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Georgia retirees, teachers and state workers complain about insurance changes

Sunday, Jan. 19, 2014 1:04 PM
Last updated 8:37 PM
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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.”

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dichotomy
37529
Points
dichotomy 01/19/14 - 02:10 pm
10
6
Premiums up....copays

Premiums up....copays up.....deductibles up........it's Obamacare time. It isn't Deals fault.....it isn't the state's fault.......call your El Presidente. All you liberal teachers probably voted for the man and supported health care reform. Well somebody has to pay for it....and TAG....YOU'RE IT.

Graymare
3802
Points
Graymare 01/19/14 - 08:09 pm
7
1
Yup, I've got the silver plan

Yup, I've got the silver plan as a retiree. And, no I don't have a huge pension. I was an office worker. HRA's stink. A cardiogram was recommended for me. The hospital said, "That'll be $1800". So, no test for me. The name of the game is you are insured but you can't afford to use it. The governor won't do a dang thing. The plans mirror Obcare. Be careful what y'all ask for! It's gonna bite us all in the butt!

Truth Matters
8084
Points
Truth Matters 01/19/14 - 02:57 pm
3
9
So why were premiums

So why were premiums increasing annually before Obama was elected?
Bush-care?? Clinton-care?? Reagan-care??
And what about this insurance commissioner who is only concerned with obstructing? He said so. My hunch is he approved the rates and without any concern for the teachers who are now seeking relief.

corgimom
38500
Points
corgimom 01/19/14 - 03:00 pm
4
12
Welcome to the real world,

Welcome to the real world, where the rest of us already had this happen a few years ago. And it had nothing to do with Obamacare.

And good luck to those people that call, if they want to waste their time, that's fine, but it's never going to go back to the way it was.

teaparty
11313
Points
teaparty 01/19/14 - 03:34 pm
12
3
'And it had nothing to do
Unpublished

'And it had nothing to do with Obamacare.'
corgi, you can stick your head in the sand but it does not change the facts NO MATTER HOW MUCH YOU WANT TOO.

vegasbaby
178
Points
vegasbaby 01/19/14 - 04:16 pm
5
1
Insurance companies and the affordable care plan both

have responsibility for the higher premium, higher deductible, higher co-pay, less for your money, lack of plan choice situation workers with recently stagnant wages are in. I have insurance but am scared if a health care emergency arises that I will not be able to cover the cost, and have co pays that will limit how often I will choose to tap into the system for problems and health maintenance. This is not the mentality that GOOD insurance should bring. Good insurance should help you access the system easily and affordable to encourage you to maintain your health, not wait till there is no choice but to spend more than you have just to survive.

corgimom
38500
Points
corgimom 01/19/14 - 04:35 pm
3
13
teaparty, well, since

teaparty, well, since people's insurance started changing well before Obamacare was signed into law, I'd say that it has nothing to do with Obamacare.

You, of course, are free to reach your own conclusion.

corgimom
38500
Points
corgimom 01/19/14 - 04:43 pm
5
8
Vegasbaby- And there lies the

Vegasbaby- And there lies the problem with American health insurance.

Homeowners insurance, car insurance, and liability insurance is all based on the idea that it is for catastrophic purposes only, and that small routine items would be covered by the policy holder.

People have now come to expect what you are saying- that health insurance should help them pay with all of their health care costs, including preventative care.

That's not health INSURANCE, that's assistance with medical expenditures. That's subsidized medicine. There's a difference. And subsidized medicine for all is unsustainable, and now things are going to go back to the way they used to be, when health insurance first was made available.

So now people have to budget for health care. It's doable, but it just means less vacations, drive your car for longer, stop charging on your charge cards for things you don't need. Cut out the luxury items, cut out the booze and cigarettes.

People think they can't afford a $2500 deductible- but those same people think nothing of spending that amount of money on a vacation.

