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Gov. Phil Bredesen of Tennessee, a Democrat, is proposing the largest cuts in the history of TennCare, his state’s Medicaid program. To trim 9 percent of the TennCare budget, he would establish a $10,000 cap on inpatient hospital services for nonpregnant adults and would limit coverage of X-rays, laboratory services and doctor’s office visits.

“I have no choice,” Mr. Bredesen said.

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“I won’t have any primary care doctors left, much less specialists,” she said. “Certainly down here nobody likes to talk about taxes, but sometimes you have to bite the bullet and do what’s right for a whole lot of people.”

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Dr. Beck said that over eight months last year, his practice wrote off $36,000 in losses from treating 17 Medicaid patients. The state-imposed payment cut, he said, was “the final straw.”

“I’m out, I’m done,” Dr. Beck said in a telephone interview. “I didn’t want to. I want to take care of people. But I also have three children and many employees to take care of.”

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