Today’s the Day

November 17, 2011

Protect your health care.  Public hearing is  Thursday , Nov. 17 at 6 PM . 

Marshall University Medical School, Harless Auditorium, 1600 Medical Center Drive (next to CHH) Huntington. 1st floor. Just walk through  main enterance , turn left and you’re there. Parking is free.

Registration begins 5 p.m. and continues through hearing.

Will post more links etc.  by next week.

 

 


PEIA PLANS Massive copays hikes, Loss of coverge for hundreds medicines

November 8, 2011

Nov. 9, 2011  Discussion of PEIA Planned Massive Take Away of Benefits

This affects WV State Employees, Retirees, many  county and municipal workers, school teachers and staff, many university and college professors and staff, state road employees, state police, etc., some other groups with grants, and retirees of all these. [ Counting actives and retirees, it's about 100,000, and dependents, it's not quite 1/10 of population a little less than  of West Virginians. ( WV has a presenting  of public workers lower than some states).] More than that it is indicative of what is being done to workers in private and public sector in many places.
Draft – Complete loss of drug coverage for many drugs, $500 copays, and copays on medications increases of over 300%   & many other copay increases. Also premium increases as much 9% for retirees and over 50% over 4 years. This is just a draft.  My comparisons and links.   Be sure to see What the teachers have  to say about PEIA changes /AFT comments are at end.  It explains a lot.

 I’ve compared the proposed increases to the present benefits in this email, and shown the percentage of increase.  Also a link to the presentation is attached.
 http://www.peia.wv.gov/forms-and-downloads/Documents/news_center/Public_Hearing_Presentation_November_2011.pdf
The current plan benefits for actives and PreMedicare retirees are in the Summary Plan Description  for Plan Year 2012 Benefits (July 1, 2011 -August 30, 2012
http://www.peia.wv.gov/forms-and-downloads/summary_plan_description/Pages/default.aspx
Shoppers Guides with current premium rates:

http://www.peia.wv.gov/forms-and-downloads/members/Pages/shopper%27s_guide.aspx

 Sample Letter to editor: PEIA proposing medication and copay increases with premium increases up to 44% of plan costs  : PEIA is looking at 4 prescription options, raising copays in all categories, some over 333% to  $212.50 for  3 months,  not covering any drugs  on their nonpreferred list, not covering any  proton pump inhibitors, or not covering any $4 generics. They are planning to raise or add copays on emergency, imaging (xarys) ($50), specialist, PT, OT, and speech therapy, in additional to already existing deductibles and coinsurance. Some copays would raise to $500. For Medicare Advantage retirees they plan a 9% premiums  increase, or 400% increase in deductible, a $600 increase in out of pocket cap, and copay increases (some 100% increases).  The proposed plan D an all WV plan, will undermine Plan A, as does Plan C.   Protect your health care. 

  
But worse, the plan to ignore the 30/70 split, and project raising retiree share to 44% (the next few years), raising premiums about 50% plus other increases for inflation. This when the state recently reported their revenues were ahead of projections,  while taking away of compensation for workers, and promised retirement benefits for retirees. No worker  or retiree, public or private should have their benefits taken, and those without should gain benefits. Perhaps it’s time for all to contact there representatives at  legis.state.wv.us/. Send 34 copies to senate clerk, and 100 to house. Finance, Pension & Retirement,  Insurance, Finance, Education, and PEIA (interim) committees  and are important. Protect your health care. Public hearing in Charleston at Civic Center at 6:00 on Monday, Nov. 7.  
 
 Comparisons:  You can submit you comments by mail  or  e-mail to: peia.help@wv.gov .  Be sure to include your contact information    They want to add  a $500 deductible for knee, and hip surgery/ replacement to “encourage exploring alternatives”.  What an insult, I don’t know anyone who had a hip or knee replacement unless it was a last resort, and all wished they hadn’t put it off so long. They could require that your physician indicate alternatives have been considered or tried, and that the surgery is needed without raising deductible to $500. This is especially onerous for the seniors as most of  the Advantage Plan is Medicare not PEIA. Retirees get a triple whammy. See below.  Is this not  a lot  just  to keep the Advantage insurance company making a big  profit? They’re trying to hang on to us in Advantage rather than taking us back to regular Medicare. They want to make profit from our Medicare.

 This  42 million in take aways is 420 per plan member. That the same as  and $420 pay reduction or pension reduction. Also Plan C has drained funds from Plan A and the pharmacy plan in that the sicker better paid stay in A, and the more healthy better paid go to plan C,  but can come back on open enrollment to plan A,  when sick.  Due to the 20/80 match for every $20,00 the plan C employee saves, the employer saves $80,000. But when  richer employees are sick, the stay on plan A or come back.  As you know for any plan to work the healthy and the sick need too be  in equally, but by setting up Plan / they  have undermined Plan A, due to the 20/80 match and sliding scale. (A better way to have done this would have been to leave all in Plan A or B and then if the better paid employees  ended up paying more than say 30% of cost of plan, their employers could give reimbursement stipends. That  would have left their higher premiums in plan when healthy, not just  when sick, and thereby the  state/employers would be giving the required 80% match to this. )This is the undermining of the whole plan.  How much did they say they would save by doing  plan C. Now you  know  whose paying for this. This has undermined the sliding scale , but more importing the  true 80/20 they agreed to.  It now becomes a spiraling ever increasing race to the bottoms, as we cede  benefits away, due to ever increasing premiums, as the healthy go to high deductible plans, and the sick cling to Plan A.  PEIA and the state are not operating I good faith, as this undermines the plan and the amounts they would have had to pay had they left it all plan A and B.  The new Plan D they don’t even explain or describe,  but it will probably  be some device to hasten the demise of Plan A!!!  

Note PEIA went to  a RESORT to work on these  take-aways. See Charleston Gazette for details

 

 Regarding  Medications: They’re looking at 4 options, all bad.        ACTIVE EMPLOYEES (STATE & NON-STATE), NON-MEDICARE RETIREES, AND  “SPECIAL MEDICARE PLAN” BENEFIT OPTIONS: (notice how that’s phrased “Special Medicare” bet this isn’t happening to regular Medicare or all Medicare  recipients. We should fight this.) 

Pharmacy Option A: Closed Formulary – loss in benefits  24 million

Top 102 Non-Preferred Brand drugs that would not be covered are:
So list in presentation is not all inclusive- many more would not be covered

See partial list in online presentation. But what other drugs are on the list?

How many  hundreds of drugs will they pay 0 on?    So if you need  need any of these medication ever you don’t get a dime of help. Think lesser used, expensive drug.   Think cancer and new  great  treatments, etc.  Also since they move medicines into this category at will, you really don’t know what medications will in up here .You will have no coverage for these medications.  Many of the suggestions substitutions aren’t the generic equivalents, or do not work the same way. Instead of not covering, they should have  step programs, or physicians explanation about why needed over others. Also some drugs are not covered just because others have rebates. 

Pharmacy Option B: Increase Copays – loss in benefits 20.5 million

Generic $8                       up form  $5       a $3 increase –             a 60% increase

90-day supply $16             up from $10     a $ 6 increase –              a 60% increase

Preferred Brand $50         up from $15      a  $   35     increase per prescription – a  70 % increase

90-day supply $125           up from $30      a  $   95     increase per prescription – a 333 % increase

Non-Preferred Brand $85 up from $50      a  $   35     increase per prescription – a  70% increase 

90-day supply $212.50      up from $100    a $ 112.50  increase per prescription –  a 112.5 % increase

Specialty  – $100               up from $50    a 200 percent increase      

 Pharmacy Option C:  loss in benefits 6 million

Remove Proton-Pump Inhibitor (PPI) Coverage. PEIA didn’t list which drugs these are but common proton pump inhibitors are:

Omeprazole (brand names: Losec, Prilosec, Zegerid, ocid, Lomac, Omepral, Omez)

Lansoprazole (brand names: Prevacid, Zoton, Monolitum, Inhibitol, Levant, Lupizole)

Dexlansoprazole (brand name: Kapidex, Dexilant)

Esomeprazole (brand names: Nexium, Esotrex)

Pantoprazole (brand names: Protonix, Somac, Pantoloc, Pantozol, Zurcal, Zentro, Pan, Controloc)

Rabeprazole (brand names: Zechin, Rabecid, Nzole-D, AcipHex, Pariet, Rabeloc. Dorafem: combination with with domperidone

Revaprazan                      So we are to throw people with stomach problems under the train. not everyone can take over the counter  versions, but need those only available by prescriptions.
 Pharmacy Option D: loss in benefits is 4.5  million   – No Coverage for $4 Generics (Mostly for prescription of 30 units)  Does this mean they won’t have pay on the 90 day rate.
 
 MEDICARE ADVANTAGE AND SPECIAL MEDICARE PLAN RETIREES MEDICAL

BENEFIT OPTIONS:

1. Option A: 9 % Premium Increase.

2. Option B: Benefit Adjustments

       1. Deductible $100  up form $25 a  400% increase. Note the $25  increase was a take away of Traditional coordination of benefits and change to “carve out” and PEIA did not even put that in the hearing presentation the year they did this.

       2. Medical Out-of-Pocket Maximum $1,350 (includes deductible and copays) up from $750 a 80% increase

       3. Adjust Copays

         Specialist $30  up form $20, and a 50% increase and double the $5 increase for actives.

         Outpatient Services $100  up from $50 a 100% increase

        Inpatient Services $150     up from $100 a 50% increase
 Plus all the changes to prescriptions  –   Why all these prescription changes for those on Medicare or retired, with federal Medicare etc. covering more than ever. With regards to people who are on Medicare or re retired the federal government  provided a $250 for those who reach th Medicare  Part D  coverage gap or “doughnut hole” in 2010. As of 2010 it also  provides  funding to encourage employers who provide health insurance  to continue to offer health benefits. As of 2011 it expands coverage for wellness and preventative care under Medicare. It also provides a 50% discount on Part D  brand-name drugs and a 7% discount on generic drugs whole in the coverage gap in 2011.  It closes the Medicare Part D  coverage gap by 2020. All the federal change should reduce costs to PEIA, as it now  fills in gaps in what federal Medicare normally covers. (This was all part of  national health care reform.) The more you get for  your Medicare premium  from Medicare, the less PEIA has to cover. Note: For retirees they project about a 50% increase in premiums over the next  4 years, to over 44% of plan rather than the 30/70 split as promised.
 
ACTIVE EMPLOYEES (STATE & NON-STATE), AND NON-MEDICARE RETIREES

BENEFIT ADJUSTMENTS:        Remove Coverage

           1. Acupuncture                2. Massage Therapy
            Adjust Copays

          1.Emergency Room $100  up from $25 as 400% increase. Loss in benefits 2.4 million

          2.Urgent Care $25

          3. Imaging $50 **** ( is this per xray or per set on one day? Loss in benefits 3.4 million

          4. Specialty Physician $25  – up from $20  a 25% increase

          5. Physical, Occupational Therapy and Speech Therapy $10 Loss in benefits 1.8 million

                                                           And they also have to pay deductibles and coinsurance – usually of 20 %
         New $500 Copays (These copays will apply and then these services will be

        subject to deductible and coinsurance.)

        1. Spine Procedures

        2. Knee Replacements

        3. Hip Replacements

        4. Shoulder Surgery

        5. Gastric Bypass

        6. Medically Necessary Dental Services
Really, they want a  $500 copay on hip and knee replacements. So people will try “alternatives”. Why not just this as a prior approval item, with no increase in copay, if that’s their goal? Just have their physician provide information on “alternatives” that didn’t work, or why alternatives don’t work, &  then NOT charge the high copay, if they really just alternatives explored. If one has bone rubbing on bone, there really isn’t an alternative. Most people put off knee/ hip replacement for years, & then say they wish they had done it sooner.

Weird Finances   

The  42 million dollar reduction is benefits amounts to a $420  loss per worker or retiree. And as the number of workers, school, state, county, municipal, university, has increased by 1000, some  of the increased cost are due to this, and they need to increase funding to cover this. So we are getting even less to compensate for inflation.  Who do you thank for these give aways, Tomblin who won’t enough budget funds, and Manchin who wouldn’t either, and got the finance director from an insurance company, one of the richest in the country.  UE local 170 pointed out last year, that when state employee process claims they did it cheaper.  Republicans are worse, some want to do away with minimum wages. Corporate lobbyist are problem.

 

  On page 15 of  PEIA  Presentation they’re adding 31 million to reserve next year. But is not the amount going into the reserve from the 30/70 match for retirees ( 20/80 actives)? But that’s the match that’s suppose to cover our medical cost nest year, and they’re diverting it.   Is not this reserve suppose to be for the employers liability over 30 years? It should come out of their funds, not next year’s 20/80 (30/70)match. So they having it both ways, the money for the 20/80 -30/70 matches for next year, is not being spent on next year’s health care, but being reserved for future years.  They’re putting into reserve  for future years, what they failed to set aside. This 31 million is 3/4 of the 42 million they’re cutting in benefits, so they don’t have to cut that 31million

They should let the rainy day fund stand for the reserve. It’s only to guarantee they’re make their payment each year. The state’s not going to cease to exist like a company. Likewise, the 3 years after next year have 31 to 38 million going into the reserve from the match. Lastly they shorted their share on both the 20/80 and 30/70 matches last year, and need to make this up.

 

Since they’ll never going to spend the reserve, if new hire get back post retirement health care, then it’s  just standing good for the  employers unfunded liability and shouldn’t come out of  our yearly 20/80 and 30/70 match. Why not use part of the state rainy day fund to stand good for the state share of unfunded reserve.  Lastly it was just in the paper how much tax revenue is up more than the state expected, and how much the can put in the rainy day fund, so fund PEIA.

 The benefit take away is 42 million. So this 31 million is 3/4 of the take  away.

 What’s more PEIA went to  a  RESORT to discuss how to reduce our benefits. Who  paid for that? Guess.

 

While benefits are cut, PEIA is budgeting 9% increase in administration costs for this year plus 4 more years. Compounded that’s over a 50% increase.  Raises??? (%  year. And how much more will insurance contracting companies make. We’re supporting to sets of executives, PEIA and all the contactors. UE Local 170 in 2009 rightly pointed out, that when state employees processed claims it was a lot cheaper. No corporate CEO’s to support. The CEO Coventry, which was over PEIA finance director’s former company and got first PEIA first Medicare Advantage contract, made 23 million in compensation (salary, bonus, and stock options one year).                

    ***** When figuring unfunded liability PEIA  put in medical inflation factor, but not all the savings soon to come from health care reform in future years.

 State has money but spend it on other extras.

Example. 6 million for decorative lighting at New River Gorge, while cutting medical benefits to state road workers.

40 to 60 to million in tax breaks to one rich coal to gas corporation/ owners in Mingo.  Also previously approved was 200 million in give-aways and breaks to out of state Penn/Texas based Consol coal. And they planned to do it 4 times more. /if this occurs, those lost taxes invested at 5% compounded over 30 years ( the length they’re looking at for the liability) it  would grow to 4.3 billion!!!!

For this reason everything needs to be audited and reviewed.  -Everyone can help. Check state budgets for waste and tax breaks. Check PEIA budget, comprehensive report, expense accounts, etc. Also check expense of all companies with which they contract. This is money for your health care, and it doesn’t need to disappear into corporate CEO profits, and PEIA expense accounts and raises. See PEIA Comprehensive report and OPEB & RHTB reports at http://www.peia.wv.gov/forms-and-downloads/financial_reports/Pages/Other_post-employment_benefits_(OPEB)_and_RHBT.aspx. Looks at state budgets, and news articles. Each person should send tips to unions and retiree groups. Unions and retiree groups should band together to audit all, form a committee of all these groups, and come up with funding suggestions and waste cuts to present to PEIA and the legislature.

 The bids and costs need to be checked. 1. Pharmacy Vendor Bid, 2. Wellness Vendor Bid, 3. Medicare Advantage Prescription Drug Program Bid 

ACTIVE EMPLOYEES (STATE & NON-STATE), AND NON-MEDICARE RETIREES :

1. No Premium Increase

2. New Plan “D” with 5% Premium Decrease

 No other info given- probably another way to total amounts employers pay under 80/20 match which will also undermine Plan A further and leaves a smaller amount available for 30/70 match for retirees too.

 3. Benefit Adjustments

How Current Plan C and Proposed Plan, will raise premiums in Plan A, and force eventually force almost all to high deductible WV only plans.    

I called and they said this Plan will be a primarily  WV only plan. once they get away with this, won’t they keep  raising plan A until we’re all prisoners of WV when it comes to medical care. Why didn’t they put anything other than one line about this plan in the handout.                            Plan D will undermine Plan A, just as plan  C did.

Plan C has drained funds from Plan A and the pharmacy plan in that the sicker better paid stay in A, and the more healthy better paid go to plan C,  but can come back on open enrollment to plan A,  when sick.  Due to the 20/80 match for every $20,00 the plan C employee saves, the employer saves $80,000. But when richer employees are sick, the stay on plan A or come back.  As you know for any plan to work the healthy and the sick need too be  in equally, but by setting up Plan C they  have undermined Plan A, due to the 20/80 match and sliding scale. (A better way to have done this would have been to leave all in Plan A or B and then if the better paid employees  ended up paying more than say 30% of cost of plan, their employers could give reimbursement stipends. That  would have left their higher premiums in plan when healthy, not just  when sick, and thereby the  state/employers would be giving the required 80% match to this. )This is the undermining of the whole plan.  How much did they say they would save by doing  plan C. Now you  know  whose paying for this. This has undermined the sliding scale , but more importing the  true 80/20 they agreed to.  It now becomes a spiraling ever increasing race to the bottoms, as we cede  benefits away, due to ever increasing premiums, as the healthy go to high deductible plans, and the sick cling to Plan A.  PEIA and the state are not operating I good faith, as this undermines the plan and the amounts they would have had to pay had they left it all plan A and B.  The new Plan D they don’t even explain or describe,  but it will probably  be some device to hasten the demise of Plan A!!! 

 

Living Wills / Advance Directive pitfalls / Note: They still have increased premiums, unless one signs a living will, and the one they send out is dangerous in that it only requires one physician to say your are terminal or (NOT and) comatose, which they describe as merely unconscious. The font is too small, not the size  used in legal wills usually, and too small for many older seniors.  PEIA will be able to have this used to override your medical power of attorney appointee if they want a second opinion or specialist. Guess we’re living too long. Be afraid, be very afraid. See peiawatch.wordpress.com for details. See article at peiawatch.wordpress.com   Look in list on right  for http://mysite.verizon.net/cureltd/id24.html

Also go to http://mysite.verizon.net/cureltd/index.html  Citizens United Resisting Euthanasia.   See Before You Sign on the Dotted Linehttp://mysite.verizon.net/cureltd/id24.html

 

You can submit comments in writing to:   PEIA Finance Board ,   601 57th St., SE, Suite 2, Charleston, WV 25304-2345         Or via e-mail to peia.help@wv.gov     

 What the teachers are saying . Go to wv.aft.org.

http://wv.aft.org/index.cfm?action=article&articleID=be7b6723-770d-4043-a7b0-6e92b873c6b1

 Their information about funding very good.

Also go to UE local 170 web site, AFSCME WV site ,and WVEA, and CWA sites and PERSA. Anyone can join PERSA. Retirees can join a union even if they weren’t in on, and the rates are cheap like $12 a year. Non education workers can  choose from CWA,UE local 170, and AFSCME. You can usually lobby with them even if not member, and get on e newsletters.

Go to peiawatch.wordpress.com and look at tabs on top for document  for  ways to help

Also has lists of other ways  government wasted money.

 

 

 

 

 

 

 

The Finance Board will hold public hearings to receive comments on the proposed financial plan for the 2013 plan year. Registration begins at 5 p.m., and the hearings run from 6 to 8 p.m. Customer service will be available from 5 to 6 p.m. 
    Please make every effort to attend a hearing to voice your concerns over these changes. The document also includes talking points for you to incorporate, if desired, into your remarks if you speak at a PEIA public hearing.

Hearings are scheduled as follows:

Monday, Nov. 7, 2011
Civic Center, Little Theater
200 Civic Center Drive
Charleston, W.Va.

Tuesday, Nov. 8, 2011
Ballroom A
One Tamarack Park
Beckley, W.Va.

Monday, Nov. 14, 2011
Holiday Inn
301 Fox Croft Ave.
Martinsburg, W.Va.

Tuesday, Nov. 15, 2011
Ramada Inn
20 Scott Ave.
Morgantown, W.Va.

Wednesday, Nov. 16, 2011
West Virginia Northern Community College
B&O Auditorium
1704 Market Street
Wheeling, W.Va.

Thursday, Nov. 17, 2011
Marshall University Medical School
Harless Auditorium
1600 Medical Center Drive
Huntington, W.Va.

If you can’t attend a hearing in person, you can submit comments in writing to:

PEIA Finance Board
601 57th St., SE, Suite 2
Charleston, WV 25304-2345
Or via e-mail to: peia.help@wv.gov

——
Plan Year 2013: PEIA Public Hearing Information, Proposed Changes

Overview and 2013 Plan Proposal

• There were no additional state dollars from the Governor for PEIA in plan year 2012, but there was a premium increase for employees that did not participate in the wellness program ($10) and/or complete the living will ($4).
• Governor Tomblin has said he will increase the PEIA budget with state dollars by 4%, or $25 million, for plan year 2013.
• Medical rate of inflation is about 6.5% and Rx inflation is around 10%.
• As a result of no additional money from the Governor/Legislature last year and only a 4% increase this year, PEIA finds itself in a pretty big hole.
• The 80/20 rule prohibits a premium increase in plan year 2013 because of last year’s premium increase with no additional state dollars (It actually threw us out of 80/20 for the year).  The difference is made up in plan year 2013 by not increasing employee premiums, which bring us back to 80/20.

Benefit reductions and increased participant costs proposed:
• As a result, the board needs to “eliminate $42 million in benefits”.  The proposals can be piecemealed and amended, but the cuts will be substantive.
• The proposals are broken down by what each will save the plan, they are (for actives and retirees pre-65):
o Capping the Pay Go Premium, aka the retiree subsidy, at $162 million with an escalator of $5million per year.  In the most recent legislative session, we agreed to a cap, but only if the escalator was a percentage and not a fixed dollar amount; and the subsidy was broken down by a per member per month calculation.  The cost to retirees under this proposal is off the charts.
o Close Tier 3 of the Rx formulary, which would change the formulary to look like $5 for Tier 1, $15 for Tier 2, 100% for all other drugs and $50 for specialty drugs.  It essentially means no coverage at all for Tier 3 drugs.  It would affect 22,000 participants and cost participants about $24 million.
o Increase co-pay in the Rx formulary.  Instead of it looking like it does today, which is $5/$15/$50/$50 Sp., it would look like $8/$50/$85/$100 Sp.  It would affect everyone and cost participants about $20.5 million.
o Eliminate PPI (proton-pump inhibitor) coverage, which are the gastric acid drugs.  Examples of PPIs include Nexium, Prevacid, Prilosec, and Aciphex.  According to PEIA’s medical doctor, the over-the-counter medications for PPIs have the same ingredients and make-up as the Rx medications.  The cost to participants would be $6 million.
o Open a new West Virginia Only plan.  The new plan would only allow participants to use West Virginia providers.  It is anticipated this will save the plan about $5.4 million.
o Eliminate coverage for the $4 Wal-Mart drugs.  Not sure of the details on this, but the cost for participants is $4.5 million.
o Increase family out-of-pocket max from 1.5x to 2x for single coverage.  The cost for participants is $3.8 million.
o Introduce imaging co-pay of $50.  The cost is $3.4 million.
o Increase emergency room co-pay from $50 to $100.  The cost is $2.4 million.
o Make physical, occupational and speech therapy a medical necessity for coverage, with a $10 co-pay.  The cost is $1.8 million.
o The list goes on and on with savings under a million for each proposal.  Some examples include introducing $500 co-pays for procedures like Hysterectomy, Knee Replacements, Hip Replacements, Gastric Bypasses, etc.
Recommendations/Talking Points
General
• School employees were given health benefits in lieu of a pay raise several years ago. Each year that premiums, co-pays, and out-of-pocket expenses are increased results in a pay cut for employees.
• In 1988, the employee share of PEIA was ZERO.
• State law mandates that PEIA should have an 80/20 premium split by 2007.
• Employees are paying more money for fewer benefits.
• West Virginia already faces a teacher shortage, particularly in critical need areas such as science, math, and foreign language. It will be difficult to attract and retain quality teachers with salary and benefit packages that are inferior to surrounding states. This will erode the quality of education delivered to WV children.
• The philosophy of these proposals flies in the face of what insurance is all about, which is about all participants sharing costs, not financially penalizing the sick.
• We should continue to strive to find innovative ways to expand the program and/or develop networks in/out of West Virginia to provide relief for active and retiree enrollees within PEIA.
• There is no reason for substantial benefit reductions when there is an excess reserve.  At the end of the 2012 fiscal year, the reserve is expected to be at $187 million. The PEIA Finance Board should use more of the excess reserve to offset at least some of the proposed benefit reductions.
• Of course, the traditional public hearing statements apply.  Some are:
o The Board shouldn’t balance the state budget on the backs on actives and retirees.
o The Governor should come up with more money to help offset the benefit reductions.
o This is taking back PEIA benefits at its worst.
o These proposals will increase the financial burden on the sickest participants of PEIA.
o It is important to offer the Board solutions.  Most speakers complain without offering suggestions.  The Board is willing to consider options, provided they are offered.
Specific Issues:

• The first, and possibly most important, issue is the Pay Go Premium.  As mentioned earlier, AFT-WV has agreed to a cap, but only if the escalator is a percentage and not a fixed dollar amount, as well as a per member per month calculation.  Here is why:  In year 1, if the cap is $5 million of $162 million (this is the cost of today’s retiree benefits) that represents a 3% increase.  In the following year, the cap is $167 million ($162 plus the $5).  If a flat dollar escalator is used, the percentage increase falls below 3%.  The difference really starts to show in the out years, let’s use year 10 as example:  The cap would be $212 million in year 10 ($162 plus 10 years of $5 million increases).  Moving to year 11, a $5 million increase amounts to a 2.3% increase.  As you can see, the further along we go, the lower the percentage increase, which amounts to additional costs placed on the backs of retirees.  That is why must ask the Board to use a percentage escalator instead of a fixed dollar amount escalator.  A supportive statement would be that health care costs are always broken down and based on percentages; the Board should not change the rules midstream in order to penalize retirees.   Additionally, we must break down the subsidy to a per member per month calculation.  The rationale is simple; each member is entitled to fair subsidy no matter the number of retirees.  Here is why:  If there are 10,000 retirees in year 1, each retiree would receive an annual subsidy of $16,200.  In year 2, without a per member per month adjustment, the retiree number increases to 11,000, which equates to an annual subsidy of $15,180, an amount that is $1,000 less than the previous year.  If a per member per month calculation is used, the subsidy is broken down individually and the increase of retirees does not affect the benefit.  Ted Cheatham is supportive of this, but we should remind him and the Board that this is the only fair way cap a benefit. 
• There is no excuse for substantial benefit reductions when there is an excess reserve.  At the end of the 2012 fiscal year, the reserve is expected to be at $187 million, or 25% of the plan.  If the reserve is reduced to only 15%, which is still 5% higher than the statute says, that would free up roughly $80 million to offset benefit reductions.  Under the proposal, $17 million is removed from the reserve to offset benefit reductions, but it still leaves the reserve at 21% at the end of plan year 2013, which is well above the recommended amount.  We should encourage the Board to use more of the excess reserve to offset at least some of the proposed benefit reductions. 
• There are 2 big ticket items related to Rx coverage.  One benefit change is worth $24 million and the other is worth $20 million.  It seems the trend under all of the proposals is that the participants who utilize more of the care should be paying more.  This is a slippery slope.  On one hand, I think utilizers should pay a little more for the coverage they receive; this is applied now in the form of co-pays.  On the other hand, that philosophy flies in the face of what insurance is all about, which is about sharing costs, not penalizing the sick.  A major plan change like one of these two options will be detrimental to those requiring 3rd Tier drugs.  If changes are made to the formulary, exceptions should be made for cases in which there is no Tier 1 or Tier 2 alternative.
• Offering a West Virginia Only plan may be a viable option for those that live in West Virginia’s “major” cities, but for many plan participants, it would simply not be an option.  In fact, the majority of West Virginians live in rural parts of the state within 50 miles of the border.  As a result, many folks can’t get the care they need in West Virginia.  This new plan would be attractive, at a 5% discount off of the Plan A rate, but it would decrease the pool of Plan A participants, resulting in increased costs for those that remain.  Note:  PEIA reimburses providers in WV less than 20 cents on the dollar.  Conversely, out-of-state providers are reimbursed at 93 cents on the dollar.  Hence, the trigger!

