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WASHINGTON - Faced with a $650 million shortfall to pay for his state's Medicaid program, Tennessee Gov. Phil Bredesen cut 191,000 low-income people from the struggling health plan.
That action and other cost-saving measures outraged advocates nationwide, who accused the Democratic governor and former health care executive of endangering the well-being of the state's poorest residents.
Similar criticism has greeted Bredesen's latest move, which is unmatched anywhere in the country: Tennessee is the only state that won't pay to cover a widely used class of anti-seizure medications for 560,000 poor adult Medicaid enrollees.
In addition, Tennessee is the only state that won't cover these people for eight other types of drugs - including fertility and weight-loss medications - that the federal government allows states to purchase under Medicaid.
The moves may burnish Bredesen's reputation for cost-cutting. But there's widespread concern that people who can't afford to buy the anti-seizure drugs on their own will suffer in silence or end up in emergency rooms across the state.
With Medicaid draining record amounts from state budgets nationwide, some worry that Tennessee's latest drug coverage cut will be repeated in other states.
"Each time somebody takes one of these actions that 10 or 15 years ago would have been considered so callous as to be inhumane, it just makes it that much easier for the next person to do something similar because they don't have to be accused of being the first," said Steve Hitov, managing attorney at the Washington office of the National Health Law Program, a public-interest group focused on health issues facing the poor.
Tennessee's $8 billion TennCare program was once a national model for serving the poor and uninsured. Recently, Bredesen called it a "damaged vehicle."
But the program cuts and enrollment trims that have ruffled so many feathers also have helped TennCare reduced its funding gap from $650 million to $115 million.
Bredesen recently announced plans to use some of the savings to try to expand health coverage for 150,000 children through a separate program funded mainly by the federal government. Tennessee currently has the nation's most restrictive income limits for children enrolling in Medicaid, according the Kaiser Family Foundation, a health research group.
Bredesen, who's running for re-election, is also trying to develop public-private partnerships to help cover 600,000 working poor who can't afford coverage on their own. He said recently that the changes could restore "the dream of TennCare" without breaking the budget.
"The enrollment cuts that we were forced to make created a great deal of pain and uncertainty that was avoidable had there been more constructive help, but we tackled it and brought it under control. ... By living within our means, we've turned the corner, and we are now able to move forward again," Bredesen said in his recent state-of-the-state speech.
A federal judge in November 2005 approved Bredesen's plan to reduce benefits and cut 191,000 people - mostly the working poor - from the program. The judge ruled that alternative measures sought by patient advocates were insufficient to sustain "one of the nation's most progressive and generous Medicaid programs in a state that has one of the nation's lowest tax burdens per person."
So Bredesen's cuts continue to ripple through the state.
Epilepsy care groups in Tennessee have reported a sharp rise in people seeking help in paying for the seizure medications, known as benzodiazepines. They include drugs such as Valium, Xanax and Ativan.
"This is a public health crisis as far as I'm concerned," said Beth Coleman, executive director of the Epilepsy Foundation of Southeast Tennessee in Chattanooga.
Also vulnerable under the coverage ban are poor, mental-health patients who use the drugs to treat depression, anxiety, panic disorders, insomnia and tremors. Benzodiazepines also help control muscle spasms in cerebral palsy sufferers such as Timothy Rickett of Wartburg, Tenn.
David Beshara, chief pharmacy officer of TennCare, said halting coverage of the drugs was about safety, not saving
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