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Governor Bredesen promised to “manage” TennCare, not destroy it

Governor Bredesen promised to manage Tenncare, but instead he is destroying it.

Bredesen cut 200,000 people and severely limited care to those remaining, regardless of patients’ conditions. It is the largest withdrawal of health coverage in US history, costing Tennesseans $1.2 billion in federal funds.

He promised he would reform TennCare“witha scalpel, not an axe.”

Instead, Bredesen fought against alternatives to his cuts. Internal State memo of November, 2004 states: Objectives: Legislative – Prevent Alternative proposals (e.g., savings, revenue generation, enrollment). Bredesen actively fought legislative proposals to save TennCare.

He promised he would allow TennCare’s sickest patients to go beyond five medicines if they need it.(Final Order, U.S. District Court) “ TennCare officials said in court Friday such a conversion from "hard" to "soft" prescription limits would likely take two to four months...’’ (Associated Press, July 29, 2005 )

But now he says he can’t allow patients to appeal for the drugs they need to stay alive, even though he’s got the power to do so. He tries to point the blame away from him by blaming advocates.

Cost-saving management tools by TennCare advocates and concerned Legislators have been advocated for years:

• Expanded drug formulary to maximize savings on medicines – the Administration is working on additional drug categories, but is pursuing some changes that would severely hurt enrollees and drive up cost.
• Reviewing prescription use to prevent fraud and over-use of drugs

This change, also, could have been done years ago, and is only now being tried. It would save more than $300 million.

• Disease management programs to treat chronic disease. The governor estimated these programs could save TennCare $45 million to $65 million.
• Better performance from private contractors TennCare’s Pharmacy Benefit Manager hasn’t done the job, but still got more $$$!
• Putting MCOs back at risk “They need to have some skin in the game to manage costs,” Bredesen used to say. The limited “shared risk” arrangement saves $90 million. Expanding to full risk would save far more.

Governor Bredesen was right; management can save TennCare. And he needs to manage the program, not destroy it!