The sudden action by the Department of Community Health board follows a deluge of complaints from members of the State Health Benefit Plan, which also covers other school personnel, state retirees and dependents.
The special meeting and new changes also came in the wake of Gov. Nathan Deal’s comments last week about the uproar. He said then that the 650,000 members of the health plan could see more choice of insurance providers for 2015. The plan now has only one insurer, Blue Cross and Blue Shield of Georgia, and members are complaining about a lack of choice.
The newly approved design will replace the current plan’s co-insurance — a patient paying a percentage of the costs of a health service — with a co-pay system for medical services and prescription drugs.
Community Health Commissioner Clyde Reese told board members Monday that the new tweaks are “a matter of some urgency’’ and will relieve financial stress that many members may be confronting with the benefit design that took effect Jan. 1.
The changes launched in January to more of a patient cost-sharing arrangement “were not well understood by many of our members,’’ Reese told board members in a teleconference.
Tim Callahan of the Professional Association of Georgia Educators, commenting on the changes Monday, said, “We are pleased that the concerns of educators and their families are being addressed.”
Deal, in a statement Monday, said, “We heard our state employees and teachers and we listened.”
“I appreciate the board and the commissioner’s willingness to work with me on a timely solution,” Deal said. “I shared the concerns of state employees and teachers about the high costs they were having to pay out of pocket. I believe this new direction addresses the core concerns of our employees.”
Differences over root causes
The governor also pointed to the federal Affordable Care Act as a cause of health plan cost increases.
But Tim Sweeney, health policy director of the Georgia Budget and Policy Institute, said that ACA provisions affecting the state health plan “are largely adding benefits for people.’’
He cited the law’s allowing children to stay on their parents’ health plan up till age 26; the protections against high out-of-pocket costs; and increased coverage of preventive health services with no co-pay.
The new co-pays for SHBP members will include $20 for generic drugs, $50 for most brand-name prescriptions and $80 for specialty medications.
Primary care doctor visits will have a $35 co-pay, while specialist care will be $45.
Rehab services will have a $25 co-pay; urgent care will be $35; and emergency room visits will be $150, Reese said.
The co-pays will begin March 14 but will be retroactive to the beginning of the year.
They will come at no increased cost to members, and the Blue Cross contract will not change as a result of the board action Monday.
The state said premiums, deductibles, out-of-pocket amounts and HRA contributions will not be affected. SHBP members do not need to take any action to receive these new benefits, Community Health said.
The cost of these changes is being absorbed by the SHBP reserves, and will not be passed on to members, officials said. The total estimated claims cost to SHBP for the new changes is about $116 million for 12 months.
Key group will wait and see
A leader of an organization of state employees and teachers critical of their health plan choices said Monday that the group is reserving judgment about the newly announced changes.
“It is encouraging to see the governor and the Department of Community Health address some of the shortcomings of the 2014 State Health Benefit Plan,” said Ashley Cline, founder of the group called Teachers Rally Against Georgia Insurance Changes, or TRAGIC.
“It does not address all of the shortcomings in the current plan, and we will have to examine the plan closely to see how it affects our members; however, we feel it is a step in the right direction,’’ Cline said in a statement Monday.
“Hopefully, by shifting to co-pays for office and ER visits, state employees will not have to worry about going bankrupt if they become seriously ill or have an accident.”
Cline said last week that she welcomed Gov. Deal’s suggestion that state employees’ options for insurance may increase next year.
A day after the benefit plan officially changed on New Year’s Day, Cline, the wife of a Cherokee County teacher, started a Facebook page to air complaints. That Facebook group now has more than 11,000 members, she said.
Members of the plan have voiced their complaints to the governor’s office, to Community Health and to their state legislators.
Cline added Monday, “We will certainly be watching to see what happens in the future with our insurance options. We feel the lack of communication from the Department of Community Health about issues facing the State Health Benefit Plan has been problematic, and the finger pointing and misinformation has been unacceptable.
“We hope the governor and the members of the DCH Board are serious about addressing this crisis and will work with us to ensure that Georgia’s state employees and retirees have access to high-quality medical coverage options that will not leave us broke.”
Deal told reporters Monday that he believes the SHBP reserves that will be left after the changes will be adequate to handle any unexpected circumstances.
When asked whether he should take the blame politically for the SHBP uproar, Deal said, “I don’t think there should be any political blame at all. We are trying to do what is best for the citizens of our state and the taxpayers as well as those who work for our state, be they teachers or employees.”