The Black Commentator - Beneath The Spin: Cover Who?

Bad News got you down during the holidays?

Tired of hearing the latest depressing statistics from the U.S. Census Bureau reporting that last year more than a million Americans joined the ranks of those living in poverty and that of the thirty-nine million people living in poverty, that a third are children-- yes, right here in the richest country in the world?

Does it momentarily dampen your holiday spirit or hinder your ‘will to shop’ knowing that in the last year, 800,000 more Americans now live without health insurance, bringing the total to 47 million--over 16 percent of our total population?

What about the fact that since the year 2000, that the total number of medically uninsured has grown by five million and that employer-provided health insurance dropped approximately 4 percent. A Yuletide bummer to be sure.

But there is good news if you live in Tennessee, according to those spinning stories on Capitol hill. Things are really looking up this holiday season--unless of course you are one of the nearly 200,000 TennCare enrollees (40% whom are African American) cut from the state funded medical insurance program in August 2005.

According to a December 6th article in the Nashville City Paper, state officials boast that cutting nearly two hundred thousand Tennesseans from TennCare last year, “saved” the state a whopping $2.8 billion. In a state that is in a perpetual budget crisis that’s a lot of cash. So, woohoo, let’s go shopping’?

Not long after slashing the TennCare program, Tennesseans began hearing a great deal about ‘Cover Tennessee’, one of the programs touted as the safety net for some of the 67,000 critical-needs enrollees cut from TennCare. Most of these Tennesseans suffer from a deadly cocktail of several major illnesses including heart disease, diabetes, alzheimers, MS, lupus and more.

Although the name ‘Cover Tennessee’ is catchy and implies that things are okeydoke, what rarely gets mentioned is that ‘Cover Tennessee’--in spite of it’s snappy branding--in all actuality will only affect about 5,000 of the 67,000 who are deemed uninsurable—never mind the other one-hundred thousand plus who were cut from the rolls.

But if you believe the hype, you’ll be giddy to learn that without making the changes, TennCare would have cost about $9.7 billion in fiscal year 2006 but instead only cost an estimated $6.9 billion, according to figures released by the TennCare bureau.

According to the bureau, most of the savings--about $1.2 billion--came from reduced spending on prescription drugs--wherein enrollees are now limited to five prescriptions per month for adults. Prior to the changes, there were no limits on prescription drugs for enrollees.

What officials neglected to mention is that the figures stated aren’t actually reflective of just state dollars but federal dollars as well. Also not mentioned is that First Health Services, the pharmacy benefits manager (PBM) charged with managing and overseeing pharmaceutical expenses had the information to manage the program and control costs, but failed after 15 months on the job to perform up to TennCare standards. Hence the massive cuts.

But instead of firing First Health Services Corporation of Glenn Allen Virgina for non-performance they were rewarded with the opportunity to make an additional $30 million over the following two year period. What a sweetheart deal!

Whether their good fortune has anything to do with Tennessee’s conservative Democratic Governor, Phil Bredesen, is anyone’s guess.

Bredesen, a physicist by education and a shrewd businessman created the HealthAmerica managed care company, a firm that bought failing HMOs and breathed life back into them. The company, which he sold in 1986 to Coventry Health Care, Inc. in Bethesda MD, made him a millionaire. Coincidentally, First Health Health Services Corp, the PBM who received the $30 million incentive, is also a Coventry Health Care company. Jingle bells anyone?

“As much as any other single factor, First Health's poor performance is what brought down the TennCare program”, says Nashville attorney, Gordon Bonnyman. “Pharmacy was the huge budget issue, and if the pharmacy benefits manager (PBM) couldn't be counted on to capture the needed savings and implement reforms, then the TennCare budget would continue to be a political problem for the Governor.” According to Bonnyman, rather than sever ties with First Health Services, the administration decided it was best to cut TennCare enrollees instead.

Tony Garr, Director of Tennessee Health Care Campaign says: “The cuts have not stopped and now the state has issued new regulations, which make TennCare one of the most restrictive Medicaid programs in the country.”

In early December, Garr said he received a desperate call from a woman whose mother has a very serious medical condition and was recently abandoned by the home health agency because TennCare’s new rules would not pay them for her care—even though their doctor said that it was medically necessary.

“These cuts have been very costly, says Garr. “Thousands of families in Tennessee are in serious medical debt, people have lost their homes, and in some cases their lives.

For bottom-line folks (CEO’s, CFO’s and such), these cuts make good business sense and mean big bonuses and more spending on the horizon. But for those on the wrong side of the guillotine, these cuts are a death sentence.

The demise of the TennCare system and the devastation that followed for several hundred thousand people is unfathomable.

Tennesseans like George W., who had a stroke that left him with monstrous medical bills and the left side of his body cold. Now he is unable to work or collect disability and is homeless. If that weren’t enough, he is also diabetic with high blood pressure.

And then there is paraplegic Don D. of Jackson, TN who lost his TennCare coverage and access to the seven prescriptions that treated his pain, cholesterol, depression and esophagus problems.

Or Lori S., who has Lupus and Multiple Sclerosis who discovered that without health insurance these potentially debilitating diseases are unmanageable. Not long after the cuts, the stress of losing TennCare caused her MS to flare up and she lost 70% of the vision in her right eye.

The list is endless. Since the cuts many people are dying and sadly there are those who only wish themselves dead. People that live down the block from us, work at the grocers, go to our churches or are too sick to do these things any longer because they are off their medications and are in too much pain to leave their beds.
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Among those whom have died after losing their TennCare is James Bryant (Rutledge TN). On official records, Bryant's doctor listed "an absence of medicines for one week" as contributing to his death. He had just lost his health insurance. James was 50 years old.

And then there is 33 year old Monique "Nikki" White who died in spring 2006 of complications due to improper treatment for her Lupus. As chronicled in the a lengthy Wall street Journal article (December 05, 2006 by Jane Zhang) Ms. White suffered excruciating physical and emotional pain after losing her TennCare coverage.

According to the Journal, Ms. White’s primary care physician, Amylyn Crawford stated "If she had insurance, she would have gone to the emergency room sooner" and "she'd probably have stayed (alive) if she had TennCare,"

"No one can say that it caused the problems. It did have an impact on her, on her stress level and on her access to medical care…”

For many Tennesseans the good news isn’t ‘Cover Tennessee’ or the new ‘surplus’ being celebrated on Capitol Hill. For some, this holiday season will be their last time with family, friends and loved ones. For others, they will simply tuck their heads under the covers and pray that the new year (and a merciful God) brings an end to their suffering.

BC Columnist Molly Secours is a Nashville writer/filmmaker/speaker and co host on several radio programs at 88.1 WFSK at Fisk. Her 14 minute documentary called “Faces Of TennCare: Putting a Human Face on Tennessee’s Health Care Failure” will be aired on the Documentary Channel beginning January 1st at 4:45pm. For more information visit mollysecours.com or to see a 30 second clip of the film visit:myspace.com/mollysecours. Click here to contact Ms. Secours.