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TennCare cuts - a moral crisis

Tennessee is currently experiencing a tremendous moral crisis because of unprecedented cuts to TennCare. As of December 2005, approximately 191,000 persons lost TennCare entirely. For most of the very sick and often very poor persons who were terminated from TennCare, there is not a viable alternative for health insurance. Instead they must depend on charity for all their health care needs.

The remaining 396,000 adults on the program are limited to 5 prescriptions a month. This forces a person who needs more than 5 prescriptions a month to defy their doctor’s best medical opinion and choose the 5 medicines they need most. Further, all 665,000 children and 396,000 adults remaining on the program face losing essential health care because of a change in the state’s policy that bases what services will be covered on whatever is “least costly” and “adequate” without anchoring it in standards of good medical practice. The Children’s Defense Fund states this “will immediately harm every child enrolled in the TennCare program.”

Why are the cuts to TennCare a moral issue?

• People have died and will die prematurely because of the loss of life sustaining health care.  This applies to people who have lost their TennCare entirely and also to those who remain on the program but are subject to a second class standard of care because of harsh limits and medical care based on “least costly” and “adequate.” An analysis by the University of Tennessee Center for Health Services research predicts that, from the disenrollments alone, there will be 275 additional, preventable deaths each year.
• The great majority of persons losing TennCare will NOT be able to afford a private health insurance policy. Charity may provide some of their health care. However, most will go without essential health care.
• Persons will be forced to choose between paying for essential health care versus other basic necessities, like food and shelter.
• The racial disparity in health care is increasing because of the cuts to TennCare. African Americans, who suffer disproportionately from chronic illnesses and poverty, are suffering disproportionately from the loss of essential health care.
• The state has taken $1.8 billion in both state and federal dollars from the health care infrastructure in Tennessee. All taxpayers will potentially bear some of this burden through increased taxes at the local level. However, the persons bearing the greatest burden are the ones who can least afford it, both economically and medically – the sick and poor who depend on TennCare for health care.
• Repeated audits and court findings document that the state and its politically powerful managed care contractors have mismanaged TennCare for years Instead of saving money by holding contractors and agencies accountable, the state is balancing the budget on the backs of the poorest, sickest, and most vulnerable Tennesseans.
• TennCare contractors, such as the pharmacy benefits manager, First Health, and the non-profit insurer, Blue Cross Blue Shield, are more profitable than ever. In the meantime, families are suffering and persons are dying because of lack of affordable health care.

More than 200 concerned clergy statewide stated in a letter to Governor Bredesen from December, 2004 regarding the TennCare cuts, “Jewish, Christian, and Islamic faiths all teach the moral imperative of a society’s obligation to its most vulnerable members. It is not an obligation that is to be borne solely by institutions and houses of worship, but one that is also shared with our government.”

In contrast to the moral imperative to be our brothers’ and sisters’ keeper, the state of Tennessee is denying health care to people who have done nothing wrong and who did not create TennCare’s management problems. People of faith and compassion are called upon to hold our government and elected officials responsible to reverse these immoral cuts and institute just, fair, and compassionate TennCare reform.

“Injustice anywhere is a threat to justice everywhere.
We are caught in an inescapable network of mutuality, tied in a single garment of destiny.
Whatever affects one directly, affects all indirectly.”
-- Letter from Birmingham Jail, April 16, 1963, Martin Luther King, Jr.