NPJC News

Key Talking Points on Bredesen’s Proposed TennCare Reforms:

1) LEAST COSTLY COST MONEY & COSTS LIVES

Under the current system, doctors decide what treatments enrollees receive, based on accepted “Standard of Care” for a particular disease or condition. Under the new plan, TennCare HMOs will decide what treatments enrollees receive, based on the new criteria “Least Costly and Only What Is Adequate.”

RESULT: Bureaucrats will deny medical treatments to enrollees that doctors universally accept as necessary. It’s no exaggeration to predict that this will lead to needless and preventable deaths.

2)    LIMITS ON DOCTOR VISITS & PRESCRIPTIONS

Most enrollees, under the new plan, will be limited to 6 prescriptions a month and 10 doctor visits a year. This may be fine for healthy people, but not for the thousands of enrollees who are chronically ill with cancer, AIDS, asthma, lupus, diabetes, etc.

RESULT: Folks will have to choose between either treating their asthma or treating their diabetes.

3) NO COVERAGE FOR OVER THE COUNTER

Over-the-counter drugs will not be covered, including no coverage for antihistamines and gastric-acid reducers.

RESULT: Folks with allergies and asthma won’t have access to anti-histamines that could help prevent an attack—so they end up in the emergency room. This means more costly treatment instead of prevention.

4) EVERYONE PAYS PREMIUMS AND CO-PAYMENTS

Under the new plan, enrollees will have to pay new premiums and co-pays and, for the first time, hospitals and pharmacies can turn them away if they can’t pay their co-pays.