Governor scrutinizes TennCare advocates’ plan, decision soon
NASHVILLE — State lawyers huddled with advocates for TennCare enrollees Tuesday, determining whether a cease fire offer in the court battle really will let Gov. Phil Bredesen move forward with his reform plan.
The governor told his Cabinet that a decision was coming soon on whether the offer holds hope for some 430,000 people who would lose coverage if TennCare is scrapped in favor of a basic Medicaid plan.
Bredesen said he wants to make sure the advocates haven’t left language in the court documents that will allow more of the lawsuits that have saddled the expanded Medicaid program. He said he essentially wants a guarantee that Tennessee Justice Center and attorney Gordon Bonnyman won’t stop his reform plan.
“This is just the time for plain talk,” he said. “If in fact they’re saying ‘We’ll let you go and ahead and do what this reform is about,’ then I think it’s wonderful and I’m going to roll up my sleeves and go ahead.”
Bredesen, who announced last week he intended to dismantle TennCare, said he’s worried about a part of the proposal offered by the Tennessee Justice Center and attorney Gordon Bonnyman that says the state still must comply with the Constitution.
Bredesen pointed out that the advocates have already said in court that the state’s overhaul is unconstitutional and worries they really won’t stand down from the lawsuits.
On Monday, the Justice Center asked a federal judge to suspend court orders over TennCare for two years. Bonnyman said in a press conference that the move would give Bredesen time to implement his reforms to control sharply rising costs.
“The documents that we were presented were much vaguer than the statements in the press conference,” Bredesen said. “Obviously it’s my responsibility to understand exactly what’s being offered here.”
Another sticking point, Bredesen said, is whether the agreement might require the state to expand enrollment again, beyond the 1.3 million people already on the plan.
“I will do anything remotely reasonable to try and preserve this program,” the governor said “I mean, I do not want to preside over asking 400,000 people to figure other ways to get health care — some of whom would not be able to do so.”
Bredesen said other hurdles would need to be cleared even if he gets the assurances he wants from Bonnyman. For instance, others could decide to sue the state, or federal regulators could deny it since TennCare operates under a waiver granted by the federal government during the Clinton administration, he said.
The federal government pays two-thirds of its cost.
Bonnyman has said all along that he doesn’t think the consent decrees in his case against the state are the real problem and thinks Bredesen has just been using him as a scapegoat to cover for a failed reform plan.
Bonnyman said the offer he made Monday mirrored one suggested by former Gov. Ned McWherter, who created TennCare in the 1990s.
McWherter said Tuesday he would have launched TennCare reform if he were in Bredesen’s place and hoped the deal would move ahead.
“I think it’s an opportunity to do what needs to be done for two years, give the governor the opportunity to make whatever changes and reforms he wants to make and needs to make,” McWherter said. “With no disrespect to the profession, lawyering can get in the way of this.”
TennCare as it currently exists is expected to cost the state $3.2 billion in 2005-2006. Basic Medicaid, the governor said, would cost the same as his reform plan, about $2.5 billion.
Bredesen’s reform plan aims to limit some enrollees to 12 doctor visits a year, 45 days in the hospital each year, eight outpatient hospital visits a year, 10 lab procedures or X-rays a year, and six prescriptions a month. It would also specify lower cost prescription drugs and impose co-payments for some enrollees.
The exact coverage offered under a return to basic Medicaid hasn’t been determined yet, state officials have said.
———
On the Net:
http://www.tennessee.gov/tenncare