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About 800,000 uninsured individuals, or 14% of the state's 5.9 million people, called Tennessee home in 2005, according to the U.S. Census Bureau.

The majority of the uninsured, says Laurie Lee, the state's executive director of benefits administration, are full-time working adults who do not have insurance because they cannot afford it or their employers do not offer it. To put a dent in that uninsured population, the state began offering CoverTN, which partners the state with private employers and individuals to give small business employees basic health coverage. It is also portable, which means the plan follows the individual, regardless of where he works.

When it launched, the program was geared toward small businesses with 25 or fewer employees. Tennessee has about 105,000 small businesses that match that description, and, Lee says, about half of those businesses do not offer health insurance to their employees. Of that amount, about 50% would qualify for CoverTN based on the program's income parameters, and so far, CoverTN has about 13,000 enrollees.

By the end of fiscal year '08-'09, Lee says the state's goal is to cover 31,000 individuals through CoverTN. In January, the state expanded program eligibility to offer coverage to businesses with 50 or fewer employees and to individuals working at companies that do not provide employer-sponsored health insurance or CoverTN. In terms of finances, Gov. Phil Bredesen says the program is performing according to expectation.

"Part of the way we started to structure it is to get out of the overall entitlement mentality of TennCare ," Bredesen says. "We are going to appropriate this much money, and when we've spent that much money, that's all we're going to spend. With CoverTN, we started out conservatively. It is working well, so now we're expanding it."

The other Cover Tennessee programs are being altered a bit this year as well. AccessTN, which offers insurance to individuals with uninsurable or catastrophic health care conditions, had several program changes effective January 1. That program, Lee says, currently has about 2,203 enrollees, and the program budget allows for about 6,000.

CoverRx, the pharmacy assistance program that provides access to prescription medications, serves about 29,202 members. At the current growth rate, Lee says it could be serving 40,000 members by 2009. This year, the program lowered some co-pays for certain members.

And finally, as of January 1, CoverKids, the program for uninsured children, provides vision benefits, including annual vision exams, annual glaucoma testing, eyeglass/contact lenses once every 12 months and routine replacement eyeglass frames once every 24 months. So far, about 17,000 kids are enrolled in the program, and by 2009, Lee says the target goal is about 30,000 enrollees.

Bredesen, who says the CoverKids program is "going well and poorly," is frustrated by the fact that that number is not already higher.

"It passes my understanding why any parent would not sign up for free, comprehensive health insurance for their child, but they're not," he says. "So, I say it's going well in that there are 17,000 kids who are covered who weren't covered last year at this time, but I wish we were covering a lot more."

He hopes that the new vision coverage (and eventual dental coverage on April 1) will increase the numbers—as taking a child to the eye doctor is probably a more routine expense for parents, and when they visit the ophthalmologist, they'll have one more person encouraging them to sign up their child.

Yet, while enrollment numbers are the best measure of the state's primary focus—coverage—the program's administrators will also look at the quality of care being delivered as another way of measuring success.

"We are continually looking at ways to better fill the gap and serve the populations of these programs," Lee says.

The bottom line, Bredesen says, is the state took $1.6 billion out of the TennCare program and replaced it with about $100 million in four different types of programs that are currently meeting the needs of about 61,000 people.

"It's not as exciting as saying, 'Oh my gosh, we have this comprehensive program to insure everybody in the state of Tennessee,' which gets you national headlines," he says. "But we actually can afford this one, and it seems to be working well and meeting many of the most significant needs out there for people that do not have conventional insurance."

And people are watching. CoverTN and CoverRx are fairly unique, and Bredesen says other governors have inquired about the programs and their success. Tennessee is beginning to receive national attention—President Bush even commended Bredesen for being "on the leading edge of health care reform." At a time when health care reform is imminent, such attention can only be positive.

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