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* Some bad news for Health Alliance, which believed it had a majority on COGFA to block the governor’s health insurance move…
A legislative oversight panel does not have the authority to block individual health insurance contracts for state employees, Attorney General Lisa Madigan’s office determined.
The decision appears to make it more difficult for lawmakers who want to reverse state government’s controversial decision to drop two popular health maintenance organizations offered to state employees and replace them with new health plans.
The General Assembly’s bipartisan Commission on Government Forecasting and Accountability sought the opinion because it was unclear if the commission could simply vote to reject the new health contracts negotiated by the Department of Healthcare and Family Services.
Madigan said COGFA can review the health plans, but state law “does not authorize the commission to approve or disapprove individual health benefit provider or administrator contracts.”
* All hope of blocking this proposal is not lost, however…
An opinion issued by Attorney General Lisa Madigan notes [COGFA] cannot nix individual contracts, but it could attempt to block the implementation by looking at the state’s overall system of insuring workers.
The AG’s opinion is here.
* The Peoria Journal Star editorialized this week in favor of slowing down the process…
This situation has been very poorly handled. Five weeks after the announcement, more information should be available. While it’s unrealistic for state employees to believe their health benefits and costs should remain the same when no one else’s are, they need and deserve the chance to make an informed decision - with full details on how much they’re being asked to pony up, plan options, physician choices, etc., as well as more time to make a call that may impact them and their families in critical ways. With the added context of what’s occurring in Springfield between possible pension changes and budget cuts that may impact their very job security, many can be forgiven for feeling overwhelmed. A delay in implementation here is warranted until the state can get its act together.
Ultimately, what’s the harm in delaying a few months - temporarily extending the existing contract, perhaps - in order to hash this out and publicly justify the monetary and service benefits, if in fact they do exist, to taxpayers as well as employees? Take the time, think this through, demonstrate that this is the right move, restore some confidence in the state’s competence.
* More coverage…
Health Alliance covers nearly 100,000 state workers and retirees, who would have to change providers under the proposal. Last month, the Illinois Department of Healthcare and Family Services announced it was dropping Health Alliance from the state’s list of health care providers, with an estimated savings of $1 billion over the next 10 years.
“The administration’s numbers are a bunch of bunk, quite frankly,” said state Rep. Chapin Rose, R-Mahomet.
State Rep. Jason Barickman, R-Champaign, said the governor’s decision would cost the state more instead of saving money.
posted by Rich Miller
Friday, May 20, 11 @ 8:08 am
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“Ultimately, what’s the harm in delaying a few months - temporarily extending the existing contract, perhaps - in order to hash this out and publicly justify the monetary and service benefits, if in fact they do exist, to taxpayers as well as employees?”
This is a fairly uninformed statement. It is extremely unusual and for an insurance company to offer a month-by-month extension. Furthermore, the original agreement price was negotiated with the understanding that after one year, the rates can be adjusted. Employees might also be ill-served since they may have to pay two deductibles in one calendar year.
I make no judgement about whether a new plan should be offered to the employees, but I will say that an extension serves neither the insurance company or the employee.
Comment by Cincinnatus Friday, May 20, 11 @ 8:31 am
They could at least phase in the change so new hires have to use the new plans but current employees get a year to switch. That at least lets the network get in place before being overwhelmed.
Comment by thechampaignlife Friday, May 20, 11 @ 8:32 am
thechampaignlife,
Has that ever happened in the private sector? Normally, the employer announces new prices and/or plans in November, called the “open enrollment” period which lasts a month or two. During that time, employees must select from among the plans being offered by the employer.
Comment by Cincinnatus Friday, May 20, 11 @ 8:55 am
What has this got to do with the private sector? We are NOT in the private sector! Sick of the comparisons!
Comment by Fed Up State Employee Friday, May 20, 11 @ 9:01 am
It’s not the first time extension, Cincy. Currently my HMO is calendar year deductible, so my year deductible was just paid in January to my current provider of HC.
There is not even slection or map up to select from as of it. Rather hard what I have to select from at this point. I will say that an open access plan could knock my ability to access prompt care using what unusual medical services I acquired this last FY. I’m quite happy with my current HMO, I could live with a switch to a blue cross plan…but do I get that option? No clue yet. Less than a month and a half to go and I have no idea if I will have any insurance July 1st with the ability to refill prescriptions and routine quarterly lab work. If I have to change plans I have to worry about getting a new dr. and also he/she fitting me in to continue without distruption.
Comment by Cindy Lou Friday, May 20, 11 @ 9:02 am
I believe all this has nothing to do with the performance of the current plans and nothing to do with saving the state money. What it is about is groups of doctors who are not part of the current plans trying to get to the money river. OK, that’s not even a rumor, but I bet it will be seen in time to be correct.