 

 

 


Monday Feb.17 President’s Day Rally for WVAFSCME and others (all welcome)

February 12, 2010
Monday, Feb 15. WVAFSCME Presidents Day Rally / Lobby Day at 9:30 Open to ALL friends and coworkers regardless of whether in union or not‏.
Please forward to those who might be interested. Thanks


Monday, Feb 15. is WVAFSCME Presidents Day Rally / Lobby Day at 9:30
Open to ALL friends and workers relatives regardless of whether in union or not. Come and enjoy free breakfast and meeting and talking to many delegates and senators at meeting. Learn how you, yes you can help. Also you can lobby afterwards if you wish.

Below is an excerpt from the WVAFSCME Newsletter.  (West Virginia  Association of Federal State County
and Municipal Employees.

http://afscmewv.org

Newsletter is at http://www.afscmewv.org/newsletters/wvorganizer_fal_win_2009.pdf          Be sure to then click the PDF symbol in center of screen.
Even if you are not a member of WVAFSCME come out and support this. Their goals imprtoved salaries, and stopping the erosion of benefits (which is really a take away of compensation), etc. are of interest to all actives an retirees.

If you can’t attend call with your support anytime in the next few days.
There are links at their web site to the state legislature, and also at peiawatch.wordpress.com

. OR at
They can be found at http://www.legis.state.wv.us/

Share your concerns about lack of raises, shortage of staff in many areas, and the constant take away of benefits.  Click

http://www.legis.state.wv.us/districts/hd/hd.cfm to find you house delegates

http://www.legis.state.wv.us/districts/sd/sd.cfm to find senate delegate to email or call

Note Banking and Insurance Committees are looking at revising PEIA. Let them know your concerns or you might get some bad changes. Some on these committees are trying to fix things for workers and retirees. They need your thoughts and support. It does not matter if they are from your district. This is an issue that affects all, and they need your input. Memebers of the Senate and House Banking and Insurance committees are: Senate Banking & Insurance -Joseph Minard (Chair),Evan Jenkins (Vice-Chair)
Chafin, Fanning, Green, Helmick, Kessler, McCabe, Palumbo, Prezioso, Deem, Facemyer, Hall
House
- Banking & Insurance -Clif Moore, Chair – Banking, Doug Reynolds, Vice-Chair – Banking, David Perry, Chair – Insurance, Alex Shook, Vice-Chair – Insurance, Tom Azinger, Minority Chair – Banking, Patti Eagloski Schoen, Minority Vice-Chair – Banking, Bob Ashley, Minority Chair – Insurance ,Ron Walters, Minority Vice-Chair – Insurance, Cann, Frazier, Hartman, Hunt, Hutchins, Iaquinta, Louisos, Mahan, Manchin, Michael, Shaver, Skaff, T. Walker, Wooton, Andes,
Carmichael, J. Miller
Othe impotant committees are Finance, Health and Human Resources, Education, and Juiciary
Also important are the heads of the Senate and House
Senate: President: Earl Ray Tomblin, President Pro Tempore: Joseph M. Minard, Majority Leader: H. Truman Chafin, Majority Whip: Larry Edgell, Minority Leader: Don Caruth, Minority Whip: Clark Barnes
House: Richard Thompson, Speaker Pro Tempore: Ron Fragale, Majority Leader: Brent Boggs, Majority Whip: Mike Caputo,
Assistant Majority Whips: Sam Argento, Larry Barker, Jeff Eldridge, Tim Ennis, Richard Iaquinta, Clif Moore, Dave Pethtel, Sharon Spencer,
Randy Swartzmiller, Minority Leader: Tim Armstead, Minority Whip: Larry Border, Assistant Minority Whips: Troy Andes, Ray Canterbury,
Lynwood Ireland
Delegate told me he gets at least 2 or 3 calls a day on this, so lets keep it up pand increase this.

Want to comment publicly or anonymously, such as the telephone comment line at the Charleston Newspapers or commenting on line on artilces you read. See tips at peiawatch.wordpress.com at Quick Ways to  Help

http://peiawatch.wordpress.com/quick-ways-to-help/

There is also an information packet at http://www.legis.state.wv.us/Educational/PACKET_2010.pdf   You will need to click the PDF symbol. It oes NOT have a map of the EAST basement
Also at peiawatch.wordpress.com is a discussion of  PEIA’s  proposed changes Nov. 2009 for July 2010 titled PEIA proposes outrageous premium increases and benefit changes -Nov. 2009 . Most were enacted, along with some things not mentioned in the Public Hearing Handout, and some not even mentioned in the hearings maybe enacted. A  few were tabled for a year with some kin of weird/condition/deal/agreement to pass or phase in next Nov.
Plan C was not approved. So bascially it  will be a major take away of beneifts.

Remember Room EB -40 is in the basement under the East Wing. “It is easy to find once you are in the basement of the east wing.
If all the meters

“WHAT: Public Employee Lobby Day
WHEN: Monday, February 15, 2010 – 9:30 AM
WHERE: WV State Capitol – Charleston

Lobby Day is a one day event beginning with a morning briefing on our issues
with coffeerginia State Capitol in Charleston.
Signs will be placed around the Capitol pointing to this meeting room and if you
need directions to and continental breakfast provided as the Legislative leadership
in the House and Senate talk with us and concluding with visits to
Legislator’s offices and to watch the legislative session in progress.
Attendees
are encouraged to car pool and arrive east wing conference and
training room (EB-54) on the basement floor
on Monday the 15th by 9:30 AM.
Bring a co-workers, neighbors and friends.
Directions and Meeting Location: Treasurer’s Office under the Treasurer’s main offices at
the West Vi the Capitol from anywhere in the state, email us at
Council77@aol.com call 304-342-2114. On February 15 (Lobby Day) if you
have any problems, call the same number.
Plenty of FREE President’s Day holiday parking at the meters on Capitol grounds.
Happy Holidays
Mark Your Calendars
Now – President’s
Day, Monday February
15, 2010. 9:30
AM -‘Lobby Day’ ‘’

Note there are also  more parking & shuttle buses from the Laidley Field parking area, but you need to deteremine if you have to park at the far end across the street by stadium

————————————————————————————————————————————————————————————————————————

WV PUblic Workers Presidents Day Rally, Feburary 15, 2010

The only way public workers are going to be heard is if we organize together and take collective action when necessary to demand our rights. Our Public Workers Presidents Day Rally is one of many ways we let the legislature know about the issues that concern us.
Join us at 10:00 am February 15 in the Capitol Rotunda and celebrate with public workers from all across this state as we rally to educate the legislature and our communities about the issues public workers face.

On Presidents Day our union members will also hold meetings with our lawmakers to make sure they understand why these issues are important to us. For carpool information – call the Union Hall at (304) 699-4401.

Other sites of interest:
UE LOCAL 170
http://www.uelocal170.org/

Recommendations for PEIA http://uelocal170.org/modules/AMS/article.php?storyid=29

WEA

http://www.wvea.org/
Recent Updates
WVEA Legislative Update During the session weekly updates are posted each Friday. Legislative Update Update #4 online – 2/5
OPEB liability sparks proposals The Senate has proposed 17 items as part of their OPEB plan. OPEB Plan
Attracting and retaining teachers WVEA President Dale Lee’s op-ed on the subject. Attracting Teach

WEA president’s blog http://wveapresblog.blogspot.com/

AFTWV
http://wv.aft.org/
Legislative update Feb.12  http://wv.aft.org/index.cfm?action=article&articleID=632f52ce-bd65-4b3d-bd7c-0caea6b840f5
Reform PEIA NOW ads http://wv.aft.org/index.cfm?action=article&articleID=47593c94-5172-4ead-897a-d4674e29677f


peiawatch.wordpress.com

wvpersa@wvpersa.org


PEIA proposes outrageous premium increases and benefit changes -Nov. 2009

January 20, 2010

Please excuse any typos etc. PEIA did not post handout on Web until 2 business days before meetings started.

This addresses concerns about the proposed PEIA Changes. The proposal can be found at their web site http://www.westvirginia.com/peia/ . Click on to More at Plan Year 2011 Public Hearings and it takes on to the meeting schedule at http://www.westvirginia.com/peia/page.cfm?parent=&section=118&storyid=6222.  Then click onto the blue PEIA Financial Plan for Plan Year 2011 and The Public Hearing Presentation can be viewed at  http://www.westvirginia.com/peia/content/Public%20Hearing%20Presentation%20PY%202011.pdf  .                        (Note though each page shows separately and views as a full page, the handout had 2 pages on each page side ( 4 to a sheet with extra margins, so that it made it hard to read the Scenario chart, and many could over local that those projected increases for 5 years equal about 60%. They also did not mail this out to plan members, so older seniors not on internet do not have this info, and the info given in releases to newspapers did not seem to mention this 60% increase in premiums.  Is PEIA planning over the next few years to by increasing the premium differences between the plan to eventually force us all into a high deductible WV only plan, with family deductibles of $2400 per year, and Out—of-Pocket Maximum of $9000?

Contents:

Discussion of Concerns with references to PEIA Handout Nov. 2009 at Public Hearings   . . .  pages  1-9

Help is on the Way From Federal Law Changes and will Save PEIA Billions                          . . .  pages  9-10

Suggestions to Avoid Increases in Premiums and to Avoid Decreases in Benefits              . . .  pages 10- 14

Other Comments                                                                                                                             . .  . page  13- 14

1. Page 17 of Public Hearing Handout PEIA plans adding a deductible, but they don’t tell us this is a new deductible, or that it takes away Traditional Coordination of Benefits between PEIA and Medicare, going to “carve out coordination of benefits, thus instituting new deductibles which will certainly grow, a major blow to retirees and that PEIA tried before without success due to the large outcry. Traditional Medicare was the Primary insurance (about 85% of needs and PEIA was the supplement (about 15% of needs) that it’s job to fill gaps in Medicare.  Apparently the hope may be that plan members and seniors will fail to notice this now amid all the other threatened take-aways.  Sadly, every $100,000 in raises recently given PEIA upper management etc. (from PEIA administrative funds ?)  would equal  the amount taken away from 4000 seniors through this loss of coordination of benefits. The state’s chief executive’s $55,000 raise would cover this deductible (this take away benefits) for over 2,200 seniors who worked 30 or 40 + years at often extremely low wages, and don’t receive COLA’s on their small pensions. The goal is probably not just the amount reaped by adding this deductible, but to establish it now, so it can be not only increased repeatedly, but perhaps in case any future federal restrictions might protect against  this take away of traditional coordination of benefits later, as  it was promised in benefit books for years.  This moves this cost outside the PEIA 70/30 match, costing shifting the entire amount to retirees.  This will affect all when they retire. What’s lost now is lost forever, and will hurt those who retire latter more than current retirees, as this increases over years.  It takes it off 70/30 match and costs shift  whole deductible to plan members.  See Help on the Way From Federal Law Changes and Will Save PEIA BILLIONS below to see more reasons to preserve this traditional coordination of benefits and not start this deductible.  Nowhere in the PEIA handout and not mentioned in the verbal presentation was this chance from “Traditional Coordination of Benefits  between PEIA and Medicare to the Carve Methods. Why? They also didn’t speak of it during the Public Hearings ( I heard 4 of them) unless asked. The Handout says add $25 annual Medical deductible. (Since the actives are nonMedicare retirees are getting a $25 increase in their already existing deductibles it’s easy for the Medicare retirees to think this is the same increase on an already existing deductible, but it is not. Originally all plan members had “traditional coordination of benefits between insurance, so if they had their spouse (who worked elsewhere at a non-state job),  both had  and 80% plan and they covered each other, then their own plan pay first, and their spouse’s plan paid the difference (the other 20% and visa versa. They took that away from the actives and non-Medicare retirees a ways back without so much as a by your leave. They did not take it from the Medicare retirees, because Medicare is primary and by definition PEIA is a supplement. It’s suppose to fill the gaps in Medicare as Medicare pays about 85%. Our handbooks given to us every year promised year after year. Even as late as the Plan year 2007 Summary Plan given to all employees it said ( I think it was on page 59). “ Medicare Coordination The PEIA PPB Plan will reimburse the difference between the amount allowed by Medicare and the amount paid by Medicare under Medicare A, and Part B, if the balance is not more that the PEIA PPB Plan would have paid  as the primary plan.                                                                                                                                                                                        When Medicare is your primary insurer, all services are considered in-network and are processed at the higher level. If you have met you PEIA PPB Plan annual medical deductible, PEIA will usually pay the balance and you will pay nothing. This is referred to as traditional coordination of benefits.”                                                                                           How this worked was that if one was hospitalized, Medicare paid it’s share and PEIA paid the rest, with what Medicare paid meeting the PEIA deductible and PEIA paying the Medicare deductible (ie. Traditional Coordination of Benefits.                                                      To  have seen this type of entry in my benefit book for decades, one can not help but feel lied to.   PEIA in Jan. 2007 Legislative Slide show showed the “current Coordination of Benefits” and a Proposed plan of $150 deductible, removing first dollar coordination of benefits.  The handouts at the old Public hearings clearly talked about the change from “traditional to Carve Out” As you may  remember this didn’t happen due to the  public outcry. Now PEIA is asking for just a $25 deductible and not identifying this as a change in coordination of benefits. This is wrong that they are surely purposely misleading on page 17. And given the legislative handout from 2007 and the $150  deductible PEIA wanted, this new deductible  of $25 will surely grow  quickly to $150 and will also be cultivated in future years, so that PEIA is no longer a good supplement to Medicare.  The $25 seems small,  but that may be so that it is not much noticed amid all the other takeaways. The true goal seems to be to take away the traditional coordination of benefits and forcing retirees onto the “carve out coordination of benefits” without even using those terms or letting them know. This is a very shabby way to trick retirees at best. The timing of this is questionable as Federal House Bill 3962 will be expanding what Medicare will cover ( See Help on the Way From Federal Law Changes  and Will Save PEIA BILLIONS farther down in this paper). Perhaps PEIA want this loss of “Traditional Coordination of Benefits”  in case new federal laws might protect against such a radical restructuring of the plan.   Also as the new Federal Health Care Policy reduces funding for Advantage Plans, and puts those funds into improving Traditional Medicare, it is possible that PEIA will let retirees go back to regular Medicare with it’s broader network (our members can’t even go to Mayo Clinic), we will need that “traditional coordination of benefits.”

2. PEIA  is projecting premium increases of 60% over 5 plan years (2010-2014 –see Scenario’s I, II, III, IV, and RHBT I pages 21-25 of their Presentation  Employee Premium increase – not these rates compound) and plans to In addition, Plan A,   serving the majority of actives, receives a greater 8 % increase now, followed by double digit increases in succeeding years (total 65% over the 5 years).   This does not match with their on page 4 that nationally health care spending has gone up 29% in past 5 years (and this is probably  over inflated), but they are they raising our premiums 60-65%!!

3Plan A (serving the majority of actives) has an unnecessary greater 8 % increase (See PEIA Handout page 16). The 4% increase(Page 7 in PEIA Presentation)  is apparently really 8% for plan A (See page 12 in PEIA presentation,) the plan most like the original one, yet the newspapers and page 4 of presentation say  4% only chart shows which is misleading as the vast majority of actives are in Plan A.  The 8% increase in Plan A assumes apparently assumes 70% of employees will move to Plan C, which is highly unlikely given the negatives of Plan C. If no one goes to Plan C or it is not enacted Plan A gets only the 4%. Furthermore, they have not completed given out tables for all income ranges and have not provided assurance me that all incomes ( only the $36,000 to$42,0000 range) will get the same equal percentage increase and in fact the higher brackets say over $100,000 might get a smaller percentage increase. PlanC and the massive changes to plan B appear to be an effort to undermines plan A the plan closest to the original  good value plan, and an effort to get members to give up benefits. Notice on page 7 it says  4% premium increase is very large letters,  but if your look at the rate increase examples on page 16 for the $36,000 to $42,000 income range, and  do the math it’s  8 to 8.5 % premium increase and it’s not even written on sheet, much less in big letters. While they do admit the 8% change in their verbal presentation, how are members who look at plan on internet and don’t go to meeting suppose to know they’re noting getting just the 4% increase mentioned in the info PEIA emphasized to the newspapers? How can we trust PEIA

PEIA plans unequal increases in the various pay grades hurting the lowest paid the most- Notice page 16 nor any other page has the full charts of premium increases for Plans A, B, and C  at all income levels. They do not mention this at public hearings unless asked. When asked after a meeting they admitted they do not have these charts, and everyone is not likely to get the same percentage increase. So  are those in the $100,000 bracket getting a smaller percentage increase? More info not in the handout or news. When they started the premiums many years ago and they were $10 or $20 we were told they would dependent on our incomes. Not that anyone has had raises lately, but in those long ago years when all got a percentage raise in income, says 1%, those making $20,000 a year got $200 a year raise, and those making $100,000 saw their income go up by $1000, which is 5  times the raise of the lower paid making the salary brackets farther and farther apart.  So now PEIA plans to take an even  bigger bite  percentage wise out of the small salaries of the lowest paid!!!  How can we trust PEIA when they don’t put the charts in the handout or tell use this. Again members checking the proposal on line will not have this info.

45 % Decrease in benefits PEIA Handout page 7, 8-9, 11-16, 18-19, 21-25, 27                                                                   All will get  a 5% (32 million) benefit decrease in benefits (raising Plan A family deductibles by $100 (Plan B’s from $1400  to $2400), doubling Family Out-of-Pocket Maximums (more in B to $9,000), and increasing  49 drug copays from $15  to $50, affecting  many actives and 33% of retirees. This decrease moves these expenses outside the outside the 80/20 match promised.

80/20 match promised, placing the whole 32 million upon the backs of the members, and circumventing the law about the 80/20 match. Left within plan members would pay only 1% more and the State/employers 1% (which is 4% of the 32 million Under the 80/20 match) under the amore thus saying employees over 25 million and keeping the whole 32 million in cuts  under the premium match 80/20. However, they can probably just cut this much from administrative fat and contracts with insurance and drug companies, etc.

5. PEIA Public Hearing Presentation Page 8  & 12 -Plan  A increases in Deductible and Out- 0f-Pocket Maximum $ 25 or $50  individual deductible increase –  25% or  50% for those in the lower paid tiers, but only 4 to 85 in the most upper salary tier – hurts the lowest paid the most. Moves this out of 80/20 match and is a take-aways $ 50 or $100  increase  in Family  Deductible family – Same as above Double Family Out-of-Pocket Maximum – This is a 50% increase for all. Increases lowest salary tier from $800 to $1600, and highest from $2,250 to $4,500. But members already pay between  triple and quadruple for a spouse in premiums .

6. Increasing  49 drug copays from $15  to $50, affecting  many actives and 33% of retirees. See PEIA Handout pages 14-15, 17-18. This decrease moves these expenses outside the outside the 80/20 match promised.  Many of these drugs do not have and exact generic substitute, and member will have to us entirely different  medications, with a different formulas. Will they not 100 to 200 more drugs to this in future years, and raise the copay to $100. And retirees don’t have cost of living increases. What about those for whom other medicines haven’t worked or have quit working, or have allergies or a medical reason not to take the PEIA suggested substitutes. They should not have to pay this higher rate.

7. PEIA on page 26 of Presentation is also proposing to financially force end of care directives though financial incentives (which effectively raise premiums/costs for those not complying – a financial penalty) and dictating with whom to store (physician, in effect whole practice, – for electronic storage and faxing with any general release?). Some feel this is an invasion of privacy, conflict of interest, financial coercion and  many feel that this should only be in the hands of their lawyer/trusted relatives until needed. In a recent spring/summer board meeting  PEIA proposed tying premiums to providing  END of Care Directives. Now they are talking about incentives that really just raise others premiums- the same effect.  Will we have to sign them for our children and babies, will mothers have to sign them for their unborn babies. Will grown children at college  but under PEIA have to sign. Will be enacted before to the parents even make it to the hospital and get a chance to say ask for a neurological consult? This sets a dangerous precedent.  If their goal were only to “make sure someone knows their (members) wishes”  PEIA would let members choose this someone, not dictate this.  Once we start down this road of PEIA having a say in End of Care Directives,  where will it end. It is a matter of trust. We can not trust PEIA the way it has been run the last few years to leave it at this.  They will continuing add requirements around this issue.Whether this very personal document is stored maybe 30 years before needed with PEIA or  third party registry with safety issues, or with  physician, it’s financial coercion (through premiums). Will this be like medication, starting with a  $5 reduction in copays for generics, which  became a  $15 copay for brand name, with $50 copays for brand names not on formulary and for  so called “specialty drugs,”   to a proposal last year not to cover any brand name drugs not on formulary? Can we look forward to ever increasing premiums, or even loss of services or coverage for not providing End of Care Directives or providing them to whom PEIA dictates?  Could they later dictate what you have to say in it.  Will they pressure physicians and family (or family through physicians) as to how to interpret them PEIA’s way? Will the insurance company not let the family get second opinions, or consult a specialist? This also puts the physician at risk if the insurance company discourages consults. Insurance companies need to quit playing doctor.  PEIA wants to dictate to whom to give this document. Give it to a doctor you give it to a whole practice and it’s get sent out to hospital under general medical release, and going into hospital on emergency  doesn’t ensure you even get a doctor you know.  Many prefer this document with lawyer and trusted relative.  Once the precedent is set that PEIA can tie  providing insurance company or third party, physician or whoever PEIA dictates to Providing End of Care(End of Life) Directive  to premiums or incentives, where will it end? This opens the door to possible Civil Rights lawsuits.  Some may contract American Civil Liberties Union  right here in Kanawha county.   Wording in many of these broiler plate documents is vague and generic,  and open to lots of interpretations.   PEIA has one such document in back of shopper’s guide. Many do more research to buy a washer or a house and the loan documents, yet this form is the more important   Many people would prudently want to clarify and want protections and safeguards. However, those who are lower income, and those that need to save a few dollars  will feel financially pressured to sign the form in the booklet, and many might not be able to afford a lawyer right now. Where is 2nd opinion provision, who picks which physician, what about the right to consult a specialist, or fax records to Mayo or Cleveland Clinic etc.  How long in a vegetative state ? a few hours,  a couple weeks/ an month? There are numerous/dozens considerations, and a lawyer could cost several hundred.  Could PEIA end up a party to a wrongful death lawsuit due to this policy and providing form. Some may want to  search “Before you sign on the dotted line” Please see We’re not Dying Fast Enough (attached for details).  Even Joe Smith of the PEIA board is quoted in the newspaper about having concerns about tying this to premiums. Note most will be on Medicare when this document is needed so costs in newspaper would be mostly Medicare’s not PEIA’s anyway.

