Comments on: The GIC and Health Care Reform… http://www.letstalkhealthcare.org/ma-health-reform/the-gic-and-health-care-reform/ Tue, 06 Jan 2009 21:50:34 +0000 http://wordpress.org/?v=2.5.1 By: Bob C http://www.letstalkhealthcare.org/ma-health-reform/the-gic-and-health-care-reform/#comment-142 Bob C Thu, 10 May 2007 17:06:54 +0000 http://www.letstalkhealthcare.org/?p=59#comment-142 Charlie, Two other major points that deserve mention with regard to potential savings to a municipality by joining the GIC. 1. Mandatory Medicare for retirees that are eligible for Medicare but don't participate. Far too many municipalities don't require their Medicare-eligible retirees to participate in Medicare. By carrying the full cost of these retirees, municipal governments are leaving tens of millions of federal dollars on the table, and are unnecessarily increasing the cost to both taxpayers (primarily) and employees/retirees. The requirement that state retirees enroll in Medicare if they're eligible and then choose a Medicare plan from the GIC offerings saves tens of millions of dollars each year and helps reduce the overall premium paid by both active employees and retirees because the Medicare-eligible retirees are rated separately and their premiums are largely funded by the federal government. Making Medicare participation mandatory for all cities and towns in the Commonwealth is a no-brainer, and should be done regardless of the GIC-related legislation. 2. The decisions regarding co-payments and other types of cost sharing/benefit design rests with the Commission, and are not subject to collective bargaining. Whereas the GIC can increase co-payments from $10 to $15 with the approval of the Commission, under the current statutory construct most cities and towns must negotiate even the smallest co-payment changes with each of their unions. This severely restricts the ability of cities and towns to manage the benefit design, thereby driving up monthly premiums. Boston, from what I understand, is still fighting with some of its unions over a $5 increase in co-payments that occurred years ago. Charlie,

Two other major points that deserve mention with regard to potential savings to a municipality by joining the GIC.

1. Mandatory Medicare for retirees that are eligible for Medicare but don’t participate.

Far too many municipalities don’t require their Medicare-eligible retirees to participate in Medicare. By carrying the full cost of these retirees, municipal governments are leaving tens of millions of federal dollars on the table, and are unnecessarily increasing the cost to both taxpayers (primarily) and employees/retirees. The requirement that state retirees enroll in Medicare if they’re eligible and then choose a Medicare plan from the GIC offerings saves tens of millions of dollars each year and helps reduce the overall premium paid by both active employees and retirees because the Medicare-eligible retirees are rated separately and their premiums are largely funded by the federal government.

Making Medicare participation mandatory for all cities and towns in the Commonwealth is a no-brainer, and should be done regardless of the GIC-related legislation.

2. The decisions regarding co-payments and other types of cost sharing/benefit design rests with the Commission, and are not subject to collective bargaining. Whereas the GIC can increase co-payments from $10 to $15 with the approval of the Commission, under the current statutory construct most cities and towns must negotiate even the smallest co-payment changes with each of their unions. This severely restricts the ability of cities and towns to manage the benefit design, thereby driving up monthly premiums. Boston, from what I understand, is still fighting with some of its unions over a $5 increase in co-payments that occurred years ago.

]]> By: Dori Lefebvre http://www.letstalkhealthcare.org/ma-health-reform/the-gic-and-health-care-reform/#comment-141 Dori Lefebvre Thu, 10 May 2007 16:13:28 +0000 http://www.letstalkhealthcare.org/?p=59#comment-141 Charlie, I realize that the Connector Authority has the main task of providing health insurance to all; however, given the scope of this monumental task, wouldn't availability of doctors (expanded visiting hours to cut back on ER visits) go hand in hand with this project? Controlling the escalation of health care costs is not the Connector's agenda at this time, but it does appear that the entire cost issue is the main issue. Is there any way for this entity to influence the general accessibility of providers? There are ongoing studies with respect to telephone consultations with doctors, etc. and whether or not care can be improved if doctors are rewarded for simply being more available to patients. I am aware of regional differences regarding evening and weekend office hours, and we all know that the need for health care doesn't stop at 4:30 p.m. If there is a regional shortage of primary care doctors, how can practices be encouraged to stagger hours? If the Connector Authority is able to find out the cost of ER visits which could have been handled by primary care physicians if they were available (i.e. 7 - 9am, 5 -8 pm, & Saturday mornings), that could be a starting point for a wider discussion of this topic. Charlie,
I realize that the Connector Authority has the main task of providing health insurance to all; however, given the scope of this monumental task, wouldn’t availability of doctors (expanded visiting hours to cut back on ER visits) go hand in hand with this project? Controlling the escalation of health care costs is not the Connector’s agenda at this time, but it does appear that the entire cost issue is the main issue. Is there any way for this entity to influence the general accessibility of providers? There are ongoing studies with respect to telephone consultations with doctors, etc. and whether or not care can be improved if doctors are rewarded for simply being more available to patients. I am aware of regional differences regarding evening and weekend office hours, and we all know that the need for health care doesn’t stop at 4:30 p.m. If there is a regional shortage of primary care doctors, how can practices be encouraged to stagger hours? If the Connector Authority is able to find out the cost of ER visits which could have been handled by primary care physicians if they were available (i.e. 7 - 9am, 5 -8 pm, & Saturday mornings), that could be a starting point for a wider discussion of this topic.

]]> By: sg http://www.letstalkhealthcare.org/ma-health-reform/the-gic-and-health-care-reform/#comment-140 sg Thu, 10 May 2007 15:33:43 +0000 http://www.letstalkhealthcare.org/?p=59#comment-140 Charlie - One point you miss in all of this is the fact that many cities and towns have seen huge healthcare premium increases due in no small part to the pressure from unions to maintain $5 copayment plans and BCBS indemnity plans while everyone in the real world has taken on an ever increasing share of the increased costs in the form of much higher copayments and large deductibles. It is no coincidence that "health insurance costs" are mentioned every time the discussion of increased property taxes comes up. If they have signed deals there is no way the unions will allow a city or town to fold into the GIC plans. It would be interesting to know what percentage of total costs (employer and employee) that the towns and cities are carrying compared to private sector businesses. I would argue that the people that work on behalf of the residents of a city or town should not have better benefits than the people who pay for their benefits by way of ever increasing property taxes. Charlie - One point you miss in all of this is the fact that many cities and towns have seen huge healthcare premium increases due in no small part to the pressure from unions to maintain $5 copayment plans and BCBS indemnity plans while everyone in the real world has taken on an ever increasing share of the increased costs in the form of much higher copayments and large deductibles. It is no coincidence that “health insurance costs” are mentioned every time the discussion of increased property taxes comes up. If they have signed deals there is no way the unions will allow a city or town to fold into the GIC plans. It would be interesting to know what percentage of total costs (employer and employee) that the towns and cities are carrying compared to private sector businesses. I would argue that the people that work on behalf of the residents of a city or town should not have better benefits than the people who pay for their benefits by way of ever increasing property taxes.

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