the funding, about two-thirds of the total cost, comes from the federal government.
The governor’s proposal has the support of doctors and hospital officials, who generally would fare well under the changes. But advocates for TennCare enrollees are concerned that it will leave the state’s most vulnerable people without options.
“How the savings are achieved will be critical,” said Gordon Bonnyman, an attorney who has successfully sued the state several times over TennCare failings.
“When you’re talking about this population — the really sick, chronically ill, elderly, disabled, and medically fragile children — it is very challenging to make reductions that don’t potentially endanger people.”