Severe changes to Medicaid programs in Tennessee and Missouri are putting some of those states' most vulnerable residents at risk for health problems and even death, according to two recent reports.
An April report by Families USA followed more than 100 people over a two-year period and found that losing benefits under TennCare, the state's Medicaid program, had some devastating effects. Residents who lost their health coverage experienced severe financial hardships, were often not able to work and reported a deterioration in their overall sense of wellbeing. In 2005, Tennessee Gov. Phil Bredesen pushed through the biggest cuts in the history of any state's Medicaid program, resulting in more than 100,000 people losing needed health care services. Making matters worse, Families USA said, Bredesen implemented the cuts without providing any safety net for people who would inevitably be rejected by private insurance companies.
Among those who lost their TennCare benefits were Patrick and Beatrice Williams of Knoxville, who relied on the state for health insurance coverage because they were too sick to work and had no income. Both have severe lung ailments and were forced to go without essential medication when their Medicaid coverage was cut, according to the report.
'I just have a really hard time believing that this could happen in America,' Beatrice Williams said in the report. 'I am becoming increasingly depressed and scared. The doctors and the pharmacists are the only ones who have helped us.'
In Missouri, legislators are considering a measure, S.B. 577, that would replace the current Medicaid program with private insurance plans called 'health improvement plans.' In the wake of 2005 budget cuts during which 100,000 Missourians lost their Medicaid coverage and 300,000 were affected by reductions in service, the legislation 'is a step backwards,' said Ron Pollack, executive director of Families USA, which released an April report on the issue. Among his group's criticism of the plan is that the details are vague, giving policy-makers 'license to determine the most critical details.' The report said moving Medicaid beneficiaries into private plans is risky because those plans may be ill-equipped to meet specific health care needs.
'This population is extremely diverse and has many different kinds of special and complex health care needs,' Pollack said. 'Therefore, real effort needs to be made to ensure that these individuals do not fall through the cracks.'
Both Missouri and Tennessee are examples of state programs with vulnerabilities, but all Medicaid programs are flawed, according to a separate report released in April by Public Citizen's Health Research Group. Problems are rife when it comes to quality of care, the scope of covered services and provider reimbursement, among other issues.
'As it enters its fifth decade, the Medicaid program is going through a mid-life crisis,' said Sidney Wolfe, MD, director of the Health Research Group at Public Citizen and co-author of the report.
Both 'Unwilling Volunteers: Tennesseans Forced out of Health Care' and 'Using Blunt Force on Missouri's Most Vulnerable Population' are available from Families USA at www.familiesusa.org. The Public Citizen report, 'Unsettling Scores: A Ranking of State Medicaid Programs (2007),' is online at www2.citizen.org/hrg/ medicaid/.
