Though she understands budgetary constraints, Nelson does not understand why Bredesen did not first try less painful steps such as asking her to contribute a bit more.
Bredesen has been slow to attempt a number of modest cost-saving changes used in other states, such as bulk purchasing of drugs and "disease management" programs. While acknowledging those approaches are worth pursuing, Bredesen said he cannot tweak his way out of what he says is a $650 million budget hole.
"With the magnitude of the problem I have, drug utilization review is like you showing up with cancer and I say, 'Eat more apples,' " he said.
Gordon Bonnyman, the Tennessee Justice Center lawyer who has spearheaded many battles with the state over TennCare's benefits, noted that it was the Bredesen administration that negotiated changes in the decree that have saved about $150 million a year.
Even with the severe cutbacks, Bredesen said TennCare will remain among the most generous Medicaid plans in the nation in terms of the percentage of residents covered and percentage of the state budget. But for much of the past decade, Tennessee neglected other public health investments, such as community clinics, health departments and specialty programs for immunizations and AIDS.
Like Lori Smith, Atha and Bart Comiskey fear that without TennCare, they and thousands of other Tennesseans will no longer be productive, taxpaying citizens. The couple lost their insurance after he suffered a heart attack and she received diagnoses of Crohn's disease and kidney cancer. They spent last week shuttling between media interviews and the cardiologists, gastroenterologists and urologists that help keep them alive.
As independent manufacturing representatives, they earned $18,000 last year and would have spent $9,300 on medicines were it not for TennCare, which charges them a small monthly premium and copayments.
"It's a terrible embarrassment that TennCare was a role model and now it has failed," Atha Comiskey said.
