by Jeff Woods
"I wish I were going out in my last couple of years here with revenues flying through the roof and I could expand pre-K and put more money in education and expand TennCare, you know, not contract it. But that's not the cards we've been dealt right now. What I'm trying to do is kind of guide the ship through some tough waters here. I think that we've avoided the worst things that could have happened and which are happening in other states right now. And if people can kind of work with me here and tighten our belts a bit, I think we'll come through this just fine."Here's the Q&A: Q: Why didn't you decide not to provide a subsidy for the Med in your budget? Bredesen: ... We are having to make some cuts across the board in some areas of TennCare and we're trying to focus those cuts on areas that don't directly affect the patients themselves. One of the areas that we've had to cut out are substantial portions of funds that have just been distributed to hospitals across the state as a general support for those hospitals. ... You can't fix the budget without affecting TennCare in some way, and we've made some choices about what we think are the fairest way that have the least affect on the individuals involved. That's the call that we have made. Q: Leaders here in Memphis and the Shelby County area were hoping for some additional funds. They say that because of all the nonpaying patients who come to the hospital, they need it. Bredesen: We've talked about that. A lot of people are hoping for funds. I guarantee you there are plenty of disappointed people in a lot of different circumstances around the state. ... If we support the Med we also ought to support a host of other hospitals that provide care to people who don't have insurance around the state. Let me say one other thing about that because the Med has come up a lot. That is, I've been talking with leaders in Shelby County and Memphis about the Med ever since I've been governor. My point has always been, don't keep coming back and saying I need $10 million or I can't make payroll two months from now. If there is a long-term strategy to solidify the Med's position in the county, which is going to be difficult because these kinds of hospitals across the country are not doing well, but if there's some strategy to do that, I would love for the state to figure out a way to be a player in that strategy. But until you get that strategy, I don't think anybody has any taste for hospitals just coming up and saying, I need money to keep the doors open, give me some. Q: We have several folks here in Knox County who have been taken off TennCare because of the Daniels case. They can't afford very, very expensive life-saving medication. In fact, I'm on my way right now to meet with a family whose husband called in and said his wife only has about 15 days to live if she can't get her medicine that they can't afford. What do I tell these people when I see them? Bredesen: First of all, you're talking to somebody who is a believer in universal health insurance. I think this country needs basic health insurance for everybody. Having said that, we are running a program in the state that is a combination federal and state program. We have to run it consistent with the law. And the Daniels people, the reason they are being taken off the rolls after a lot of protection and a lot of consideration, is they don't qualify to receive Medicaid. Their income is too high or they are not in the right categories. This goes back to the 1980s. The state has been regularly criticized by its own auditor ... for not seeking more actively to change this court decision that put them on the rolls temporarily and get them off. We finally said OK, we need to deal with this issue. I'm trying to make sure that I can provide care to all the people who are legally entitled to be on Medicaid. If we have people who are not legally entitled to be on it, we need to deal with that issue. We've put in place a bunch of sort of safety nets and protections. The CoverRx program we have that provides drugs to some people, we actually are going to be able to reopen. It had been closed for the past two or three months. That may provide some help. I would say to that person, talk to somebody here, talk to somebody in the health department at TennCare. We may well have something that can help. Certainly if somebody has 15 days to live without the drugs, we're going to figure out how to get the drugs to them. ... Q: About the $10,000 annual cap on in-patient hospital care, how do you feel these proposed cuts could impact hospitals in this state? Bredesen: They're going to hurt hospitals. I don't think there's any way around that. That particular change is probably not going to hurt TennCare beneficiaries because if they have a serious enough illness to run up a $10,000 bill, they're not going to get thrown out of the hospital. I mean, they legally can't throw you out of the hospital. That's something they are going to have to absorb. Again, I've had to ask a lot of people in government and outside to say, look these are very tough times and we're going to have to ask you to help me get through this. If that means a hospital is going to have to take on a little more responsibility for people who are poor, I mean I've got to ask people to do that. I'm sorry for that. But you know the TennCare costs are such a huge part of the budget that you can't balance the budget without dealing with some of these TennCare issues. ... Q: Following up on that, do you have concerns that some of the hospitals that treat indigent populations, Metro General comes to mind here, could possibly be run out of business because of having to shoulder these additional costs? Bredesen: I don't think that by itself will do that to General and the Med ... They're problem is not so much TennCare changing its benefits as it is the very large numbers of people with no insurance who go to these hospitals. In most cities in the nation, in fact in most places in Tennessee, this is a burden that's picked up by a variety of hospitals in that particular market. ... TennCare reimbursement is not the source of their problem. The source of their problem is the large number of people with no insurance.