ATLANTA -- In 15 days, Ashley Cline has suddenly acquired nearly 9,000 new friends because of one thing they have in common.
While none of these new Facebook friends is likely to invite her to lunch or even send her a Christmas card, they do appreciate her for bringing them all together. She founded Teachers Rally Against Georgia Insurance Charges, or TRAGIC, as a protest against the State Health Benefit Plan insurance options that took effect Jan. 1.
Cline, the wife of a Cherokee County teacher, probably won’t be getting lunch invitations or Christmas cards from Gov. Nathan Deal now 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.
The HMO plan was popular, with two of every five people covered by the State Health Benefit Plan were enrolled in the HMO. Its premiums have been climbing, and Cline only paid $147 per month for it in 2007.
By 2011, the HMO as well as the HRA and a high-deductible health plan, together were headed toward an $800 million deficit.
That prompted a quest for alternatives by the board of gubernatorial appointees overseeing the Department of Community Health that runs the program.
When the board voted last August to eliminate the HMO option, it did because state employees and teachers were crying out for relief from soaring premiums at a time when their pay was frozen, according to Lisa Marie Shekell, the department’s communications director.
“One of the things that we had continuously heard from our members -- particularly as they had furloughs and no pay raises -- and the board was figuring, how can we respond to people asking how can you contain my premium level or maintain it,” she said.
So the board set up three deductible levels, gold, silver and bronze. The gold, like what Cline enrolled in, has the lowest deductible but the highest premiums. The bronze has a $2,500 deductible and the lowest premiums. In the middle is the silver with a $2,000 deductible that was designed to keep the premiums the same as most people paid for the HMO.
The bronze with the lowest premiums was the most popular.
Prescription drugs don’t count toward the deductible, but after it is met, the insurance pays from 75-85 percent of costs with the patient paying the balance until the out-of-pocket maximum is reached. A family in the gold plan can pay as much as $8,000 each year before the insurance starts to cover 100 percent. In the bronze plan, it’s $12,000 or twice that for using doctors or hospitals outside of the Blue Cross/Blue Shield provider network.
The idea of co-insurance is that when patients are paying part of the expense, they will use less expensive treatment and avoid needless office visits.
For Melissa McCoy, a 34-year-old English teacher who’s suffered from malignant hypertension since her teens, the annual cost of just one of the many drugs she has to take would satisfy her yearly maximum out-of-pocket expense.
“I understand the concept of coinsurance. But what I do not understand is how a teacher in the state of Georgia is supposed to have $1,100 to spend on a stress test/echocardiogram in February,” she wrote to the editors of the Savannah Morning News.
Lawmakers who began the 2014 legislative session last week, have already heard from plenty of teachers and state workers.
“It will be a topic of discussion, I’m sure,” said Rep. Pat Gardner, D-Atlanta. “Will there be changes during this legislative session? I would be surprised. But there are opportunities.”
Sen. Chuck Hufstetler, R-Rome, predicts a Senate bill will seek to require an HMO option in the future when the DCH board renews its contract for Blue Cross to administer the plan. But the physician’s assistant isn’t laying the entire fault on the board.
“I certainly don’t want to blame all this on Washington, but some of the federal policies are causing increases,” he said. “When you try to cover everything, the insurance companies’ costs go up, and we’ve seen that nationwide --deductibles increasing, trying to make people have more responsibility instead of just going (to the doctor) for every little thing.”
House Speaker David Ralston told reporters the legislature may probe the matter.
“I think some of the concern may be subsiding. There’s still some out there,” said Ralston, R-Blue Ridge. “I think that ultimately we, as a General Assembly, may have to take a look at that.”
As for the governor, he was quoted in the Atlanta Journal-Constitution pointing the finger at the insurance administrator that lost the business to Blue Cross, United Healthcare which is suing the state over it.
“I think that’s the genesis of it, and in some cases people have been given false information,” Deal said.
His communications director, Brian Robinson, points toward the Obama administration for the coverage requirements of the Affordable Care Act.
“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.
At DCH, Shekell said the meetings, flyers and websites given to employees during last year’s open-enrollment period didn’t get through to some people.
“The silver lining of what’s come out is more people are contacting us, asking questions,” she said, allowing the department to suggest ways to economize on prescriptions or lifestyle changes.
She’s looking ahead, too.
“Certainly, we’re receiving feedback from members -- just as we always have,” she said. “We’re looking at what we’ll be doing in 2015.”
And for Ashely Cline, she can’t understand why no one saw this coming.
“If a regular person can make a Facebook page and have it explode with all of these responses of people who said they’re not going to be able to go to the doctor ... DCH should have anticipated some of this.”