On Monday, the office of Gov. Nathan Deal started keeping a list of people who called about the health insurance changes, many of whom were members of the online Facebook group TRAGIC, or “Teachers Rally Against Georgia Insurance Changes.”
Sasha Dlugolenski, spokeswoman for the governor’s office, said their phone lines were inundated with calls Monday, Tuesday and Wednesday from people who were concerned about the changes to the health plans.
“The governor’s office always keeps a detailed list of people who call in and the appropriate people are informed regarding the volume and nature of the calls,” Dlugolenski said Wednesday. “In total, we have received around 600 calls.”
The TRAGIC group was created Jan. 2, just one day after the new State Health Benefit Plan took effect, and leaders of the group asked its members to contact the governor’s office this week as part of an action plan aimed at raising awareness and fixing what they see as a problem with the new health care for state employees.
Ashley Cline, creator of TRAGIC and wife of a public school teacher in Cherokee County, said she created the group because there was a lot of confusion surrounding the changes to the plans, and because of concern for her children who are covered by the State Health Benefit Plan.
“We’ve got a 4-year-old daughter in occupational therapy, she’s got special needs, and I’m scared to death,” Cline said. “We’ve been paying out of pocket for occupational therapy and we had a $25 co-pay for as long as we can remember. Now, under this new plan I have to pay $130 a week, $1,000 gets me four hours of therapy a month.”
Since Cline created the group just a week ago almost 5,000 people across the state had joined.
The TRAGIC group is planning a rally at the Georgia State Capitol for Feb. 18.
“Once we started to grow, we put together a team of about eight of us that are administrators. We had a meeting on Saturday night and planned out steps for the group, basically action steps to do weekly,” Cline said. “We want people to share stories and help one-another, but with that many people we also need direction.”
Since the group was created last Thursday, many members have posted their experiences of frustration and concern about the changes to their health insurance plans on the group’s Facebook page.
Almost 650,000 individuals, including teachers, state employees, retirees and their dependents, were impacted by the changes to the State Health Benefit Plan, according to the Georgia Department of Community Health — the department that administrates the program.
Cline said the plan to call was the first action step for the group and was posted this week.
“This week we’re going to contact the governor in force ... we’re also going to turn our sights toward contacting the nine-member board who makes these decisions,” Cline said. “Our goal is to impact decision in the future.”
Dlugolenski said it’s important to note the governor’s office doesn’t decide SHBP options.
“Even though people may be calling here, I want to reiterate that the governor’s office does not decide SHBP options. That issue is handled by the Department of Community Health board,” she said.
Lisa Marie Shekell, communications director for the Georgia Department of Community Health, said the 2014 plan options were presented to a nine-member board, appointed by the governor, who approved the three-
tier Health Reimbursement Arrangement, or HRA, plan options last August. Shekell said Blue Cross Blue Shield was selected through the department’s bid process.
“The board votes on those plan designs,” Shekell said Wednesday. “The contract itself goes through our competitive bid process, like all of our contracts, and those contracts are awarded by the department itself. Those don’t require board approval.”
The 2014 State Health Benefit Plan offered state employees the option of three tiers of a HRA plan through the third-party administrator Blue Cross Blue Shield of Georgia, Shekell said.
In contrast, the 2013 plan offered state employees a choice of two different third-party administrators that offered the same set of plan options, which included: a High Deductible Health Plan, a Health Maintenance Organization option and a Health Reimbursement Arrangement.
Jamie Lynn Wills, mother of two and a teacher in Cherokee County, said she’s just starting to see the impact of the changed health insurance plan.
“The biggest impact so far, is that I can no longer take my children to see their doctor,” Wills said. “I just lost it on the phone, I broke into tears. It’s an emotional thing because they know my children. The doctor was there when one of my daughters was born. She knows my children inside-out.”
Wills said her family was “so attached” to their pediatrician, and now they can’t see her again.
“Just after the beginning of the year I called the pediatrician’s office and said, ‘I just want to be sure. You take the Blue Cross Blue Shield HRA plan, the state employee plan, right?’ And she said, ‘No, I’m sorry we’re not going to take that … we’re only going to take HMO and PPO,’” Wills said.
Shekell said changing the plan to a one-party administrator will save the state an estimated $200 million in 2014.
“In 2014, that contract that was awarded to Blue Cross Blue Shield, State Health Benefit Plan did make a decision to go to a one-party administrator. That decision is very similar to what many of the large employers in the private sector do,” she said. “There are administrative savings and efficiencies that you realize by going to one third-party administrator.”
Shekell said the Georgia Department of Community Health also “utilized a strategy to eliminate the HMO, the co-pay program that had been previously offered.”
“I think historically, with some of the state budget deficits that we had, including deficits within the State Health Benefit Plan, continuing to offer co-pay programs is an unsustainable way to offer health insurance to employees,” she said.
Wills said her children are frequently sick, and paying a high deductible on a teacher’s salary may leave her in debt over health care costs.
“I don’t think a lot of people realize what they’re dealing with,” Wills said. “When those HRA dollars are gone, you’re going to get stuck paying a really high deductible.”
Wills said the change to the state employee health plan “is just tragic.”
“How is anyone who is strapped for money like the state employees are supposed to navigate this and not fall into debt?” Wills said.
Shekell said it’s important for SHBP members to understand they do not pay “at point of service.”
“The HRA dollars are in everybody’s account, the amount depends on which plan someone enrolled in,” she said. “An employee can earn up to $480 in additional HRA dollars, if you have a covered spouse on the program, your spouse can also earn HRA dollars.”
Each level of the three-tier plan starts members with a different amount of HRA account dollars. For an individual with no dependents on the plan, the Bronze option starts with $100 in HRA credit, the Silver option starts with $200 HRA credit and the Gold option starts with $400 HRA credit, according to the 2014 SHBP Active Employee Decision Guide published by the Georgia Department of Community Health on Nov. 8.
Shekell said if a member’s HRA dollars are used up, they still would not pay up front. A claim would be filed with Blue Cross Blue Shield, and the member would receive an “explanation of benefits.”
“Within that explanation of benefits, they would have a very clear picture of what discounts were applied as a result of negotiated rates that Blue Cross Blue Shield may have with the provider, and then they would also be provided with information related to what they owe the provider for that remaining amount,” Shekell said.
Members are responsible for paying for healthcare costs between the time when their HRA dollars run out and their deductible is reached. The co-insurance kicks in once a SHBP member’s deductible has been met, Shekell said.
The deductible for an individual state employee for in-network coverage by the bronze option is $2,500, the silver option is $2,000 and the gold option is $1,500, the SHBP documents show.
Deductibles for family coverage range from $3,000 to $5,000 for in-network health care, or from $6,000 to $10,000 for out-of-network health care.