Tennessee Health Care Campaign (THCC)
Too many children and people fall through the cracks of our health care system / non-system

Calls needed to legislators this morning before 9:30 AM.

Ask them to support House Bill 644.

Why is it important to expand the scope of the TennCare Oversight Committee (House Bill 644) to include Cover Tennessee and the Safety-Net program?

Do it for the kids. Let me explain. There are 30,000 children who are in TennCare who will be moved to CoverKids. In addition every child who applies for CoverKids (estimated at 75,000) will be tested to see if they are first TennCare eligible. Families income change. Low-income working families change jobs. Their children will lose eligibility and have to regain eligibility. How well with this work?

In addition, if a women who is covered under CoverTN gets pregnant, she will have to apply for CoverKids to get prenatal care, but she will not be eligible for CoverKids until she is first tested to TennCare eligibility. Even if there is some form of presumptive eligibility, who will the provider bill? How well will this work?

Call legislators on the Industrial Impact Committee. Ask them to support the passage of House Bill 644. Dial the toll free number and then their 5 digit extension.

Rep. David Shepard, 1-800-449-8366, x13513

Rep. Richard Montgomery, 1-800-449-8366, x15981

Rep. John Deberry, 1-800-449-8366, x12239

Rep. Joanne Favors, 1-800-449-8366, x12702

Rep. Dennis Ferguson, 1-800-449-8366, x17658

Rep. Jim Hackworth, 1-800-449-8366, x14400

Rep. Bill Harmon, 1-800-449-8366, x16849

Rep. David Hawk, 1-800-449-8366, x17482

Re. Joe McCord, 1-800-449-8366, x15481

Rep. Dennis Roach, 1-800-449-8366, x12534

Rep. Charles Sargent, 1-800-449-8366, x16808

Rep. Park Strader, 1-800-449-8366, x12264

Rep. Curry Todd, 1-800-449-8366, x11866

Rep. Eddie Yokley, 1-800-449-8366, x16871

How many children and pregnant women will fall through the cracks? Policymakers would want to know and this would not be possible unless these programs have one group of legislators providing oversight.

One of the problems with our health care system is that it is splintered. Public and private programs are very different and have very different eligibility criteria. Now we have a very splintered public insurance program. Having several different legislative oversight committees will foster our system to remain splintered. 

History tells us that we need one legislative oversight committee is what Tennessee families need

Before TennCare, TN only had Medicaid and several small optional Medicaid expansions. Tennessee did have a high risk pool called TN Comprehensive Health Insurance Pool (TCHIP) that was covering about 3,500 people.

When TennCare started in 1994, there were four major groups of people who became eligible for TennCare:

1. Former TCHIP enrollees had the option to rollover into TennCare - Most people did;

2. Uninsured adults were eligible to apply;

3. Uninsured children, not eligible for Medicaid, were also eligible to apply; and

4. People on Medicare who were not able to purchase Medicare Supplemental insurance because of a medical condition. Most of these folks were disabled and below the age of 65. Insurance companies in Tennessee are not required to sell Medicare Supplemental Insurance to Medicare enrollees below the age of 65.

As of January 1, 1995, enrollment for the uninsured adults and children was closed, except for adults and children who were uninsurable as well as people who had Medicare who were not able to purchase a Medicare Supplemental policy. From this point forward, TennCare enrollment for uninsurable people grew to between 60,000 to 70,000 uninsurable people. Sixty-nine thousand uninsurable adults were terminated from TennCare in 2005.

In 1996, enrollment was opened to uninsured children, regardless of their income. However, if the family was able to purchase dependent/family coverage through their employer, then the child was not eligible.

Around 1997, eligibility for children was expanded to include children whose family did have access to employer coverage but could not afford it. When the national State Children's Health Insurance Program (SCHIP) program started in 1998, states had the option to expand their Medicaid program or to create a separate program outside of Medicaid. Tennessee chose not to have an SCHIP program because its children were covered under TennCare and the state would receiving a higher matching rate.

In 2000 or 2001, eligibility for people who were uninsurable was cut back to cover only people who were below poverty. The people who were already on the program were grandfathered in.

At this time, enrollment for children was also restricted to only Medicaid eligibility. Children with higher incomes were grandfathered into the program and children who rolled off of Medicaid eligibility This gave Tennessee the distinction of having the most restricted insurance program for school age children (age 6 to 18) in the nation.

With the cuts in the program in 2005, there was a commitment not to cut eligibility for children. However, studies have shown that when parents lose their insurance coverage that their children are at risk of also losing their coverage. Through the annual survey conducted by Bill Fox, 30,000 children lost their coverage in 2005 and 2006.

With the creation of CoverKids as a separate program from Medicaid and because children will roll back and forth within these programs, studies have also shown that children will be caught in the switch and will lose coverage. This is just one reason why the TennCare Oversight needs to also have Oversight of CoverKids.

In a similar vein, adults will be losing their Medicaid coverage and will be going either uninsured or signing up for CoverTN, or other insurance. How many adults will this be happening to? By having this as part of the Oversight Committee , legislators will be able to know how the new program is helping or not helping working adults.

In regards to the 69,000 uninsurable people cut from TennCare, AccessTN is the principle program created to meet their health needs. Will AccessTN meet their health needs? Will the premium assistance program help a significant number of those who were terminated?

For the people who were cut from TennCare, the safety-net program, CoverRx, has been one of the most popular programs and has reached the most people. By TennCare having oversight of this program, legislators will have a better idea of how this program and policy decisions by legislators are helping constituents and the people who were cut from TennCare and the thousands of other Tennesseans who need this program.

Other aspects of the Safety-net program have been critical for the survival of thousands of people who were undergoing chemotherapy, transplants, etc. This program has been critical in saving lives, yet it is scheduled to end on June 30, 2007. Is this a good policy decision? Who made this decision to end this program? Legislators need to be involved in this decision.

By the Oversight Committee expanding its scope of oversight to include the Safety-net, AccessTN and the other Cover Tennessee programs, state legislators will have a unique opportunity to understand how these public program are helping or not helping their constituents.