8. PLAN BRadical Changes to Plan B expose members to Financial Ruin and undermine Plan A, while shifting costs from PEIA to members .  See pages  9, 13 & 16. Could PEIA be planning to eventually drop plan A and force over 60,000 members onto this new Plan B in future years. Plan B has traditionally been a plan similar to A where members to save a little on their premium say  288 per yr. single ( salary range 36,000-$2,000 ) to $684 pr. family plan, while assuming a somewhat greater deductible when compared to plan A ( at least double or more in lower salary tier, and somewhat less increase in the higher tiers and higher Out-of-Pocket maximums. Only perhaps 3500 members are on this plan now. But it was a nice alternative.  However, they are now raising the individual deductible by $700 (140%  0n the lower salary tiers, and by $200 (40%) in the upper tiers, and the family plan  by 140% ($1200 ) to $2400 in the lower tiers, and 60% ($900) in the upper tiers to $2400. Clearly this is more punitive on the lowest paid, but is harsh for all.   The changes in Out-of-Pocket Maximum are if possible much worse. All get 125% increase to $4000 for individuals and a whopping $9000 for family plan.  This is not the 80/20 match as promised and expose the lower paid to possible bankruptcy if health problems arise.  This would now be a HIGH DEDUCTIBLE CONSUMER DIRECTED PLAN, and eligible for members to use a HAS account (see below) save to pay the bills that previously been covered by PEIA. Those in the lower tiers would have to earn over 155 % interest in the 1st year  on their invested premium savings to earn the $700 increase deductibles for individuals plus the $36 account fee. For the family plan  they would have to earn about $211 % interest on the $684 premium saving to equal even 1 year’s increase in family deductible increase plus $36. This is an unheard of interest rate in most safe investments. And yes, they could add their tax savings but that would be only about 5 to 15% of the premiums saved and will not help much.  For the extra $4500 in family Plan OOMP  and member in the lowest tier would have to earn 684% in the year. Those in the highest income brackets might fair a little better taking a risk,  by the increase in family deductible + Out-of Pocket maximum is still $5400.  When asked PEIA said Plan B members could return to Plan A on open enrollment dates, without penalty for any health problems developed while on Plan B but will this change.  Plus these members being allowed to come back to the better plan after paying the lowest premiums undermines the financial stability of plan A the better plan. Obviously, some will need and should come back to Plan A when they experience $9000 OOMP’s year after year. Many lower paid will feel pressured to take Plan B to save a few dollars especially as most have not had a raise in years, and some of the best paid ( over 100,000) may be willing to gamble on not needing to meet the $9000 OOMP, but as a whole this radically revised Plan B is fraught with risk.

9. A new WV only Plan C penalizes those in border counties, making members virtual medical prisoners of the “great HMO of WV”.  Without this plan C, Plan A’s increased premiums would be only 4% not 8%. Plan C undermines the other plans, and will most assuredly spread to the retiree plans as well.  It does not meet the needs of those in border counties ( 665 of employees), not those who travel out of state on their vacations to see elderly relatives, or on the job ( or to border counties) nor their dependents who do any this travel, nor the need of children going out of state to camps, or to college. There is absolutely no help for any but emergency bills out of state or with permission to a couple of facilities  for special care. If you go out of network (out-of state) you get nothing not even with double deductible or double Out-of-Pocket Maximum.

10. A new provision penalizes those with a spouse on the family plan (for whom they already pay a greater premium–about triple), by adding a $50 surcharge per month ($1200 yearly penalty), if that spouse has coverage available through their employer, even if it is inadequate/more expensive. This isn’t equal pay for equal work. A benefit is available to one employee, should be the same for the employee who works next to him. Could this be the beginning of the demise of family coverage piece by piece not only for public plans but private plans?  See page 27 of PEIA Handout).

11.  Health Savings Accounts – Page 9-10 of PEIA Handout. Can’t earn enough to cover increases in deductibles and OOMP’s to $9000 quickly enough- See Plan B #8 above. Charge a $36 fee yearly for one mentioned by PEIA, but IRS says can be at any bank, credit union, or brokerage can provide HAS account. Note some banks and credit unions may not charge $36.  Must be in high deductible plan B to use HAS’s. If use money for other than medical not only pay taxes but 10%  penalty. This penalty was not mentioned in PEIA’s handout. If in stock or annuities not FDIC insured and  could lose part or all of your money as market goes down or your investment firm bankrupts.  Most Banks with savings, checking, and CD’s have Federal FDIC insurance. Most Credit Unions have (NCUSIF ? insurance by Federal gov. on same saving, checking and CD’s. For comparison many have IRA’s without a fee, and one can get CD’s within IRA,s etc.  Brokerage houses sometimes charge a big fee ($85 for just writing a check) if you want to rollover and IRA or HAS to another bank, CU, or brokerage. The main point is that members will be saving to try and cover the increased deductibles and OOMP’S and probably won’t have enough soon enough to make up these decreases in benefits if anything major develops over the first 10 years. Why not work to modify the Federal laws so even lower deductible plans can use HSA’s.                                                                                                                               12.Non- Medicare Retirees - PEIA Handout pages 17-18, &25                                                                                         Shows $25 increase in deductibles – This again transfer 80% ($20) of this $25 to retirees. If it remains in the plan under the 20/80 match it would only cost the retirees $5 a year!!! To keep this under the premiums. Again this is cost shifting. Cutting waste in PEIA and contracts with insurers could eliminate this. Compare it to the raises in PEIA  which might have covered this for 4000 retirees or state’s chief executive raise that would have covered this for 2,200 retirees. (See 1. On first page above). They are also subject to cut in medication benefits –see #3 above. Affects 33% of retirees. Most of us may eventually need a drug in the $50 copay class. 4 % rate increase- Why did they not show table for preferred non-smokers. What is it??? The way Non-medicare retirees are pooled hurts them -Non Medicare retirees pay premiums on a 30/70  match , while actives pay on an 80/20 match, but while an active in the $30,000 -$42,000 pay range individual pays $71 as month, and retiree in the  maximum years of service category pays  $227 rather than $107 which would 30% in comparison to the active. (Note those with less service pay more and this is much much more if they have a dependant). They pay this $227 per month regardless of how low their income was or how small their pension. The difference is due not only to the actives being group with the other nonmedicare retirees, but because they are grouped with the sickest of the younger plan members ( the disabled pensioners). As members with a serious work related 100% disabilities they  leave Workman’s Compensation receive disability pensions a are pooled with the retirees theoretically raising the costs of the age related retirees. The same holds true for those younger people non-work-related 100% disabled they are pooled with retirees. (This condition exists until 2 years after they are judged eligible for Social Security Disability when they finally become eligible for Medicare. Note elderly are all eligible  Medicare at age 65 without the 2 year delay).   The idea of insurance is to share the risk. Should not everyone be pooled together, but the retirees pay the 30% match, instead of the 20%. At the very least those with work related disabilities 9 and probably the younger people with non-work-related disabilities) should remain pooled with the actives. This would receive a lower  premiums (for the 100%  disabled)  to the 80/20 match, and this would also lower costs for the age related non-Medicare- retirees because they are not pooled with the cost

13. Medicare Retirees  Assistance Program – Page 20. An extra tax on other retirees PEIA is raising this assistance on Premiums about 130% for those with the most years of service, or 80% for those with least service.  For the lowest income this is and increase of $114 per month in premium assistance which is good.  But why now, does this not increase the unfunded liability and is PEIA then adding an inflation factor to this assistance which even further increases the unfunded liability. This needs based assistance does not come from state revenue directly as a separate expenditure, but from the 30/70 match with retirees, in effect charging other retirees more (raising premiums) and using their state match to cover the premiums of the lower income. It is a needs based program and amounts to an extra tax on the other retirees.  So someone with a $12,000 pension and a spouse with income and therefore over the 250% FPL, pay a higher premium, to help with the premium of someone whose pension might actually be more. No one would dream of not helping – The Retire Assistance Program is a good thing, but is should be paid in it’s entirety by the state, rather than the other retirees who often have even smaller pensions but have a spouse with income, or have just a few dollars more than the retirees they are helping. (Note the cost of this program will only grow, as those who can only use 50% of their sick leave, or none of their sick leave to pay premiums retire and have high premiums. Also as many traded in their sick leave they some may have problems with premiums, and the other retirees will have to bear the cost through higher premiums to finance the assistance.) Other insurances, private insurances don’t raise members premiums to pay the premiums of others. The state should cover this program not the other retirees. This program is needed due to all the increases in deductibles, OOPM, and copays the lower  income retirees have suffered, and the lack of cost of living increases.                       **** The Application on PEIA web page for this shows The Medical Out-of-Pocket Maxium is reduced to $200 from the Standard $500, but their new plan only reduces this to $300, plus it Says it reduces cost sharing ( Will they no longer get reduced Drug Copay? Why is hand out  not clear on this. Currently the prescription out of pocket Maximum standard is $1750, reduced to $250 for those on this plan, but what will it be now that cost sharing is being reduced for them?????? Will it go up to $1750?? As these retirees us their premium savings for utililty bills, etc.  will they have enough for drug copays if cost sharing is greatly ??? Note I checked on this and though it is not in PEIA’s Handout, the prescription Out-of-Pocket Maximum will actually go up to the Standard amount $1750, and $1500 increase over the Prescription OOMP of $250 they have currently with the benefit assistance, and more than the additional increase premium assistance for those in the category that gets the most assistance ( 25 + years of service and below 1005 of federal poverty level, and is even a greater burden on those at the higher poverty levels say 200-250% of FPL, whose additional premium assistance is $31 more  dollars a month or $372  a year, but their prescription OOMP goes up to $1750 and  net loss of $1378 . This hurts the oldest, sickest and poorest would lose $1500 in OOMP protection. PEIA did not even address Prescription OOMP in their handout. The handout merely says in a small note at the bottom of page  20 “Benefits – Cost sharing reduced and MOOP for Medical is $300 rather than $750.” Why did they not mention the Prescription OOMP. We can not trust their pages in the handout.

14.  Lifetime Maximum increases to from 1 million to 1.5 million (PEIA handout page 8) Sounds great but Government is probably going to require this later. Why figure it in now, since they have already been helping those few individuals in this situation . Has PEIA now figured this increase into the unfunded liability and even added and inflation factor, multiplied it out over 30 years, etc. And it says this is for Plan A. Does it not apply to Plan B or C?

15. Medicare retirees – PEIA Page 17-18 *** Lose Traditional Coordination of Benefits*** Which is disastrous (See #1 on page 1 above. )***   While this is a $25 deductible it would be twice that if they have  dependent?   This will grow over the years.                                                                                            4% increase in premiums – but no COLA’s   Those with dependents will be hurt the worst                                                                                                                                              49  medications move to higher tier $50 copays affecting 333% of retirees See # 6 above.

16.  Wellness program incentive. “Fat Tax” page 28  _ This was going to be BMI, now it’s waist circumference but chart is not provided. Incentives for some mean higher premiums for others, so it’s really a premium increase.  Only one state has done this so it’s not a trend. PEIA want  data blood pressure, Cholesterol, Glucose etc. There are privacy issues here.  While we all should try to improve our health, PEIA should not be doing this. It may discriminate against women who have had had babies recently and don’t loose the wait fast enough, and the aged as their bodies don’t work as well and their height shrink. What next, DNA testing,  penalties for riding ATV’s , skiing, motor cycle riding, DUI’s, drug tests, using tanning beds, playing football (those sports injuries and knee replacements add up). Will all family members have to do this, dependents, children?? There are other ways to deal with this. See Food, Inc. the movie. Anyone can go to the intro free Dean Ornish meetings, and take home handouts. Ask them to mail the list of brands that meet their guidelines, and the book (there’s several choices) and is the CD is cheap on Amonzon.com or Ebay. And of coarse talk to you doctor about this.    *** Any incentives such as improve your score (etc. pages 29-31) are paid for out of premiums and therefore increase premiums of those who don’t get them. Many members live a long way from the Ornish Programs etc. or are not available on nights the are, and many have said there’s problems with making up missed sessions. What companies  go to the worksite to do these screening, what are they paid including travel to do this and how does it compare to PEIA usual and customary fee for this service through your regular physician. Who owns these wellness screening companies, and of what companies are the  subsidiaries??? Any insurance companies or insurance people have money in them??? Help on the Way From Federal Law Changes  and Will Save PEIA BILLIONS Recently passed House Bill 3962 was noted to have these Provisions:                                                                               *Medicaid (at a minimum ) to be expanded to all adults earning up to $16, 245 per year                                                 *Can keep employer related health plan, doctors, etc, Medicare                                                                                          *Small Businesses (over a certain size as really small businesses exempt) can buy from private or pool. Large businesses will be added over time.                                                                                                                                               *Public Option removes “middle person”, thereby lowering costs in all plans setting quality standards, good value, competitive prices and benefits.                                                                                                                                                    *Cost of uninsured raises everyone else’s premiums $1,100 per year as hospitals, etc. shifts costs to others. Now that they will have coverage it will reduce this cost shift to those who have insurance.                                            *Improvement in quality and other system changes will reduce health care costs, minimize hospital readmissions.    * “New Medicaid and Medicare payment policies will lower drug prices and insurance regulations will be strengthened.” Will end monopoly enjoyed by private insurers.                                                                                  ***“Limits will be set on percentage of premiums insurers can use for profits, versus actual patient care.”**** “Employers must pay at least 72.5 % of their workers’ premiums (65 percent of family coverage) or up to 8% of their payroll into a fund for workers coverage. Very small employers will be exempt. Employers will also be required to contribute for part-timers on a sliding scale.” (Note PEIA does 80/20 and 70/30 matches, but the 72.5 is a minimum and the limits on profits and administrative costs and the above referenced profits verses actual care PEIA members should come out ahead. This is also another reason to keep all benefits under insurance  and not cut benefits and raise deductibles, copays, Out-of-Pocket  maximums, and drug tiers, as it keeps these cost split with employer and not taken out of plan and paid 100% by employees and retirees.***                                                                        *** ”Medicare will be preserved and off much needed new  benefits, like free preventive care” This means PEIA will no longer have to pay these costs and will save PEIA millions and help with unfunded liability !!! *** Many employers will receive a subsidy to maintain their health benefits for pre-Medicare Retirees.” ( Another way PEIA can save millions/billions and help the unfunded liability.)                                                                                 ** “Prices paid by retires for many prescriptions in the Medicare drug benefit  “donut hole” will be cut in half. Overtime, this gap in coverage will be fully eliminated, saving retirees thousands per year.” As PEIA gets funds for covering things covered under this Medicare Part D, will they not get more as D fills the donut hole!!

** “Overpayments to private HMO’s  and insurance plans traditional Medicare will be cut, freeing dollars to protect Medicare, reduce retiree premiums and increase benefits.” (All of which will save PEIA on Retirees without cutting benefits. Note while this make end up in a return to Traditional Medicare and it’s great broad network that most others enjoy, it will be a much more generous Medicare in preventive care, and prescriptions, leaving less for PEIA cover. Hence the importance of preserving Tradition Coordination of Benefits between PEIA and Medicare 9 See Page 1 No. 1 above).

*** “ In their capacity as employers, providers, and payers of health care states will be able to save billions of dollars under reform.This means West Virginia will  save as will the cities, and counties, education, etc.

Source of all quotes and info above is “Health Care Reform What’s In It For Union Members and Families?  AFSCME Works Oct/Nov 2009. Note comments about PEIA added to show how it helps PEIA                     Suggestions to Avoid Increases in Premiums and to Avoid Decreases in Benefits

  1. Pass strong drug transparency laws,  so we can avoid paying for drug advertizing
  2. Perhaps reimport drugs from Canada, but only if can very source of production and it’s same as US drugs, they are the same, and it’s optional to members, and members aren’t penalizes if they only want US drugs.
  3. Pass menu bills so restaurant foods are well marked.
  4. Pass laws so food coming into WV are marked if cloned or genetically altered
  5. Pass laws to put caps on insurance company and drug company margin of profits.  The bill that just passed the US House addressing taking away protection from anti-trust laws from insurance companies, which will help with price fixing, gouging, and other monopolistic practices
  6. Set a state wide standard and usual customary fee for any medical types service and drugs, so everyone’s starting charge is the same regardless of which insurance company they have, or even if they don’t have insurance. A loaf of bread at Kroger’s  costs everyone the same, by the charge for a service at a hospital ( the usual and customary set with each insurance company before the insurance pays part is different depending on insurance company  plan or if you have no insurance).
  7. Encourage plan participants to obtain flu and pneumonia  immunizations through their local health departments ( if those departments offer them free or at a reduced rates as some do. Note some of them are free). Do not penalize retirees financially who gets these at their physicians office, but do put information about which county health departments have free or reduced price. Think how much PEIA could save year after year! Why are they not already doing this? What does PEIA pay as usual and customary for flu and pneumonia shots?
  8. On local pharmacy receipts they usually on show what member pays. The need to show full price ( the usual and customary amount PEIA allows, what PEIA paid and what member is to pay. Years ago the receipts used to show what PEIA paid, not just what member paid. That way members can more easily get a sense of the full cost of their medication and it would underscore to them the ones that are very expensive, and hopefully, spur their discussions with their physician regarding whether there is a cheaper appropriate alternative.
  9. 9. ***Move  PEIA back under control of legislature – PEIA is out of Control****

10.  When contracting with insurance companies do not allow them to include lobbying, and advertizing costs into costs (PEIA selects providers by putting out requests for bids, not by reading advertisements, so PEIA should not pay for this.)  Also take the fat out of the details in relation to expenses and expense accounts, ( i.e. travel, conferences [think AIG’s excesses],  staying at high end hotels like Hyatt or Hilton, fancy meals), and do the same with any companies with which PEIA contracts for either insurance, prescriptions, or wellness. Same goes for PEIA itself.

11.  Limit administrative increases for PEIA and contractors. – PEIA is building in built in 5% administrative increases for itself each year, that compound to 27.62% over 5 years. Seem to be planning on more greater raises, travel, etc. Most state employees haven’t had raises in 2 years, but just 6 upper levels PEIA executive, etc. got over $95,000 in raises(6 raises in 2008 and 2 gone another raise in 2006, raises + overtime , travel, etc ( See PWE handout for details).  If it was all raises and overtime it translates into over an  extra 1.7 million in pension benefits (assuming 30 years of service each and living 30 years past retirement) over and above what their pensions would have been had they not got these exorbitant raises. They are feathering their nests (i.e. pensions) at our expense (the raises).   Likewise don’t built in automatic high percentage administrative increases for insurance, prescription , wellness contracted companies.

12.  Would you pay a bank  8 to 30% for online  bill pay. It’s our premiums and those of employer, paid in our behalf.  But insurance companies get this much. Medicare processes for 5%. So Why would PEIA pay more.?

13.  Move administrative cost out of PEIA and back to State to pay. When employees, after one year of employment had their entire health care premiums covered by the state employer, they administrative costs were paid by the state as an expense, not out of premiums, because we had none. Now we have an 80/20 split/match on health care costs,  but it’s not a true 80/20 on the health bills, because they are taking the administrative funds out of this match.   Why have they been allowed built in these automatic administrative increase for themselves.

14. Managed Care Capitation also has a 8 percent per year increase built in for each of 5 years, for a compounded increase of $46.9%, but this also includes an increase in profits in  dollars and all expenses not just medical.  Again why give them an automatic increase on administrative costs.

15.   Likewise the  governor got a $55,000 raise, which translate into almost a million dollar increase in his pension ($990,000 given 30 years of public service and 30 years of retirement). Each dollar spent extra on his pension is invested over 30 years would grow to over  4.3 dollars.  The entire earning almost 3.3  million for a total loss to the state of over 4.3 million. Yet  employees haven’t had raises in 2 years and retirees don’t get COLA.

16.  Stop tax breaks to special interests. The governor, by trade a coal brokerage company owner, gave an out of state Texas/Penn. company, CONSOL,  $200 million  in tax breaks, for a coal-to-liquid plant that only creates 60 jobs (that’s 3 million a job). That company had/found $600 million elsewhere for the project, so why the tax break? There may be 4 more of these plants later -Will that cost the state another $800 million? That’s a billion in tax breaks. 1 billion  X a conservative 5% APR interest compounded daily over 30 yrs. equals about 4.48 billion,& could have met a major portion of the unfunded  PEIA liability, or all of it as the unions audit found it to be less than 4 billion. See http://wvgazette.com/latest/200808080271 for initial article of deal August 8, 2008  Coal-to-liquid plant gets $200 million in tax breaks  By Ken Ward Jr.

17. The Governor failed to budget/request the 51 million needed this year for the retirees heath care unfunded liability fund. This amounts to only about  $ 510 per active or retiree this year. Not much, as many state employees earn as little as 17, 20, or 30 thousand per year, with some retirees’  pensions as small as $400 or $500 per month.  In comparison, the governor’s $55,000 per year raise (should he complete 30 year of state employment) will net almost 1 million in increased pension (about $990,000), if he lives thirty years past retirement. Adding this much each year, and investing it at a conservative 5% APR compounded daily over 30 years, yields over 3.5 billion.

18.  Rainey Day Fund -Recently (Spring Summer2 009) it was reported that apparently there’s about $ 475  million (about half a billion) in 4 state ‘rainy day’ reserve funds. Surely part of this could be used for the PEIA unfunded liability fund, as it would still be saved.  (Note though article mentioned fun had dropped about 76 million in market meltdown, a previous article noted that state would regain almost all of it as market normalizes, as WV had very little in anything risky like Lehman, so we have to remember that this is really worth almost the full $475 million and growing as it earns interest.)  Also Brick street has since repaid the last 85 million of their low interest 200 million loan (at only 1.5% interest, costing the state millions in lost interest), so this money could now be added to rainy day fund to increase it and used for the PEIA unfunded liability. If some of these funds were saved instead in the PEIA reserve fund for unfunded liability it would still help the state bond rating and earn interest for PEIA.  ( Note if this PEIA fund were in vested in home loans for WV citizens the property would be collateral and it would create construction jobs, thus creating tax revenue, and earn PEIA interest. A win win  win for all.). {Or once PEIA is changed does the governor expect to use part of these rainy day funds as a slush fund, instead??}.

