One headline got it right:
Bredesen makes King Solomon-like TennCare decision.
King Solomon is perhaps most remembered for picking between two women who both claimed to be the mother of a child. Solomon threatened to split the baby in half. One woman accepted the decision. The other begged Solomon to give the baby to the other woman rather than let it die. Solomon knew then the second woman was the mother.
The governor had to choose between two populations who depend on TennCare versus saving the state $575 million (but losing $1.7 billion because we're losing fed matching funds).
A moment of mercy, perhaps, for he chose to spare the children but scratched most of the adults. The editorial does not elaborate on how this choice was similar to Solomon's. Solomon's choice was meant to reveal the real mother. Bredesen's was meant to save us from taxation in a state that has no income tax, but has a regressive sales tax with seven states bordering Tennessee that have lower sales taxes.
But at some level the damage was like cutting a baby in two. For of the 1.3 million on TennCare now, 323,000 will be dropped. Here's a breakdown of those being dropped:
- Of the total 323,000 - 450 will die a year because of lack of care, quality of care, etc., according to a Center for Health Services Research report at UT Med School in Memphis.
- 121,000 uninsured adults - those ineligible for Medicaid but don't make enough for insurance. That is, a single person making less than $18,000 per year or a family of four making less than $37,000 per year.
- 67,000 uninsurable adults - those with chronic diseases and no insurance company will touch.
- 39,000 seniors - those aged with inadequate Medicaid coverage will find no relief.
Another 396,000 adults will see strict caps put on everything, giving over decisions for healthcare to a state administrator rather than a physician. Another restriction: only four prescriptions a month, which is tough for those who have multiple problems or, say, "metabolic syndrome" and need seven, ten, even eighteen meds at a time.
And then there are the 600,000+ children Bredesen says he will save. But wait. The governor has stepped attempts to "water down the state's definition of 'medical necessity' in a way that would enable state bureaucrats to deny needed health care services" (see Avram Goldstein's piece).
And then of course there are the rural hospitals which are expected to start closing once the plan is implemented.
And then the urban hospitals overflowing with emergency room cases which are costlier and harder to collect on.
Finally these costs and problems will drive up hospital costs and thus premiums, in strange circularity of stinginess.
Some say over 40,000 have called the TennCare offices in Nashville, worried about whether their coverage will be dropped. They are told the same thing: "Not yet. Wait until you see a letter."
Tennessee, which modeled the best state healthcare system in the country (started by Clinton and McWherter), will go from first in the country to eighth or ninth, saving little money and wasting a lot of lives.