Uncovering the Common Grounds of TennCare Stakeholders: A Complete Timeline from 1935-2010 with the Stakeholders’ Perspectives
Abstract
In 1994, Tennessee began its Medicaid-waiver program as a solution to fiscal, political, and social issues. The program, TennCare, was developed using managed care to increase the number of enrollees receiving government-funded health care while controlling or reducing costs. Through multiple changes the program has continued, in some form, until the present day. In this paper, I provide a detailed history of the creation and implementation of TennCare along with the perspectives of the major stakeholder groups (the State, the managed care organizations, the providers, and the advocates and enrollees). TennCare was implemented in 1994, and enrollment swelled from 750,000 to over 1.4 million. Since 2002, the enrollment has decreased to about 1.2 million. Since its creation, factions and individuals have disagreed on the benefits, the enrollment, and the funding for this program. What began as a collaboration of sorts has developed into a policy stalemate with nearly all lamenting the program’s current form. This paper suggests that future health care reform success may hinge on the ability to avoid this pattern of polarization to the point of policy paralysis or completely unilateral action.