Comment by Excessively Rabid Friday, May 20, 11 @ 9:17 am
This is a huge deal to lots of central/southern IL workers and families. It appears that workers will face either paying a lot more to keep their current doctors or being forced to find a new one. And I heard that a rival clinic in Champaign (Kristie?) said they don’t have enough docs to fill the gap. Not good. Paying a bit more is one thing. This is really short-sighted.
Comment by Middle of the Road Friday, May 20, 11 @ 9:54 am
“Normally, the employer announces new prices and/or plans in November, called the “open enrollment” period which lasts a month or two. During that time, employees must select from among the plans being offered by the employer.”
Well, suppose the employer in question informed you in October that two of the plans available in your area, which you and many other fellow employees used, were being removed as options, but by Thanksgiving still had NOT told you exactly what options WOULD be available to you? Suppose further that you still had no idea, with less than 6 weeks to go before the change, whether or not your doctor would be in any of the new plans? Wouldn’t you be getting a little antsy?
Comment by Secret Square Friday, May 20, 11 @ 9:58 am
Madigan’s opinion was so predictable. She does whatever the governor and Dems want. She enabled Blago and let him embarrass Illinois
Comment by Soccertease Friday, May 20, 11 @ 10:00 am
That’s a cheap shot at the AG, with no back-up at all.
Comment by steve schnorf Friday, May 20, 11 @ 10:14 am
Assumption: most current Health Alliance members will switch to the highest cost Quality Care program to either (a) keep their current doctors or (b) to get access to any doctors downstate.
Unless Health Alliance was raising their charges over about $2,400 per year, this does not save the State any money. I base this on the non-Medicare numbers being published where the State wants retiree’s to start paying for their insurance. Unless those non-Medicare retiree numbers were cooked, they should be accurate because it is a group plan where everyone is *supposed* to be charged/paying the same.
You take a cost increase of $2,400 per over 100,000 current HA members, you get a *cost increase* of $240M per year … so where is this touted $103M a year of “savings” coming from?
Comment by Retired Non-Union Guy Friday, May 20, 11 @ 10:20 am
- Retired Non-Union Guy,
Do you know how much the past plan company was going to raise it’s rates? Need both pieces of the pie (yours is one) before we can say how much the state saves/loses. Averages across the US show a 10% increase in premiums for this year.
Comment by Cincinnatus Friday, May 20, 11 @ 10:29 am
According to the State Journal Register this morning, the Blue Cross Blue Shield plan is only available in 38 counties. Last time I knew, there are 102 in Illinois. So that means for employees in 63% of the counties they don’t even have the choice of going to BCBS - they will HAVE to go to the higher rate plan. And the question remains for the remaining 37% if the current doctor’s network can absorb a huge influx of patients. The common-sense option would be to simply leave Health Alliance in play, with an appropriate premium so everyone would have an HMO option no matter where they live in Illinois. But then again, when was the last time our State Government used “common sense”?
And speaking of insurance costs and therefore budget costs… since many of our retirees are eligible for Medicare, why doesn’t the state replace their full-ride insurance policies with Medicare supplements? The retirees still get all the services they’ve had but it would greatly cut the cost to the State. Again, COMMON SENSE!!!
Comment by Both Sides Now Friday, May 20, 11 @ 10:39 am
From the Champaign News-Gazette–
Health Alliance spokeswoman Jane Hayes said the state agency intends for Health Alliance and Humana HMO members to switch to self-funded Open Access Plans, in which the state would pay medical claims directly instead of paying premiums to health insurance companies that would assume the risk.
That would mean 80 percent of the state’s employee group insurance members would be switching to self-funded plans when only 45 percent of state members are in self-funded plans now, she said.
“That’s a huge, fiscal economic policy change, because that moves the risk from the insurance carriers to the state,” she said.
And, we all know how fast the state pays their bills!
Comment by Nearly Normal Friday, May 20, 11 @ 10:39 am
===Assumption: most current Health Alliance members will switch to the highest cost Quality Care program===
I doubt that, at least for those workers that live in or near bigger cities. These workers are not going to pay a huge increase in their healthcare services when other HMO options are available. I also can’t believe Springfield Clinic will sit back and watch patients walk out because HA is no longer available to state workers. HA MDs will want to be able to join another HMO because many of their patients will want that.
Comment by Joe from Joliet Friday, May 20, 11 @ 10:56 am
Both Sides Now,
The State does pay less for the Medicare eligible retirees. The State insurance, in effect, only pays for what Medicare doesn’t cover. In General, that is the doctor co-pays in some cases (some doctor’s waive the co-pay for Medicare patients) and the prescription coverage. Both of those coverages are basically the same as supplemental Medicare insurance.
Comment by Retired Non-Union Guy Friday, May 20, 11 @ 11:56 am
Joe form Joliet,
Most of us downstate don’t have an HMO option. It’s either the Quality Care (costliest) or Open Access (next costliest) plans. Either way, those cost more based on the published figures. We don’t know the *real* numbers because the State hasn’t released them and won’t until after the protests are settled. Health Alliance made doctors sign non-compete clauses … so the vast majority of downstate doctors are tied to *only* the HA HMO.