That's human nature, there's always money for fun stuff, but paying for necessities hurts, doesn't it?

teaparty
11313
Points
teaparty 01/19/14 - 04:59 pm
7
2
" That's not health
Unpublished

" That's not health INSURANCE, that's assistance with medical expenditures. That's subsidized medicine."
corgi, I agree with that statement 100%. The 3rd party payer system is one of the big problems with healthcare. It removed individual responsibility. Obamacare has made things MUCH WORSE. But the real objective is as Obama said a single payer system run by the gov't.

Darby
29318
Points
Darby 01/19/14 - 05:00 pm
4
2
"In an election year, that could send

650,000 votes to Deal’s opponents."

.
Yeah, like ANY of those people were going to vote for a Republican to begin with.

Darby
29318
Points
Darby 01/19/14 - 05:05 pm
4
2
And YES, cost were going up before OzBamaCare,

but that was due to inflation and the laws forcing emergency rooms to accept anyone without payment.

Now, due to the "If you like it you can keep it." guru, it's going up exponentially with no end in sight.

dahreese
4907
Points
dahreese 01/19/14 - 05:27 pm
3
8
Some of you need to smart'in
Unpublished

Some of you need to smart'in up.

These new insurances rules are written as much for, and by, the insurance corporations for their own increased profits.

Think of thousands of Americans not insured vs all Americans insured and the difference in profits.

You're a fool if you think the Congress itself said, "We represent all the American people and we think it would be 'wonderful' if they all had health insurance to meet all of their health needs - especially the baby-boomers who've lived most of their lives without health insurance.

Look just how much money we have already lost because they were not insured.

The only argument Congress has put up against the insurance companies is who is covered, and who is not; 'pre existing conditions' and 'pregnancies.'

The insurance companies are laughing their behinds off at you folks trying to lay blame on Obama.

InChristLove
22485
Points
InChristLove 01/19/14 - 05:31 pm
5
3
"People think they can't

"People think they can't afford a $2500 deductible- but those same people think nothing of spending that amount of money on a vacation. "

I'd like to see who all blows $2500 on a vacation each year. The most I can remember spending on a vacation was when my husband and I took a cruise for our 25th anniversary and then I don't believe it came to $2500.

InChristLove
22485
Points
InChristLove 01/19/14 - 05:36 pm
4
3
Well the way I see it, the

Well the way I see it, the insurance companies wouldn't be laughing their behinds off if Obama hadn't signed it into law now would they. So insurance companies can jump on the band wagon but the driver or this carriage is the President himself.

rmwhitley
5547
Points
rmwhitley 01/19/14 - 06:17 pm
0
0
Politicians!
Unpublished

Ain't worth killing.

teaparty
11313
Points
teaparty 01/19/14 - 06:17 pm
3
1
' So insurance companies can
Unpublished

' So insurance companies can jump on the band wagon but the driver or this carriage is the President himself.'
I disagree this is more like a train as in a train wreck.

teaparty
11313
Points
teaparty 01/19/14 - 06:21 pm
4
3
"The insurance companies are
Unpublished

"The insurance companies are laughing their behinds off at you folks trying to lay blame on Obama."
dahreese, yeah we know nothing is the fault of the community organizer after all he is black so it can't be his fault.

dahreese
4907
Points
dahreese 01/19/14 - 06:28 pm
3
8
You folks can't see anything
Unpublished

You folks can't see anything unless you can blame Obama, or the Democrats, or the liberals, can you?

Even when whistle blowers like Wendell Potter tell it like it is, you're so obsessed you don't want to/refuse to hear it.

Y'all are well trained to be group members (conservatives) - and you don't know that, either.

dahreese
4907
Points
dahreese 01/19/14 - 06:31 pm
5
8
@Teaparty; "dahreese, yeah we
Unpublished

@Teaparty; "dahreese, yeah we know nothing is the fault of the community organizer after all he is black so it can't be his fault."

