GEORGIA’S STATE HEALTH CARE BENEFIT PLAN: THE CURRENT CRISIS AND PROPOSALS FOR A BETTER WAY
A Statement from the Professional Association of Georgia Educators
Our state is struggling, as are many states across the nation, with rapidly escalating healthcare costs for its employees. As we have seen in Georgia, governors are taking a lead role in negotiating with insurers the best deals for their states, with cost containment being a top priority.
As recent events have indicated, state employees are locked out of the policymaking and fiscal decision process. In Georgia the approximately 600,000 state employees and their families have no representation on the board of the Department of Community Health (DCH) which sets policy for the State Health Care Benefit Plan (SHBP). During the most recent crisis, when United Health Care was selected to administer the SHBP, DCH board members themselves claimed to have no knowledge of the plans and negotiations that preceded the move to United Health Care.
While the governor and his staff have made the key decisions with little or no input from the DCH board and absolutely no input from the 600,000 covered state employees and their families, recent policy decisions have resulted in higher premiums, higher deductibles and higher out of pocket costs for these employees and their families. Many of them report decreased quality of service and a decline in the accessibility of health care providers.
The latest change in the SHBP, which began January 1, 2006 - designed to save the system approximately $60 million annually - is for UHC to become the plan administrator. Providers around Georgia, well aware of UHC’s cost containment priority around the nation, were reluctant to sign on board the UHC network, thus leaving large portions of the state without providers.
Both sides – providers and UHC – appeared to be using the resulting outcry from state employees and their families to drive the negotiations in their favor. While some providers have enrolled with UHC during the past few weeks, many more are continuing to negotiate, holding out for the most favorable arrangement and leaving many thousands of state employees and their families in limbo, waiting to see if their doctor or hospital joins the network or not.
The current system, with decision and policymaking in the hands of a very few, and virtual secrecy surrounding those fiscal and policy decisions, creates needless confusion, anger and puts state employees and their families in a constant position of reacting to the latest real or perceived “outrage” perpetrated, perhaps unwittingly, by a governor and an agency who purport to be providing an employee benefit and service.
While acknowledging the very real crisis in health care, PAGE believes the entire process needs to be “opened up” so that SHBP policy decisions are more transparent, the economics of a state health care plan more open to public understanding and comment, and we begin to make policy decisions on the basis of input – not just from the “bean counters” - but input from the hundreds of thousands of insured state employees and their families.
Cost is certainly a legitimate priority for policymakers to consider, but if cost is the sole consideration, then issues of quality and access are secondary at best, if not ignored completely and state employees as well as the general public are all badly served.
To that end, PAGE proposes the following steps be taken:
- Formation of a fifteen member State Health Benefit Plan Advisory Committee composed of educators and state employees who are covered by the plan. The group will meet quarterly and will be involved in all SHBP policymaking activities, including but not limited to, plan administration, plan design, plan changes, qualitative reviews of plan service, scope of services, networks, etc. This group will recommend plan changes to the governor, the legislature and the DCH.
- Appointment of a Executive Study Committee on the State Healthcare Benefit Plan, with members to be named by the Governor, the Speaker, the Senate President, PAGE, GREA, GAE, GSBA, GSSA, and GAEL. The committee will be charged with holding a series of public meetings across the state to hear from citizens, providers and others on their views of the status of the current plan and their suggestions for plan improvements with regard to access, quality of service and plan costs. The committee will meet quarterly through 2006 and issue a final report in December 2006 with findings and recommendations to be acted upon during the 2007 session of the General Assembly.
- The governor and the Department of Community Health will contract with a Georgia school of public policy for a state by state survey and analysis of innovative state healthcare plans across the nation with emphasis on cost, access and quality. This study will be conducted during 2006 and the school will make quarterly reports and presentations of their findings at each of the Legislative Study Committee meetings. A final report with summary recommendations will be made by the contractor to the governor and the legislature in December 2006.
Everyone involved in the SHBP situation must realize that healthcare nationally is in an economic crisis. That crisis does not stop at the state line. But acknowledging the immensity of the problem should not preclude good faith attempts at solving the larger, long-term, structural problems within the system. In the coming days, PAGE will be working with the governor, legislative leaders and others to begin putting in place safeguards and processes such as we enumerate above. Providing a system of state health care benefits to several hundred thousand employees and their families in today’s economic and health care environment is a daunting task, no question. But it is doable and it does not have to be done as it has been this year. Surely we can all do better than this.
PAGE, the state's largest organization for professional educators, is a nonunion association of more than 65,000 teachers, administrators and support personnel members with the purpose of promoting better education for the children of Georgia.