Once a Model, a Health Plan Is Endangered

NASHVILLE, Nov. 19 - A decade after Tennessee inaugurated a health care plan for the state's most vulnerable residents that was hailed as a model for the nation, the program is once more being held up as a model - of failure in an era of soaring medical costs and voters' aversion to higher taxes.

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Today the plan, TennCare, which sought to improve health care for Medicaid recipients while covering those who fall through the federal program's cracks, is on the ropes.

Gov. Phil Bredesen, a conservative Democrat and former health maintenance organization entrepreneur, has threatened the program with extinction, saying that rising costs and generous benefits - TennCare consumes nearly a third of the state's $25 billion budget - make it unaffordable unless it can be radically restructured to save money and limit benefits.

In the coming year alone, the program faces a potential deficit of $650 million.

After more than a week of tense negotiations between the governor and advocates for TennCare's 1.3 million users - nearly a quarter of the state's population, including an estimated 430,000 who would not be covered by Medicaid if TennCare disappeared - the two sides decided to "step back from the brink," as Mr. Bredesen put it.

"Before I go down the road of taking 430,000 people off the rolls - more specifically, before I can face even one of them, individually, and tell them that it is over, that I can no longer help - I need to be clear in my own heart that I've done everything that I know how to do to solve this," the governor said.

Rather than immediately kill TennCare, as he was poised to do, the governor agreed on Wednesday to one more round of talks after Thanksgiving, though he said saving the program was still a long shot.

In the meantime, TennCare's precarious future leaves those who depend on the program in a state of vigilance and dread.

"In this country, rich as it is, people shouldn't have to choose whether their child will live or die," said Angela Ray, the mother of a severely ill 12-year-old girl in Lawrenceburg. "It's amazing to me that it's come down to this."

Her daughter, Jasmine, must take 20 extremely expensive medications every day to control the rare stew of chronic diseases, including Elephant Man Syndrome, that make it impossible for her to run and play. There are no doctors in Tennessee who can treat her, so her parents must frequently drive her to Birmingham, Ala., for care.

Soon, she may lose that care - out-of-state trips are covered by TennCare, but not by Medicaid - and possibly, her life.

Anita Hyche, 35, a suburban Nashville homemaker who suffers from a rare and agonizing disorder that causes her bone joints to dislocate easily, takes a battery of painkillers that make it possible for her to live a normal active life. Her disease makes her uninsurable, and she would not qualify for Medicaid, so if TennCare ends she will no longer receive $1,200 a month worth of pills.   Continued...