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New state health plan stirs outrage over cost, coverage

POSTED: January 19, 2014 12:12 a.m.

An upheaval in the state health benefits plan has led to tension between the board that put the changes in place, the state government that claims it has no ties to it and employees and retirees who say they’re being negatively impacted both in their wallets and at the doctor’s office.

“It’s very expensive, and particularly compared to what (employees) were paying,” Brad Brown, human resources executive director for the Hall County School District, said. “On the flip side of that is it’s still very comparable and a lot better than what other people (in private companies) are having to pay.”

Blue Cross and Blue Shield of Georgia took over the state health care plan Jan. 1 from United HealthCare and Cigna, while Express Scripts now oversees prescription drug benefits. There are approximately 650,000 employees, dependents and retirees on the plan, about 30 percent active teachers. Retired teachers make up around 16 percent.

So while the changes encompass all state employees, teachers make up a large portion of those on the insurance plan, and they’re speaking out.

The Facebook group Teachers Rally Against Georgia Insurance Changes, or TRAGIC, has grown to more than 9,000 members since its inception Jan. 2. Comments on the group’s page say state employees have been told not to speak to the press about any of the health care changes.

But they are speaking to Gov. Nathan Deal, whose office has received around 1,100 calls and emails about the issue.

They’ve got the wrong guy, Deal spokeswoman Sasha Dlugolenski said.

“Much of what is driving the complaints has nothing to do with switching providers,” she said. “That’s being ginned up by the insurance companies. Most of this is driven by Obamacare mandates. It was coming regardless.”

Under the former plan, employees had the option between an HMO or HRA; now, there’s only an HRA, or health reimbursement arrangement, option.

“There (are) three tiers that teachers or (state) employees could choose from: bronze, silver, gold,” Brown explained. As might be expected, bronze is the most inexpensive level, gold the costliest.

“You have higher deductibles and more out-of-pocket expenses (with the bronze plan),” he said. “It’s kind of like buying insurance on your car or your house. You know if you want your insurance rates to go down, you raise your deductible and then you hope you don’t have an accident or something.”

With an HMO, there’s a primary health provider and a fixed payment, often called a co-pay.

“Whereas in an HRA, you go and there’s a certain amount of money put into an account based on the plan you have,” Brown explained. “So you go to a physician and it’s charged and it comes out of that account. First, nothing’s out of pocket. Once you run out, then it kicks into a different bracket. So, if you have a lot of medical issues, then ... yeah, it could cost you more out of your pockets, and that’s why people love the HMO (option).”
But one change that has caused concern is the individual’s deductible must be reached before that funding kicks in, so medical bills can be more expensive over a person’s previous co-pay under the HMO option.

The two main complaints are that the plan is more expensive and there aren’t as many in-network physician options.

Gainesville City School Superintendent Merrianne Dyer said she hasn’t heard many complaints but does know some employees were unable to get the same level of insurance.

“I have heard people complain about the prescription coverage changes,” she said. “The new plans only pay for generic drugs.”

She also knows of people who have had to change doctors.

“That’s probably more of the complaint that we get about anything,” Brown said. “‘Yes, we’re paying more, (but) why didn’t they give us a choice?’ And the answer is, ‘I can’t tell you, I didn’t negotiate the contract.’”

“We welcome the calls of all Georgians, but the White House is where people need to call if they don’t like what’s happening to their family’s insurance plan,” Dlugolenski said. “The governor isn’t happy about it, either.”

The governor does appoint the nine-person board that governs the Department of Community Health, which included Longstreet Clinic CEO Mimi Collins when the change was made. She pointed out the three tiers have the option for people to select a doctor out of their network, though the deductible would be higher.

“I have heard people say that, and I do think that comes from folks perhaps not understanding,” Collins said. “I don’t understand where that comes from. The United HealthCare and, at least in this region, the Blue Cross Blue Shield plan are very similar in their provider makeup.”

She also said the change in providers is a routine process any business providing employee health care would go through.

“From my perspective as a provider ... the state goes through this process periodically in rebidding the vendor that provides the network, the insurance plan and the benefit plan design,” Collins said. “This is not the first time Blue Cross Blue Shield has provided benefit plan design for the state. ... This is a process the state goes through, just like any other employer about who is going to provide our insurance product and cover our employees.”

In hopes to reverse the changes, the teacher Facebook group is planning a rally at the Capitol at noon Feb. 18.
The change seems to boil down to the bottom line.

“I will tell you this,” Brown said. “I’d be willing to say it came down to money, because if the state says they’re saving ... that money’s got to come from somewhere, and that money is coming from higher premiums and more out-of-pocket (costs).”

The Department of Community Health’s public relations manager, Pamela Keene, confirmed an estimated $200 million will be saved by the state this year through “administrative simplifications” by switching plans.

Keene said the insurance was selected through a “competitive bid process” with the Request for Approach posted last February on the Department of Community Health’s website. The contract with Blue Cross and Blue Shield runs through Dec. 31. There are four renewal options written within the contract, as well.

“I do think that there’s just tons and tons of confusion out there (over the health care),” Collins said. “So many things are changing for all of us, and it’s so easy to get confused.”


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