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Chapter Position on TennCare and the Uninsured

Tennessee Chapter of American College of Physicians Takes Stand on TennCare

Tennessee physicians have both loudly praised and derided TennCare, but overall, most physicians have taken for granted that Tennesseans benefit from having health insurance. The American College of Physicians-American Society of Internal Medicine (ACP-ASIM), which represents over 115,000 physicians and medical students nationwide, has long advocated for all Americans to have access to health insurance. Why should we care if people in Tennessee have insurance? Multiple studies conclusively show that people with insurance are less likely to die prematurely. If we care about our neighbors, we should care that they have access to insurance.

Despite its many problems, TennCare has expanded access to insurance in Tennessee, especially for those with pre-existing illnesses. This has been very important given the increasing reluctance of private insurers to cover those with pre-existing conditions. Therefore, the Tennessee ACP-ASIM has viewed recent threats to Tennesseans' access to insurance through TennCare with great concern. The Tennessee ACP-ASIM represents board-certified internal medicine physicians (doctors for adults) throughout Tennessee. Internists provide the majority of health care to adults in America. In response to these recent threats to Tennesseans' access to health insurance, the Governor's Council of the Tennessee ACP-ASIM unanimously adopted the following position statement:

"Research clearly shows that people with health insurance are less likely to die prematurely or get severely ill. We want Tennesseans to live longer, fuller, and more abundant lives. Therefore, we recommend that measures be taken either to maintain and improve access to insurance for Tennesseans through TennCare, or to implement insurance reforms to insure that Tennesseans with pre-existing conditions can obtain affordable health insurance."

This resolution clearly recognizes the importance of insurance for health. Whether health insurance is made available to Tennesseans through the private sector in order to reduce the tax burden on the public, or through the public sector, is only of secondary importance to the Tennessee ACP-ASIM. Tennessee's people, Governor and legislature must have a plan to insure that Tennesseans retain access to health insurance.

The Governor's current plan divides and limits TennCare in order to reduce the overall tax burden of TennCare and increase individual responsibility for health insurance premiums. These are worthy goals, but Tennesseans' access to insurance must be protected simultaneously. The Governor's plan seriously endangers Tennesseans' access to insurance while doing little to insure that Tennesseans cut off from TennCare will be able to obtain insurance through the private sector. The Governor's plan may make it even more difficult to meet our citizens' needs, since we would forfeit a substantial portion of the current federal funding for our state's healthcare system. Alternatively, if TennCare is to be sustained in its current form, steps must be taken (as the Governor has suggested) to make its administration efficient and effective, to hold managed care organizations accountable, and to streamline and standardize administrative procedures and formularies. TennCare should be as efficient at collections as the most motivated for-profit health plan and should encourage citizens to take responsibility for their health and health insurance premiums.

If TennCare is to be limited, insurance reform is essential to guarantee Tennesseans' access to insurance. This approach would require our state government to pass legislation, as have other states, to prevent private companies from denying insurance coverage to those with poor health and pre-existing conditions. Although this approach would also be expensive and would face insurance industry resistance, it could provide Tennesseans with additional benefits by making insurance companies accountable to the public they serve and by preventing discrimination against individuals on the basis of their medical conditions.

Tennesseans benefit from access to affordable health insurance. Whether access to insurance is protected through TennCare or through real insurance reform is less important than our determination as a state to plan for the health of our citizens. Let us choose to care for our neighbors and demand accountable health insurance systems that are accessible to all Tennesseans.

James E. Bailey, MD, MPH, FACP, Governor's Council Member
Richard G. Lane, MD, FACP, Chairman, Public Policy Committee
J. Fred Ralston, Jr., MD, FACP, Governor

American College of Physicians-American Society of Internal Medicine (ACP-ASIM) is the nation's largest medical specialty organization. ACP, founded in 1915, and ASIM, founded in 1956 merged in July of 1998. Membership comprises more than 115,000 internal medicine physicians and medical students. Internists provide the majority of health care to adults in America. Internists (doctors for adults) in our region are joined in the Tennessee Chapter, to speak for Internal Medicine in our state and to reflect the interests and concerns of our specialty.

Contact: Wilma Cooley, Executive Director, at 615-385-2100

Contact Information

Richard G. Lane, MD, FACP,
Governor, Tennessee Chapter

Renee Arnott
Executive Director
Ph: 615-460-1657
E-mail: renee.arnott@tnmed.org