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: 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.