State Health-Care Task Force Meets in Knoxville for a Lot of Talk

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by Thomas Fraser

Louise McKownThomas Fraser

Louise McKown

Louise McKown and her flower-adorned walker moved slowly down the hall of the J.L. Goins Administrative Building at Pellissippi State on Thursday evening.

“I’ve been in this battle since 1994,” she said after sitting through a two-hour meeting of the 3-Star Healthy Project, a controversial task force empaneled by state House Speaker Beth Harwell to seek ways to help close the “coverage gap” facing 300,000 Tennesseans frozen out of both the state Medicaid program and coverage available through the federal Affordable Care Act. They make too much for state coverage and too little to receive tax credits for ACA coverage. One presumption in planning the ACA was the expansion of state Medicaid to provide coverage for the poor. But in Tennessee and other states, that did not occur.

McKown didn’t much like what she’d just heard. The panel—which on Thursday included Knoxville Republican Rep. Roger Kane, Crossville Republican Rep. Cameron Sexton, and Memphis Democrat Rep. Karen Camper—refereed discussion ranging from the importance of smoking cessation to obesity and substance abuse prevention and the need for more primary care providers in the state. One option discussed: The use of health savings accounts for the poor, which one medical provider dismissed as largely unworkable.

McKown thinks the panel, in its apparent emphasis on preventative care, also missed a crucial chronic-care point: Sometimes catastrophe strikes. In her case it was a progressive neurological disease called olivopontocerebellar atrophy (OPCA) she was diagnosed with in 1989.

“You know what? I’m not overweight. I didn’t smoke, I didn’t do drugs… Please. Enough is enough,” said McKown, 66, who first took on the mantle of health care reform when she went without care for a few months after her COBRA coverage expired in 1994 and she had to desperately search for a willing insurer. Medicare now provides the health-care coverage she relies on to this day. She advocates a single-payer system, and “we’ll get over this business of funding the gap.”

McKown and dozens of others at the committee meeting sported “Close the Gap” stickers. That same simple message was communicated to lawmakers by silent protesters standing at the rear of an auditorium holding a banner.

A wealth of Knoxville-area health care providers and executives offered testimony to the panel. Most of them shared a similar theme: East Tennessee health care is in a world of hurt.

While recent figures based upon University of Tennessee research suggest only 8.2 percent of the state population is now without health insurance, “every county in East Tennessee is far above 8 percent in uninsured (adults),” said Ben Harrington, executive director of the Mental Health Association of Tennessee. He said the number of uninsured is about 14 percent in Knox County, and is higher in nearby, more rural counties.

“Starting a pilot program and trying to chip away at 5-10 percent [of the uninsured population] isn’t going to help these folks one bit,” Harrington said.

Kane said the initial pilot program would include about 150,000 people, and could ultimately expand to cover 500,000. “We understand that the working poor, there’s really no other option for them,” he said. He noted “at this point there are a lot of variables we are working with.”

“We want to have a phased-in approach,” Sexton said in response to Bo Carey, a small-business owner and member of the National Federation of Independent Business who told the panel other members were “wary” of an expansion of government-subsidized health-care in Tennessee.

“I think anything we come up with there will be measurable outcomes,” Sexton said.

Executives and health-care providers from the University of Tennessee Medical Center, Covenant, Tennova Health Care, and Cherokee Health System stated their cases before the panel, and most were in agreement on the need to expand health services, bolster primary care networks, and adopt, in many cases, a case-management system for more vulnerable patients. This would likely limit visits to the ER for nonemergency ailments—a major source of monetary hemorrhage for hospitals.

“I think we all agree that the problem is not access to care,” said David Hall, chief operating officer of UT Medical Center. “It’s where and when people receive that care.” Often those lacking a primary care physician will wait for treatment “until they’re really, really sick.”

He said more than 13,000 annual patient “encounters” at UTMC were with the uninsured, and 85 percent of those originated in the emergency department. This cost the medical system $19 million a year, money that otherwise would “be able to be invested back in our community.”

This prompted a discussion of expanding access to urgent care centers, where acute problems can be identified before they progress. Other ideas revolved around “Telenet” remote diagnostic opportunities and other technology, expanding payment and fee-waiver options, and reducing the overall cost of health-care services.

This applies to both medical and mental-health needs—which were a prominent part of the discussion. Knoxville Police Department Deputy Police Chief Gary Holliday told the panel about more money needed to fund a successful program in behavioral-health-based judicial diversions. The Knoxville Early Diversion Program is a $398,000 grant-funded collaboration with Helen Ross McNabb Center. Those charged with misdemeanor public order crimes are evaluated for behavioral health issues, including substance abuse, and are given the option to receive treatment in exchange for diversion of the case and ultimate dismissal of charges, Holliday said.

“It’s good to keep folks out of jail,” he said, and the program has yielded a cost savings of $110,000 over three years. But the grant money “left us quickly,” largely because of the cost of providing health services to those in the program.

There were many numbers bandied about during Thursday’s latest installment of the traveling 3-Star Healthy Project—the legislative committee has also met in Johnson City, Nashville, and Memphis—but one doctor who provided testimony said raw statistics should not cast a shadow over the real purpose of trying to close the health-care gap.

Dr. Eboni Winford, a Cherokee Health System psychologist, relayed the story of a man who finally received TennCare coverage two weeks before he died.

“We really want to emphasize that we are talking about people,” she told the panel.

Later, out in the hallway, as people walked by and greeted her by name and she kept a smile affixed to her face, Louise McKowan gripped her walker and reflected how quickly everything, including one’s health, can fall apart.

She remembers when she was diagnosed with OPCA.

“I’d just turned 40,” said McKowan, now 66, of Oak Ridge. “And they said life begins at 40. The whole world tumbled, and I moved back here to live with my parents.”

Rep. Camper said after the meeting that failure to close the public insurance gap means “we’ll lose some of our rural hospitals,” and that common themes heard throughout the state include issues of “co-morbidity”—when a person has multiple health problems at once—worries from businesses about health-insurance costs and the need for better mental-health coverage.

Knoxville’s committee meeting, she said, “really just continued stories we’ve heard from the working poor.”

She urged those in attendance to “be positive. We’re not doing this just for show.”

Sexton, the committee chairman, urged patience as the panel works on a solution: “We know how high the mountain is; we’re willing to climb it, we just need a little time to get it right.”

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