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Tennessee's medical emergency
April 2, 2003
Even as Gov. Phil Bredesen's budget calls for an additional $328 million for TennCare, the program is teetering predictably on the brink of collapse. But TennCare's failure, and the public's preoccupation with its prolonged demise, have obscured a more fundamental problem: Access to affordable health care is diminishing for all Tennesseans, regardless of income or employment status. Spiraling costs of insurance, prescription drugs and defensive medicine are to blame for Tennessee's medical emergency. The U.S. Department of Health and Human Services reports that malpractice insurance premiums here increased faster than the national average last year. More than 300 health care facilities lost coverage in February when Tennessee's largest reciprocal insurer of doctors and hospitals went into receivership. Facing the possibility of running out of cash around July 1, the Regional Medical Center at Memphis is trying to persuade the state to release about $9 million in expected supplemental TennCare funds and commit to a more generous funding formula. MY SENATE office receives an increasing number of calls for assistance with health insurance issues. They are no longer from the poor or homeless. After a lifetime of entrepreneurship, a 58-year-old service station owner regrets owning his business. He can no longer afford to pay the full premium for his wife's health insurance, and a recent medical condition rendered her uninsurable. A 61-year-old grandmother whose husband retired and lost his group health insurance coverage learns that she is uninsurable because of diabetes. Even though she can afford to pay $600 a month in premiums, she is too young for Medicare and too risky for private health insurance. An alderman from rural West Tennessee writes that her town has been hit with a 20 percent increase in employee health insurance premiums for the third year in a row. Like many private employers and businesses in Tennessee, the town will reduce benefits, raise deductibles and increase premiums to a level that some of its employees will not be able to afford. THERE IS NO silver-bullet solution to these problems. Improving access to affordable insurance coverage, containing the cost of prescription drugs and providing competitive workers' compensation coverage all are measures that should be taken. So is medical malpractice reform. I am sponsoring legislation that would quantify the risk for insurers by capping damages for non-economic losses such as "pain and suffering." Although such losses are real, recovery for them is speculative. For plaintiffs, suing may be like playing the lottery. But insurers find their exposure increasingly difficult to predict, and as their risk rises, so do premiums. If we are not careful, providers will quit providing care altogether. Whether the insurance industry can assume more responsibility for covering high-risk Tennesseans without burdening private business or government also needs to be explored. I propose creating a high-risk pool funded by individual premiums but subsidized by insurers who, under TennCare, seem too quick to dump the once-insured. TennCare may die of its own weight, but in the meantime it is losing more than $100 million annually because of prescription drug costs. In his budget message, Bredesen said he is working on a plan to place "reasonable limits" on TennCare's use of costly prescription drugs. My proposal for trimming TennCare's drug costs would establish a reasonable formulary based on the physician's right to prescribe and the patient's right to choose. Relatively simple changes in the formulary could result in significant rebates, and thus significant savings to the State of Tennessee. FINALLY, Tennessee's workers' compensation laws must be modernized to discourage employers from leaving Tennessee for neighboring states with lower premiums and awards. I propose capping attorneys' fees in reasonable settlements, to help resolve claims quickly and maximize recovery while reducing employers' risk and expense. Of all the problems that face Tennessee, access to affordable health care should be at the top of the legislature's list this year. Without substantial reform, and the public debate needed to achieve it, we are all at risk. Copyright 2003, GoMemphis. All Rights Reserved.
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