  1. What the unfunded liability will be is unknown because it is partly dependent upon changes in Medicare and other federal changes. If Medicare just fills the hole in Medicare D prescription plan it could save PEIA millions yearly.  Multiply this savings by 30 years, plus the interest that can be earned on the funds saved, as Medicare will be paying  more for prescriptions, and it would go a long way to reduce and fund the unfunded liability.
  2. 20. In PEIA’s 2007 Comprehensive Annual Financial Report page 51 Schedule C  it shows Member and Employer contribution and it appears in 2003, 2004, 2005 & 2006 employer contributions were NOT at an 80/20 ratio and the amount unpaid by employers was under by  35.885, 82.562, 103.133 and 81.937 million respectively for a total of 306.517 million  underpaid by employers, while the employers paid an extra 78.299million in 2007, which makes for an STATE/EMPLOYER underpayment for  the years 2003 through 2007 of 228.18 million. Had those payments been made each year, (with 80 million taken out in 2007 to avoid the over payment) part of those funds would have begun earning interest in 2003, and at end of 2007 plan year been  worth over 267 million and in 30 years with interest as computed at  5% APR compounded daily =  $1,198,048,896 or 1.198 billion LOST, THAT’S  ABOUT 1/3 OF THE UNFUNDED LIABILTY!!!
  3. Identify funds not collected, and interest not earned- several counties and cities failed to pay their share of premiums for some of their participants (retirees) for years, and this cost the rest of plan interest because the plan had to use other funds to cover this and lost interest. The State always need investments, Let the state  loan those few counties/cities etc. that failed to pay the monies to repay PEIA the money and the interest PEIA lost, as it had to use others premiums and their employer matches to pay these bills rather than investing in unfunded liability.  Se Phil Kabler 2-23-09 http://www.wvgazette.com/News/PhilKabler/200902220425 Pay up $6.65 M to PEIA
  4. Be aware that any money wasted by PEIA, or over paid to contracted insurance companies, also costs PEIA interest it could  have earned on those funds. Every dime wasted is like wasting 44.8 cents over 30 years. Every million wasted is really 4.48 million.
  5. Look for wasteful state spending (example 200 million tax break to a coal to liquid plant for a Texas/Penn that only provides 60 jobs (that’s 3 million per jobmay build 4 more. Does that mean another 800 million in tax breaks? That equals 1 billion, if invested at a conservative 5% compounded daily for 30 years, equals 4.48 billion, a sizable part of the OPEB.
  6. Identify unfair spending – Governor got $55,000 raise. IF completes 30 years of service, will increase his pension by almost 1 million ( $990000) if he lives 30 years past retirement.
  7. Identify extravagant state spending like $37,000 for leather embossed conference room chairs. 2 million plane (a trade up of the second plane for a 3rd. Thinks what this 2million would have grown o if invested over 30 years –almost 9 million. An the cost of insurance on this  3nd plane to replace the 2nd, maintenance, and all the other associated costs) when had 1 bet they lost money on trading in a relatively new plane, think of the depreciation. The trips to football games, liquor for parties, etc.  See Charleston Gazette December 21, 2008  Phil Kabler’s column http://www.wvgazette.com/News/PhilKabler/200812200236?page=2&build=cache  “In fact, the governor’s office budgets about $60,000 out of what is called the governor’s office custodial fund to pay for the four receptions.” … “Records show that since January 2007, the governor’s office has paid Atomic Distributing a total of $17,555.31 – with all invoices noting the purchases are for the Governor’s Mansion.”  That’s enough to prevent that $25 new deductible for 702 Medicare retirees, who worked their whole lives at low paid jobs, and therefore have small pensions without COLA’s, and small social Security Checks.
  8. Identify failures to fund PEIA, like not putting the 51 million into the OPEB this year, which is only $510 per active or retiree and some of those workers only make$17,000 a year, and some pension are only 4 or 5 hundred a year. If one looks at 2007 fiscal reports it looks like about 4 of previous 5 years, state did not do a full 20/80 match and was short by many many million. Emphasize interest over 30 years this could have produced.
  9. Identify wasteful and questionable spending at PEIA, like $30,000 for fitness books from friend of governor etc. Review profit margin given contracted companies and CEO wages and bonuses. OR PEIA being only insurance company pay to start over priced exercise facility in Marshall County (Cameron School) that is open to public. ($37,000 for 10 bikes and a wii)And it may be a proto type.  This is an extra tax just on PEIA members, as all other funds were from public sources. No other private insurance plan paid into this. “The project is a collaborative effort of the West Virginia Public Employees Insurance Agency, the Northern West Virginia Rural Health Education Center, the West Virginia University School of Medicine and Tygart Valley Rehabilitation and Fitness”  …”The project, which is expected to cost nearly $58,000, will be funded through the SBA and the four entities named”  http://www.theintelligencer.net/page/content.detail/id/520216.html?nav=510      While this is a worthy project, it is an extra tax on PEIA members that people on other  insurance or without insurance do not pay. This needs to be funded by regular taxes which we all pay, rather than PEIA
  10. paying this extra tax on top of their taxes that funded the other sources.  Review expense accounts. This money could be earning interest for OPEB.
  11. Identify changes in Medicare etc. and any future federal health plan by new federal administration that will help PEIA. Even just filling the donut hole in Medicare part D prescription drug plan would save PEIA millions a year. Nothing should be done until we see what US Congress does over the next few years.
  12. Identify legal changes that will help, such a passing a drug transparency law that will save everyone money, not just PEIA. There must be other laws that can help. The menu law,  and laws to limit profit & administrative fees and expense accounts for insurance companies. Coventry’s profits went up over 900% since 2000.  CEO got 11.3 million in salary, bonuses, and stock options in 2007.  Coventry is parent company of our Medicare Advantra Company.
  13. Identify and counter every misleading statistics released by PEIA. Get newspapers to print retractions and corrections. Example the OPEB. They overinflated, plus are they not reporting the OPEB for state, counties, and cities together. The state part  of OPEB should be reported separately. etc.
  14. Identify funds not collected, and interest not earned- several counties and cities failed to pay their share of premiums for some of their participants ( retirees) for years, and this cost the rest of plan interest because the plan had to use other funds to cover this and lost interest.   Perhaps these entities could borrow the money from the state ( the state has to invest it’s excess funds in something) and then pay their missing premiums plus interest to PEIA 9Note PEIA had to use other members funds to pay the bills of these entities where that money  should have been invested drawing interest for PEIA).A “fiduciary” is someone who is charged with acting in the best interest of someone else; in other words, they are not supposed to act with self interest.” PEIA is such an entity. They collect our premiums, and pay medical bills.  A private insurance would not take benefits from policy holders who pay their premiums, to give them to those for who their employer or former employer did not pay premiums. How are they performing their duties and managing fund appropriately if they allow this situation to happen.
  15. 33. Be aware that any money wasted by PEIA, or over paid to contracted insurance companies, also costs PEIA interest it could  have earned on those funds. Every dime wasted is like wasting 44.8 cents over 30 years.
  16. Be aware that at 4% inflation over 30 years,  incomes & taxes will be up 324%, so state will have more & be paying with dollars worth 1/3 of what they are now, but retirees don’t have COLA’s.
  17. PEIA has been involved  in starting the small business fund insurance plan. It’s even on their website. But PEIA funds and staff etc. are paid out of the PEIA match with active a retirees, and using their staff time and energy  costs the PEIA that pays their salaries. Plus when staff time is diverted to other issues outside the agency, it causes other staff to pick up the PEIA work, and causes overtime that EPIA has to pay. Has PEIA been fully reimbursed for it’s costs on all this consultation etc., as well as overtime caused for them or other staff?   **** Likewise, mixing this small business program with PEIA with regards to benefits, could hurt PEIA members, as these include some small businesses which have traditionally not had health plans, and will not want to fund  good plans such as large private employers have.

Other Comments: *** PEIA is held public hearings in July  about their plan to eliminate help with retiree health care coverage for new hires after Jan. 2010.  PEIA works much like Social Security as a semi- pyramid set up, as actives pay a 20/80 match fund from which the state pays a 70/30 match with retirees.  Besides the inherent unfairness of some actives earning  retiree  health care benefits , working beside  those who do not (treating people who work side by side differently- not earning equal benefits for equal work), this scheme may affect funding for retiree benefits. Are the new hires not covered to pay the same premiums as those who will receive this retirement health benefit? Or will they pay  lower premiums  as none off their premiums go to the retiree 70/30 match? Then as more retire, fewer will be paying  the 80/20 match from which the state takes the 70/30 match.  How will the plan survive? I have been told new hires without post-retirement health care benefits will pay the same premiums as those who have this benefit.  (How long until PEIA says this is unfair and  says since new hires don’t have post retirement health care benefits, they use it as an excuse to take away post retirement health care benefits from those who have them???  Could this be the true goal of PEIA. This will be in effect soon!!!

****We should insist at public hearings to PEIA that one solution to problem is for the unions and retirees to form a group to come up with solutions. We don’t need PEIA permission to do this, but they will either have to recognize group, or look like they don’t want solutions if they don’t. Each union  retiree group should pick their representatives not PEIA.

*** The  laws to make agencies look at unfunded liability for post employment benefits was not meant to be used to take benefits way, but to fund them.  Law suit against the state for not paying these benefits really doesn’t help the state’s loan rating, and the state wastes money trying to get out of it’s honest obligations. Could this be more about  not giving money to the fund this year to have money for tax discounts for a few “friends’ than the unfunded liability??     Increasing and adding deductibles, copays, and raising Out-of-Pocket maximums, and limiting networks rob members of promised 80/20 match.

***There are about 1.8 million citizens in WV, and 100,000 members and retirees + 100,000 dependents on PEIA, but that is state county, county, city, schools, and those with grants  like HUD, contact, etc.  They salt the roads in freezing weather, cook at and clean the schools, educate our children, insure clean water, immunizations, and thousands of other services. They pay federal, state, property, city, sales taxes, Medicare, and Social Security taxes. They spend their money instate at local businesses and this creates more jobs, and those jobs create more jobs, as does their use of most of their medical benefits locally. WV is reported to receive more federal dollars than it pays in taxes. PEIA member jobs are often in part funded by the Feds, and they bring in federal funds for roads, schools, special ed, Medicaid, Health and Human Resources, etc. most of which is spent instate creating more jobs in the private sector. They shop at businesses where many have better health care . They should receive the promised benefits, not have funds spent on out-of-state corp. like CONSOL that takes profits out of state.  If each member voice their concerns surely these take-aways by PEIA would stop. (That’s enough to swing any near election. And they have spouses and family not on PEIA.) How this state treats employees is a good indication, as to how it will treat regular workers in the private sector.

Concerns about PEIA Board- All appointed by one person. Director former CEO of Care Link, a subsidiary of Coventry of which the Medicare Advantage Plan we were forced Onto Advantra is also a subsidiary. PEIA Website shows Joe Smith represents retired Public Employees (Note has a Consulting firm with contracts with governor’s office and was Director of Personnel (Is that an appointed position?)). Michael Smith representing Public Employees has his employer listed as Spilman Thomas & Battle, PLLC. , and John R. Ruddick, representing Public at large shows Verizon as business, and Verizon employees a lot of CWA workers, as does the state. How can these persons serve without conflict of interest or represent actives and retired when they are neither? And what about the legal concept of detrimental reliance. Most state employees were extremely low paid. They were told that we had the insurance instead. Retirees worked for 30 to 40 plus years, and now that they live on small pensions, and the insurance bears no resemblance to the original plan. It’s like buying a house (our labor for decades), making  some of the  payments (the low wages they gave us), and then deciding to keep the house but only paying a part of what is owed. We couldn’t do that, so why can the state. The health insurance is deferred compensation for labor provided  for decades.  These negative changes and all the negative changes over the years, and amounts to a decrease in pensions and salaries, and will prevent some from retiring when they are eligible.     Sincerely,   Marilyn Howells, retiree, 5364 Newcomb Ck. Rd., Huntington, WV 25704. 304-529-2060

WE’RE NOT DYING FAST ENOUGH !!!!! Just a few thoughts on :

PEIA  proposed at recent board meeting that  plan participants provide End of Care Directives or pay a higher premiums than those who do. Note this was at a board meeting, but  is not in Plan Presentation.

Something new and very, very scary !! I wonder if anyone has ever heard of this or had it happen to them. They want to propose that we Provide End of Care Directives  (Advance Directive) or pay higher premiums than those that do provide this. This should and may be unconstitutional.  While most don’t disagree with someone’s right to have and End of Care Directive, many would be outraged that the insurance company wants to financially coerce us into providing the paper to them or some third party registry. They saying they’re lowering premiums for those who sign, and this won’t affect premiums of those who don’t sign, but that is untrue. This really that would mean in the long run higher premiums for those  who don’t sign.

Say the difference starts at $5 per month. Have you ever known a copay, deductible, OOMP,  not to raise over the years. So what’s start as $5 per month extra could go up to $10, $25 or $50 a month extra. Just this about your copays for brand name drugs not on the formularly and so called specialty drugs. Also we’re a 70 %/ 30 % plan with retirees paying 30%, and the only way to give a premium break to those who sign the directive, is have the others pay more, so something is wrong with their  70/ 30 math even if they don’t raise our premiums. They next time they compute, we won’t be getting out 70/30 match or we would all have the same premium.

Will parents have to fill these out for their children. Just retirees?? Age discrimination?? How will this affect too quick decisions on asthmatics, elderly those in the beginning stages of MS. Many serious diseases like cancer, ALS, MS, etc. give you  months, and years to decide on how to handle the end stages, but insurance companies view these as expensive early on, and already charge $50 copay on many MS drugs.

Will this be like medication, starting with a  $5 reduction in copays for generics, which  became a  $15 copay for brand name, with $50 copays for brand names not on formulary and for  so called “specialty drugs,”   to a proposal last year not to cover any brand name drugs not on formulary? Can we look forward to ever increasing premiums, or even loss of  services or coverage for not providing End of Care Directives?  Could they dictate what you have to say in it.  Will they pressure physicians and family (or family through physicians) as to how to interpret them PEIA’s way? Will the insurance company not let the family get second opinions, or consult  a specialist? This also puts the physician at risk if the insurance company discourages consults. Insurance companies need to quit playing doctor.  Once the precedent is set that PEIA can tie Providing insurance company or third party of their choice to Providing End of Care Directive  to premiums, where will it end . Once you go down this path where does it end? Euthanasia? For whom the old, the expensive, the retirees?

It should NOT be the insurance company where CEO’s make up to 124 million based on company profits, who interpret these living wills, or their flunkies or any third party entities they choose. Our Medicare Advantage plan was Coventry’s  Advantra Plan, and the CEO of all Coventry made 11.3 million in 2007 in salary, bonuses, and stock options, big bonuses base on saving money at your expense. These End of Care Directives should only be interpreted by the family in conjunction with your physicians.

Once the precedent is set the even one insurance company require proof of a living will and it affects your payment, then how long until others follow suit???? Obviously, if this gets started other insurance companies will jump on the band wagon, and a lot of people will be mislead into signing dangerous broilerplate directives, that don’t protect them adequately and are wide open to interpretation, and could be misused, and more poorly worded than you would think. If we don’t stop the insurance companies now, it will be to late later.

As far as I know, no other insurance company has done this. As far as I know neither Medicare, Medicaid, VA, Federal Employees Insurance, nor any private insurance of anyone I’ve asked requires this or ties it to premiums.  Seems we are some kind of guinea pig population, as I think we were also the first state to force it’s retirees onto Medicare Advantage. We did not have a choice, it was either got to Medicare Advantage or loss your supplementary insurance.  If they can get way with doing this to us, they’ll try this on others. I feel that other insurance companies will follow suit if this company gets away with this. will Workman’s Comp?

The idea that an insurance company who put financial pressure on plan members to PROVIDE this directive to them, is outrageous and probably unconstitutional and unAmerican. Talk about a totalitarian dictatorship. Terms that come to mind are invasion of privacy, conflict of interest, financial coercion, draconian, unconstitutional, ACLU, violation of religious freedom, and un-American. The whole idea makes one think of 1984 (by James Orwell), Make Room, Make Room (by Harry Harrison, think Soylent Green, the movie), or Logan’s Run.

It is definitely fodder for the ACLU and could end up in expensive supreme court litigation., thus causing PEIA needless expense. ACLU could add a number of other violations of our civil rights, and dozens or hundreds of points and arguments, plus hundreds if not those thousands of examples. Many people will raise moral, ethical legal, constitutional, and medical objections to such coercion, not to mentions all those who will raise religious objections, and complaints about  religious discrimination. Others will raise invasion of privacy issues. And does not such measures discriminate against the elderly or disabled. Is the current state administration planning to request a law requiring everyone is the state to sign an advance directive??? If not should State, County, and Municipal workers be required to sign? This gives new meaning to the term public servant. What was their purpose for requiring this? How was it to be used. And how were they to save money by using it.

Anyone making an Advance Directive would want to be real careful into whose hands they put it and when. I doubt if they can legally force you to make one, or if you have one force you to hand it over to get care. But this suggestion of tying premiums to providing this is financial coercion. Some feel that this should only be trusted to a group of several relatives to decide when to hand it over to the hospital. Many feel it’s best to have it give someone medical power of attorney to interpret your wishes, so some “bean counter” won’t. One certainly wants relatives to have time to find and consult with specialist and physicians of your and their choosing. After all no one ever went to several doctors over several months or years until they finally got the right diagnosis or treatment. In an emergency or after an accident, do you really want you this to be enacted before your relatives even have time to get to the hospital and select a doctor they want or  a specialist for a second opinion.  Anyway this gives new meaning to the phrase –

BURY IN HASTE, REPENT AT LEISURE.

They may be planning to have us store our End of Care/Advance Care Directive at a Central Repository. One national one out in California does not require Social Security Numbers, but they are optional as someone people object to giving it out.  After someone sends them their living will, they are sent a special identification card with an assigned number that a physician can use to call the company and have the Advance Directive Faxed or emailed. But if the person doesn’t have the card, the hospital can order it by name and SSN, or if the person didn’t give the repository their SSN, the hospital can get it by just giving the patient’s name and birth date. How long until one John Smith is mixed with another? How many people in this country have the same name as someone else, and maybe even are about the same age. Google your name and also run it on yahoo people search, and don’t forget to use alternate spellings (especially of your first name), and nick names.

What are the chances one of the faxed or emailed forms will get enacted before the family even gets there if you are in an accident. What are the chances one John Smith’s forms will be mixed up with another John Smith’s form. Or some of the middle pages will get switched with someone else’s middle pages. After all none of us have ever be mixed up with someone else, received a bill or piece of mail that is wrong etc. Of course there will be mix ups. However, if you die because of it, you won’t be around to straighten it out.

Then what will happen over the years. Will the  insurance companies  dictate the wording on these directives, raise your premium even more if you don’t sign one,  withhold services if you don’t sign, or drop your insurance if you don’t sign. Or maybe eventually, they won’t pay for certain services if you don’t sign one. But if they know you have a directive or even the content, will services you might want be withheld, or withheld prematurely. Eventually, will this lead to insurance companies to put pressure on your physicians and family, or on your family through the pressure the insurance company puts on the  physicians. Will the insurance company or some supposed mediator or adviser presume to interpret the living will? They already withhold antibiotics on the very sick sometimes. What if you have a slow cancer, like prostate and are only in for tests and could like for years on lupron, and choke on you dinner steak? Will you not be resuscitated because technically you are terminal. How can we trust insurance companies in this. End of Care / Do Not Resuscitate Directives are very serious and every word is open to interpretation.

Apparently on average health insurance companies spend the most on health care for people during the last two years of life. Will duh! You pay your premiums for decades when you often need very little health care and then when you get sick, they want rid of us quickly. There’s a big financial incentive for insurance companies to want physicians and families to interpret the End of Care Directive as broadly as possible when is comes to withholding treatment, what is terminal or irreversible, and what is life prolonging. Where you and you family might prefer to be very cautious when enacting the End of Care.

Think you won’t be affected because your insurance company doesn’t require this? Think again. You never filed an End of Care Directive with a repository. You’re in an accident and are taken unconscious to a hospital, which calls a few repositories with you name and birth date, and a match is found, faxed, and used to withhold care. But it was only the directive of someone with the same name. Too late, R.I.P.

Help needed:

  1. Please post on this site if you’ve ever heard of an insurance company requiring you to Provide an   End of Care Directive or pay a higher premium if you don’t.
  1. Also if you know of any web sites

about the dangers of misuse of Advance Directives/Living Wills, or problems with interpretation of these documents, and tips on wording them please post those site.

Sites: Below is a  listing a couple of sites found in a quick search with some 2006 Federal law, and concerns about wording of this type of document, or misuse. While  one might not support every word at sites they provide a lot of helpful information, concerns, and example.

For tips on writing living Wills and Advance directives, and pros and cons of language.

http://www.internationaltaskforce.org/rpt2006_2.htm#212

Before You Sign On The Dotted Line http://mysite.verizon.net/cureltd/id24.html

Good article and web site. Talks about Interpretation of End of Care Directives

Federal law about Advance Directives that prohibits requiring one as a condition of treatment.  See    Advance Directives, 42 CFR 489.102 (a) (3) (2006).

http://law.justia.com/us/cfr/title42/42-3.0.1.5.27.8.206.2.html

You might want to read or skim it all, but it reads in part:   “489.102   Requirements for providers  (a) Hospitals, critical access hospitals, skilled nursing facilities, nursing facilities, home health agencies, providers of home health care (and for Medicaid purposes, providers of personal care services), hospices, and religious nonmedical health care institutions must maintain written policies and procedures concerning advance directives with respect to all adult individuals receiving medical care, or patient care in the case of a patient in a religious nonmedical health care institution, by or through the provider and are required to:       . . .     (3) Not condition the provision of care or otherwise discriminate against an individual based on whether or not the individual has executed an advance directive”

“Throw Granny from the Train: The Washington Post Gives a Boost to Age-Based Health Care Rationing”   Note this site has lots of great article

http://unsilentgeneration.com/category/death-end-of-life-care-and-choices/

*****They very fact that the PEIA Board even brought this up with financial incentives, would now eliminate the PEIA (any agency which they retain or with contractor any state agency) with regards to just providing people with general information about the pros and cons of and End of Life Directive, even without any financial incentives or coercion in the future, as the PEIA Board has already shown itself to have an agenda and opinion on this matter many could rightly question their ability to provide balanced complete information not affected by their perceived and demonstrated preferences.    * * * * **

While many have valid reasons for personally wanting Advance Directives, these are matters best left to the patients and their families, with their doctors, and perhaps lawyers. Advance Directives are an option under the law, not a requirement. Medicare doesn’t require this nor INCO/Special Metals Retirees Blue Cross. To my knowledge Medicaid, VA, and Federal Employees Insurance do not require this. What next? Will they require this form Workman’s Comp. Will other workers in the private sector be forced to do this by their employers. Will members of the UMW have to do this????

Most generic broilerplate Advance Directives only require 2 doctors, with no mention of a specialist with regards to the part of the body involved, or a 2nd opinion of a specialist. How many times have you heard of someone going to several doctors before getting the correct diagnosis and satisfactory treatment??  It sometimes takes a few days to research  a condition and get better medical care, and an Advance Directive in the wrong hands could lead to hasty irrevocable decisions. Even an murderer has a trail and appeals, and yet we still sometimes execute an innocent person. Yet it appears workers, especially retired or disabled, if a victim of too hasty a decision will not have recourse, as they will just be dead without any court of appeal. This reminds one of disposable labor, think slave, feudal serf, peon, etc.

The generic basic broilerplate Advance Directives do not cover all possible scenarios. They often include a do not resuscitate order, or a no code. You could fall in the hospital and just knock the wind out, and maybe not be resuscitated. Are they more likely to not resuscitate if your older??  You at leas need a family member present to interpret. When you sign one of these broiler plate directives you are  waiving certain medical protections. While most of us do not want to be hooked up to machines for years when we are unconscious and in  pain (though pain can now almost always be well controlled), the Advance Directives usually are far broader and open to interpretation, and interpreted more broadly  than we would like, no matter how well written. They may be taken to mean, no antibiotics, even for hospital acquired infections, etc. Example, you have cancer, it’s terminal, but will take a couple of years, and your current quality of life is good, but you choke on food, or have an allergic reaction to the wrong medicine – Do you want to be resuscitated, or given oxygen for a day?  Many MS patients live years in which the quality of their life is usually good, as they often experience long remissions. And what about asthmatics with another serious illness? We’ve all heard of healthy people who suffered and injury, went into a coma, but completely recovered after weeks in coma, even through the doctors predicted otherwise.

We all hear the horror stories of people on a ventilator for years. But did you know that life prolonging intervention can be interpreted to mean an IV?  The problem with end of care directive is that there are 4 issues, parts or steps to the process plus a 5th consideration.

Disclaimer: First of all realize that everything above and below in this discussion, is just that, a general discussion and personal opinions, as are most or all web sites, and books. The only way to get a legal opinion is to go to lawyer.

The first issue is that you have to have accurate diagnosis and evaluation, not just in regards to your main illness, but also in regards to your situation and prognosis over the next couple of days. If this is not accurate, or wrongly pessimistic, then they could stop the very treatments, that could save you.  In case of an accident or sudden onset of health emergency, most people would want to get it right, and that could require consults with specialist, or waiting a reasonable time to see how things go.

Second one needs lifesaving treatment.  If you don’t have accurate diagnosis or treatment, then the rest of the End of Care Directive could be enacted prematurely or erroneously. Elderly people are slower to bounce back from surgery, anesthesia, or illnesses than younger one, but they do bounce back, just more slowly. Medication clears their bodies more slowly, so they are sometimes over medicated.

Many people, even healthy young ones die needlessly each year due to medical error, administration of the wrong medication, or hospital infections.  A senior could go in the hospital for a broken hip, pick up a hospital infection, and maybe be considered terminal just a little more easily than a younger person. Then they pull the IV, and the prediction becomes a self fulfilling prophecy.

Step 3 is the stopping or use of  life prolonging intervention..

So if steps one or two are not done correctly, then step 3 could be jumped to prematurely

Apparently the law allows an End of Care Directive that only requires one physician! (See link to web site below about this). A murder get a jury of 12 , but for granny one poor physician has to decide all on his own. Who would want that legal liability or exposure.  And why for the important decision of your life would you not want a 2nd opinion. I do research to buy a car, or before starting a new medicine etc.  Also consider that your attending physician at any given time in the hospital might not be your regular  physician. You came in at night though ER. Your physician is out of town. You needed a specialist in a field that you had never needed before. You were traveling and are in a hospital out of town. People used to get at least 2 estimate before a car repair under insurance, but one doctor!  Medicine is a science, but it’s not perfect. It’s hard. And who should pick  which physician will provide the 2nd opinion, or specialist, some would want this to be their family in consultation with the doctor?

Step 4   But what is life prolonging treatment?

Who defines what is life prolonging in such a situation.

Unfortunately, some people have found that once the decision is made that someone is terminal, most everything is considered life prolonging, and only the barest palliative care is given, and even routine maintenance medicines you’ve been on for years are stopped. But there’s a big difference in not putting someone on a ventilator, and not giving routine medication.

At  West Virginia Center for End of Life Care

http://www.hsc.wvu.edu/chel/wvi/resources/changes.html

The site says that the law says, “Only one physician is required to certify that the patient is in a persistent vegetative state or terminally ill on the Living Will form.”

But on something so serious most would want a second opinion, and probably a consultation with more than one specialist. Insurance companies often want you to get 2nd opinions before having surgeries such a  hysterectomy,  but the law doesn’t ensure  you get a second opinion or a specialist consultation or two before ending the very measures that could save your life. Broiler plate advance directives don’t have this in them.

The site does have some discussion of some changes in the law, but some would feel that these changes don’t necessarily protect you.

The site states with regards to definitions and the law.

