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[bob ford <bobford79 AT yahoo.com>]

We have several list members from TN.  I thought this was an interesting 
article.  I don't know anything about it, other than what is in the article.  
Maybe it is like the Mass. plan?  From today's WSJ

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 NOVEMBER 22, 2008

 What Tennessee Is Doing About Health Insurance Coverage with limits is 
better than no coverage at all.

By PHIL BREDESEN


Three years ago, I realized something about health care. I've taken part in 
uncounted policy discussions about America's uninsured, both as governor of 
Tennessee since 2003 and before that as CEO of Nashville-based HealthAmerica 
Corp. Everyone regularly criticizes the unfairness of the system. But we 
don't make progress.

What I realized was this: Everyone proposing solutions or criticizing 
unfairness was doing so from the comfortable vantage point of having good 
health insurance. While we work to build a better system, wouldn't it also be 
responsible to find a way to get something -- not a perfect solution, not 
even a long-term solution -- into the hands of the more than 46 million 
uninsured Americans who don't share our good fortune?

Dottie Landry is one of those uninsured Americans. She lives in Nashville and 
is self-employed. She makes and sells jewelry. Over the years, she has been 
generally healthy but uninsured. In 2000 she got very sick -- from a tick 
bite -- and had to spend about $9,000 for medical care. She put most of it on 
her credit cards, which took years to pay off.

We all want to help Ms. Landry, but here's the problem: a comprehensive 
health-insurance policy for her costs about $5,000 a year, and someone has to 
pay that. That's a real number that won't go away with group purchasing or by 
beating up insurance companies. Ms. Landry can't afford that, and in a world 
of trillion-dollar deficits it's hard to see how the federal government can 
either.

We need a national health-insurance solution, but isn't it sensible in the 
meantime to make sure everyone has a basic health plan before we give a few 
more people a perfect but expensive one? Shouldn't we make sure everyone at 
least has a Chevy rather than providing a Cadillac to a few and letting the 
rest walk? We're trying that in Tennessee with CoverTN.

CoverTN, which began in 2006, is a health-insurance plan for those who are 
self-employed, or who work for small businesses that can't afford a 
traditional policy.

It is not free health care. Rather it is a limited plan with shared costs. In 
devising this plan, we didn't start out the usual way -- by defining what 
benefits we wanted -- but instead set how much we wanted to pay. And then we 
began a competitive-bidding process to see how much health care we could buy. 
We initially set the amount we would pay at an average of $150 a month, and 
split the responsibility for that premium three ways. The company would be 
responsible for $50, the individual for $50, and the state for the final $50.

The bidding was vigorous. It was ultimately won by BlueCross BlueShield of 
Tennessee with a benefit package that meets a great many -- not all -- of the 
real needs of the uninsured at a cost far below conventional plans.

At these premium levels -- less than half of what a conventional plan might 
cost -- the benefits are limited. But the benefit structure is also different 
than in a conventional plan. Most limited plans achieve their savings with 
high front-end deductibles, requiring a person to spend often thousands of 
dollars out-of-pocket before benefits kick in. But when we asked our 
customers -- uninsured Tennesseans -- what they actually wanted, we found 
that they were most interested in some help with the more common things; a 
doctor's visit, prescriptions, a short hospital stay.

CoverTN emphasizes covering these front-end costs. It features free checkups, 
free mammograms and $15 doctor visits without deductibles, for example. And 
it achieves its savings on the back end, with relatively low limits on 
hospital stays and an overall $25,000 benefit limit in any one year. It does 
not cover truly catastrophic events.

This makes medical sense. Good access to a doctor and a drugstore when you 
first have a problem can avoid a lot of cost and heartache later.

One thing that has been unexpected is the success of a generics-only 
prescription drug program. We needed to cover medications, but because of the 
high prices and aggressive marketing of branded prescription drugs, we were 
concerned that the costs would overwhelm the program. With some misgivings, 
we required our bidders to propose a largely generic prescription program. 
It's worked surprisingly well. Physicians have typically been able to select 
suitable medications for their patients, and patient satisfaction has been 
high and complaints few.

Having been badly burned by uncontrolled growth in costs in Tennessee's 
Medicaid program (TennCare once gobbled up a third of the state's budget), we 
proceeded cautiously with CoverTN and have been rewarded with good control of 
costs. This fall we added some benefits: The number of primary care visits 
doubled from six to 12, for example. Best of all, we added them without 
increasing rates. When did you last hear of a health-insurance plan whose 
annual update was a benefit improvement but no rate increase?

An obvious and valid criticism of health insurance such as this is what 
happens when a patient exceeds the benefit limits.

What we're finding is that even in health care, when people know that there 
are limits, they work to manage their costs. This year, as of the first nine 
months, only four people out of the more than 15,000 people covered had hit 
the maximum overall limit of $25,000, and only three had exceeded the 
separate in-patient hospital limits. A larger number, under 4%, hit the 
quarterly pharmacy limits during those first nine months.

Even those who go over the benefit limits get the significant advantage of 
being able to piggyback their personal expenditures on the contracts CoverTN 
has negotiated. By doing this, they often can cut their costs on uncovered 
health care in half.

Ms. Landry, to continue her story, has joined CoverTN and is very happy with 
it. About a year and a half ago, right after she joined, she had a bad dog 
bite that put her in the emergency room with several follow-up visits. The 
cost for this episode was about $4,000, and CoverTN paid for almost all of it.

The Chevy plans certainly have their critics, and I don't offer CoverTN as 
the perfect or ultimate answer, but it sure has worked for Ms. Landry and 
thousands of other Tennesseans.

Mr. Bredesen, a Democrat, is the governor of Tennessee.