TennCare

TennCare is a managed care health program implemented in the state of Tennessee to replace the Medicaid program.

TennCare was proposed and implemented in 1990 by former Governor of Tennessee Ned McWherter. He demonstrated how the program could cover many of the medically-underserved uninsured and uninsurable population for about the same amount of money as was being spent to cover only the medically indigent under Medicaid.

Unfortunately, the program has never seemed to live up to its considerable potential. Tennessee now has a higher proportion of its population on state-assisted healthcare than any other state. The cost savings largely evaporated when health-care advocates for the poor and disabled challenged many of the managed-care features and the state agreed to modifications at considerable expense. Two of the managed care organizations founded to be involved in the administation of the plan filed for bankruptcy and were liquidated, and several other of the insurance companies initially involved in it later opted to leave. The program became increasingly unpopular with doctors and hospitals as well, due to low reimbursement rates and slow payments. Providers complained that the reimbursment rates were so low as to force cost-shifting from private-pay and privately-insured patients to cover the losses on TennCare patients.

Other criticisms of TennCare have been that it has allowed to become a "dumping ground" for persons that private health insurers do not wish to insure, and that Tennessee employers now have little incentive to offer group health insurance benefits to their employees, who then have recourse to TennCare. Also criticized has been the TennCare bureau's failure to use resources that have been available to it, such as drug utitilization review. Also coming under criticism has been the salaries paid to some of the major exectuives of the managed care organizations out of TennCare funds.

Phil Bredesen was elected Governor of Tennessee in 2002 largely on the strength of his background in managed healthcare and his promise to implement major TennCare reforms. These efforts are ongoing. Bredesen has recently indicated that if the "advocates" of health care for the poor continue to sue to prevent the enforcement of managed-care provisions that he will have no alternative but to dismantle TennCare and return to the Medicaid program. On November 10, 2004 he announced that Tennessee would be doing just that, stating that there was a "glimmer of a hope" that the program could be saved if TennCare activists (implying especially Nashville attorney Gordon Bonnyman) would agree to refrain from continued legal actions against the program. Former Governor McWherter has weighed in favoring a plan to save TennCare in some form. Some of Bredesen's more outspoken political opponents charged that the threat to abolish TennCare altogether was mere "political theater" designed to encourage the health care advocates to see the extreme seriousness of the situation and to relent from some of their demands and was not really an honest effort to begin the abolition of the program, which in any event would take many months to implement fully. However, subsequent political and legal moves by the Bredesen Administration proved the seriousness of his intent to the satisfaction of most.

In April 2005 the United States Court of Appeals for the Sixth Circuit overruled a decision made in the United States District Court for the Middle District of Tennessee to the effect that disenrollment of person from TennCare was to be enjoined. This means that the state can begin removing approximately 322,000 current recipients from the TennCare rolls beginning in mid-2005..