THE TWISTS AND TURNS IN THE STATE’S HEALTH COVERAGE
- July 24, 2013: The Department of Community Health releases a "notice of intent to award" the administrative/management contract for Georgia's state employee health care program to Blue Cross and Blue Shield. UnitedHealthcare accuses the state of secretly bidding out the contract to administer health care for about 650,000 teachers, state employees, retirees and their family members.
- Aug. 21, 2013: A Superior Court judge rejects UnitedHealthcare's bid to stop rival Blue Cross and Blue Shield from taking over the contract currently held by UnitedHealthcare.
- Sept. 22, 2013: A 60-second "Freedom Means" commercial runs during the Atlanta Falcons game. The ad says that state workers, teachers and retirees are being stripped of their choice of health care plans and that citizens should rise up and condemn this threat to liberty. The spot, bought by a group whose backers include UnitedHealthcare, does not mention UnitedHealthcare. It says the spot was "paid for by Taxpayers for Healthcare Choice Inc." and refers viewers to a website called myhealthcarechoice.org.
- Nov. 7, 2013: DCH Commissioner Clyde Reese upholds his agency's decision to award the contract to Blue Cross and Blue Shield. The company has already started enrolling teachers, employees and retirees for the upcoming year. UnitedHealthcare officials have filed suit and will now fight the award in court.
- Jan. 1, 2014: Blue Cross and Blue Shield takes over the health plan.
- Jan. 12, 2014: Teachers Rally Against Georgia Insurance Changes, or TRAGIC, starts a Facebook page to organize opponents of the change.
- Jan. 25, 2014: Gov. Nathan Deal signals he will support changes to the health plan. The DCH will call on the health board to add HMO-managed care features to the plan and reinstate co-payments many teachers and employees preferred, cutting out some big out-of-pocket costs. Participants in the plan have complained about higher out-of-pocket costs and fewer health care options since Blue Cross and Blue Shield of Georgia took over the plan.
- Jan. 27, 2014: The DCH board agrees to spend about $114 million to restore co-pays in its new health care plans for state workers.
- April 15, 2014: The state announces another round of major changes to the health care plan, a little more than a month before the May 20 primaries that a group of teachers, state workers and retirees promises to influence. The DCH says it will increase the number of companies managing the $3 billion State Health Benefit Plan and offer more options, including HMOs, starting next year.
- July 1, 2014: The state announces that UnitedHealthCare and Kaiser Permanente will also offer health insurance to state employees next year.
- Aug. 14, 2014: Department of Community Health board approves new plans and rates for 2015, increasing offerings with minimal change in premiums for many.
To follow more news about state government and politics in Georgia, go to www.myajc.com/s/news/georgia-government/.
Teachers, state workers and retirees got their payoff Thursday for months of election-year protesting.
The state Department of Community Health’s board approved a health insurance plan for the upcoming year that offers far more coverage options with no big sticker shock for many.
For some of the 650,000 teachers, retirees, state employees and their dependents on the State Health Benefit Plan, premiums will remain the same or even go down next year, DCH officials said Thursday.
The DCH board made major changes in the plan for the second time in a year after months of protests by teachers and retirees angry about the lack of health care choices and money they were having to pay out for services. The decision comes less than three months before a general election in which the focus of much of the protesters’ anger — Gov. Nathan Deal — is up for a vote.
DCH officials said health insurance premiums for some of those in the $3 billion State Health Benefit Plan would go up, and some would go down, based on the coverage and provider they choose. Some will pay the same.
Earlier this year, DCH officials said they had to limit the providers and coverage, and increase out-of-pocket costs to save money. A switch to Blue Cross and Blue Shield of Georgia was expected to save the state about $200 million a year, but DCH Commissioner Clyde Reese said his agency did not see the savings it expected.
The plan has been a political thorn in Deal’s side since last summer, when the contract to manage the program for 2014 was awarded to Blue Cross. That prompted one of the companies that had been managing the plan, UnitedHealthcare, to sue the state, accusing the DCH of resorting to “state-sponsored bid-rigging” to steer the contract to Blue Cross.
To save money, the state limited the insurance offerings to three plans, with different deductibles and premiums, along with higher out-of-pocket costs.
Once those higher costs started kicking in, teachers, state employees and retirees revolted, forcing Deal and the DCH to add back co-payments for services, costing more than $100 million. The extra money, however, didn’t solve all the plan’s problems, and teachers and retirees called for more choices and better coverage. A class-action lawsuit was filed in May arguing that thousands of plan members had been overcharged on their premiums.
Deal and the DCH announced last month that plan members would see new offerings from three companies: Blue Cross, UnitedHealthcare and Kaiser Permanente.
“I am very happy we put choice back in the plan for members,” DCH board member Jamie Pennington of Sandy Springs said Thursday.
John Palmer, a Cobb County middle school band director and member of the protest group Teachers Rally to Advocate for Georgia Insurance Choices, or TRAGIC, said he is supportive of new coverage options but is concerned about deductibles in some plans that are “higher than a Department of Corrections officer’s salary for a year.”
Palmer said there are still some questions about the impact of the changes the DCH made, but he added, “In terms of what they presented, it looks great today.”
Reese said any increase in state spending required by the changes would be made up with reserve funding. “Any financial cost impact as a result of these changes will not be borne by employees,” he said.
While there was plenty of praise to go around Thursday, the DCH’s decisions will continue the rivalry between Blue Cross and UnitedHealthcare over the business.
Morgan Kendrick, the president of Blue Cross and Blue Shield of Georgia, said his company expected the DCH’s changes. “It’s more of a business-as-usual perspective,” he said. “It looks like we’ll have a competitive situation.”
UnitedHealthcare officials said the DCH put the company at a competitive disadvantage because under the plan approved Thursday, members would have to pay 30 percent more for its HMO than the one offered by Blue Cross. UnitedHealthcare’s HMO would cost a family about $1,700 more a year than Blue Cross’.
“In most cases, where UnitedHeathcare is offered alongside other vendors, the UHC rates offered are much more competitive,” said Tracey Lempner, a company representative. The rates for the State Health Benefit Plan that were released Thursday “make it much harder for members to have an affordable choice,” Lempner said.
DCH spokeswoman Lisa Marie Shekell said one reason HMOs might have different premiums is because companies pay providers — such as doctors — different rates. Paying doctors less, for instance, could mean a company has lower costs and, hypothetically, it can charge lower premiums.
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