Left in Limbo (Page 2 of 4)
February 22, 2007By:
A similarity between TennCare and CoverRx is that generic drugs are pushed, even mandated, over name brands. For some classes of drugs, generic alternatives may not work as well as their more expensive counterparts —a contingency that the state has yet to address.
“They say there’s no real difference [between generics and brands],” Miller says. “But when my blood pressure medication [switched to generic] my heart started skipping beats and [I was] getting headaches. They stopped as soon as I went back to the name brand.”
CoverRx is just one component of Cover Tennessee, the state’s proposed substitute for the slashed TennCare program. Cover Tennessee was due to start in the fall of 2006, but two months into the New Year, the program has yet to begin. With the Cover Tennessee replacement plan stalling before its implementation, almost one million Tennesseans like Miller, including children, remain without health care or insurance.
“Governor Phil Bredesen developed Cover Tennessee to create health insurance options that are affordable and portable, and meet the needs of the uninsured in our state,” the official Cover Tennessee Web site states. “Cover Tennessee is not an entitlement program—it is voluntary health insurance coverage that is affordable to participants and affordable to the state.”
With a highly vested interest in the program, Miller says she tries to keep up on all the current information about Cover Tennessee.
“I read the paper and listen to the news. They keep saying that Cover Tennessee is coming out soon,” she says. “I’ve turned in my name and information to all the places and have never heard a thing from any of them.”
In addition to CoverRx, Cover Tennessee consists of four other components: AccessTN, Coverkids, CoverTN and ProjectDiabetes/Coordinated School Health.
The different programs, none of which are currently up and running, are aimed at different types of people, from those with full-time jobs to those with a handful of uninsurable medical issues. Eligibility requirements vary, but almost all require participants to be United States citizens who have lived in Tennessee for at least six months.
AccessTN is designed “for seriously ill adults who can afford health coverage, but have previously been turned down by insurance companies as uninsurable ... No one will be turned away due to an existing medical condition,” states the Web site.
AccessTN will start processing applications March 1, but only 6,000 people will be enrolled. “We will enroll only the number we think the Plan can pay for,” page two of the 29-page application packet states.
Starting March 1, roughly 4,500 spots will be reserved specifically for those disenrolled from TennCare, says Susan McKay, statewide coordinator for the Tennessee Health Care Campaign (THCC), a nonprofit advocacy group. After a 60-day window, the remaining spots will be opened to the uninsured.
At an AccessTN board of directors meeting on Feb. 15, it was reported that 30,000 Tennesseans had already shown interest in the program via its Web site and toll-free number. Another 130,000 mailings are expected to go out to those who were cut from TennCare and radio marketing is also about to begin.
“For 6,000 total slots, there’s a huge need that won’t be met,” McKay says. But even if someone manages to be picked up by the program, it requires a six-month period without coverage. The state is calling this period “Go Bare” and the application describes it as a period when pre-existing conditions aren’t covered.
The CoverKids initiative is for children under the age of 18 with a yearly family income well below the federal poverty level. The state Web site claims emphasis will be placed on preventative care and will offer comprehensive benefits, but dental care and vision are not included. “Cavities are the number one preventable disease for children,” says Tony Garr of THCC.
ProjectDiabetes/Coordinated School Health consists of a number of preventative programs like GetFitTN and Healthy Teen Intervention aimed at teens and children to help prevent Type 2 diabetes by making educating about healthier lifestyle choices. “ProjectDiabetes also provides grants to health care providers for innovative education, prevention, and treatment of diabetes and obesity,” states the Web site.
