TennCare Patients, Doctors, Advocates Try to Prevent Enrollment Closure

US District Judge William J. Haynes, Jr. could decide as early as today whether to prevent Tennessee Gov. Don Sundquist from closing TennCare, the state's insurance plan for the poor, to people who cannot get insurance elsewhere.

The closure is the first step in the state's plan to overhaul TennCare and divide it into three parts. The largest part would be TennCare Medicaid. The second part would be TennCare Standard and would have fewer benefits than the larger version, with stricter eligibility standards. The third part would be TennCare Assist, in which the state would subsidize the insurance premiums of those who have access to employment-based health insurance but cannot afford to purchase it.

Because 180,000 of TennCare's 1.4 million current enrollees would be ineligible for any portion of the revamped program, the state would save an estimated $155 million a year. However, it would also forgo an additional $435 million federal funds that purchase premiums and pharmacy rebates.

The revamped program would severely affect the state's mentally ill population and many thousands of Tennesseans with incurable diseases who are considered medically uninsurable. According to Gordon Bonnyman of the Tennessee Justice Center, who sought the restraining order, closing the rolls to the uninsurable violates the settlement of a previous lawsuit that he and state officials negotiated last year.

Many of the affected enrollees are those most in need of health care coverage. Some have Medicare, but it doesn't pay for prescription drugs. Specifically affected will be individuals with HIV. Dr. Stephen Raffanti, a Vanderbilt University professor and medical director of several HIV clinics, testified that the average HIV patient needs about three drugs at a total cost between $1,000 and $1,500 per month. Those patients are typically poor and would have to cover the costs themselves if not for TennCare. "TennCare is crucial for HIV-positive individuals," he said.

Elisabeth Rukeyser, Sundquists' commissioner of mental health and developmental disabilities, is also against the changes. She told state legislators that the new TennCare plan would cost the state $100 million to replace the mental health services lost through the restructuring, as well as $200 million in matching federal funds.

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