Word: medicaid
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...million in net profits last year, a 25% increase from 1993--that experts suggest that members of Arizona's "notch" population--the uninsured working poor--be added to the plan as well. But that is an unlikely outcome now. Even states like Arizona, which have created a lean Medicaid machine with very tight eligibility requirements, are facing the same federal budget cuts as states locked into traditional Medicaid programs...
...months after the Federal Government approved the state for a 1115 waiver, TennCare was under way. Perhaps the most ambitious state-waiver program in the nation, this managed-care system provides coverage to about 1.2 million people, or nearly one-quarter of the entire state. The breakdown: 750,000 Medicaid patients and an additional 400,000 people who were previously uninsured--a generous move that means funds are especially tight...
TennCare, however, is not the product of a long, thoughtful, democratic process. Stealth attack is more like it. In 1993 then Governor Ned McWherter, alarmed that Medicaid had ballooned from 13.4% of the state's budget in 1987 to more than 26%, presented lawmakers with a managed-care program contained in an innocent-looking 1 1/2-page bill. Before the powerful lobbyists for doctors, insurance companies and the elderly knew what had hit them, the bill passed, with virtually no debate...
From the moment TennCare was law, its opponents had much to grouse about. The speed of the transition from a fee-for-service Medicaid plan to the new system, in which the state takes $2.9 billion in federal and state funds and contracts with 12 privately run managed-care organizations, wreaked havoc on doctors and patients alike. The chaos that even a small private business often undergoes when switching medical plans was multiplied a thousand-fold. Many patients did not know which managed-care group they had been assigned to, and in the early days it could take hours...
...with Arizona's program, one of TennCare's greatest successes has been in mainstreaming Medicaid patients, who no longer see doctors at so-called Medicaid mills. This too was accomplished cunningly. The architects of TennCare created a controversial rule called the "cram down." A doctor who opts out of TennCare is not permitted to participate in BlueCross and BlueShield's commercial network, thereby losing a huge amount of potential business from approximately 1.2 million non-Medicaid people, including state and municipal employees and teachers. Initially, almost one-third of the doctors in the BlueCross and BlueShield network refused to join...