Associated Press (10.11.01) - Thursday, October 11, 2001
US District Judge William J. Haynes, Jr. could decide as early
as today whether to prevent Tennessee Gov. Don Sundquist from
closing TennCare, the state's insurance plan for the poor, to
people who cannot get insurance elsewhere.
The closure is the first step in the state's plan to overhaul
TennCare and divide it into three parts. The largest part
would be TennCare Medicaid. The second part would be TennCare
Standard and would have fewer benefits than the larger
version, with stricter eligibility standards. The third part
would be TennCare Assist, in which the state would subsidize
the insurance premiums of those who have access to employment-
based health insurance but cannot afford to purchase it.
Because 180,000 of TennCare's 1.4 million current enrollees
would be ineligible for any portion of the revamped program,
the state would save an estimated $155 million a year.
However, it would also forgo an additional $435 million
federal funds that purchase premiums and pharmacy rebates.
The revamped program would severely affect the state's
mentally ill population and many thousands of Tennesseans with
incurable diseases who are considered medically uninsurable.
According to Gordon Bonnyman of the Tennessee Justice Center,
who sought the restraining order, closing the rolls to the
uninsurable violates the settlement of a previous lawsuit that
he and state officials negotiated last year.
Many of the affected enrollees are those most in need of
health care coverage. Some have Medicare, but it doesn't pay
for prescription drugs. Specifically affected will be
individuals with HIV. Dr. Stephen Raffanti, a Vanderbilt
University professor and medical director of several HIV
clinics, testified that the average HIV patient needs about
three drugs at a total cost between $1,000 and $1,500 per
month. Those patients are typically poor and would have to
cover the costs themselves if not for TennCare. "TennCare is
crucial for HIV-positive individuals," he said.
Elisabeth Rukeyser, Sundquists' commissioner of mental health
and developmental disabilities, is also against the changes.
She told state legislators that the new TennCare plan would
cost the state $100 million to replace the mental health
services lost through the restructuring, as well as $202
million in matching federal funds.