A history of the struggle among competing stakeholders in one of
the oldest and most controversial experiments in US health care
policy, a precursor to Obamacare. In 1993, Tennessee launched a
reform initiative designed to simultaneously expand the proportion
of residents with health insurance and curtail cost increases. It
was guided by principles that nearly match those that guided the
creation of the Affordable Care Act, also known as Obamacare. Like
the ACA, TennCare used corporations, rather than a single
government payer, to implement the plan, and it relied on a mix of
managed care, market competition, and government regulation.
While many states cut back on their Medicaid enrollments from 1993
to 2001, TennCare grew from 750,000 to 1.47 million enrollees. The
state was less successful in controlling costs, however. Each major
stakeholder group (the state, the managed care organizations, the
providers, and the enrollees and their advocates) pushed back
against parts of the state's strategy that adversely affected their
interests, and they eventually dismantled the mechanisms of cost
constraint.
The author lays out the four stakeholder perspectives for each
period in the history of TennCare and provides a link to
difficult-to-access primary documents.
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