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Location: Nashville, Tennessee, United States

6/04/2002

Expensive Strings Attached
The Tennessean breathlessly editorializes that the just-approved reform of TennCare "buries" the "whipping boy" of the budget stalemate and that "lawmakers who have insisted that TennCare reform must precede tax reform have just lost they're (sic) last excuse."

Not hardly.

Not only does the paper make an error of basic grammar, it skirts the whole truth of the reform-TennCare-first point of view.

TennCare remains the biggest single cause for budgetary concern. True, the reform means TennCare is being split into three programs, and there will be sliding-scale premiums and co-pays for some enrollees based on their income. Yes, the state will have more flexibility to alter eligibility requirements and benefits for TennCare enrollees who aren't eligible for Medicaid, potentially saving money.

Those are all good.

But the much-ballyhooed reform plan does nothing to address the epidemic of mismanagement and bureaucratic eye-winking at fraud and abuse that has plagued TennCare since its inception.

Merely splitting TennCare into three programs won't address TennCare's lack of consistent and effective enrollee eligibility verification. It won't change the fact that tens of thousands of people are on the program despite being ineligible because they live out of state or have other health coverage. It doesn't change the fact that for eight years Tennesseans have shelled out tax dollars to pay HMOs for health care for dead people, millionaires and out-of-state freeloaders.

Nor does the reform change the overall TennCare dynamic that has the program always seeking more money from the taxpayers. The reforms mean the legislature now may alter the level of benefits for the non-Medicaid-eligible portion of TennCare enrollees by altering the appropriation - but the pressure will remain for higher spending and more generous benefits. The Tennessean editorial itself accidentally admits this: "If lawmakers decide down the road to cut TennCare funding, they'll not only hurt recipients who could be covered, they'll also hurt the doctors, clinics and hospitals who will be put in the position of either providing free care or turning patients away."

As the Tennessean says, the reform means a "healthy increase" in federal funding for TennCare, but the paper damages its own credibility by ignoring reality and tossing up the "it's free money" canard:

Says the Tennessean: "Since the federal government pays about two-thirds of the cost of TennCare, every dollar the state doesn't fund will take another two dollars out of the state's health-care system."

Looked at another way, that's an acknowledgement that federal largesse for TennCare comes attached to an expensive string: Every $2 Uncle Sam provides must be matched by $1 from Tennessee taxpayers. More federal dollars for TennCare means more tax dollars from Tennesseans too. So every dollar of federal money we don't commit to taking is one less dollar that must be taken from some hard-working Tennessean who is already struggling to pay her bills.

But, then, the Tennessean has never shown as much concern for protecting the tight budgets of the average hard-working Tennessee taxpayer as it does for padding the ever-more-bloated budget of the state bureaucracy.

A state income tax and $1.4 billion more of your money remains firmly in the crosshairs of legislative leaders and the big-government cheerleaders at 1100 Broadway. Which explains why the paper's editorial board is so eager to hoodwink readers into believing the latest TennCare reform has completely fixed the program, even though it really hasn't.