You like to sneak in a little racism and think we don't notice, don't you.

teaparty
11313
Points
teaparty 01/19/14 - 06:44 pm
6
3
dahreese, Blacks have been
Unpublished

dahreese,
Blacks have been brainwashed by the liberals, democrats and black leaders. They take the small handouts and keep supporting the democrats. The liberals seem to think blacks are not very smart because they need special privileges or they cannot complete. But it is really about control and the democrats are controlling black folks well. LBJ said, “I’ll have those N-word voting Democratic for the next 200 years.” and I guess he was correct.

teaparty
11313
Points
teaparty 01/19/14 - 06:47 pm
5
3
"You like to sneak in a
Unpublished

"You like to sneak in a little racism and think we don't notice, don't you."
dahreese, just responding to your racist remarks.

dahreese
4907
Points
dahreese 01/19/14 - 07:14 pm
3
7
"Blacks have been brainwashed
Unpublished

"Blacks have been brainwashed by the liberals, democrats and black leaders. They take the small handouts and keep supporting the democrats. The liberals seem to think blacks are not very smart because they need special privileges or they cannot complete. But it is really about control and the democrats are controlling black folks well. LBJ said, “I’ll have those N-word voting Democratic for the next 200 years.” and I guess he was correct."

Seems some of those black have more depth than you do.

itsanotherday1
48344
Points
itsanotherday1 01/19/14 - 07:29 pm
4
1
Corgi @ 4:43

Good observation. Healthcare is not a "right"; it is a part of life that has a cost, just like housing, food, etc.

teaparty
11313
Points
teaparty 01/19/14 - 07:32 pm
5
3
dahreese, it is very sad but
Unpublished

dahreese, it is very sad but very true and will not change until blacks wakeup.

itsanotherday1
48344
Points
itsanotherday1 01/19/14 - 07:33 pm
8
2
ICL

I don't know about vacations, but I see $2500 worth of tires/rims, thumpers, etc. all the time. Some of these same folk show up at the ER for you and me to pay for their care.

teaparty
11313
Points
teaparty 01/19/14 - 08:20 pm
6
1
"I don't know about
Unpublished

"I don't know about vacations, but I see $2500 worth of tires/rims, thumpers, etc. all the time. Some of these same folk show up at the ER for you and me to pay for their care."
Yeah and a lot of those folks show up at Wal-Mart with food stamps. Ride though a section 8 housing project and you will see A LOT OF THE $2500 WORTH OF TIRES/RIMS.

dahreese
4907
Points
dahreese 01/19/14 - 09:05 pm
2
4
We're
Unpublished

We're done.
---------------------------------------

And I'm not the one who gave you the thumbs down, either.

corgimom
38500
Points
corgimom 01/19/14 - 10:28 pm
2
5
People spend $2500 on

People spend $2500 on vacations all the time.

It's not hard to do, especially if a family is involved.

Just because some people don't, or won't spend money on a vacation, doesn't mean that others don't do it.

Take a look at Disney World. That's outrageously expensive, but it's always packed with people.

Or look at the people that eat out. The restaurants are packed, every weekend. $50 a week- and for a couple at a moderately-priced restaurant, that's not extravagant- and there's $2500 right there.

WMartin
119
Points
WMartin 01/20/14 - 12:24 am
2
3
Can we get a thank you?

A lot of people have tough and/or important jobs including teachers. A lot of those folks are responsible for paying their own health insurance premiums. Teachers' insurance premiums are subsidized by tax payers. For once, could those of us who pay out of our nose for our own health insurance AND subsidize teachers' health insurance PLEASE GET A BIG FAT THANK YOU???

myfather15
56910
Points
myfather15 01/20/14 - 06:35 am
7
2
Don't you just LOVE the smug, know it all attitudes;

Some people on here just think they've got ALL the right answers and their way is always the best!!

No matter how much you get screwed, or how much worse it gets, don't worry about it, just listen to them!!!

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