(Please pardon the alliteration.  It is kind of catchy, though, isn't it?)

The American Legion visits Music City

And John Kerry will be there to make a speech during the GOP convention.

Regarding our state health insurance plan

If and when the federal government begins to consider new health care plans, the state insurance in Tennessee– a managed care plan known as TennCare– will probably be considered as an example of one possible way to go. The original TennCare plan was based upon Hillary Clinton’s proposals for federal health insurance under the previous administration. TennCare ran into serious financial problems a few years ago (i.e.– it’s more expensive than anyone predicted it would be), and our present governor, Phil Bredesen, is expected to propose sweeping changes in the system any day now. He’s been working up to this since his election, and the legislation enabling the state to enact the changes passed in May. Yesterday, some initial components of the overall changes to come were announced, and I’ll be watching the reamining proposals as they come out with interest.

I’m thinking that my readers may be interested, as well, because TennCare does a lot of what some people hope to see a federal program achieve: it extends Medicaid by offering coverage to all children and all low-income people who are ‘uninsurable’ through private insurance companies due to a chronic medical condition. (Adults who can buy insurance through their workplace are automatically excluded, however, because workplace plans typically do not exclude applicants on the basis of pre-existing conditions.) Originally, it was designed to cover anyone who was uninsured for any reason, but the Bureau stopped taking new applications from the merely uninsured several years ago. Some people with TennCare pay premiums, but most do not, today.

The change announced yesterday is, in fact, the elimination of all required premiums for coverage for children. (Parents who choose to pay premiums will still be given that option.) Curiously, the first official announcement, then, is of a change which will increase the cost for the state. Obviously, reductions in other areas are expected to be greater than the increases here-- presumably, Bredesen just wanted to start out on a positive note. There is also an exemption for children from the proposal to discontinue TennCare payments for prescription antihistamines and antacids.

Changes expected in the future include more limitations on the medications which will be covered and some extensions of the requirements for premium payments by adults. The state has already undergone a series of painful attempts to clear the rolls of people who no longer qualify for coverage or those who were getting their coverage fraudulently (e.g.– Kentucky citizens who came across the state line for insurance and medical care).

I’m particularly interested, because the majority of my clients are eligible for TennCare through the ‘uninsurable’ qualification, which has lately become known as ‘Medically Eligible’ TennCare, so TennCare determines their treatment options, and, consequently, I’m interested because my company bills TennCare to pay my salary. I know that some of the newer psychotropic medications have been noted as one of the bigger financial burdens on TennCare the yearly cost of two medications– one an anti-psychotic and one something for heart disease– was equivalent to the yearly cost for the entire UT School of Medicine); and I’m hoping that other cuts in the services provided for the mentally ill will not be among the proposals.

Curiously, almost none of my clients qualify for Medicaid coverage. I’m not sure how other states pay for treatment for the mentally ill, but, upon reflection, I think TennCare provides pretty good coverage for this population. All prescriptions are fully covered, and although short-term hospitalization is very difficult to get, long-term residential treatment is provided for those people who most need it. One nice, if complicated to manage, benefit is that TennCare clients are given free transportation to their medical treatment or appointments. Outpatient treatments are covered pretty fully, although better service in this area would be possible with more money, naturally. These would be the main desiderata, in fact, because the governments have decided, over the past half-century, that treatment in the community for the mentally ill is preferable to long-term institutionalization. I feel that this imposes an obligation to provide the quality of treatment which could keep the mentally ill off the streets and out of the jails and prisons.

So, I expect to report more on these changes as they are announced. Same blog time, same blog channel. (vlog, that is.)

8:25:27 AM    comments? []