Life-prolonging intervention has been expanded. It now includes, among other things, nutrition and hydration administered intravenously or through a feeding tube.”

What other things?

And  isn’t there  a world of difference between and IV and a ventilator??

Site also says that the law was modified to:

remove the specification that death occurs “within a relatively short time.” The new definition reads as follows, “Terminal condition means an incurable or irreversible condition as diagnosed by the attending physician or a qualified physician for which the administration of life?prolonging intervention will serve only to prolong the dying process.” ”

Notice that’s or incurable OR irreversible. Why not AND.

But how imminent must this death be? Without any relatively short time limit, or specific time limit, they could stop a glucose IV.

The fifth consideration, is the Medical Power of Attorney. Someone has to be able to make medical decisions if you can’t. Say you have surgery and are still sedated and a medical emergency comes up. If you’ve names a medical power of attorney they can ask for a consult, or a specialist, or help choose between 2 possible treatments, to pick the best, or in consult with doctor and specialist, help make decisions about IV’s or more heroic measures. This is why one really needs to have long talks with their medical power of attorney and other family members etc., so they will know how to interpret your wishes in various situations. Also if you medical power of attorney for what ever reason isn’t available or  can’t serve, is there a backup??

If  legally possible, why not a group of  two to four relatives (named by patient in their legal document) in which all have to agree that there is no hope and to stop life support, as well as the physicians, and if any one feels more information/consults are needed, or more time then the End of Directive is not enacted.

Need for an attorney: For something so serious as an advance directive, one would hardly want just what you can get in a broiler plate form. This is especially true because what is considered life prolonging is not only a ventilator, but often and IV, or maybe even and antibiotic. Many if not all prudent people would need a lawyer to help you decide such things as  how this kind of generic advance directive would play out if you were 80, recovering from hip surgery, and say had a severe allergies reaction or choked on food and needed to be resuscitated.

Haste: At the public hearing today, someone with PEIA or the board gave an example, of the danger of a person being in the hospital and a relative not being located or with a living will, and that person being hooked up to a ventilator. The point being that with a living will already available, they would not have to hook them up. But why the haste to enact a living will? How can you be sure that you are terminal if no relative has had a chance to select a physician you and or they trust, or maybe even get you primary care physician or specialist. Have you never shopped around for a doctor, or had problems getting a proper diagnosis or treatment that worked?  That comment by the person with PEIA  and similar attitudes is just what scares some.

Some people spend more time researching the lens material for their glasses (did you know there’s  a  newer material 6 times stronger than polycarbonate and optically superior) than the time allowed to relatives to get information and consultation before they enact End of Care Directive,  at  least the way some entities interpret the directives

Who Holds the Medical Power of Attorney: Personally, I would want an End of Care Directive that doesn’t put it routinely in the hands of  a third party other than family and/or my lawyer, and would not  want it given routinely, to the hospital upon every admission, or every series illness, or crisis, but would want relatives to hand it over, only when they are comfortable with the diagnosis, evaluations,  treatments, and second opinions that have been rendered and provided, and they truly feel all hope is gone.  This to insure that it’s not misinterpreted or used prematurely.

Problems with ability to afford attorney and discrimination: Many state employees don’t earn much and don’t have extra funds for attorney and many more retirees have very little income. Yet if the provision of an end of care directive is tied to lower premiums, this very lack of income, will coerce them into signing a broiler plate directive, to save on premium. This kind of policy discriminates against the poorest, oldest, and disabled. This also in a way discriminates against women and minorities. To this day the average income for women and minorities is lower than the average Caucasian man. But as seniors earned their salaries (on which their pensions and Social Security are based) long ago, when these income differences were even greater, so due their lower income this policy is even more discriminatory. They are more likely to simply not  be  to afford an attorney.  As usual, as with the justice system, those that are both richer may fair better, as for if they have concerns  they will go to their attorneys have the best directive drawn up, the best that money can buy, and the rest of us, will try to fill in the blanks in the generic broiler directive form and hope for the best.

Dangers of Not Having an End of Care Directive:

Think you’d rather just go without an End of  Care Directive.  If you don’t have one you’re governed by state law. Some states require only one physician to decide. Some name the order of who, can make medical decisions in your behave, and it may not be who you would think would be automatic like a spouse, and some states say something like the doctor can appoint whoever they think is best. So you go in through a ER, and a physician who doesn’t know you or your family picks. And they don’t even have to appoint a family member. A  lawyer in passing mentioned to me that WV requires just physician, and that they can appoint someone to make medical decisions, and it doesn’t have to be the closet  relative or even a relative. Is this true? In any event,  whatever the law is, you may not like it.

From not Being Allowed to End Treatment to Being Pressed to End Prematurely: In the past people had to fight to refuse certain types of care. People fought long and hard for this right of choice. Those that were opposed, worried about misuse of End of Care Directives. Now the pendulum seems to have swung the other way toward the opposite extreme.  Not only do we have the right to refuse certain treatments, but some fell these documents are too broad and are being interpreted too broadly, and too soon.   When it’s literally a matter of life and death, one should err on the side of caution. Regulations are needed to ensure patient/family decision-making and  stricter guidelines are needed increase patient and family controls and ensure that too broad interpretations not used.

Most of us will never be in a brain damaging accident, where we are placed on life support and will not recover. We will get cancer, or be in end stage diabetes/liver failure, or one of the rarer chronic life ending illnesses (MS, ALS, emphysema, or advancing congestive heart failure) and we will have weeks, months, or years to make, or alter our living wills to suit our illness. It is almost impossible to make a living will to cover all possible contingencies. On the other had you could be that person with the brain injury or severe stroke. Many people have  come out of a coma from which no one thought they would recover, and lived many quality years and even subsequently returns to work, or recovered from other things when not expected to. There have been people that come out of hospice and live for years.

Summary: Whether or not to have an Advance Directive, what form it takes, what wording and what loved ones will have access to it, in a private matter, and is NOT the business of insurance company bureaucrats, whom we do not know, and who work for companies whose bottom line is the bottom line. Insurance companies  have said that the last 2 years are the most expensive for insurance companies. Are we as a group want to give up 2 years on average, after we worked all our working live for  the state. How much more will the CEO’s  and other executives of the insurance companies with PEIA contracts,  get in bonuses due to this plan?  PEIA should not be providing End of Care Directive Forms. Due to their suggestion about tying the Provision of an End of Care Directive to premiums, they should not be giving us advise about the pros and cons of making an end of care directive, or even referring people to groups or agencies etc. for advise. They should not be doing those things in relation to something in which they have a conflict of interest. They could easily direct to some third party that presents a point of view they like. Unfortunately, most of us (unless we are already in the final stages of a specific disease) will be faced with researching these issues though numerous sources, applying this knowledge to all possible scenarios and then unfortunately for our pocketbook, consulting an attorney, or at least making some educated  choices on what to write in on  a form.

End of Car Directives, Can’t Live with Them, Can’t Die Without Them


Nov. 2009 PEIA proposes 60% premium increases over 5 years and 5% benefits cuts (this year)

November 10, 2009

See how you can help on Quick Ways to help tab.

Below is link PEIA Public hearing  handout.

Also at there website home page if you click on the public hearing announcement to  http://www.westvirginia.com/peia/page.cfm?parent=&section=118&storyid=6222. Click on the blue text about the 2011 financilal plan  and it will take you to presentation.
 
This contains a quick summary of some changes, listing of Public hearings and a few news articles, and some info from various union web site. WVAFT, WVEA, WVPWU and also link above to Public Hearing Presentation
 
Summary of some proposed changes:
1. They are projecting  outrageous premium increases totaling about 60% over the 5 year period of plan years 2010 to 2014 (that includes this year’s increase),
2.  Raising deductibles in  Plan A as much as $100 for some, and 140% in plan B to $1200 and $2400, 
3. Raising Family Out of Pocket Maximums by double,  and even more than double (140% for plan B to $9,000).
4. All the while increasing copays on 49 drugs, by moving them to a different tier from $15 to $50 tier copay, which will affect 9% of the actives, and 33% of retirees.  (How long until they add a few hundred more medications to this higher bracket and raise it to $100 copay?)
5. Plus they want to tie end of care directives to premiums, and dictate to whom  give it.
(Require you to give to doctor, rather than you choosing say trusted relative and or lawyer. When you give it to doctor it’s really the whole practive, and might this not go to hospital, etc. with any general release of medical information?  Plus would not it be scanned and stored electronically with your other records? When you go into the hosptal in emergency there’s no guarantee you will get your doctor or anyone in same practice!).
6. Also they’re talking about a WV only option for Care that penalizes those in border counties. Exposes them to double deductibles, double copays, and the difference between PEIA and hospital charge.
7.  Plans to remove traditional coordination of benefits between PEIA and Medicare,  thus instituting  deductibles which will certainly grow,  a major blow to retirees and that PEIA tried before without success due to the large outcry. Apparently the hope may be that plan members and seniors will fail to notice this now amid all the other threatened take aways.  Sadly, every $100,000 in raises recently given PEIA upper management etc. (from PEIA administrative funds ?)  would equal  the amount taken away from 4000 seniors through this loss of coordination of benefits. The state’s chief executive’s $55,000 raise would cover this deductible (this take away benefits) for over 2,200 seniors who worked 30 or 40 + years at often extremely low wages, and don’t receive COLA’s on their small pensions. The goal is probably not just the amount reaped by adding this deductible, but to establish it now, so it can be not only increased repeatedly, but perhaps in case any future federal restrictions might protect against  this take away of traditional coordination of benefits later, as  it was promised in benefit books for years.            

 8.  Lastly, a new provision penalizes those with a spouse on the family plan (for whom they already pay a greater premium–about triple), by adding a $50 surcharge per month ($1200 yearly penalty), if that spouse has coverage available through their employer, even if it is inadequate/more expensive. This isn’t equal pay for equal work. A benefit is available to one employee,  should be the same for the employee who works next to him. Could this be the beginning of the demise of family coverage piece by piece not only for public plans but private plans?

 

PEIA has 100,000 members and 100,000 dependents, about 1 in every 9 people in the state.
You can stop this if we all try.
 Go to peiawatch.wordpress.com for Quick ways to help.
 
The Public Hearings
Registration for the hearings will begin at 5:30 p.m., and the hearings will start at 6 p.m. If you wish to testify at the hearing, you must indicate that at registration.

The hearings will be held as follows:

Monday, Nov. 9, 2009
Civic Center, Little Theater
200 Civic Center Drive
Charleston, W.Va.

Tuesday, Nov. 10, 2009
Tamarack Theatre
One Tamarack Park
Beckley, W.Va.

Monday, Nov. 16, 2009
Holiday Inn
301 Fox Croft Ave.
Martinsburg, W.Va.

Tuesday, Nov. 17, 2009
Ramada Inn
20 Scott Ave.
Morgantown, W.Va.

Wednesday, Nov. 18, 2009
West Virginia Northern Community College
1704 Market Street
Wheeling, W.Va.

Thursday, Nov. 19, 2009
Marshall University Medical School, Harless Auditorium
1600 Medical Center Drive
Huntington, W.Va.

If you can’t attend a hearing in person, you can submit comments in writing to:

PEIA Finance Board
601 57th St., SE
Charleston, WV 25304
Or via e-mail to: peia.help@wv.gov

Customer Service
PEIA will provide customer service in each location from 4-6 p.m. If you have questions about medical, prescription or life insurance benefits, come early and get answers from the PEIA staff.

http://www.wvgazette.com/News/200911090805?page=2&build=cache
 
 

“November 9, 2009
Testy crowd objects to squeezing PEIA
Chip Ellis
Robert Morgenstern, with the West Virginia Federation of Teachers, questions PEIA Executive Director Ted Cheatham as members of an often-testy crowd listen.
Staff writer
 
 
CHARLESTON, W.Va. — A testy crowd of about 80 voiced objections to proposed premium increases and benefit cuts in Public Employees Insurance Agency coverage, during a public hearing Monday in Charleston.
Audience members frequently interrupted PEIA executive director Ted Cheatham’s presentation of the proposed 2010-11 coverage plan with questions, comments and catcalls.
At one point, Administration Secretary Robert Ferguson admonished the crowd to tone down its interjections.
“We’re not here to debate. We’re here to hear your proposals,” he told the audience.
Besides premium increases of an average of 4 percent – and 8 percent for the most common Plan A coverage – the 2010-11 plan proposes increasing annual deductibles by $50, and increasing out-of-pocket maximums for family coverage by an average of $1,500 a year.
“This is just a blatant money grab from the pockets of employees,” West Virginia Education Association President Dale Lee said. “Keep in mind these employees are among the lowest paid in the nation and are the backbone of our state’s workforce. You should be ashamed.”
PEIA also brought several controversial proposals to the table for Monday’s hearing, including:
 
  • Possible higher premiums for overweight insurees.
     
     
  • A $50-a-month penalty for employees who carry their spouse on their PEIA coverage, when the spouse has health insurance available from his or her employer.
     
     
  • A premium discount for non-tobacco users who verify they have executed a living will that includes end-of-life directives.
     
     
  • A lower-cost health insurance option, but one that would only cover in-state medical care. PEIA would reimburse costs for out-of-state medical care only for emergencies, or for specialized treatment for patients referred to either the Cleveland Clinic or Duke University Medical Center.
     
  •  
     
     
    From Public Workers Union    http://www.uelocal170.org/
    “PEIA Finance Board Picks Workers Pockets AgainPublic workers have taken up the slack for statewide staffing vacancies throughout the Manchin Administration, suffering with years of frozen pay and increased expenses imposed by the PEIA Finance Board, the so called employee benefit provider. By increasing the employee deductibles, increasing the employee’s share of premiums and by cutting employee benefits denying access to out of state health care, the PEIA Finance Board has planned to impose draconian cost saving measures at the expense of every state employee’s physical and financial health, endangering the welfare of every public worker and our families.

    As the WV Public Workers Union has previously reported, the 2009 state employee budget surplus bonus proposal was pulled off the table at the request of Governor Manchin when the WV House of Delegates attempted to make the bonus as fair as possible for public workers and retirees. According to State Tax Department Officials, West Virginia realized a 2009 fiscal year state budget surplus of $168 million dollars because of the statewide staff shortages. Even though several times Governor Manchin promised that any 2009 budget surplus would be shared with public employees who earned it, the bonus was killed by the Governor because it would have applied fairly to public workers and retirees.

    Frozen pay and increased costs for health care services is insulting enough. Cutting the benefits of public workers access to health care significantly reduces the quality of life for public workers and their families all across this state. Because of the statewide pay freeze, increased health costs imposed by the PEIA Finance Board is a pay cut for all public workers and public worker retirees. The same Finance Board Members have accepted thousands of dollars in pay raises while forcing a pay freeze on state workers.

    Take Action – Attend one of the following PEIA Finance Board Public Hearings and voice your objections to this planned increase in premiums, increased deductibles and benefit cuts by denying access to health care beyond the state line. The details of the PEIA 2011 Plan proposals are now available on the agency website. www.wvpeia.com

    Compare your pay raise to some of the PEIA Executive pay raises*
    PEIA Finance Board members and the PEIA executives pay is not frozen.
    PEIA Finance Board member Joe Smith, representing retired state employees, is employed as a Governor’s Office employee. Joe Smith is also a paid member (employee) of the Racing Commission. In addition to collecting retirement, and two sets of state paychecks, Joe Smith is also the chief enforcer of the Governor’s questionable pay freeze, while at the same time he is cutting benefits Joe Smith has been accepting thousands of dollars in pay raises at the Governor’s Office.
    PEIA Finance Board member Robert Ferguson, Secretary of the Department of Administration, has received $5,000 pay raises for each of the past two years. 2006 = $77,291; 2007 = $82,291; 2008 = $87,291
    PEIA Director, Ted Cheatham, was given a $5,000 raise. 2007 = $134,348; 2008 = $140,076
    PEIA Medical Director, Shelda Martin, got a $37,000 pay increase. 2007 = $133,013; 2008 = $171,873
    PEIA Deputy Director, Gloria Long, was given a $17,000 pay increase. 2007 = $81,308; 2008 = $98,293
    PEIA Finance Section, Clifford Myers, was given a $10,000 pay increase. 2007 = $52,808; 2008 = $62,909
    PEIA Supervisor, Sherra Barker, was given two $8,000 increases. 2006 = $36,115; 2007 = $44,332; 2008 = $52,638
    *All salary figures are from the WV State Auditors website from the WV State Employees Total Compensation searchable data bases. Joe Smith’s compensation was obtained by FOIA request and other public records.

    This PEIA 2011 plan will impose pay cuts on public employees while rewarding their own executives with pay raises.

    Say NO to the PEIA 2011 plan pay cuts for public workers.

    PEIA Public Hearings schedule – sign in to speak at 5:30, the hearings begin at 6:00 pm

    Monday, November 9
    Civic Center Little Theater
    200 Civic Center Drive
    Charleston, W.Va

    Tuesday, November 10
    Tamarack Theater
    One Tamarack Park
    Beckley, W.Va

    Monday, November 16
    Holiday Inn
    301 Fox Croft Ave.
    Martinsburg, W.Va

    Tuesday, November 17
    Ramada Inn
    20 Scott Ave.
    Morgantown, W.Va

    Wednesday, November 18
    West Virginia Northern Community College
    1704 Market Street
    Wheeling, W.Va

    Thursday, November 19
    Marshall University Medical School
    Harless Auditorium
    1600 Medical Center Drive
    Huntington, W.Va

    All union members are encouraged to attend at least one of the PEIA Finance Board Public Hearings and speak out in protest to this pay cut.

    Things to watch out for that indicate the PEIA Finance Board doesn’t really care what people think:
    Does the PEIA Finance Board have a quorum of Board Members in attendance at the public hearing?
    Is the public hearing being recorded and are notes being taken by someone from the agency so that there is a record of the comments?
    Does the moderator interrupt and offer his opinion contradicting the speaker when they should be listening to the concerns of the public employees?

    Petition for a Pay Raise.
    You can help public workers get a well deserved pay raise. Public workers and retirees in West Virginia deserve a pay raise, not a pay cut. Every study the state has done shows there is a problem recruiting and retaining employees to serve our government. You can help solve the state worker staff shortage all across West Virginia by helping to demand that the Legislature enact a cost of living increase for all public workers and public worker retirees. Sign our petition today calling for a cost of living pay raise of at least $1,000 for public workers and retirees. Say yes to a raise for our public workers”
     

     http://www.wvea.org/news/articles/PEIA_discussing_FY2011_plan,44.aspx
     Charleston Gazette
    “PEIA discussing FY2011 plan

    Published: September 25, 2009 8:00 AM
    By Phil Kabler

    September 24, 2009

    PEIA recipients face premium increases, benefit cuts

    By Phil Kabler

    Staff writer

    CHARLESTON, W.Va. — Public Employee Insurance Agency recipients could see 4 percent premium increases, and benefit cuts totaling $23 million next year, under a plan given preliminary approval Thursday by the PEIA Finance Board.

    As an alternative, board members tentatively approved offering a lower-priced plan for West Virginia-only coverage, which would pay for out-of-state health care only for emergencies or specialized treatment not offered in state.

    The proposed benefit cuts come just two months after the PEIA board voted to eliminate retiree health coverage for all public school and state employees hired after July 1, 2010 — an action intended to freeze a $7 billion unfunded liability in future retiree health costs.

    Thursday’s plan, which will be up for final approval in December, drew objections from employee representatives and retirees.

    “For us to send out any increase in premiums, or any reduction in benefits, after what we have done is appalling to me,” said public education representative Josh Sword, referring to the board’s vote in July.

    PEIA Executive Director Ted Cheatham noted that PEIA was formally served Thursday with a lawsuit filed by the West Virginia Education Association challenging the elimination of retiree health benefits for new hires.

    “We have taken it on the chin,” said Sword, a lobbyist with the West Virginia Federation of Teachers. “We took it on the chin last month when a $500 bonus was promised to public employees, and then snatched away from them. … Morale is at an all-time low.”

    Retired state employee Sandy Latimer told the board that many retirees can’t afford any increase in their health care costs.

    “I wonder how many more nails can be pounded into the retirees’ coffin?” Latimer asked the board.

    “Every year, PEIA takes away from retirees’ income, but state government does not add to it,” he said. “Retirees are having a tough time as it is.”

    Administration Secretary Robert Ferguson, who serves as the board’s chairman, said he understands that employees and retirees are struggling with health care costs, but said the board is mandated to come up with a financially sound plan.

    “The numbers are the numbers,” he said. “We have a fiduciary obligation, and a moral obligation, that whatever plan we adopt, we’ve got to be able to pay for.”

    In addition to 4 percent premium increases, the proposal calls for increasing annual deductibles for active employees and retirees by either $25 or $50 a year.

    It also would double the annual out-of-pocket maximum for family plans, based on employees’ salaries.

    The proposal does offer one benefit increase: increasing the lifetime maximum benefit for each insuree from $1 million to $1.5 million.

    Cheatham said there about 20 retirees who have reached the current lifetime maximum, but continue to receive coverage under the Medicare Advantage plan — a federally funded program that could end in the near future.

    “If they come back into PEIA, they won’t have any coverage,” he said.

    The proposal also calls for creation of a “high performance” prescription drug formulary that covers only a very limited number of brand-name drugs, cutting PEIA’s costs by about $8 million a year.

    In order to cut premium costs, employees would have the option of switching to a new West Virginia-only plan. Under that coverage, PEIA would cover expenses for out-of-state care only for emergencies, or for patients referred for specialty care, but only at the Cleveland Clinic or Duke University.

    With costs for out-of-state claims running about five times higher than in-state claims, that plan would save PEIA an additional $9.5 million a year, Cheatham said.

    However, he conceded the proposal could be controversial in border counties, particularly in the Eastern Panhandle, where there are no in-state providers of services such as advanced cardiac care.

    “They’re not going to perceive it as, “You’re saving me money,” Cheatham said. “They’re going to perceive it as, “You’re punishing me for living in the Eastern Panhandle.”

     The Finance Board will conduct a series of public hearings around the state on the proposed 2010-11 plan, with a final vote on the plan slated for its December meeting. “

     
     

    PEIA Finance Board unveils FY 2011 plan

    WVEA opposed to a number of proposals
     
    Thursday, October 22, WVEA President Dale Lee attended the PEIA Finance Board meeting. During the public comment segment of the meeting, President Lee stated that WVEA is very disappointed and concerned about stripping retirement subsidy benefits of new employees while the board continues to increase premiums and deductibles.

    WVEA opposes increasing employee’s premiums without increasing employee’s salaries.  WVEA understands the rising cost of health care, however, school employees have not received a pay increase in more than two years and had a $500 bonus snatched from them in September.

    WVEA is committed to ensure that PEIA provides an adequate benefit to employees and those benefits be provided at the lowest possible cost to members. It is unheard of today that the State of WV expects to get by with only a 4% increase in health insurance costs and dump the balance on the backs of hard-working school employees and state employees.  Furthermore, WVEA has real problems with proposed concepts that single-out classes of employees (i.e. obese) and charging those individuals higher premiums.

    In addition, WVEA is further concerned that the proposed plan includes at least an 11% employee premium increase in the 2012 plan; 12% in 2013; and 11% in 2014. The increasing cost of health care is a problem that must be addressed; the answer must not be simply to place the burden on the backs of employees. 

    Finally, the Finance Board is considering, at the Governor’s request, imposing a a possible premium reduction for those who live healthy lifestyles.  WVEA has real problems with the proposal:

    1  What is the definition of a healthy lifestyle?  What is the procedure for gathering that information on any insured? 
    2  PEIA should be promoting good health practices if they truly encourage healthy lifestyles.  They should expand their assistance efforts

    3  In may parts of our state employees do not have available to them the kinds of programs that assist employees with weight management or lifestyle programs. In fact, many counties in WV do not even have a YMCA. How will PEIA ensure equitable opportunities for healthy lifestyles in those areas

    During the meeting, the board voted on a proposed plan that will be taken to public hearings in November.  The plan proposes premium and benefit plan changes for next fiscal year, which begins in July 2010. 

     
     
     The proposed changes include: 
     
    * A 4% increase in Governor Manchin’s funding of PEIA
     
    * A 4% average increase in premiums for active employees and retirees -
              (However, certain income tier increases will be higher and others lower).
     
    Example of premium increases for employees earning between $36,001 and $42,000

      Employee only Employee & child Family Employee spouse
    Plan A From $50 to $54 From $94 to $102 From $187 to $202 From $130 to $140
    Plan B From $26 to $27 From $42 to $44 From $130 to $135 From $82 to $85
    Plan C (new) $52 $98 $194 $135

     
    * A 5% benefit reduction in the form of increased deductibles and out of pocket maximums.
     
    * Creation of a new in-state only plan, titled Plan C, requires the use of West Virginia health care providers for all health services. In addition, agreements would exist with Duke University Hospital and the Cleveland Clinic to provide some specialty care services.  Details of this new plan are not yet complete.
     
     
    Proposed changes to PEIA PPB Plan A - 
     
    Increase annual deductible by either $25 or $50.
     
    Example of a $25 annual deductable increase for employees earning $36,001 and $42,000.

      Employee only Employee & child Family Employee spouse
    Plan A From $225 to $250 From $450 to $500 From $450 to $500 From $450 to $500
    Plan C $250 $500 $500 $500

     
    Example of a $50 annual deductable increase for employees earning $36,001 and $42,000. 

