ATLANTA — Private-sector employees affected by the federal health care overhaul won’t be the only ones seeing changes in their insurance Jan. 1. The half-million state workers, retirees, teachers and school workers will also see their coverage revised.
State officials boast that premiums are being held in place, but some
critics complain that they’ll still be paying more out of pocket because of limits on coverage.
“The main message that we want to convey – and we’re trying to convey – is for most members the premiums will stay the same or go down,” said Pam Keene, a spokeswoman for the Department of Community Health, which oversees the State Health Benefit Plan.
One key way to hold premiums down, she said Monday, was the department’s decision to contract with just one administrator for employees outside of metro Atlanta.
Traditionally, employees had a choice between two insurers. Though they both offered the same plans, each had its own network of doctors and hospitals.
The department still plans to have two insurance companies administering claims in the Atlanta area.
Rep. Ben Harbin, R-Evans,
said he’s gotten calls from teachers and state workers complaining about the lack of choice.
“People are going to have to change doctors, possibly hospitals, because people don’t have a choice, and it’s a decision made by some bureaucrat in Atlanta instead of families around the kitchen table,” he said.
The company administering the plan next year, Blue Cross Blue Shield of Georgia, says it has agreements with all but one hospital in the state and one of the largest physician networks.
“Pretty much anyone should be able to stay with their current providers,” company spokesman Bert Kelly said.
The number of administrators is less of a concern to the Georgia State Retirees Association than the reduced coverage, said its treasurer, BJ Bennett.
“I take real issue with the statement that the premiums are not going to go up for employees,” she said.
Comparing the current plans to next year’s alterations to reflect federal health-reform requirements is complicated, Bennett admits. But her analysis shows that since 2011, the maximum out-of-pocket expense for deductibles and coinsurance has doubled in some cases. And what employees and retirees pay for prescription medicines no longer count toward their maximum.
Bennett sees only one solution, convincing elected officials to pitch in more taxpayer money to subsidize the employee premiums rather than using it for education, jobs, tax breaks or other policy options.
“The governor and the legislature would have to have some heat on them,” she said. “As long as there’s not a lot of heat, they’re going to put the money where they want to put it.”