Currently, in Georgia, a fight is going on between a group of teachers, state employees, and public education workers and the state’s Department of Community Health and the Office of Governor Nathan Deal. The reason: recent changes made to the State Health Benefit Plan’s (SHBP) insurance policy and the new and only provider, Blue Cross Blue Shield of Georgia. Insurance costs have gone up, concerns over the out-of-pocket expenses that must be paid by the plan’s members, and the seemingly “cold” response from those in charge has lead to the mobilization of the Facebook group: Teachers Rallying Against Georgia Insurance Changes or T.R.A.G.I.C.
The concerns of members of T.R.A.G.I.C and others tend to focus on the overall costs of the plans. Co-pays have been done away with. Before the plan covers care, members and their dependents must meet their deductible so a doctor’s visit can now run around $150 instead of a co-pay of $25-40.
The Athens Banner-Herald ran a story, “Teachers, state workers upset about health plan changes”, that spoke to the founder of T.R.A.G.I.C., Ashley Cline. An excerpt is quoted below:
Cline, the wife of a Cherokee County teacher, probably won’t be getting lunch invitations or Christmas cards from Gov. Nathan Deal either. That’s because the first request she’s made of her new friends is to flood his office with phone calls complaining about the insurance plan that covers teachers, state workers and retirees.
In an election year, that could send 650,000 votes to Deal’s opponents. That’s how many people are covered in the plan.
Her main complaint and that of her growing membership is that they no longer have the option of a health maintenance organization in favor of a type of co-insurance where the patient pays along with the insurance. In the HMO, she was able to take her 4-year-old daughter Avery to occupational therapy and only have to pay $25 per weekly visit. Now, she must pay the full $130 until she has met Avery’s yearly deductible of $1,500 before the new health reimbursement arrangement plan, or HRA, begins paying the majority of the costs.
Her monthly premiums were $420, but now they are $540. As jolting as the 29-percent premium increase was, she would have gladly accepted an even higher premium to stay in the HMO and avoid deductibles.
“Every single person I’ve talked to who had the HMO said they would have paid more,” she said.
Many people were confused by the fact that the providers changed and felt that they had been duped when this happened. In the past few years, there were a few choices between what you could have: HMO vs. PPO vs. HRA and companies like United Healthcare, Kaiser Permanente, and others. Now there is only one provider: Blue Cross Blue Shield.
I spoke to Pamela Keene, Media and Public Relations Manager for the Department of Community Health, which oversees the SHBP, via email about the concerns over the changes.
Regarding the changes in healthcare providers, Ms. Keene writes “the SHBP had reached the end of its contract cycle with its current vendors, and was required to follow an open, competitive bid process to procure new vendors. Blue Cross Blue Shield of Georgia (BCBSGA) has been awarded the contract to provide health plan administration and medical management. BCBSGA will coordinate closely with Express Scripts Inc., selected to administer pharmacy benefits, and Healthways Inc., selected to administer wellness programs and related incentives.” Ms. Keene stated that this was done using a competitive bid process
DCH has acknowledged that there have been complaints made to them about the 2014 plan, which may be expected with over 600,000 members. Ms. Keene encouraged SHBP members to contact DCH with any questions about the new plan as they wish to provide options that are customized to members while seeking to “provide financial stability for the Plan.”
Governor Nathan Deal did speak to the Atlanta Journal-Constitution about the anger from plan members and T.R.A.G.I.C. over the changes for a recent article, pointing the finger at United Healthcare for stirring things up.
In a recent article UnitedHealthcare and CVS Caremark, which lost the plan’s pharmacy business as of Jan. 1, have sued the state, hoping to persuade the courts to throw out the contracts and force the state to rebid the business.
Gov. Nathan Deal said Friday he thinks the losing bidders are ginning up criticism of the plan. “The party that lost the bid … has attempted to generate this kind of uproar,” the governor said. “I think that’s the genesis of it and in some cases people have been given false information. If there’s a problem, we will address it. But at this point in time many people aren’t aware of the details.”
Deal’s Office did speak to the Athens Banner-Herald about the reasons behind the supposed anger in the article mentioned above. Blame seemed to lie with the Affordable Care Act, not the state.
Gov. Deal’s communications director, Brian Robinson, points toward the Obama administration and the coverage requirements of the Affordable Care Act as the cause for higher insurance rates on state workers.
“A lot of this is because the mandates of ACA are taking place and impacting the State Health Benefit Plan, definitely, and the governor is as concerned about it as teachers are,” he said. “If you are upset about what’s happened to your healthcare plan, it’s not the Governor’s Office where you should call. It’s the White House.”
Robinson began his response by pointing out that it was Deal’s appointees on the DCH board, not the governor himself, making the specific policy decisions.
No matter who is to blame for the anger and concern shown by SHBP members, one thing is for sure, the changes have come and people are going to have to make some tough decisions. T.R.A.G.I.C. is planning on continuing their phone and email campaigns as well as working on a protest to show that they are concerned. Contact with Blue Cross Blue Shield of Georgia had been made, but at press, no statements were given.
Part Two of this series will look at the personal side of this issue. I spoke to two teachers about their worries, fears, opinions, and using the new plan.