Issue Position: Health Care Fairness in Tennessee

Issue Position

As I attended a meeting of the TennCare Oversight Committee recently, I heard members of the Governor's staff describe the serious problems with TennCare and what must be done to balance the state budget. The reality is around 330,000 people will lose their coverage under the Governor's latest plan. This will include about 1,500 patients in nursing homes and 100,000 enrollees identified as "medically needy." I'll be working with my colleagues in the legislature to explore any other possible options to avoid disenrolling truly needy citizens. In the meantime, we also need to prepare for a time when thousands of Tennesseans with health care needs have no insurance and can't get insurance.

I'm filing legislation this session that will require that hospitals provide health care to individuals without insurance at a fair price. Hospital charges for the uninsured will average around 300% or more than what the hospital will be paid by Medicare for the same services. Health care bills for the uninsured are a major contributor to thousands of bankruptcies in Tennessee. Hospitals need to make a fair profit to survive, but the charges to the uninsured must also be reasonable.

While insurance companies and Medicare are able to negotiate significant discounts from hospitals, these same discounts are not available to the uninsured. An example from a constituent in my district illustrates this point. This particular individual spent three days in the hospital for surgery related to cancer. The hospital charges for the stay were listed at $14,422.02. The rate charged to the insured patient because of the discount negotiated by the insurance company was $2,688.00. In this particular case, a patient without insurance would be expected to pay the $14,422.02 -- or 536.5% more than the patient with insurance.

The legislation I'm proposing would require hospitals to charge uninsured patients no more than 120% of the Medicare reimbursement for the same health care services. That means hospitals still make a reasonable profit. And it means health care bills will be more manageable for the uninsured.

One out of every four Tennesseans has no health insurance. The cost of health insurance continues to increase and more and more hard-working families cannot afford to buy insurance. Additionally, many individuals have pre-existing medical conditions and are denied insurance coverage. Many small and mid-sized businesses simply cannot afford to provide health insurance to their employees and individual policies are far too expensive for the average citizen to purchase. This leaves the uninsured hospital patient with medical bills that often far exceed their ability to pay.

I'm proposing simple fairness in health care pricing. Under my plan, patients would get the care they need at an affordable price and hospitals would make a reasonable profit. As we enter an era without TennCare as we've known it, I see this as a common sense approach that balances the needs of all parties.

If there are issues you'd like me to address, please don't hesitate to contact me. My Senate office address is 10 Legislative Plaza, Nashville, 37243. My toll-free phone number is 1-800-449-8366 extension 1-4499. My email address is sen.doug.jackson@legislature.state.tn.us.

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