Health care reform through Medicaid managed care: Tennessee (TennCare) as a case study and a paradigm

The Article considers and analyzes elements of TennCare's design and implem entation from a legal and policy perspective. It concludes that in contrast to the contemporaneous Clinton Administration plan for improved access, Te nnCare's design demonstrated the triumph of pragmatism over ideology. It fo cused on reform of Medicaid rather than comprehensively encompassing the en tire health care market; it adopted a pluralistic rather than a unitary app roach; and, at least nominally, it adopted a standard of adequacy rather th an equality in defining the scope of the public's obligation to TennCare be neficiaries. Because the 1997 Balanced Budget Act allows states to adopt ma ndatory managed care for Medicaid, TennCare's managed care features can be replicated by other states without the need for a waiver. Finally, the Article reports on empirical findings about such issues as qua lity of care, hospital profitability, and patient and physician satisfactio n. The Article concludes that quality of care, in general, has not suffered , that patient satisfaction has been good, that physician participation rat es in the program exceed those of the pre-existing Medicaid program, that h ospital capacity has been decreasing at levels above the national average, that hospital profitability overall has not suffered, but that levels of ph ysician satisfaction are very low.