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MYTH #18: REALITY While state health care contractors publicly supported the Governor’s proposed cuts, almost all experts and groups that are financially independent of the state have strongly opposed the cuts as ill-conceived and harmful. During a 30-day comment period in August-September 2004, the Governor’s Office received over 2,000 letters and other messages. State officials never released the comments for public inspection but did admit that the majority expressed concern regarding the impact of the Governor’s proposals.1 Those expressing concern that the planned changes would be harmful included national medical organizations, the Children’s Defense Fund, AARP, national Civil Rights organizations and over 200 religious leaders from across Tennessee. Physicians, non-profit agencies and advocates not only expressed concerns but worked diligently to offer constructive proposals for alternative policies that would achieve savings without harming patients. They pointed to a large body of medical evidence that the kinds of arbitrary cuts imposed by the Governor drive up expenditures for later, more expensive institutional care, and that good care management is therefore a more effective way to contain costs.2 A broad array of non-profit agencies serving TennCare patients worked for months to develop real reform proposals. In April 2004, the Tennessee Health Care Campaign, an umbrella organization representing those agencies, presented to state officials a detailed, 27-page report with specific recommendations.3 Other groups, including AARP, the National Alliance for the Mentally Ill and the Southern Christian Leadership Conference, submitted additional expert recommendations that would have saved money and improved TennCare’s management. The Tennessee Justice Center submitted a series of detailed technical recommendations in June, November and December 2004 that would have produced substantial budget savings.4 There was little genuine dialogue, however, because state officials were under orders from the Governor prohibiting them from discussing the TennCare plans with anyone outside of the Administration.5 1 Testimony of Dave Goetz, Tennessee Commissioner of Finance and Administration, in Grier v. Goetz, No. 79-3107 (M.D. Tenn.) on July 11, 2005, at transcript pp. 1799-1800. 2 See “Doctors fear end to TennCare’s preventive care”, The Tennessean, April 27, 2004, p. 1. See also Center for Health Care Strategies, Clinical Pharmacy Management Initiative: Integrating Quality into Medicaid Cost Containment (April 2003), posted at http://www.chcs.org/usr_doc/quality_cost.pdf. By contrast, arbitrary limits and co-payments leave overuse by some patients (e.g., those using less than 6 prescriptions/month) untouched, while denying care to the sickest patients for whom the denied treatment is both necessary and cost-effective. Such limits therefore raise concerns about the affect on both patient safety and program costs. See S. Soumerai, “Benefits and Risks of Increasing Restrictions on Access to High Cost Drugs in Medicaid”, Health Affairs 23: 135-146 (Jan./Feb. 2004); Ctr. for Medicaid and Medicare Services, The Use of Quantity Limitations in State Medicaid Prescription Drug Programs (1/02)(http://www.chcs.org/publications3960/publications_show.htm?doc_id=214935; Goldman, et al., “Pharmacy Benefits and the Use of Drugs by the Chronically Ill”, JAMA 2004;291; 2344-2350. 3 Tennessee Health Care Campaign, “Recommendations for minimizing harm to enrollees while reforming & preserving the fiscal integrity of the TennCare program” (April 20, 2004). http://www.tenncare.org/pages/06_our_plan/recommendations_from_thcc.pdf 4 “Saving TennCare Safely: Strategies that Reduce Costs by Improving Patient Care” (May 2004). http://www.tenncare.org/pages/06_our_plan/saving_tenncare_4-26-0.html5 State employees were told that they would spend the rest of their lives “filling potholes” if they talked with anyone outside of state government about the proposals. Tennessee Journal, 7/5/04.
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