The Tennessean has an excellent story about the great elephant in the closet facing the 107th Tennessee General Assembly-and possible future incarnations of the Legislature for some years to come-how to continue to fund TennCare. Even staunch conservatives such as this writer are forced to admit that outgoing Democratic Governor Phil Bredesen has largely kept one of his most critical campaign promises to reign in spending on the massive State behemoth. TennCare still eats a huge hole in the State's budget, but nearly everyone agrees that the hole isn't nearly as gaping as it was when Bredesen came to office in 2003.
Many Republicans warned that the new federal health care law could cost States untold billions of dollars, and Bredesen, who has a special expertise in the area of health care, was rare among Democrats for his outspoken cries of "foul" as the new law, which many conservatives dub "ObamaCare" was being debated and ultimately passed. Bredesen warned that the mandates in the law could cost States untold billions of dollars, and required Medicaid expansion by 2014 will likely mean that TennCare could be the medical insurance for one of every three Tennesseans.
TennCare is an expanded Medicaid program. It was the insurer for one of every three Tennesseans at the program's height under Republican former Governor Don Sundquist. TennCare was begun, of course, by Democratic former Governor and House Speaker Ned Ray McWherter of Dresden, and McWherter left Sundquist with the resulting mess to clean up. Many Tennesseans remember McWherter as one of the most popular Governors in modern Tennessee history, and Sundquist as the last Governor to try-unsuccessfully, thank God-to ram an income tax down the throats of the people of this State. That is only half of the story, of course. It was McWherter who first made the income tax an issue, because it was he who proposed it (flowery wording and all) in his second inaugural address. McWherter didn't really move on his income tax proposal, because he knew what the public reaction would be, but he saw the fiscal train wreck of TennCare coming and rather than try to reign in cost, McWherter did what Democrats and liberals often like to do-pass the mess that he created on to their Republican successor and let them deal with it while the Democrat gets all of the faux-glory. Governor Don Sundquist was faced with two choices-either make cuts to TennCare or try to pass an income tax to pay for it-and he chose his second option.
With the failure of the income tax, Bredesen knew he had but one way to bring the cost of TennCare down, and that was to make cuts to the program. Many people talk about the human costs of TennCare disenrollment and program cuts, and those costs absolutely do exist. However, one of the stated goals of the new federal health care law is to bring costs down, but there is little indication that real cost will be contained, so if cost efficiency for the State becomes an issue, that may mean that to comply with the new health care law while still keeping the State budget balanced-something Tennessee legislators are constitutionally obligated to do-the State will provide a massive number of new enrollees with a very minimum of care-so minimum that many might find that they were better off without health insurance. Federal requirements that will likely expand TennCare once again could very well mean rationed care for many, and medical supplies of much poorer quality for those who do have need of durable medical equipment.
As a person with a disability, this writer lives with both the need and the cost of health care on a daily basis, so the cost of health care in both monetary and human terms does not elude our thought process. The human cost of TennCare will be catastrophic indeed if care becomes rationed or if medical equipment is less than quality and care is less than the best because the State must, by law, enroll many more people than it can otherwise afford. Many on the Left thought the attempt in the last General Assembly to "nullify" the federal health care law in Tennessee was just a cheap political stunt. Unless the General Assembly takes some action quickly, however, the situation for both the budget and the chronically ill will soon become dramatically worse in relatively short order.
Tennessee's very economic and fiscal survival may depend on how the 107th General Assembly chooses to deal with TennCare and the costs of health care in Tennessee.
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