Editors note: The Herald Newspapers know that the people of East Tennessee are very concerned about the TennCare situation so we feel it a service to our readers to print an open letter to the people of this great state by the governor.

In the two years since I became governor of Tennessee, we’ve made enormous strides toward improving this great state and bettering the lives of its citizens. We’ve balanced two budgets – each time with no new taxes. We hit a milestone by raising the average salary of our schoolteachers above the southeastern average. We’ve brought new industry to Tennessee and created new jobs. Together, we managed to right the course of our state and begin steering it again in a forward direction.
Today we are faced with our biggest challenge yet, the outcome of which will impact every aspect of state government and, by extension, the lives and livelihood of every Tennessean. I’m talking about TennCare, our state’s financially troubled $7.8 billion health program. Ballooning pharmacy costs, restrictive court mandates and decreased federal funding have translated into out-of-control annual cost increases that the state just can’t afford. Next year alone, TennCare, without any changes, is projected to cost an additional $650 million – some $200 million more than the state as a whole is expected to bring in.
From the beginning, my goal as governor has been to bring TennCare under control. We began that reform process earlier this year by examining the root of the program’s problems. What we found was startling. We found that the average number of prescriptions per person in the United States is 10, in TennCare it is over 30. We found that we spend more in the pharmacy benefit portion of TennCare than we spend on higher education in this state. The end result was that without any changes, TennCare would consume nearly all new state dollars that we could invest in education improvements, economic improvements and other priorities. It was obvious that if we didn’t act soon, we risked jeopardizing all the State’s other priorities and the very financial health of our state government.
Our research concluded that there are two main ways to control costs in TennCare, either limit benefits and keep people on the program or limit people on the program and maintain higher benefits. I proposed a reform plan based on the first option. This just seems like the American way, the Tennessee way – where everyone gets the bronze plan, rather than the platinum plan for some and nothing for others.
But that option, which received overwhelming bipartisan support in the General Assembly, the backing of almost every major TennCare stakeholder, was blocked by legal challenges – challenges we worked hard to resolve with lawyers involved in the cases. Unfortunately, it proved an impossible task. As a result, on November 10 I made the painful decision to begin the process of dismantling TennCare and returning the state to a traditional Medicaid program. I said that before we got too far down the road of going back to Medicaid that I would give legal negotiations another week. Since that time, the legal negotiations have not proved fruitful, but I have decided to take a step back and look for new ways to save TennCare and protect our state’s fiscal health.
TennCare is the most difficult problem I have ever faced. In the past year I have gotten the opportunity to meet and talk with TennCare enrollees across the state. While it was only a few dozen of the hundreds of thousands who are out there, their stories and their faces haunt me.
I said I would solve the TennCare fiscal crisis, and I will. But before I go down the road of taking people off the rolls, before I can face even one of them individually and tell them it’s over, I need to be clear in my own heart that I’ve done everything I can to save TennCare.
That is why in the coming weeks I plan to take a fresh look at this problem to determine if there is a third approach to solving this crisis that may be acceptable to all involved. I want to be very clear that there is no guarantee of success. In fact, it is a long shot. But if we succeed, it would be a huge win for a lot of people I feel a great responsibility for; if it fails, we will be no worse off than we are today.
One of the things that I learned from my wife Andrea early in our years together is that you deal with what is in front of you, you play the hand you are dealt. It’s useless to cry about what has already gone, it’s useless to worry about things you have no control over. You get up in the morning, you have a set of realities to deal with, and you deal with them. That is what I plan to do.
In the end, it comes down to balance. Health care is important – vitally important – but so is education, and job creation, and public safety. It makes no sense for one facet of our responsibilities to completely smother all other good we must do as a state.
One of my primary goals in the coming year is to begin the process of establishing a quality preschool program for children statewide. Studies have shown its benefits, teachers testify to its success, but a preschool program will remain only a wonderful dream if we don’t get our arms around TennCare’s mushrooming costs. Many people have argued that unlimited health care is an entitlement, but I ask, shouldn’t having what you need in education be an entitlement, too?
If you have questions or comments about this issue or any other, please email me at phil.bredesen@state.tn.us.

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