      Employee only Employee & child Family Employee spouse
    Plan A From $225 to $275 From $450 to $525 From $450 to $525 From $450 to $525
    Plan C $275 $525 $525 $525

     
                                
    Increase the family Maximum Out Of Pocket (MOOP) to double that of the individual maximum. 
     
    For members earning between $36,001 and $42,000.

                Employee only Employee & child(ren) Family Employee spouse
    Plan A Remains $1500 From $1,500 to $3,000 From $1,500 to $3,000 From $1,500 to $3,000
    Plan C $1500 $3000 $3000 $3000

     
             
    Increase lifetime maximum from $1 million to $1.5 million. 
     
     
     Proposed changes to PEIA PPB Plan B
     
    Dramatic Increases in Deductibles
     
    Increase in Deductable for employees earning between $36,001 to $42,000

                Employee only Employee & child Family Employee spouse
    Plan B From $500 to $1100  From $1100 to $2200  From $1100 to 2200 From $1100 to $2200

     
    Increase the family Maximum Out Of Pocket (MOOP) for the Employee Only plan and double that of the individual maximum for Employee with Child (ren), Family and Family with Employee Spouse plans.
     
    MOOP for Plan B members earning between $36,001 and $42,000 increases

                Employee only Employee & child Family Employee spouse
    Plan B From $2000 to $4500 From $4000 to $9000 From $4000 to $9000 From $4000 to $9000

     
    Plan B participants would also be offered a Health Savings Account (HSA) under the proposed plan.  Health Savings accounts involve pre-tax contributions placed into specified accounts to pay for qualifying medical distributions. Earnings from HSAs are tax-free.  The participant owns and controls the account.  Contributions made in one year can be used in subsequent years to pay eligible medical expenses
     
     Proposed Changes for all PEIA participants 
     
    PharmacyPEIA plans to adopt a High Performance Formulary.  This maximizes some brand rebates and moves some drugs to higher copay tiers – which will result in 9.4% of participants seeing a tier increase, therefore resulting in higher costs while 1.5% of participants will see a tier decrease, resulting in savings.  PEIA believes that increased utilization of generic drugs would lower costs.
     

    Non-employee spouses covered by PEIA
    - If a PEIA member’s spouse has the option of enrolling in health insurance coverage with his or her employer, and the spouse elects or elected to forgo that coverage for enrollment in PEIA, there would be a $50 per month premium increase.
     
    Living Will – Under this proposed plan change, any PEIA member providing an affidavit to PEIA verifying he or she executed a living will receives a premium reduction similar to the tobacco-free premium reduction.  There is some confusion surrounding the logistics of the reduction.  Originally, the proposed concept allows an employee to receive either a tobacco free reduction or a living will reduction, but not both.  Dale Lee, President of WVEA, suggested in if this option is selected, PEIA should provide three tiers- one for tobacco free, one for living will and a third for both.
     
    Proposed Changes for Retirees
     
    Retirees would see an average of 4% increases in premiums
     
    Retiree Assistance Program- which provides premium reductions to certain retirees meeting income guidelines is increased at all levels and the Maximum Out Of Pocket (MOOP) is $300 opposed to $750 for qualifying retirees.

    Click here for the dates and locations of the public hearings.   “

     
     
    http://wvea.org/news/default.aspx
    http://wveapresblog.blogspot.com/

    “WVEA President’s Blog

    By WVEA President Dale Lee

    Here We Go Again

    President’s Blog
    October 27, 2009

    The air is getting that familiar chill, the leaves have turned and the holidays are just around the corner. This means the annual PEIA Public Hearings are upon us. This past Thursday (October 22) the Finance Board met to adopt the plan to present at the public hearings. Once again, we were the only organization to speak at the Finance Board meeting. As I voiced my concerns about the plan, I assured the Finance Board we would be a loud voice at the Public Hearings.

    As we all know, the cost of health care continues to skyrocket no matter where you are employed, but to expect the employees to bear the blunt of the cost when there have been no pay increases in two years is just plain wrong. The Governor likes to say we need to look at what is happening in the private sector and I can assure you, no business in the private sector is getting by with a 4% increase in health care.

    Adding a West Virginia only plan is also punitive to those school employees in border counties, especially the Eastern Panhandle. Their choices in health care are limited, and to expect a higher premium is wrong. Last year, the Finance Board proposed a 70/30 plan which would have paid out of state providers only 70% of the cost leaving the employee paying 30%. Through our efforts, we were able to defeat that proposal. This is just another version of the same song. We must speak loudly.

    Finally, the proposal to examine a “fat tax” is highly discriminatory and just plain wrong. I voiced my concern at the Finance Board meeting and again to the Governor. The Governor has backed off this saying it is “off the table.” However, unless the Finance Board meets again to take it off the Public Hearing agenda, we must be prepared to speak out. I understand it is better to identify health problems such as diabetes, high blood pressure, etc. early, but to take this to the extreme suggested is a highly punitive measure. We should be encouraging wellness programs, not to penalize a few. We should come to the hearings prepared to offer recommendations on promoting healthy life styles.

    As I continue to say, we must stand strong and united. This is just another attack. Together, we can be successful.


    Date: Mon, 26 Oct 2009 19:40:20 +0000
    From: info@aftwv.org
    To: mariwv@hotmail.com
    Subject: PEIA Alert

    AFT West Virginia
    Home Calendar Hot Topics About Us AFT-WV President & Executive Board Recent News Political Action Member Benefits Publications and Reports Press Center Professional Development and Enrichment Higher Education AFT-WV Locals Resources Useful Links Just For Parents Photo Albums AFT.org Contact Us
    Dear Marilyn Howells,

    2010 PEIA Proposed Plan & Talking Points

    The PEIA Finance Board met on Thursday, October 22, 2009, and adopted a preliminary plan (effective July 1, 2010).  The proposed plan represents cost-shifting at its worst and will create severe economic hardships for many PEIA plan participants if enacted.  Some provisions of the plan may constitute a violation of our constitutional rights.  AFT-WV will be present at all the public hearings to make our voices heard and may be pursuing legal avenues to prevent some of the PEIA Finance Board’s proposals from being enacted if they are ultimately adopted by the Board . 
    Their proposal will be presented at public hearings (see below) for your comments and includes the following:
    I.  Premium and out-of-pocket increases:

    • A 4% increase in premiums for both employees and employers;
    • An increase in deductibles:
      • Either $25.00 or $50.00 for active employees;
      • $25.00 for retirees;
    • An increase in the maximum out-of-pocket costs for family plans – the amount will be equal to double the rate for a single plan.  Your out-of-pocket maximum depends on your employment status, salary, where you receive your services, whether your provider is in network and whether you have prior approval.
      • For example, a teacher making $40,000, their out-of-pocket maximum for the family plan moves from $1,500 to $3,000.
      • For example, a school service employee making $22,000, their out-of-pocket maximum for the family plan moves from $1,100 to $2,200.

    II. Benefit reductions:

    • A change in the prescription drug formulary;
      • Many drugs will be moved to a higher tier thereby resulting in higher costs.
    • The creation of a new WV plan (this will be optional) that will limit employees to receiving care in West Virginia.  If there is a need for specialty care, plan participants will have access to limited care and services at the Cleveland Clinic and Duke University.

    III. As well as these potential changes:

    • A requirement that all employees will have to undergo blood work and other testing.
      • Failure to undergo the blood test will result in an increase in premiums.
    • A requirement that employees sign an affidavit that they have a living will on file.
    • Public employee’s spouses, who have access to health care through employer but choose a PEIA family plan, will have to pay a higher premium.

    The only “good news” is that the lifetime cap on benefits is increased from $1 million to $1.5 million.
    These are only proposals and they will be the subject of the public hearings.  The public hearings are as follows (registration at 5:30, hearing starts at 6:00 pm).

    Monday, Nov. 9, 2009 – Civic Center, Little Theater, Charleston
    Tuesday, Nov. 10, 2009 – Tamarack Theatre, Beckley

    Monday, Nov. 16, 2009 – Holiday Inn, 301 Fox Croft Ave., Martinsburg

    Tuesday, Nov. 17, 2009 – Ramada Inn, 20 Scott Ave.
    Morgantown
    Wednesday, Nov. 18, 2009 – West Virginia Northern Community College, Wheeling
    Thursday, Nov. 19, 2009 – Marshall University Medical School, Harless Auditorium, Huntington
    Talking Points

    • In light of the PEIA Finance Board’s recent decision to eliminate the retiree subsidy for new hires, which will free up billions and billions of state dollars, why is it necessary for the Board to cut our benefits?
    • The actuary hired by AFT-WV demonstrated that the OPEB liability is only $3.2 billion, not the $7.8 billion claimed by PEIA.  If we can’t trust PEIA’s figures as they relate to the OPEB liability, how can we trust PEIA’s assessment that premiums must be increased and benefits must be reduced to make the plan solvent?
    • Is it constitutional for the PEIA Finance Board to:
      • Require employees to complete a living will?
      • Require employees to complete blood work tests?
    • Is it fair to penalize family plan participants for choosing PEIA for coverage over a spouse’s employer offered plan?
    • In many cases, the spouse’s employer offered plan may be inferior than the one offered by PEIA.
    • Given that we have not had a salary increase since 2008 and since the Governor has already stated that a raise is not in the near future, is it fair to increase premiums for the second year in a row?
    • A doubling of the out-of-pocket maximum for family plan participants is an outrageous example of cost-shifting from the employer to the employee.

    AFT-WV urges you to attend the public hearing in your area.  In addition to expressing our outrage over these Draconian proposals, AFT-WV may pursue legal action to stop these attacks on our health care depending upon the Board’s ultimate action.  
    Below is link PEIA Public hearing  handout.Also at there website home page if you click on the public hearing announcement to  http://www.westvirginia.com/peia/page.cfm?parent=&section=118&storyid=6222. Click on the blue text about the 2011 financilal plan  and it will take you to presentation.
     
    This contains a quick summary of some changes, listing of Public hearings and a few news articles, and some info from various union web site. WVAFT, WVEA, WVPWU and also link above to Public Hearing Presentation
     
    Summary of some proposed changes:
    They are projecting  outrageous premium increases totaling about 60% over the 5 year period of plan years 2010 to 2014 (that includes this year’s increase),
      Raising deductibles in  Plan A as much as $50 for some, and 140% in plan B to $1200 and $2400, 
    and raising Family Out of Pocket Maximums by double,  and even more than double (140% for plan B to $9,000).
    All the while increasing copays on 49 drugs, by moving them to a different tier from $15 to $50 tier copay, which will affect 9% of the actives, and 33% of retirees.  (How long until they add a few hundred more medications to this higher bracket and raise it to $100 copay?)
    Plus they want to tie end of care directives to premiums, and dictate to whom  give it.
    (Require you to give to doctor, rather than you choosing say trusted relative and or lawyer. When you give it to doctor it’s really the whole practive, and might this not go to hospital, etc. with any general release of medical information?  Plus would not it be scanned and stored electronically with your other records? When you go into the hosptal in emergency there’s no guarantee you will get your doctor or anyone in same practice!).
    Also they’re talking about a WV only option for Care that penalizes those in border counties. Exposes them to double deductibles, double copays, and the difference between PEIA and hospital charge.
    PEIA has 100,000 members and 100,000 dependents, about 1 in every 9 people in the state.

    You can stop this if we all try.
     Go to peiawatch.wordpress.com for tips to help.
     
    The Public Hearings
    Registration for the hearings will begin at 5:30 p.m., and the hearings will start at 6 p.m. If you wish to testify at the hearing, you must indicate that at registration.

    The hearings will be held as follows:

    Monday, Nov. 9, 2009
    Civic Center, Little Theater
    200 Civic Center Drive
    Charleston, W.Va.

    Tuesday, Nov. 10, 2009
    Tamarack Theatre
    One Tamarack Park
    Beckley, W.Va.

    Monday, Nov. 16, 2009
    Holiday Inn
    301 Fox Croft Ave.
    Martinsburg, W.Va.

    Tuesday, Nov. 17, 2009
    Ramada Inn
    20 Scott Ave.
    Morgantown, W.Va.

    Wednesday, Nov. 18, 2009
    West Virginia Northern Community College
    1704 Market Street
    Wheeling, W.Va.

    Thursday, Nov. 19, 2009
    Marshall University Medical School, Harless Auditorium
    1600 Medical Center Drive
    Huntington, W.Va.

    If you can’t attend a hearing in person, you can submit comments in writing to:

    PEIA Finance Board
    601 57th St., SE
    Charleston, WV 25304
    Or via e-mail to: peia.help@wv.gov

    Customer Service
    PEIA will provide customer service in each location from 4-6 p.m. If you have questions about medical, prescription or life insurance benefits, come early and get answers from the PEIA staff.

    http://www.wvgazette.com/News/200911090805?page=2&build=cache
     
     

    November 9, 2009
    Testy crowd objects to squeezing PEIA
    Chip Ellis
    Robert Morgenstern, with the West Virginia Federation of Teachers, questions PEIA Executive Director Ted Cheatham as members of an often-testy crowd listen.
    Staff writer
     
     
    CHARLESTON, W.Va. — A testy crowd of about 80 voiced objections to proposed premium increases and benefit cuts in Public Employees Insurance Agency coverage, during a public hearing Monday in Charleston.
    Audience members frequently interrupted PEIA executive director Ted Cheatham’s presentation of the proposed 2010-11 coverage plan with questions, comments and catcalls.
    At one point, Administration Secretary Robert Ferguson admonished the crowd to tone down its interjections.
    “We’re not here to debate. We’re here to hear your proposals,” he told the audience.
    Besides premium increases of an average of 4 percent – and 8 percent for the most common Plan A coverage – the 2010-11 plan proposes increasing annual deductibles by $50, and increasing out-of-pocket maximums for family coverage by an average of $1,500 a year.
    “This is just a blatant money grab from the pockets of employees,” West Virginia Education Association President Dale Lee said. “Keep in mind these employees are among the lowest paid in the nation and are the backbone of our state’s workforce. You should be ashamed.”
    PEIA also brought several controversial proposals to the table for Monday’s hearing, including:
     
  • Possible higher premiums for overweight insurees.
     
     
  • A $50-a-month penalty for employees who carry their spouse on their PEIA coverage, when the spouse has health insurance available from his or her employer.
     
     
  • A premium discount for non-tobacco users who verify they have executed a living will that includes end-of-life directives.
     
     
  • A lower-cost health insurance option, but one that would only cover in-state medical care. PEIA would reimburse costs for out-of-state medical care only for emergencies, or for specialized treatment for patients referred to either the Cleveland Clinic or Duke University Medical Center.
     
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    CHARLESTON, W.Va. — A testy crowd of about 80 voiced objections to proposed premium increases and benefit cuts in Public Employees Insurance Agency coverage, during a public hearing Monday in Charleston. Audience members frequently interrupted PEIA executive director Ted Cheatham’s presentation of the proposed 2010-11 coverage plan with questions, comments and catcalls.
    At one point, Administration Secretary Robert Ferguson admonished the crowd to tone down its interjections.
    “We’re not here to debate. We’re here to hear your proposals,” he told the audience.
    Besides premium increases of an average of 4 percent – and 8 percent for the most common Plan A coverage – the 2010-11 plan proposes increasing annual deductibles by $50, and increasing out-of-pocket maximums for family coverage by an average of $1,500 a year.
    “This is just a blatant money grab from the pockets of employees,” West Virginia Education Association President Dale Lee said. “Keep in mind these employees are among the lowest paid in the nation and are the backbone of our state’s workforce. You should be ashamed.”
    PEIA also brought several controversial proposals to the table for Monday’s hearing, including:
     

  • Possible higher premiums for overweight insurees.  
     
  • A $50-a-month penalty for employees who carry their spouse on their PEIA coverage, when the spouse has health insurance available from his or her employer.  
     
  • A premium discount for non-tobacco users who verify they have executed a living will that includes end-of-life directives.  
     
  • A lower-cost health insurance option, but one that would only cover in-state medical care. PEIA would reimburse costs for out-of-state medical care only for emergencies, or for specialized treatment for patients referred to either the Cleveland Clinic or Duke University Medical Center.  
    Mary Anthalz told the PEIA Finance Board she objects to PEIA charging higher premiums for behavioral issues – as PEIA currently does for tobacco users, and is considering imposing for overweight insurees.
    “Obesity can take 10 years off your life,” she said. “That’s a whole lot of claims you don’t have, not to mention pensions.”
    Cheatham and the audience debated at length whether the proposal is “wellness incentive” as he termed it, or a “fat tax” – as some speakers dubbed it.
    “You’ve never heard me use that term, or the governor use that term,” Cheatham commented.
    West Virginia Federation of Teachers President Judy Hale decried the proposals as part of PEIA’s continuing efforts to shift more of the burden for health-care costs from the state onto its employees.
    Hale also said she does not believe the public opposition will sway the Finance Board.
    “These hearings, as well as the ones we had this past summer, are just for show,” she said.
    Hale was referring to public hearings that drew unanimous opposition to a PEIA proposal to eliminate retiree health insurance subsidies for all public school and state employees hired after June 30, 2010.
    Despite the opposition, the Finance Board voted last July to eliminate the benefit, which has been causing a multibillion-dollar unfunded liability for PEIA.
    Meanwhile, Bruce Dotson with the state Public Workers Union UE 170, dismissed the proposed “fat tax” and spousal-coverage penalty as “gimmicks.”
    “Selling insurance by the pound, or taxing workers who have spouses with employer-provided coverage – these are just the kind of schemes you’d expect from overpaid bureaucrats,” Dotson said.
    About a dozen UE 170 members picketed in front of the Charleston Civic Center Little Theater prior to the public hearing.
    After Monday’s hearing, the Finance Board goes on to Beckley this evening, and will host public hearings in Martinsburg, Morgantown, Wheeling and Huntington next week.
    A final vote on the 2010-11 benefits plan is set for Dec. 3, with the new coverage going into effect next July 1.
    Reach Phil Kabler at ph…@wvgazette.com or 304-348-1220.
  •  
     
     
    From Public Workers Union    http://www.uelocal170.org/
    PEIA Finance Board Picks Workers Pockets AgainPublic workers have taken up the slack for statewide staffing vacancies throughout the Manchin Administration, suffering with years of frozen pay and increased expenses imposed by the PEIA Finance Board, the so called employee benefit provider. By increasing the employee deductibles, increasing the employee’s share of premiums and by cutting employee benefits denying access to out of state health care, the PEIA Finance Board has planned to impose draconian cost saving measures at the expense of every state employee’s physical and financial health, endangering the welfare of every public worker and our families.

    As the WV Public Workers Union has previously reported, the 2009 state employee budget surplus bonus proposal was pulled off the table at the request of Governor Manchin when the WV House of Delegates attempted to make the bonus as fair as possible for public workers and retirees. According to State Tax Department Officials, West Virginia realized a 2009 fiscal year state budget surplus of $168 million dollars because of the statewide staff shortages. Even though several times Governor Manchin promised that any 2009 budget surplus would be shared with public employees who earned it, the bonus was killed by the Governor because it would have applied fairly to public workers and retirees.

    Frozen pay and increased costs for health care services is insulting enough. Cutting the benefits of public workers access to health care significantly reduces the quality of life for public workers and their families all across this state. Because of the statewide pay freeze, increased health costs imposed by the PEIA Finance Board is a pay cut for all public workers and public worker retirees. The same Finance Board Members have accepted thousands of dollars in pay raises while forcing a pay freeze on state workers.

    Take Action – Attend one of the following PEIA Finance Board Public Hearings and voice your objections to this planned increase in premiums, increased deductibles and benefit cuts by denying access to health care beyond the state line. The details of the PEIA 2011 Plan proposals are now available on the agency website. www.wvpeia.com

    Compare your pay raise to some of the PEIA Executive pay raises*
    PEIA Finance Board members and the PEIA executives pay is not frozen.
    PEIA Finance Board member Joe Smith, representing retired state employees, is employed as a Governor’s Office employee. Joe Smith is also a paid member (employee) of the Racing Commission. In addition to collecting retirement, and two sets of state paychecks, Joe Smith is also the chief enforcer of the Governor’s questionable pay freeze, while at the same time he is cutting benefits Joe Smith has been accepting thousands of dollars in pay raises at the Governor’s Office.
    PEIA Finance Board member Robert Ferguson, Secretary of the Department of Administration, has received $5,000 pay raises for each of the past two years. 2006 = $77,291; 2007 = $82,291; 2008 = $87,291
    PEIA Director, Ted Cheatham, was given a $5,000 raise. 2007 = $134,348; 2008 = $140,076
    PEIA Medical Director, Shelda Martin, got a $37,000 pay increase. 2007 = $133,013; 2008 = $171,873
    PEIA Deputy Director, Gloria Long, was given a $17,000 pay increase. 2007 = $81,308; 2008 = $98,293
    PEIA Finance Section, Clifford Myers, was given a $10,000 pay increase. 2007 = $52,808; 2008 = $62,909
    PEIA Supervisor, Sherra Barker, was given two $8,000 increases. 2006 = $36,115; 2007 = $44,332; 2008 = $52,638
    *All salary figures are from the WV State Auditors website from the WV State Employees Total Compensation searchable data bases. Joe Smith’s compensation was obtained by FOIA request and other public records.

    This PEIA 2011 plan will impose pay cuts on public employees while rewarding their own executives with pay raises.

    Say NO to the PEIA 2011 plan pay cuts for public workers.

    PEIA Public Hearings schedule – sign in to speak at 5:30, the hearings begin at 6:00 pm

    Monday, November 9
    Civic Center Little Theater
    200 Civic Center Drive
    Charleston, W.Va

    Tuesday, November 10
    Tamarack Theater
    One Tamarack Park
    Beckley, W.Va

    Monday, November 16
    Holiday Inn
    301 Fox Croft Ave.
    Martinsburg, W.Va

    Tuesday, November 17
    Ramada Inn
    20 Scott Ave.
    Morgantown, W.Va

    Wednesday, November 18
    West Virginia Northern Community College
    1704 Market Street
    Wheeling, W.Va

    Thursday, November 19
    Marshall University Medical School
    Harless Auditorium
    1600 Medical Center Drive
    Huntington, W.Va

    All union members are encouraged to attend at least one of the PEIA Finance Board Public Hearings and speak out in protest to this pay cut.

    Things to watch out for that indicate the PEIA Finance Board doesn’t really care what people think:
    Does the PEIA Finance Board have a quorum of Board Members in attendance at the public hearing?
    Is the public hearing being recorded and are notes being taken by someone from the agency so that there is a record of the comments?
    Does the moderator interrupt and offer his opinion contradicting the speaker when they should be listening to the concerns of the public employees?

    Petition for a Pay Raise.
    You can help public workers get a well deserved pay raise. Public workers and retirees in West Virginia deserve a pay raise, not a pay cut. Every study the state has done shows there is a problem recruiting and retaining employees to serve our government. You can help solve the state worker staff shortage all across West Virginia by helping to demand that the Legislature enact a cost of living increase for all public workers and public worker retirees. Sign our petition today calling for a cost of living pay raise of at least $1,000 for public workers and retirees. Say yes to a raise for our public workers
     

     http://www.wvea.org/news/articles/PEIA_discussing_FY2011_plan,44.aspx
     

    PEIA discussing FY2011 plan

    Published: September 25, 2009 8:00 AM
    By Phil Kabler

    September 24, 2009

    PEIA recipients face premium increases, benefit cuts

    By Phil Kabler

    Staff writer

    CHARLESTON, W.Va. — Public Employee Insurance Agency recipients could see 4 percent premium increases, and benefit cuts totaling $23 million next year, under a plan given preliminary approval Thursday by the PEIA Finance Board.

    As an alternative, board members tentatively approved offering a lower-priced plan for West Virginia-only coverage, which would pay for out-of-state health care only for emergencies or specialized treatment not offered in state.

    The proposed benefit cuts come just two months after the PEIA board voted to eliminate retiree health coverage for all public school and state employees hired after July 1, 2010 — an action intended to freeze a $7 billion unfunded liability in future retiree health costs.

    Thursday’s plan, which will be up for final approval in December, drew objections from employee representatives and retirees.

    “For us to send out any increase in premiums, or any reduction in benefits, after what we have done is appalling to me,” said public education representative Josh Sword, referring to the board’s vote in July.

    PEIA Executive Director Ted Cheatham noted that PEIA was formally served Thursday with a lawsuit filed by the West Virginia Education Association challenging the elimination of retiree health benefits for new hires.

    “We have taken it on the chin,” said Sword, a lobbyist with the West Virginia Federation of Teachers. “We took it on the chin last month when a $500 bonus was promised to public employees, and then snatched away from them. … Morale is at an all-time low.”

    Retired state employee Sandy Latimer told the board that many retirees can’t afford any increase in their health care costs.

    “I wonder how many more nails can be pounded into the retirees’ coffin?” Latimer asked the board.

    “Every year, PEIA takes away from retirees’ income, but state government does not add to it,” he said. “Retirees are having a tough time as it is.”

    Administration Secretary Robert Ferguson, who serves as the board’s chairman, said he understands that employees and retirees are struggling with health care costs, but said the board is mandated to come up with a financially sound plan.

    “The numbers are the numbers,” he said. “We have a fiduciary obligation, and a moral obligation, that whatever plan we adopt, we’ve got to be able to pay for.”

    In addition to 4 percent premium increases, the proposal calls for increasing annual deductibles for active employees and retirees by either $25 or $50 a year.

