Teachers and retirees are hoping to persuade lawmakers in this final week of the 2014 session to give them some say about the health coverage the state provides for them.
The Department of Community Health made substantial changes in the $3 billion State Health Benefits Plan this year, reducing the number of insurance companies providing coverage and dramatically increasing out-of-pocket costs for the plan’s 650,000 members. The plan covers teachers, state workers, retirees and their dependents, many of whom are now loudly protesting the changes.
The protests have already pressured Gov. Nathan Deal, who faces re-election this year, to recommend more money for the plan to eliminate some of the high out-of-pocket costs. The General Assembly has agreed to provide the extra money, and also called on DCH to offer more options in providers next year.
Fresh from those hard-fought victories, associations supporting teachers and retirees are hoping for passage this week of legislation that would put two plan members on the DCH board, which oversees state health plans. They also want the state to set up a council that would advise DCH leaders on the State Health Benefits Plan.
The activists say these fixes would help people like Cherokee County schools retiree Lula Hayes, 70, who depend on the state health plan.
Hayes’ lungs work at about one-third of capacity because of chronic obstructive pulmonary disease, and she uses oxygen and medications to help her breathe more easily. Since the start of the year, she said, her oxygen tank deliveries have been cut back, and some of her drug costs have jumped 300 percent.
Hayes said she’s afraid of running out oxygen when she’s away from home.
“This thing is a mess,” Hayes, who worked as an employee benefits manager, said.
Adding plan members to the board and creating the advisory council would help to clean up part of that mess, advocates say.
“It would increase transparency and provide for better understanding,” said Chuck Freedman, a retired state budget officer who has worked on the issue for Georgia State Retirees Association. “The department has been working behind closed doors. We’re looking to open up the process and improve communications.”
Deal’s office declined to comment on any pending legislation, but throughout the process, lawmakers have recognized they have to run for re-election this year and can’t afford to make a large group of politically active voters angry.
Legislators say it’s not just about the elections. They say most teachers and state employees are doing important work at moderate pay, and they shouldn’t have to worry about health coverage bankrupting them.
“Some things we do here are politics,” said Rep. Winfred Dukes, D-Albany. “But this is personal.”
Besides costing more, the plan has forced members to search for doctors because their longtime physicians aren’t in their new networks, the members say. They also complain that they’ve had to search for affordable prescription drugs and that they’ve had a harder time getting treatment and medicine approved.
State officials say the health benefits plan has faced financial problems in recent years in part because during the Great Recession, Gov. Sonny Perdue and lawmakers essentially used plan reserves to fill holes in the state budget. So state officials have raised premiums and sought ways to save money to rebuild reserves. The changes this year were supposed to save the state $200 million a year.
The Atlanta Journal-Constitution reported last summer that lawyers for one of the former plan providers, UnitedHealthcare, accused DCH of “state-sponsored bid-rigging” in its decision to go with a single company to manage the program. They warned that it was all part of a plan to cut state costs, and the company went to court to fight DCH’s decision.
However, thousands of plan members didn’t understand what the changes meant until they started seeing their out-of-pocket costs skyrocket when they went to the doctor or sought other treatment. A group called TRAGIC quickly formed to start putting pressure on Deal and legislators.
By late January, Deal and DCH agreed to eliminate some of the out-of-pocket costs. That move, which was to take effect last week, is expected to cost the state about $100 million a year.
But plan members said the changes fall short of what they need, and they have continued to push for more choices in health plans and more say in what those plans will cover.
Robby Richardson, a high school special education teacher in Savannah, started blacking out in class and had to be hospitalized and shocked to get his heart rate back to normal when it spiked.
Richardson hadn’t been feeling well, but he’d been putting off going to the doctor in part because he worried about the cost under the new plan. It turned out he had a bacterial infection and he had to stay in the hospital for several days. He called the changes Deal and DCH have made so far a “Bandaid on a hemorrhaging wound.”
DCH Commissioner Clyde Reese, who took over the agency after the new plan had been designed, acknowledged some of the changes weren’t well explained. He called the move toward expecting teachers, retirees and employees to pay greater up-front costs for their health care “a very significant culture change.”
While the General Assembly wants DCH to look at having alternative providers and plans, Deal said he is leaving any further changes up to the agency. Reese isn’t making any promises, but he said during a Legislative Black Caucus forum earlier this month that “everything is on the table, and we are looking to learn from this experience.”
Plan members’ hopes of winning legislation to give them more say in the process may hinge on their ability to amend House Bill 511, another State Health Benefits Plan measure.
The amended bill would have to get through both chambers in the final two days of the session, not an impossibility in a Capitol known for last-minute deals. But DCH board members are appointed by Deal, and governors typically don’t appreciate lawmakers — or groups like teachers and retired employees — telling them who they can appoint. If the bill passes, Deal will get the final say.