Some Tennessee hospitals are questioning why they should continue paying a self-imposed tax to prop up the state's Medicaid program because competitors are getting back much more in reimbursements while they lose money treating TennCare patients. Hospital executives were shocked to learn that insurance contractors for TennCare, the state healthcare program for the poor, were paying more than four times as much to some hospitals as to others for outpatient procedures. In some cases, the disparities amounted to millions of dollars. The tension threatens to fracture a carefully negotiated alliance that keeps the state from losing hundreds of millions of dollars in federal matching money.