    It also would double the annual out-of-pocket maximum for family plans, based on employees’ salaries.

    The proposal does offer one benefit increase: increasing the lifetime maximum benefit for each insuree from $1 million to $1.5 million.

    Cheatham said there about 20 retirees who have reached the current lifetime maximum, but continue to receive coverage under the Medicare Advantage plan — a federally funded program that could end in the near future.

    “If they come back into PEIA, they won’t have any coverage,” he said.

    The proposal also calls for creation of a “high performance” prescription drug formulary that covers only a very limited number of brand-name drugs, cutting PEIA’s costs by about $8 million a year.

    In order to cut premium costs, employees would have the option of switching to a new West Virginia-only plan. Under that coverage, PEIA would cover expenses for out-of-state care only for emergencies, or for patients referred for specialty care, but only at the Cleveland Clinic or Duke University.

    With costs for out-of-state claims running about five times higher than in-state claims, that plan would save PEIA an additional $9.5 million a year, Cheatham said.

    However, he conceded the proposal could be controversial in border counties, particularly in the Eastern Panhandle, where there are no in-state providers of services such as advanced cardiac care.

    “They’re not going to perceive it as, “You’re saving me money,” Cheatham said. “They’re going to perceive it as, “You’re punishing me for living in the Eastern Panhandle.”

     The Finance Board will conduct a series of public hearings around the state on the proposed 2010-11 plan, with a final vote on the plan slated for its December meeting.

     
     

    PEIA Finance Board unveils FY 2011 plan

    WVEA opposed to a number of proposals
     
    Thursday, October 22, WVEA President Dale Lee attended the PEIA Finance Board meeting. During the public comment segment of the meeting, President Lee stated that WVEA is very disappointed and concerned about stripping retirement subsidy benefits of new employees while the board continues to increase premiums and deductibles.

    WVEA opposes increasing employee’s premiums without increasing employee’s salaries.  WVEA understands the rising cost of health care, however, school employees have not received a pay increase in more than two years and had a $500 bonus snatched from them in September.

    WVEA is committed to ensure that PEIA provides an adequate benefit to employees and those benefits be provided at the lowest possible cost to members. It is unheard of today that the State of WV expects to get by with only a 4% increase in health insurance costs and dump the balance on the backs of hard-working school employees and state employees.  Furthermore, WVEA has real problems with proposed concepts that single-out classes of employees (i.e. obese) and charging those individuals higher premiums.

    In addition, WVEA is further concerned that the proposed plan includes at least an 11% employee premium increase in the 2012 plan; 12% in 2013; and 11% in 2014. The increasing cost of health care is a problem that must be addressed; the answer must not be simply to place the burden on the backs of employees. 

    Finally, the Finance Board is considering, at the Governor’s request, imposing a a possible premium reduction for those who live healthy lifestyles.  WVEA has real problems with the proposal:

    1  What is the definition of a healthy lifestyle?  What is the procedure for gathering that information on any insured? 
    2  PEIA should be promoting good health practices if they truly encourage healthy lifestyles.  They should expand their assistance efforts

    3  In may parts of our state employees do not have available to them the kinds of programs that assist employees with weight management or lifestyle programs. In fact, many counties in WV do not even have a YMCA. How will PEIA ensure equitable opportunities for healthy lifestyles in those areas

    During the meeting, the board voted on a proposed plan that will be taken to public hearings in November.  The plan proposes premium and benefit plan changes for next fiscal year, which begins in July 2010. 

     
     
     The proposed changes include: 
     
    * A 4% increase in Governor Manchin’s funding of PEIA
     
    * A 4% average increase in premiums for active employees and retirees -
              (However, certain income tier increases will be higher and others lower).
     
    Example of premium increases for employees earning between $36,001 and $42,000

      Employee only Employee & child Family Employee spouse
    Plan A From $50 to $54 From $94 to $102 From $187 to $202 From $130 to $140
    Plan B From $26 to $27 From $42 to $44 From $130 to $135 From $82 to $85
    Plan C (new) $52 $98 $194 $135

     
    * A 5% benefit reduction in the form of increased deductibles and out of pocket maximums.
     
    * Creation of a new in-state only plan, titled Plan C, requires the use of West Virginia health care providers for all health services. In addition, agreements would exist with Duke University Hospital and the Cleveland Clinic to provide some specialty care services.  Details of this new plan are not yet complete.
     
     
    Proposed changes to PEIA PPB Plan A - 
     
    Increase annual deductible by either $25 or $50.
     
    Example of a $25 annual deductable increase for employees earning $36,001 and $42,000.

      Employee only Employee & child Family Employee spouse
    Plan A From $225 to $250 From $450 to $500 From $450 to $500 From $450 to $500
    Plan C $250 $500 $500 $500

     
    Example of a $50 annual deductable increase for employees earning $36,001 and $42,000. 

      Employee only Employee & child Family Employee spouse
    Plan A From $225 to $275 From $450 to $525 From $450 to $525 From $450 to $525
    Plan C $275 $525 $525 $525

     
                                
    Increase the family Maximum Out Of Pocket (MOOP) to double that of the individual maximum. 
     
    For members earning between $36,001 and $42,000.

                Employee only Employee & child(ren) Family Employee spouse
    Plan A Remains $1500 From $1,500 to $3,000 From $1,500 to $3,000 From $1,500 to $3,000
    Plan C $1500 $3000 $3000 $3000

     
             
    Increase lifetime maximum from $1 million to $1.5 million. 
     
     
     Proposed changes to PEIA PPB Plan B
     
    Dramatic Increases in Deductibles
     
    Increase in Deductable for employees earning between $36,001 to $42,000

                Employee only Employee & child Family Employee spouse
    Plan B From $500 to $1100  From $1100 to $2200  From $1100 to 2200 From $1100 to $2200

     
    Increase the family Maximum Out Of Pocket (MOOP) for the Employee Only plan and double that of the individual maximum for Employee with Child (ren), Family and Family with Employee Spouse plans.
     
    MOOP for Plan B members earning between $36,001 and $42,000 increases

                Employee only Employee & child Family Employee spouse
    Plan B From $2000 to $4500 From $4000 to $9000 From $4000 to $9000 From $4000 to $9000

     
    Plan B participants would also be offered a Health Savings Account (HSA) under the proposed plan.  Health Savings accounts involve pre-tax contributions placed into specified accounts to pay for qualifying medical distributions. Earnings from HSAs are tax-free.  The participant owns and controls the account.  Contributions made in one year can be used in subsequent years to pay eligible medical expenses
     
     Proposed Changes for all PEIA participants 
     
    PharmacyPEIA plans to adopt a High Performance Formulary.  This maximizes some brand rebates and moves some drugs to higher copay tiers – which will result in 9.4% of participants seeing a tier increase, therefore resulting in higher costs while 1.5% of participants will see a tier decrease, resulting in savings.  PEIA believes that increased utilization of generic drugs would lower costs.
     

    Non-employee spouses covered by PEIA
    - If a PEIA member’s spouse has the option of enrolling in health insurance coverage with his or her employer, and the spouse elects or elected to forgo that coverage for enrollment in PEIA, there would be a $50 per month premium increase.
     
    Living Will – Under this proposed plan change, any PEIA member providing an affidavit to PEIA verifying he or she executed a living will receives a premium reduction similar to the tobacco-free premium reduction.  There is some confusion surrounding the logistics of the reduction.  Originally, the proposed concept allows an employee to receive either a tobacco free reduction or a living will reduction, but not both.  Dale Lee, President of WVEA, suggested in if this option is selected, PEIA should provide three tiers- one for tobacco free, one for living will and a third for both.
     
    Proposed Changes for Retirees
     
    Retirees would see an average of 4% increases in premiums
     
    Retiree Assistance Program- which provides premium reductions to certain retirees meeting income guidelines is increased at all levels and the Maximum Out Of Pocket (MOOP) is $300 opposed to $750 for qualifying retirees.

    Click here for the dates and locations of the public hearings.

     
     
    http://wvea.org/news/default.aspx
    http://wveapresblog.blogspot.com/

    WVEA President’s Blog

    By WVEA President Dale Lee

    President’s Blog
    October 27, 2009

    The air is getting that familiar chill, the leaves have turned and the holidays are just around the corner. This means the annual PEIA Public Hearings are upon us. This past Thursday (October 22) the Finance Board met to adopt the plan to present at the public hearings. Once again, we were the only organization to speak at the Finance Board meeting. As I voiced my concerns about the plan, I assured the Finance Board we would be a loud voice at the Public Hearings.

    As we all know, the cost of health care continues to skyrocket no matter where you are employed, but to expect the employees to bear the blunt of the cost when there have been no pay increases in two years is just plain wrong. The Governor likes to say we need to look at what is happening in the private sector and I can assure you, no business in the private sector is getting by with a 4% increase in health care.

    Adding a West Virginia only plan is also punitive to those school employees in border counties, especially the Eastern Panhandle. Their choices in health care are limited, and to expect a higher premium is wrong. Last year, the Finance Board proposed a 70/30 plan which would have paid out of state providers only 70% of the cost leaving the employee paying 30%. Through our efforts, we were able to defeat that proposal. This is just another version of the same song. We must speak loudly.

    Finally, the proposal to examine a “fat tax” is highly discriminatory and just plain wrong. I voiced my concern at the Finance Board meeting and again to the Governor. The Governor has backed off this saying it is “off the table.” However, unless the Finance Board meets again to take it off the Public Hearing agenda, we must be prepared to speak out. I understand it is better to identify health problems such as diabetes, high blood pressure, etc. early, but to take this to the extreme suggested is a highly punitive measure. We should be encouraging wellness programs, not to penalize a few. We should come to the hearings prepared to offer recommendations on promoting healthy life styles.

    As I continue to say, we must stand strong and united. This is just another attack. Together, we can be successful.


    Date: Mon, 26 Oct 2009 19:40:20 +0000
    From: info@aftwv.org

    AFT West Virginia
    Home Calendar Hot Topics About Us AFT-WV President & Executive Board Recent News Political Action Member Benefits Publications and Reports Press Center Professional Development and Enrichment Higher Education AFT-WV Locals Resources Useful Links Just For Parents Photo Albums AFT.org Contact Us
    Dear ,

    2010 PEIA Proposed Plan & Talking Points

    The PEIA Finance Board met on Thursday, October 22, 2009, and adopted a preliminary plan (effective July 1, 2010).  The proposed plan represents cost-shifting at its worst and will create severe economic hardships for many PEIA plan participants if enacted.  Some provisions of the plan may constitute a violation of our constitutional rights.  AFT-WV will be present at all the public hearings to make our voices heard and may be pursuing legal avenues to prevent some of the PEIA Finance Board’s proposals from being enacted if they are ultimately adopted by the Board . 
    Their proposal will be presented at public hearings (see below) for your comments and includes the following:
    I.  Premium and out-of-pocket increases:

    • A 4% increase in premiums for both employees and employers;
    • An increase in deductibles:
      • Either $25.00 or $50.00 for active employees;
      • $25.00 for retirees;
    • An increase in the maximum out-of-pocket costs for family plans – the amount will be equal to double the rate for a single plan.  Your out-of-pocket maximum depends on your employment status, salary, where you receive your services, whether your provider is in network and whether you have prior approval.
      • For example, a teacher making $40,000, their out-of-pocket maximum for the family plan moves from $1,500 to $3,000.
      • For example, a school service employee making $22,000, their out-of-pocket maximum for the family plan moves from $1,100 to $2,200.

    II. Benefit reductions:

    • A change in the prescription drug formulary;
      • Many drugs will be moved to a higher tier thereby resulting in higher costs.
    • The creation of a new WV plan (this will be optional) that will limit employees to receiving care in West Virginia.  If there is a need for specialty care, plan participants will have access to limited care and services at the Cleveland Clinic and Duke University.

    III. As well as these potential changes:

    • A requirement that all employees will have to undergo blood work and other testing.
      • Failure to undergo the blood test will result in an increase in premiums.
    • A requirement that employees sign an affidavit that they have a living will on file.
    • Public employee’s spouses, who have access to health care through employer but choose a PEIA family plan, will have to pay a higher premium.

    The only “good news” is that the lifetime cap on benefits is increased from $1 million to $1.5 million.
    These are only proposals and they will be the subject of the public hearings.  The public hearings are as follows (registration at 5:30, hearing starts at 6:00 pm).

    Monday, Nov. 9, 2009 – Civic Center, Little Theater, Charleston
    Tuesday, Nov. 10, 2009 – Tamarack Theatre, Beckley

    Monday, Nov. 16, 2009 – Holiday Inn, 301 Fox Croft Ave., Martinsburg

    Tuesday, Nov. 17, 2009 – Ramada Inn, 20 Scott Ave.
    Morgantown
    Wednesday, Nov. 18, 2009 – West Virginia Northern Community College, Wheeling
    Thursday, Nov. 19, 2009 – Marshall University Medical School, Harless Auditorium, Huntington
    Talking Points

    • In light of the PEIA Finance Board’s recent decision to eliminate the retiree subsidy for new hires, which will free up billions and billions of state dollars, why is it necessary for the Board to cut our benefits?
    • The actuary hired by AFT-WV demonstrated that the OPEB liability is only $3.2 billion, not the $7.8 billion claimed by PEIA.  If we can’t trust PEIA’s figures as they relate to the OPEB liability, how can we trust PEIA’s assessment that premiums must be increased and benefits must be reduced to make the plan solvent?
    • Is it constitutional for the PEIA Finance Board to:
      • Require employees to complete a living will?
      • Require employees to complete blood work tests?
    • Is it fair to penalize family plan participants for choosing PEIA for coverage over a spouse’s employer offered plan?
    • In many cases, the spouse’s employer offered plan may be inferior than the one offered by PEIA.
    • Given that we have not had a salary increase since 2008 and since the Governor has already stated that a raise is not in the near future, is it fair to increase premiums for the second year in a row?
    • A doubling of the out-of-pocket maximum for family plan participants is an outrageous example of cost-shifting from the employer to the employee.

    AFT-WV urges you to attend the public hearing in your area.  In addition to expressing our outrage over these Draconian proposals, AFT-WV may pursue legal action to stop these attacks on our health care depending upon the Board’s ultimate action.  

    The Public Employees Insurance Agency Finance Board has once again proposed to pick state workers pockets. After years of a questionable pay freeze imposed by the Governor’s contract employee on the PEIA Finance Board, who at the same time pretends to represent retired public workers while holding three state jobs and has accepted numerous pay increases and offers tens of thousands of dollars in raises for Governor’s office staff, who now votes to further cut public workers pay. The Governor’s handpicked PEIA Finance Board has continued to take back the pay earned by public workers through benefit cuts, increased co-pays and increase deductibles while members of the PEIA Finance Board enforce a pay freeze while some of these same board members have been collecting hefty pay increases. With the stroke of a pen the PEIA Finance Board has proposed to cut the pay of public workers and offers nothing of value in return for their so called “cost saving” proposal. A tough time attracting people to work for West Virginia just got much more difficult because the low pay just got lower.

    The Public Employees Insurance Agency Finance Board has once again proposed to pick state workers pockets. After years of a questionable pay freeze imposed by the Governor’s contract employee on the PEIA Finance Board, who at the same time pretends to represent retired public workers while holding three state jobs and has accepted numerous pay increases and offers tens of thousands of dollars in raises for Governor’s office staff, who now votes to further cut public workers pay. The Governor’s handpicked PEIA Finance Board has continued to take back the pay earned by public workers through benefit cuts, increased co-pays and increase deductibles while members of the PEIA Finance Board enforce a pay freeze while some of these same board members have been collecting hefty pay increases. With the stroke of a pen the PEIA Finance Board has proposed to cut the pay of public workers and offers nothing of value in return for their so called “cost saving” proposal. A tough time attracting people to work for West Virginia just got much more difficult because the low pay just got lower.


    What’s New; PEIA Takes Away More Benefits

    July 8, 2009

    Now PEIA is planning to take away more benefits from retirees and actives when they retire !!!

    What’s new at this site .

    1.  There are  2 tabs above of interest. EASY Ways to Help (includes 2 tips that only take 30 seconds and others that just take a few minutes and both are anonymous/pen names only, but can have a big impact. (Calls to Voice of the people and comments sections at newspapers) Contains links to legislature to email/write call and links to all newspapers in state.           Meetings lists the next PEIA Board Meeting that is open to public.

    2. On links on right you may want to skim down to he new 3rd box/ section on right titled  Newest Newsapaper Articles and Links June/July 2009, See  150 picketing in Morgantown!! (With picture  & video ). See what all the  newspapers, other unions retiree  groups say & do,  delegates comments,  AFT talking points, WVEA blog and AFSCME tips to get your letters published, & their talk board. We will be adding material daily. Please email anything of  interest, links your comments and ideas to us at savepeia@live.com

    3.  Updated as  always  near bottom  right are links to unions and retiree groups. And  a must see are  links under Shennaegains.

    4. Three most recent postings are  3 articles below this one.

    5. Also you might want to see comment in Comment section on right from noted national columnist James Ridgeway who  contributes Mother Jones Magazine and has the popular Unsilent  Generation Blog. (click contac not his name  for comment as name leads to blog.)

    6. Current concerns

    A. PEIA Proposed Option D Cuts PEIA Medicare Retiree Benefits 50% B. Board meeting proposed tying premiums to Providing End of Care Directive. C. Failing to have new hires paying into health care retiree benefits undermines  funding for whole plan, affecting current employees and retirees, and will bring it crashing down.   Affects hiring too and unfair. Takes benefits from those returning from lay offs.           .                                                          4.  Funding irregularities

    7.  The  3  most recent postings  below address these issues

    1. PEIA Proposed Option D Cuts PEIA Medicare Retiree Benefits 50% up to $1000 !!!    Item  1 of  this is a long dicussion, so you might want to  skim, a go to sections 2 through 11.  # 8 is a must read about possible underfunding of state’s mandated share. Toward the end of this posting is a section  labeled PROBLEMS WITH  PEIA PLAN PRESENTATION about PEIA’s hand out and contain a link to it.

    2. NEED FOR JOINT TASK GROUP – What can be done

    3. WE’RE NOT DYING  FAST ENOUGH !!!! Has links to other sites about  this issue.

     


    Dismantling of PEIA Continues: Problems with PEIA Presentation

    July 8, 2009

    Dismantling of  PEIA  Continues

    July  20009

    Now PEIA is planning more take aways!!!
    1. PEIA Proposed Option D Cuts PEIA Medicare Retiree Benefits 50% up to $1000
    2. Board meeting proposed tying premiums to Providing End of Care Directive
    3. Failing to have new hires paying into health care retiree benefits undermines funding for whole plan, and will bring it crashing down
    .

    Item  1 of  this is a long dicussion,but important,  so you might want to  skim it, and go to sections 2 through 11. # 8 is a must read


    PEIA Proposed Option D Cuts PEIA Medicare Retiree Benefits 50% up to $1000 !!!
    1. Optin D There are now more damaging proposals that PEIA somehow didn’t manage to have widely publicized. PEIA has proposed changes for it’s current Medicare retirees that under Option D would reduce it to only a 50% plan with “carve coordination of benefits,” while raising the Out of Pocket to $1000, thus greatly reducing benefits by 50%, and opening door to further reductions. … [more] This in essence would cut benefits in half, as the previous “Traditional Coordination of Benefits” with “Original Medicare” was 100%. In other words on any bills not covered by Medicare and totaling up to $2000 or less you will have to pay 50% until you reach $1000 coinsurance. While everyone will not reach $1000 many will pay $500, $600, $700, $800, and $900+ under Option D.

    As Medicare has a deductible, most of us will feel this change immediately each and every year. Medicare A deductible for a hospital stay (say just for a day or two for tests) is $1024, with no coinsurance changes for days 1 to 61, so under PEIA proposed option D you would have to pay $512 instead of the 0 under the traditional plan. In other words PEIA will only pay 1/2 of the residual after Medicare pays. But isn’t this the very bill that a supplementary insurance like PEIA is intended to pay? There is also $135 deductible under Medicare part B which would no longer be covered completely by PEIA. You would pay 50%, or $67.50. Just a few other services after the above day or two in the hospital and you’ll easily end up spending almost $1000 each and every year just on medical. And one still has the deductible on prescriptions and copays. Also not clear in the presentation is the percent covered by PEIA of any items not covered by Medicare. Will this to be reduced to 50 %?

    If these expenses are left as a Traditional Coordination of Benefits between PEIA and Medicare, former employer’s premiums will pick up 70% of these costs ( $1400 of the first $2000 in bills), and retirees’ aggregated premiums will pick up 30% of the costs ($600), but under Option D 50% of this $2000 is transferred to the retirees (the $1000 OOPM). So of the first $2000 the retirees pay a total of 65% ($1000 coinsurance, plus $300 in aggregated premiums), while the former employer pays only 35% of the first $2000 not covered by Medicare (through aggregated premiums of $700 through PEIA (which is the $1000 paid by PEIA minus the $300 that is really the 30% retiree premiums)}.  This 65/35 split is not the 30/70 split promised, and cost shifts another 35% to the retirees. It is actually taking away 1/2 of what was promised, and retirees really are paying  two thirds of the first $2000 as a coinsurance payment of $1000 plus the $300 from their aggregated premiums that are part of the $1000 paid by PEIA.

    In summary, on this first $2000 in bills each year, you no longer have the promised 70/30 plan, but a 35/65 plan, and your former employers are only paying 35% on this first $2000 though their premiums rather than the promised 70%, and the retirees as a group are paying 65% through aggregated premiums and aggregated coinsurance, rather than the 30% promised in the 70/30 split. This is cost shifting and is not a 70/30 plan as promised.

    Option C- PEIA is also considering an Option C that is 80% coordination of benefits, but that also increases the OOPM to $1000. It too is not a 30/70 split when considering premiums and coinsurance, but a 44/56 split of the first $5000 not covered by Medicare. Retirees pay $2200 ($1000 coinsurance plus  $1200 of  the next $4000 –  their 30% through their premiums) and their former employers pay $2800 (70% of the remaining $4000 through their premiums). Besides this not bing the preomised traditional coordination of benefits promised, it opens the door to further erosion of benefits.   And how long until they come back and change Option C to a 70%, 60%, and then 50% plan?

    Lastly as Medicare normally covers about 80 to 85% of most bills, so PEIA has only to cover the remaining 10 to 15 %, but under Option D PEIA will then be covering only 5% to7.5 % of bills when considering what Medicare pays in general, or under Option C 12% to 16%.  PEIA under options C&D is refusing to do exactly what supplements are intended to do, fill the gap in Medicare!!! Traditional Coordination of Benefits with Medicare had been in the PEIA Employee Plan Summaries for many years, but they are now reneging on their promised benefit. It’s like taking $1000 out of your pension, as health care benefits were part of the promised retirement package. And how long until the raise the OOMP more and more??

    2. They also plan to eliminate help with retiree health care coverage for new hires after Jan. 2010.  PEIA works much like Social Security as a semi- pyramid set up, as actives pay into a 20/80 match fund from which the state pays a 70/30 match with retirees.  Besides the inherent unfairness of some actives earning  retiree  health care benefits, working beside  those who do not, this scheme may affect funding for retiree benefits. Are the new hires not covered in retirement to pay the same premiums as those who will receive this retirement health benefit? Or will they pay  lower premiums? Then as more retire and others are hired, fewer will be paying  the 80/20 match from which the state takes the 70/30 match. How will the plan survive? This will also apply to those returning a 2 yr. lay off.

    3. In a recent board meeting  PEIA proposed tying premiums to providing  END of Care Directives. This sets a dangerous precedent. Whether this very personal document is stored with PEIA or  third party registry with safety issues, it’s financial coercion (through premiums). Will this be like medication, starting with a  $5 reduction in copays for generics, which  became a  $15 copay for brand name, with $50 copays for brand names not on formulary and for  so called “specialty drugs,”   to a proposal last year not to cover any brand name drugs not on formulary? Can we look forward to ever increasing premiums, or even loss of  services or coverage for not providing End of Care Directives?  Could they dictate what you have to say in it.  Will they pressure physicians and family (or family through physicians) as to how to interpret them PEIA’s way? Will the insurance company not let the family get second opinions, or consult  a specialist? This also puts the physician at risk if the insurance company discourages consults. Insurance companies need to quit playing doctor.  Once the precedent is set that PEIA can tie Providing insurance company or third party of their choice to Providing End of Care Directive  to premiums, where will it end .

    4. The Governor failed to budget/request the 51 million needed this year for the retirees heath care unfunded liability fund. This amounts to only about  $ 510 per active or retiree this year. Not much, as many state employees earn as little as 17, 20, or 30 thousand per year, with some retirees’  pensions as small as $400 or $500 per month.  In comparison, the governor’s $55,000 per year raise (should he complete 30 year of state employment) will net almost 1 million in increased pension (about $990,000), if he lives thirty years past retirement. Adding this much each year, and investing it at a conservative 5% APR compounded daily over 30 years, yields over 3.5 billion.

    5. Recently it was reported that apparently there’s about $ 475  million (about half a billion) in 4 state ‘rainy day’ reserve funds. Surely part of this could be used for the PEIA unfunded liability fund, as it would still be saved.   (Note it was recently reported that the funds lost 76 million in market meltdown, but in a previous article a few months before it was reported that since WV had little in risky  investments like Lehman, that most of the loss would return as the market  rebounds.) Also Brick street has since repaid the last 85 million of their low interest 200 million loan (at only 1.5% interest, costing the state millions in lost interest), so this money could now be added to rainy day fund to increase it and used for the PEIA unfunded liability.

