Tennessee Gov. Phil Bredesen (D), who is presiding over one of the largest cuts to Medicaid rolls in the program's history, appeared before a Washington, D.C., audience June 24 to call for increased cost-sharing by beneficiaries and extra flexibility for states to manage their programs.
The reforms Bredesen outlined mesh with a package of proposals put forth June 15 by the National Governors Association that would fundamentally overhaul the state-federal program that serves 53 million poor and disabled Americans.
Bredesen said that all Medicaid recipients should pay at least a small portion of the costs of their care and that states should be given latitude to determine which medical services and prescription drugs to provide at government expense.
Bredesen plans to drop as many as 323,000 people from the rolls of TennCare, the state's Medicaid program, which by some measures has been the most comprehensive in the nation but which has proved financially unsustainable. Without cutbacks, he said TennCare would need $650 million new state dollars in 2006, about $200 million more than the total growth in the state's revenue.
Bredesen added that he would have preferred to reduce benefit levels rather than cut recipients to reduce costs but was handcuffed by federal rules. Increased flexibility from Washington has been a drumbeat of governors' recent reform efforts.
Medicaid has become a hot federal topic since Congress in April called for $10 billion in cuts to the program over five years, although those cuts are less than proposed by President Bush. Governors are hoping to turn the focus to long-term, policy-driven reforms, rather than short-term budgetary fixes.
Bredesen said he has been frustrated by discussions with federal policy-makers who he said are disconnected from the challenges governors face to balance their budgets and fund other priorities such as education without curtailing much-needed health care services.
"The people at least that I've talked to in Washington are more caught up in an ideological debate about what health care is and what should government's role be in providing it. ... Bottom line is, I think what I've found so far is that Congress has been more ideological about it. I have a lot of people who were very nice to me and told me I was a great Democrat and listened to me and couldn't have cared less about the problems I face as governor in balancing the budget," he said.