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Gov. Phil Bredesen is giving his State of the State speech
now, and we bet you can guess who's taking the biggest hits in his last state budget proposal. That's right, TennCare is playing the piñata again. Bredesen is cutting health care benefits to some of the sickest people in Tennessee. And this time, while he's at it, he's putting the screws to publicly owned charity hospitals like Nashville's General that struggle to care for all these poor people.
Of the $400 million in new cuts in the recession-battered state budget, fully half would come from Tennessee's beleaguered version of Medicaid. Among them: a $10,000 annual cap on hospital stays for each Medicaid patient, and a ceiling on hospital reimbursements.
That means General Hospital and the state's other charity hospitals will wind up holding the tab for enormous medical expenses--that is, if they don't start kicking out Medicaid patients once they hit that magic $10,000 cap. The Med in Memphis says it might go out of business. But Bredesen scoffs at this. Sounding a lot like a former HMO executive--which is what he is, of course--Bredesen says the Med needs a new business model:
The Med is something of an unusual animal in the world of hospitals today, and it needs to either find some permanent long-term source of charity funding or structure itself so that it has a higher proportion of paying patients, which is what more typically happens in cities around the country.
And until that time, the governor added, the Med shouldn't bother him with its little problems. He's still chapped over all the grief he took in 2005 when he essentially gutted TennCare. Since then, he's been whacking away year after year.
As the governor said again today during a media budget briefing, "The process we went through back in 2005 was extraordinarily painful. I mean, I didn't enjoy having protesters sleeping 24/7 in the hallway outside my office for six months." And that's "not to mention, you know, all the other impacts that it had," the governor quickly added, hoping to sound sufficiently concerned about carbon-based life forms who are in ill health.
Bredesen says, "TennCare is such a big piece of the budget, you can't get from here to there without substantial cuts in TennCare." There's a certain truth to that--TennCare is one-fourth of the state budget--but at the same time Bredesen's slashing there, he's recommending the state spend $167 million to give state workers 3 percent bonuses. State workers deserve a little something extra in their paychecks as much as anyone, but at the expense of poor sick people?
Gordon Bonnyman, the governor's nemesis at the Tennessee Justice Center, calls Bredesen out of touch with ordinary Tennesseans and his latest TennCare cuts "tragically misguided." Here's his email to Pith regarding the governor's budget recommendations:
The governor continues to run TennCare the way he ran his private HMO, by focusing on how much surplus it can generate. He continues to divert hundreds of millions of dollars in TennCare reserves, refusing to spend funds that were appropriated to help desperately ill Tennesseans and the hospitals that serve them.
That is tragically misguided and reflects how far removed the governor is from the harsh realities of many Tennessee families. The governor 's policies endanger a hospital infrastructure that all Tennesseans count on. As a result of the TennCare cuts of 2005, many rural and public city hospitals are already struggling, and his new round of cuts will force some to cut services or close altogether.
The governor singles out The MED, the large public hospital that serves Memphis, as a source of personal irritation to him. He makes it painfully clear that it is not his problem whether the hospital survives and suggests that it is the hospital's fault that it is in trouble. That is ironic, since The MED's financial problems can be traced directly to the fact that TennCare has taken away millions in the hospital's revenues over the past five years, is diverting federal funds that The MED has earned, and has burdened the hospital with the uncompensated care of thousands of uninsured patients who have lost their TennCare.
This is not just about the poor or uninsured. The MED operates the major trauma center for Tennessee's largest city. It operates the principal neonatal intensive care unit in a city with the highest infant mortality rate in the nation. It is the research and training facility for UT Medical and Nursing Schools.
Nashville General Hospital at Meharry is also imperiled by the proposed cuts. It not only provides a safety net for Nashvillians who lose their insurance. General is also the principal teaching and research facility for Meharry Medical College, which would have difficulty maintaining its accreditation if General closed.
There are rural communities that will lose their hospitals if these cuts go through. Those hospitals are among the largest employers in their communities. If the hospitals close, it is hard to recruit or retain doctors. Industry is less likely to relocate to a community that lacks a local hospital. The closure of these hospitals will not only hurt the delivery of care but will alter the communities forever.
The governor does not see these results as the moral and management failures that they are, If he does not accept his responsibility to ensure the continuation of these critically important services, it is up to the legislature and our other elected officials to do so.