September 1, 2005
By BOB HERBERT
"What he's decided to do is save health care costs simply by not giving people health care."
How's that for a solution to a tough public policy issue?
What is happening in Tennessee is profoundly cruel. The people being removed from the rolls - some of them disabled, some suffering from such serious illnesses as cancer and heart disease - are mostly working-poor individuals who cannot afford private insurance. They are being left with no coverage and in many instances are in a state of absolute panic.
"People are going to die because of this," said Carolyn Cagle, a widow from Paris, Tenn., whose 34-year-old son, Lloyd, is a diabetic who has already lost part of his right foot. He is being dropped from the program.
Phil Dedrich, a resident of Waynesboro, has also been notified that his coverage is ending. "I am very sick," he said in a statement distributed by opponents of the cuts. "I have severe coronary artery disease, including a 70 percent blockage of my aorta, lung disease, thyroid disease, diabetes, painful neuropathy from the diabetes and high blood pressure."
In addition to the people being dropped from the rolls, benefits are being cut for hundreds of thousands of TennCare participants, and there is a chance that 100,000 more people will lose their coverage next year.
"I'm scared," said Terilyn Gotlieb, a TennCare enrollee whose prescription coverage was reduced sharply. Kidney disease has all but destroyed Ms. Gotlieb's family. She told me her mother, her grandfather, a brother and a sister all died from the disease. Ms. Gotlieb herself underwent a kidney transplant in 2000. She's in constant pain from a broken back she suffered in an auto accident last year, and she's severely depressed.
In a normal month Ms. Gotlieb takes 12 medications, but now TennCare will pay for only 5 and she can't afford the other 7. "I'm scared that if I don't get the right medication, I'm going to end up back on dialysis and lose my kidney I fought so hard to keep," she said. "I could die."
Medicaid was established to provide health coverage for the poor. In the 1990's the TennCare program extended Medicaid benefits to low-income working people who could not otherwise secure health insurance. Among those hailing the program at its inception was Bill Frist, a Tennessee Republican who is now the Senate majority leader. At the time he was the surgical director of the Transplant Center at Vanderbilt University.
Mr. Frist called the program a "bold experiment" and wrote in a newspaper article that "the extension of coverage to working Tennesseans without health insurance is necessary to reduce the need for hospitals to shift these costs to patients who have insurance."
TennCare reduced the number of uninsured residents in the state by one-third and indisputably saved many lives. But the program ran into problems. Parts of it were mismanaged by state officials and by managed care organizations that performed so poorly they either had to be taken over by the state or their contracts were terminated. More insidious is the fact that residents of Tennessee (which limits its state income tax to dividends and interest income) are even less willing than their counterparts in most other states to pay for crucial public services.
So rather than do the heavy lifting necessary to shore up an important and admirable program, Governor Bredesen resorted to the draconian, life-threatening expedient of severing the health coverage of people who have nowhere else to turn.