Phil Bredesen

NASHVILLE -- While applauding President Barack Obama's effort to reframe health care reform as a "moral imperative," Gov. Phil Bredesen said Thursday he remains concerned Congress may wind up imposing new costs on states to help fund the proposal.

Gov. Bredesen also voiced skepticism about President Obama's intentions to find enough money to expand health coverage to the uninsured by curbing Medicare waste, fraud and abuse.

And the governor, a one-time health care entrepreneur who started an HMO, said he didn't care much for the president's "vilifying" of insurance companies.

He said President Obama's plan, outlined Wednesday night in a joint address to Congress, does not call for imposing additional costs on states. But Gov. Bredesen said he remains concerned about a U.S. Senate plan floated by Finance Committee Chairman Max Baucus, D-Mont., to carry out some of the expansion through Medicaid, a state and federally funded program.

"What happens if this stuff gets substantially laid off on states?" said Gov. Bredesen, a Democrat who is advocating for Democratic governors on reform issues. "It's a huge problem, and it is definitely going to cut into what we can do in other areas, most particularly education."

He said he's concerned the plan being touted by Sen. Baucus may cost Tennessee $600 million to $700 million per year.

Efforts to reach Sen. Baucus were unsuccessful.

Tennessee Health Care Campaign Executive Director Tony Garr said he doesn't think states will get stuck with a significant part of the reform tab.

One proposal, he said, holds states such as Tennessee "harmless" for any expansion of Medicaid to single adults, with the costs falling solely on the federal government.

Under another proposal, he said, states would pay a share for the health care expansion but well below the customary federal/state funding match rate for Medicaid. Yet another proposal delays costs on states for a number of years, he said.

"Advocates think it's going to be unlikely the federal government will shift a significant cost," Mr. Garr said. "If there is, it would be much less than the existing matching rate. Some proposals hold states harmless forever."

With regard to President Obama's plans to use savings from Medicare waste, fraud and abuse, Gov. Bredesen noted similar arguments were made with regard to TennCare, an effort in 1994 to expand the state's version of Medicaid to cover many more people.

"Tennessee has been there and done that," said Gov. Bredesen, who became governor in 2003. "That's exactly the argument for TennCare and it didn't turn out that way. Maybe they (federal government) will do a better job ... than we did in managing TennCare in the 1990s and the early part of the 2000s. I had a sense of deja vu when you hear all that kind of stuff."

TennCare's growth was unsustainable and could only be curbed through cuts in enrollment and benefits, he said, a plan he pushed in 2005, prompting a major war with health care advocates.

Mr. Garr said he agreed with Gov. Bredesen that there was not much savings for Tennessee when it came to waste, fraud and abuse in Medicaid, but he said Medicare is different.

But he took issue with Gov. Bredesen's contention that major cuts to enrollment and trimming areas such as prescription drug benefits were the only options in the TennCare battle.

"That's the only way this governor knows to do it," Mr. Garr said. "But I guarantee you other states have better ways and other ways. Other states have found you can control costs other than cutting benefits or cutting enrollment."

Gov. Bredesen also said President Obama's effort to restart the health reform debate by "moving it to more of a moral imperative issue than a budgetary issue was an important thing for him to do."

"It's both," he said, "but I think the moral imperative is a much more potent political argument."

But he said he didn't like the president "vilifying of the insurance companies."

In the "great stacks" of books on health care reform he has read, the governor said the "efficiency of insurance markets sort of hardly ever appears as part of the problem.

"There clearly are abuses, you know, the stuff that he (Obama) called out," Gov. Bredesen said. "I mean people who have had insurance dropped for sort of narrow technical reasons just because (insurers) could when (patients) really needed it is a huge abuse and it ought to be stopped.

"But the reason health insurance costs are high is because of doctors' pens, not because of insurance companies," he said. "I think there's a lot of devil in the details of how you get into the real problem underneath this."

IF YOU GO

* What: Roundtable discussions on state-focused health issues, hosted by state Sen. Andy Berke, D-Chattanooga.

* When: 9:15 a.m.-2:30 p.m. today.

* Where: Hamilton County Commission Room, County Courthouse, 625 Georgia Ave., Chattanooga.