Myth #1 The Reality

The TennCare cuts are the result of calculated political decisions, and state officials can still make better choices, if the people demand it. The legislature could address this public health crisis by restoring the program. Or, the Governor could relent and use TennCare’s reserves, which currently exceed $300 million, to reinstate coverage.

Other elected officials could also make different political choices that would relieve suffering and save lives. Tennessee’s congressional delegation has been sitting on the sidelines throughout this unfolding disaster. No other state has allowed its health care system to suffer such a blow, and when other states’ Medicaid programs have faced similar problems, their congressional representatives have worked successfully to obtain federal financial relief. Governor Bredesen has publicly ridiculed suggestions that Tennessee seek the aid of its congressional delegation, and especially the help of its powerful senior Senator, Bill Frist, who is the Senate Majority Leader.

While Governor Bredesen has rejected the idea out of hand and committed the resources of state government to slashing TennCare, leaders of other states have averted similar cuts by obtaining federal aid. In 2004, lame duck Democratic Senator John Breaux obtained $774 million in federal aid to prevent Medicaid cuts in his state.1 Alabama received $900 million in federal financial relief for its Medicaid program.2 In 2005, Democratic Senator Hillary Clinton and Republican George Pataki obtained $1.5 billion in aid for New York’s Medicaid program.3 At the request of several governors, the federal government also agreed in 2005 to make an additional $1.5 billion in federal aid available to help border states deal with the burden to providing Medicaid to undocumented aliens.

Tennessee can make an especially strong case for federal aid, because federal actions have contributed to the current crisis. During the 2002 renegotiation of the TennCare waiver, the federal government took advantage of a weakened former Governor. C.M.S. took back several key parts of the original financial agreement between the state and the federal government. Those changes cost the state hundreds of millions of dollars and reneged on commitments upon which the TennCare program depended. Those funds should be restored.

If the Governor won’t ask Senator Frist for federal aid, Tennesseans can. As a Vanderbilt physician, Bill Frist chaired a state Medicaid task force in 1993, and was an outspoken supporter of TennCare’s creation.4 Shortly after entering the Senate, he arranged for congressional hearings to examine TennCare’s early success.5 He has successfully supported increased federal funding for TennCare in the past.6 He has sponsored a bill to reduce racial disparities in health status, a problem that will become much worse in his home state if the TennCare cuts stand.7 As Senate Majority Leader he recently pushed federal legislation to maintain medical care for Terri Schavo.8 There is no reason to believe that he would not – or could not – advocate as effectively on behalf of his state as his colleagues of both parties have done for their constituents.

1J. Moller and B. Walsh, “774 million in Medicaid approved – Decision averts ‘catastrophe’, Breaux says”, The Times-Picayune (April 21, 2004).

2 K. Chandler, “Medicaid chief says huge increase needed”, Birmingham News (Dec. 28, 2004).

3 “HHS Agrees to Give New York More Medicaid Funds if It Implements Changes to Program.” Kaiser Daily Health Policy Report (March 17, 2005) available at kaisernetwork.org.

4 William H. Frist, M.D., Guest commentary: “TennCare’s a bold experiment that should benefit all Tennesseans”, Nashville Banner (August 6, 1993).

5 U.S. Senate, Committee on the Budget, Field Hearing on The Federal Budget: Opportunities for Privatization in Social and Entitlement Spending: Medicaid Reform, Nashville, TN (March 25, 1995).

6 See: Press Release: “Thompson, Frist Push HHS for TennCare Funds” (Dec. 13, 2000), posted at: http://frist.senate.gov/index.cfm?FuseAction=PressReleases.Detail&PressRelease_id=912; Press Release: Frist Commends CMS Approval of TennCare Funding Boost (April 30, 2003), posted at:
http://frist.senate.gov/index.cfm?FuseAction=PressReleases.Detail&PressRelease_id=1387

7 See S.2091, Closing the Health Care Gap Act of 2004; see also: Press Release: “Frist Goes Right to Work, Leads Health Disparities Roundtable” (Nov. 8, 2000), at: http://frist.senate.gov/index.cfm?FuseAction=PressReleases.Detail&PressRelease_id=902. The TennCare cuts will have a disproportionate impact on minority health status, as 41% (385,000) of Tennessee’s African-American population depends on TennCare for health coverage, compared to only 19% (870,000) of white Tennesseans. See Tennessee Department of Mental Health and Developmental Disabilities, “TennCare Eligibles, July 31, 2004”, p. 5, available at: http://www.state.tn.us/mental/publications/tcp/tce20040731.pdf; Compare: U.S. Census Bureau, 2000 Census: Summary File 1; General Profile 1: Persons by and Race, Age and Sex: Tennessee, at: http://cber.bus.utk.edu/census/2k/stf1/sf1s0001.pdf.

8 Senator Frist advocated for the legislation in order to ensure that Terri Schioavo received “medical treatment necessary to sustain her life”.See Speeches: Statement on Terri Schiavo Bill; Floor Statement – Remarks as Prepared for Delivery March 20, 2005. http://frist.senate.gov/index.cfm?FuseAction=Speeches.Detail&Speech_id=175&Month=3&Year=2005. A U.T. Center for Health Services Research analysis indicates that the TennCare cuts can be expected to result in hundreds of deaths annually from the withdrawal of necessary medical treatment. See note 73, above.