Evolution of TennCare yields valuable lessons.

dents. In 2005, the state’s inability to overcome numerous financial and legal difficulties finally led to painful cutbacks in both enrollment and medical services. The program has undergone many structural and implementation changes, some initiated by the state and some forced on the state by litigation and court rulings (Chang, 2005). This article traces the history of TennCare and describes the program’s design. It then summarizes the root causes of the various problems that have plagued the program and discusses Gov. Phil Bredesen’s current reform effort to save TennCare. The article ends with a discussion of the new state program called “Cover Tennessee” as part of a larger concerted effort initiated in May 2006 to provide insurance coverage to small businesses and uninsured workers and to mitigate the adverse effects brought on by the recent cutbacks in TennCare.