Bottom line: right now downstate employees and retirees have to choose a pig in a poke … we probably won’t get to know the details until it is too late because the State is *NOT* going to notify anybody by mail or any other method than a web site announcement.
Comment by Retired Non-Union Guy Friday, May 20, 11 @ 12:01 pm
Nearly Normal,
“self funded” is code speak for the State’s Quality Care plan … the most costliest one, the one they *supposedly* want everyone to get off of … and the one that the State takes 9 months of more to make the provider payments to.
Writing the above paragraph, I just realized the *real* agenda. The State *has* to make monthly payments to the HMOs. By cramming all of us onto Quality Care and following the normal payment pattern, the State can *skip* 9 months of health insurance payments for 100,000 employees. Just one more ploy to make the State employees help balance the budget.
Comment by Retired Non-Union Guy Friday, May 20, 11 @ 12:08 pm
Retired Non-Union Guy,
You nailed it.
Comment by Nearly Normal Friday, May 20, 11 @ 12:18 pm
First the skipped pension payments
Soon the skipped health insurance payments
Next skipped paychecks
Balancing the State budget on the back of the employees who don’t have enough votes to count … PRICELESS
Comment by Retired Non-Union Guy Friday, May 20, 11 @ 12:32 pm
From the U of I website–
Senate Hearing on State Healthcare Options - Monday, May 23 (05/20/11)
Senator Michael Frerichs is sponsoring a subject matter hearing, chaired by William Haine, on State Employees Group Health Insurance Healthcare Benefit Options on Monday, May 23 at 9 AM in Room 212 of the State Capitol.
Notice of the hearing is posted on the Illinois General Assembly Website at http://www.ilga.gov/senate/committees/hearing.asp?CommitteeID=914.
https://hr.uillinois.edu/main/ViewComm.cfm?ID=101
Comment by Nearly Normal Friday, May 20, 11 @ 12:32 pm
Retired non-union guy, actually the springfield clinic has an ownerhsip interest in health alliance. They entered into the partnership so they could avoid negotiatng fair rates and so the doctors could profit by not performing procedures thorugh kickbacks.
Your health alliance doctor is not happy just making money as your docotr, they want to make money as your insurer too.
On a side note, the larger an insurance pool the cheaper the cost. Having lots of plans and no clear number on the size of th epool makes it difficult to minimize costs. Also the opan access plans have tiers which are cheaper then health alliance, but I digress.
Our insurance can be a lot cheaper with just a couple solid plans then lots of shotgun plans. Healthalliance is owned by springfield clinic and carle clinic, so if they want the medical business they can negotiate with the insurance companies they dont own.
Comment by Ghost Friday, May 20, 11 @ 1:25 pm
FYI, according to the COGFA website, there will be a public meeting to discuss the HMO/OAP contracts (and life insurance) next Wednesday.
Comment by unknown known Friday, May 20, 11 @ 1:33 pm
Ghost: Isn’t it Carle clinic in Champaign that has an ownership interest in Health Alliance, not Spfld Clinic?
Comment by Middle of the Road Friday, May 20, 11 @ 1:40 pm
“Also the opan access plans have tiers which are cheaper then health alliance, but I digress.”
Are you talking premium or overall costs? In an OAP, Tier 1 pays like an HMO IF your doctor falls under that tier. Tier 2 pays 90% +copayments and Tier 3 pays 80% +copayments. And of course, there’s the “usual and customary” tag attached.
Comment by SgtSchultz Friday, May 20, 11 @ 1:57 pm
When one views the plans available per the FY11 map there are like 38 or 39 counties currently with a bluecross presence…while the state seems to want to keep this FY12 map ‘top secret’ for the time being, any ‘clues’ if the currently present presence is the same planned 38 counties for FY12 or will that be changing also?
Comment by Cindy Lou Friday, May 20, 11 @ 1:59 pm
As I understand it, Carle / HA bought into Spfld Clinic and Memorial Hospital.
Comment by Retired Non-Union Guy Friday, May 20, 11 @ 2:08 pm
I just called Spfld Clinic…not true. Neither Health Alliance or Carle have any ownership in it. I know that they don’t have any stake in Memorial either.
Comment by Middle of the Road Friday, May 20, 11 @ 2:35 pm
–Balancing the State budget on the back of the employees who don’t have enough votes to count … PRICELESS–
The folks on the right say you have the Dem politicians wrapped around your fingers. Could they be wrong?
Comment by wordslinger Friday, May 20, 11 @ 2:49 pm
Cindy Lou, the State cannot release a map until the health carriers are determined.
Comment by SgtSchultz Friday, May 20, 11 @ 4:10 pm