    6. What the unfunded liability will be is unknown because it is partly dependent upon changes in Medicare and other federal changes. If Medicare just fills the hole in Medicare D prescription plan it could save PEIA millions yearly.  Multiply this savings by 30 years, plus the interest that can be earned on the funds saved, as Medicare will be paying  more for prescriptions, and it would go a long way to reduce and fund the unfunded liability.

    7. The governor, by trade a coal brokerage company owner, gave an out of state Texas/Penn.company, CONSOL,  $200 million  in tax breaks, for a coal-to-liquid plant that only creates 60 jobs (that’s 3 million a job). That company had/found $600 million elsewhere for the project, so why the tax break? There may be 4 more of these plants later -Will that cost the state another $800 million? That’s a billion in tax breaks. 1 billion  X a conservative 5% APR interest compounded daily over 30 yrs. equals about 4.48 billion,& could have met a major potion of the unfunded  PEIA liability. (Note since this tax break was arranged, the plant was canceled at least temporarily reportedly due to the drop in oil/gas prices and a subsequent need to find backers. After PEIA benefits are reduced, will the rainy day fund & other state funds be used to loan or give even more to this project or some other scheme for some big business??)

    8. In PEIA’s 2007 Comprehensive Annual Financial Report page 51 Schedule C  it shows Member and Employer contribution and it appears in 2003, 2004, 2005 & 2006 employer contributions were NOT at an 80/20 ratio and the amount unpaid by employers was under by  35.885, 82.562, 103.133 and 81.937 million respectively for a total of 306.517 million  underpaid by employers, while the employers paid an extra 78.299million in 2007, which makes for an employer underpayment for  the years 2003 through 2007 of 228.18 million. Had those payments been made each year, (with 80 million taken out in 2007 to avoid the over payment) part of those funds would have begun earning interest in 2003, and at end of 2007 plan year been  worth over 267 million and in 30 years with interest as computed at  5% APR compounded daily =  $1,198,048,896 or 1.198 billion

    9. No worker public or private should have their health care cut or taken. In fact, those who lost their health care or do not have health care through their employer should gain it. The state should be setting a good example for private business, rather than a bad example.

    10. They will be paying off benefits in 30 to 50 year in cheaper dollars

    If inflation runs about 4% a year, then in 30 years, it will take $3.24 to equal  one of today’s  dollars. Wage would also be up 324 % over  30 years, and  therefore tax revenues will be up 324%. They will be using cheaper dollars to pay benefits in 39 years. But retirees do not have COLA’s.  When looking at the unfunded liability it should be discussed in real dollars. Some of the OPEB they discuss in presentation is for mire than 50 years.

    $1 today will equal           in  21 years   $2.28  ,

    in 30 years   $3.24    a 324% change

    in 51 years   $7.39

    in  57 years  $9.35

    11.  Waste in the form of overpayment to insurance contractors, and drug manufactures etc. should be eliminated. How much did Coventry Advantra make in profit. Was PEIA changed for advertising. What about expense account, were they too big. Where are the funds parked pending distribution to providers. If  somewhere with Advantra were they properly earning interest for PEIA, not Coventry. Everything should be checked including Wellness programs like BeBetter.  Who owns these companies, runs them, and what companies own them.

    Many drugs a 30 to 70% less in Canada often from same  manufacture. But using Canada must be optional without penalty to plan members and we must be able to insure country of manufacture and origin.

    Someone from an union, not one of ours, gave me the following info “this tentacle of Wells Fargo is” is taking   “millions of WV taxpayer money, processing PEIA benefits claims – work previously done by WV state workers. In 2008 alone, Wells Fargo Third Party Administrators received over $23 million from WV taxpayers.”      Note you can check this out and Express Scripts, and Coventry etc. at The Auditor’s website and look for the Vista portal here:
    https://www.wvsao.gov/vista/login.asp click on Public access, and search for ANY vendor name.

    PROBLEMS WITH  PEIA PLAN PRESENTATION

    You can find it at http://www.westvirginia.com/peia/ Click on download near bottom of page

    **NEW** Plan Year 2010 Summary Plan Description

    It takes you to http://www.westvirginia.com/peia/content/SPD%202010%206-30-09.pdf

    1.Options A & B don’t say if they are for traditional coordination of benefits

    2. Options C $ D are a change to “carve out coordination of benefits and needs to say this.(See 1. above concerns.

    3. Regarding cost to employees and employers of 72% for retirees, if they weren’t covering the $22 for return to regular Medicare  would be more like the 70%. Before employees had premiums, this 70% was covered entirely by employer.

    4.The unfunded liability is the employers’ unfunded liability for it’s 70% share, and is not the responsibility of the retirees or actives. Employers should have been setting money aside and earning interest on this for 30+ years***.

    5. The 18 billion unfunded liability for FY 2030 would be for benefits through 2060 or for 51 years. The graph goes to 2066 or 57 years.  So in 2030 18 billion is only worth 7.89 billion in today’s real dollars. Also this would be the funds needed to cover benefits 30 years forward from 2030, so you’re really talking about benefits to be paid through 2060. By the end of 2060 it is likely that it will take about $9.35 to equal today’s $1.00 and tax revenue will be up 935%.

    6. Under item 2 page 14 they talk about costs to actives. but only reason the liability is so high is that they failed to fund it each year, and therefore are not earning interest on the funding. They can not expect employees to cover funds at all (and certainly not in 1 year) they failed to set aside for 30 years and the interest thereby lost.  No employee or taxpayer has to pay more, they have the funds in the rainy day funds and the coal-to-liquids tax breaks. If some of this was put in PEIA and earned interest they could solve.

    7. Item 2, page 16. Why they singling out 1991. For many, many years we’ve have a 70/30 match for retirees. It was used to recruit and retain employees and was in our PEIA Plan summary books every year. Now they want to change it after we retire!!!

    8. Page 17. Non subsidized Premium of $946. Why so high. Inco/Special Metals unsubsidized premium is $600 and the main difference in plan is a 70/30 prescription split rather that 80/20.

    9. PEIA Medicare retiree non subsidized premium seems high. Why? As the new administration improves Medicare this will be lower. Just fixing some of the problems with the Medicare prescription plan will same millions.


    NEED FOR JOINT TASK GROUP

    July 8, 2009

    July 2009

    1. Suggestion FORM YOUR OWN SOLUTION GROUP if you haven’t done so already-  TASK FORCE. Since PEIA can only suggest cutting benefits form an ad hoc committee with 3 or 4 representatives from each union or retiree group plus a few other interested actives and retirees not associated with any union or retiree group. PERSA an CORPE too. Get actives from each agency DHHR highways etc. and retirees from each. Divide into subcommittees as needed.  Group can consult with delegates and senators who are committed to saving benefits and finding funding. Board did not mail out notice of public hearings to plan participants.  PEIA Board  does not represent the public employees.  Make a group that does. Name  group and can do press releases, plus then each union or retiree group and go back and release their own take on things. The committee would:

    a. Identify possible state funding sources and state waste (See number 2 below). Must be many more. Apparently there’s about $ 475  million (about half a billion) in several state ‘rainy day’ reserve funds. Surely part of this could be used for the PEIA unfunded liability fund, as it would still be saved. (note though article notes a drop of  about $76 million in market meltdown, a previous article indicted WV would regain most of this drop as the market goes back up as it had very little in risky investments like Lehman).

    b. Look for wasteful state spending ( example 200 million tax break to a coal – to  liquid plant for a Texas/Penn that only provides 60 jobs (that’s 3 million per job) and they may build 4 more. Does that mean another 800 million in tax  breaks? That equals 1 billion, if invested at a conservative 5% compounded daily for 30 years, equals 4.48 billion, a sizable part of the OPEB.

    c. Identify unfair spending – Governor got $55,000 raise. IF completes 30 years of service, will increase his pension by almost 1 million ( $990000) if he lives 30 years past retirement.

    d. Identify extravagant state spending like $37,000 for leather embossed conference room chairs. 2 million plane (a trade up) when had 2 , liquor for parties, etc.

    e. Identify failures to fund PEIA, like not putting the 51 million into the OPEB this year, which is only $510 per active or retiree and some of those workers only make$17,000 a year, and some pension are only 4 or 5 hundred a year. If one looks at 2007 fiscal reports it looks like about 4 of previous 5 years, state did not do a full 20/80 match and was short by many many million. Emphasize interest over 30 years this could have produced.

    f. Identify wasteful and questionable spending at PEIA, like $30,000 for fitness books from friend of governor etc. Review profit margin given contracted companies and CEO wages and bonuses. OR PEIA being only insurance company pay to start over priced exercise facility in Marshall ounty that is open to public. ($37,000 for 10 bikes and a wii)And it may be a proto type. Review expense accounts. This money could be earning interest for OPEB.

    g. Identify changes in Medicare etc. and any future federal health plan by new federal administration that will help PEIA. Even just filling the donut hole in Medicare part D prescription drug plan would save PEIA millions a year. Nothing should be done until we see what US Congress does over the next few years.

    h. Identify legal changes that will help, such a passing a drug transparency law that will save everyone money, not just PEIA. There must be other laws that can help. The menu law,  and laws to limit profit & administrative fees and expense accounts for insurance companies. Coventry’s profits went up over 900% since 2000.  CEO got 11.3 million in salary, bonuses, and stock options in 2007.  Coventry is parent company of our Medicare Advantra Company.

    i. Identify and counter every misleading statistics released by PEIA. Get newspapers to print retractions and corrections. Example the OPEB. They overinflated, plus are they not reporting the OPEB for state, counties, and cities together. The state part  of OPEB should be reported separately. etc.

    j. Identify funds not collected, and interest not earned- several counties and cities failed to pay their share of premiums for some of their participants ( retirees) for years, and this cost the rest of plan interest because the plan had to use other funds to cover this and lost interest.   k. Be aware that any money wasted by PEIA, or over paid to contracted insurance companies, also costs PEIA interest it could  have earned on those funds. Every dime wasted is like wasting 44.8 cents over 30 years. l

    You should insist at public hearings to PEIA that one solution to problem is for the unions and retirees to form a group to come up with solutions. You don’t need PEIA permission to do this, but they will either have to recognize group, or look like they don’t want solutions if they don’t. Keep control of your group, each union and retiree group picks their representatives not PEIA.

    m. Unions compete for members but there are plenty of people not in any union & seeing the unions work together will help recruit members for all, especially from the new hires.

    n.  Be aware that at 4% inflation over 30 years,  incomes & taxes will be up 324%, so state will have more & be paying with dollars worth 1/3 of what they are now, but retirees don’t have COLA’s.

    The  laws to make agencies look at unfunded liability for post employment benefits was not meant to be used to take benefits way, but to fund them.

    Remember Options C & D in PEIA presentation take benefits and defeat the 30/70 split., as do increases in deductibles, copays, coinsurance, and OOPM. It’s cost shifting away from the 30/70 and gives employees/retirees 100% of those increases. As Medicare pays 80 to 85% of most things, the PEIA  Option C and D at 80% and 50% could really means they’re paying  only 16%  or 7.5%. We were promised traditional coordination of benefits and C&D are not that.


    WE’RE NOT DYING FAST ENOUGH !!!!!

    July 8, 2009

    July 2009

    Just a few thoughts on  :

    PEIA  proposed at recent board meeting that  plan participants provide End of Care Directives or pay a higher premiums than those who do. Note this was at a board meeting, but  is not in Plan Presentation.

    Something new and very, very scary !! I wonder if anyone has ever heard of this or had it happen to them. They want to propose that we Provide End of Care Directives  (Advance Directive) or pay higher premiums than those that do provide this. This should and may be unconstitutional.  While most don’t disagree with someone’s right to have and End of Care Directive, many would be outraged that the insurance company wants to financially coerce us into providing the paper to them or some third party registry. They saying they’re lowering premiums for those who sign, and this won’t affect premiums of those who don’t sign, but that is untrue. This really that would mean in the long run higher premiums for those  who don’t sign.

    Say the difference starts at $5 per month. Have you ever known a copay, deductible, OOMP,  not to raise over the years. So what’s start as $5 per month extra could go up to $10, $25 or $50 a month extra. Just this about your copays for brand name drugs not on the formularly and so called specialty drugs. Also we’re a 70 %/ 30 % plan with retirees paying 30%, and the only way to give a premium break to those who sign the directive, is have the others pay more, so something is wrong with their  70/ 30 math even if they don’t raise our premiums. They next time they compute, we won’t be getting out 70/30 match or we would all have the same premium.

    Will parents have to fill these out for their children. Just retirees?? Age discrimination?? How will this affect too quick decisions on asthmatics, elderly those in the beginning stages of MS. Many serious diseases like cancer, ALS, MS, etc. give you  months, and years to decide on how to handle the end stages, but insurance companies view these as expensive early on, and already charge $50 copay on many MS drugs.

    Will this be like medication, starting with a  $5 reduction in copays for generics, which  became a  $15 copay for brand name, with $50 copays for brand names not on formulary and for  so called “specialty drugs,”   to a proposal last year not to cover any brand name drugs not on formulary? Can we look forward to ever increasing premiums, or even loss of  services or coverage for not providing End of Care Directives?  Could they dictate what you have to say in it.  Will they pressure physicians and family (or family through physicians) as to how to interpret them PEIA’s way? Will the insurance company not let the family get second opinions, or consult  a specialist? This also puts the physician at risk if the insurance company discourages consults. Insurance companies need to quit playing doctor.  Once the precedent is set that PEIA can tie Providing insurance company or third party of their choice to Providing End of Care Directive  to premiums, where will it end . Once you go down this path where does it end? Euthanasia? For whom the old, the expensive, the retirees?

    It should NOT be the insurance company where CEO’s make up to 124 million based on company profits, who interpret these living wills, or their flunkies or any third party entities they choose. Our Medicare Advantage plan was Coventry’s  Advantra Plan, and the CEO of all Coventry made 11.3 million in 2007 in salary, bonuses, and stock options, big bonuses base on saving money at your expense. These End of Care Directives should only be interpreted by the family in conjunction with your physicians.

    Once the precedent is set the even one insurance company require proof of a living will and it affects your payment, then how long until others follow suit???? Obviously, if this gets started other insurance companies will jump on the band wagon, and a lot of people will be mislead into signing dangerous broilerplate directives, that don’t protect them adequately and are wide open to interpretation, and could be misused, and more poorly worded than you would think. If we don’t stop the insurance companies now, it will be to late later.

    As far as I know, no other insurance company has done this. As far as I know neither Medicare, Medicaid, VA, Federal Employees Insurance, nor any private insurance of anyone I’ve asked requires this or ties it to premiums.  Seems we are some kind of guinea pig population, as I think we were also the first state to force it’s retirees onto Medicare Advantage. We did not have a choice, it was either got to Medicare Advantage or loss your supplementary insurance.  If they can get way with doing this to us, they’ll try this on others. I feel that other insurance companies will follow suit if this company gets away with this. will Workman’s Comp?

    The idea that an insurance company who put financial pressure on plan members to PROVIDE this directive to them, is outrageous and probably unconstitutional and unAmerican. Talk about a totalitarian dictatorship. Terms that come to mind are invasion of privacy, conflict of interest, financial coercion, draconian, unconstitutional, ACLU, violation of religious freedom, and un-American. The whole idea makes one think of 1984 (by James Orwell), Make Room, Make Room (by Harry Harrison, think Soylent Green, the movie), or Logan‘s Run.

    It is definitely fodder for the ACLU and could end up in expensive supreme court litigation., thus causing PEIA needless expense. ACLU could add a number of other violations of our civil rights, and dozens or hundreds of points and arguments, plus hundreds if not those thousands of examples. Many people will raise moral, ethical legal, constitutional, and medical objections to such coercion, not to mentions all those who will raise religious objections, and complaints about  religious discrimination. Others will raise invasion of privacy issues. And does not such measures discriminate against the elderly or disabled. Is the current state administration planning to request a law requiring everyone is the state to sign an advance directive??? If not should State, County, and Municipal workers be required to sign? This gives new meaning to the term public servant. What was their purpose for requiring this? How was it to be used. And how were they to save money by using it.

    Anyone making an Advance Directive would want to be real careful into whose hands they put it and when. I doubt if they can legally force you to make one, or if you have one force you to hand it over to get care. But this suggestion of tying premiums to providing this is financial coercion. Some feel that this should only be trusted to a group of several relatives to decide when to hand it over to the hospital. Many feel it’s best to have it give someone medical power of attorney to interpret your wishes, so some “bean counter” won’t. One certainly wants relatives to have time to find and consult with specialist and physicians of your and their choosing. After all no one ever went to several doctors over several months or years until they finally got the right diagnosis or treatment. In an emergency or after an accident, do you really want you this to be enacted before your relatives even have time to get to the hospital and select a doctor they want or  a specialist for a second opinion.  Anyway this gives new meaning to the phrase –                                                                      BURY IN HASTE, REPENT AT LEISURE.

    They may be planning to have us store our End of Care/Advance Care Directive at a Central Repository. One national one out in California does not require Social Security Numbers, but they are optional as someone people object to giving it out.  After someone sends them their living will, they are sent a special identification card with an assigned number that a physician can use to call the company and have the Advance Directive Faxed or emailed. But if the person doesn’t have the card, the hospital can order it by name and SSN, or if the person didn’t give the repository their SSN, the hospital can get it by just giving the patient’s name and birth date. How long until one John Smith is mixed with another? How many people in this country have the same name as someone else, and maybe even are about the same age. Google your name and also run it on yahoo people search, and don’t forget to use alternate spellings (especially of your first name), and nick names.

    What are the chances one of the faxed or emailed forms will get enacted before the family even gets there if you are in an accident. What are the chances one John Smith’s forms will be mixed up with another John Smith’s form. Or some of the middle pages will get switched with someone else’s middle pages. After all none of us have ever be mixed up with someone else, received a bill or piece of mail that is wrong etc. Of course there will be mix ups. However, if you die because of it, you won’t be around to straighten it out.

    Then what will happen over the years. Will the  insurance companies  dictate the wording on these directives, raise your premium even more if you don’t sign one,  withhold services if you don’t sign, or drop your insurance if you don’t sign. Or maybe eventually, they won’t pay for certain services if you don’t sign one. But if they know you have a directive or even the content, will services you might want be withheld, or withheld prematurely. Eventually, will this lead to insurance companies to put pressure on your physicians and family, or on your family through the pressure the insurance company puts on the  physicians. Will the insurance company or some supposed mediator or adviser presume to interpret the living will? They already withhold antibiotics on the very sick sometimes. What if you have a slow cancer, like prostate and are only in for tests and could like for years on lupron, and choke on you dinner steak? Will you not be resuscitated because technically you are terminal. How can we trust insurance companies in this. End of Care / Do Not Resuscitate Directives are very serious and every word is open to interpretation.

    Apparently on average health insurance companies spend the most on health care for people during the last two years of life. Will duh! You pay your premiums for decades when you often need very little health care and then when you get sick, they want rid of us quickly. There’s a big financial incentive for insurance companies to want physicians and families to interpret the End of Care Directive as broadly as possible when is comes to withholding treatment, what is terminal or irreversible, and what is life prolonging. Where you and you family might prefer to be very cautious when enacting the End of Care.

    Think you won’t be affected because your insurance company doesn’t require this? Think again. You never filed an End of Care Directive with a repository. You’re in an accident and are taken unconscious to a hospital, which calls a few repositories with you name and birth date, and a match is found, faxed, and used to withhold care. But it was only the directive of someone with the same name. Too late, R.I.P.

    Help needed:

    1. Please post on this site if you’ve ever heard of an insurance company requiring you to Provide an   End of Care Directive or pay a higher premium if you don’t.
    2. Also if you know of any web sites

    about the dangers of misuse of Advance Directives/Living Wills, or problems with interpretation of these documents, and tips on wording them please post those site.

    Sites: Below is a  listing a couple of sites found in a quick search with some 2006 Federal law, and concerns about wording of this type of document, or misuse. While  one might not support every word at sites they provide a lot of helpful information, concerns, and example.

    For tips on writing living Wills and Advance directives, and pros and cons of language.
    http://www.internationaltaskforce.org/rpt2006_2.htm#212  

    Before You Sign On The Dotted Line http://mysite.verizon.net/cureltd/id24.html

    Good article and web site. Talks about Interpretation of End of Care Directives

    Federal law about Advance Directives that prohibits requiring one as a condition of treatment.  See    Advance Directives, 42 CFR 489.102 (a) (3) (2006).

    http://law.justia.com/us/cfr/title42/42-3.0.1.5.27.8.206.2.html

    You might want to read or skim it all, but it reads in part:   “489.102   Requirements for providers  (a) Hospitals, critical access hospitals, skilled nursing facilities, nursing facilities, home health agencies, providers of home health care (and for Medicaid purposes, providers of personal care services), hospices, and religious nonmedical health care institutions must maintain written policies and procedures concerning advance directives with respect to all adult individuals receiving medical care, or patient care in the case of a patient in a religious nonmedical health care institution, by or through the provider and are required to:       . . .     (3) Not condition the provision of care or otherwise discriminate against an individual based on whether or not the individual has executed an advance directive”

    “Throw Granny from the Train: The Washington Post Gives a Boost to Age-Based Health Care Rationing”   Note this site has lots of great article

    http://unsilentgeneration.com/category/death-end-of-life-care-and-choices/

    *****They very fact that the PEIA Board even brought this up with financial incentives, would now eliminate the PEIA (any agency which they retain or with contractor any state agency) with regards to just providing people with general information about the pros and cons of and End of Life Directive, even without any financial incentives or coercion in the future, as the PEIA Board has already shown itself to have an agenda and opinion on this matter many could rightly question their ability to provide balanced complete information not affected by their perceived and demonstrated preferences.    * * * * **

    While many have valid reasons for personally wanting Advance Directives, these are matters best left to the patients and their families, with their doctors, and perhaps lawyers. Advance Directives are an option under the law, not a requirement. Medicare doesn’t require this nor INCO/Special Metals Retirees Blue Cross. To my knowledge Medicaid, VA, and Federal Employees Insurance do not require this. What next? Will they require this form Workman’s Comp. Will other workers in the private sector be forced to do this by their employers. Will members of the UMW have to do this????

    Most generic broilerplate Advance Directives only require 2 doctors, with no mention of a specialist with regards to the part of the body involved, or a 2nd opinion of a specialist. How many times have you heard of someone going to several doctors before getting the correct diagnosis and satisfactory treatment??  It sometimes takes a few days to research  a condition and get better medical care, and an Advance Directive in the wrong hands could lead to hasty irrevocable decisions. Even an murderer has a trail and appeals, and yet we still sometimes execute an innocent person. Yet it appears workers, especially retired or disabled, if a victim of too hasty a decision will not have recourse, as they will just be dead without any court of appeal. This reminds one of disposable labor, think slave, feudal serf, peon, etc.

    The generic basic broilerplate Advance Directives do not cover all possible scenarios. They often include a do not resuscitate order, or a no code. You could fall in the hospital and just knock the wind out, and maybe not be resuscitated. Are they more likely to not resuscitate if your older??  You at leas need a family member present to interpret. When you sign one of these broiler plate directives you are  waiving certain medical protections. While most of us do not want to be hooked up to machines for years when we are unconscious and in  pain (though pain can now almost always be well controlled), the Advance Directives usually are far broader and open to interpretation, and interpreted more broadly  than we would like, no matter how well written. They may be taken to mean, no antibiotics, even for hospital acquired infections, etc. Example, you have cancer, it’s terminal, but will take a couple of years, and your current quality of life is good, but you choke on food, or have an allergic reaction to the wrong medicine – Do you want to be resuscitated, or given oxygen for a day?  Many MS patients live years in which the quality of their life is usually good, as they often experience long remissions. And what about asthmatics with another serious illness? We’ve all heard of healthy people who suffered and injury, went into a coma, but completely recovered after weeks in coma, even through the doctors predicted otherwise.

    We all hear the horror stories of people on a ventilator for years. But did you know that life prolonging intervention can be interpreted to mean an IV?  The problem with end of care directive is that there are 4 issues, parts or steps to the process plus a 5th consideration.

    Disclaimer: First of all realize that everything above and below in this discussion, is just that, a general discussion and personal opinions, as are most or all web sites, and books. The only way to get a legal opinion is to go to lawyer.

    The first issue is that you have to have accurate diagnosis and evaluation, not just in regards to your main illness, but also in regards to your situation and prognosis over the next couple of days. If this is not accurate, or wrongly pessimistic, then they could stop the very treatments, that could save you.  In case of an accident or sudden onset of health emergency, most people would want to get it right, and that could require consults with specialist, or waiting a reasonable time to see how things go.

    Second one needs lifesaving treatment.  If you don’t have accurate diagnosis or treatment, then the rest of the End of Care Directive could be enacted prematurely or erroneously. Elderly people are slower to bounce back from surgery, anesthesia, or illnesses than younger one, but they do bounce back, just more slowly. Medication clears their bodies more slowly, so they are sometimes over medicated.

    Many people, even healthy young ones die needlessly each year due to medical error, administration of the wrong medication, or hospital infections.  A senior could go in the hospital for a broken hip, pick up a hospital infection, and maybe be considered terminal just a little more easily than a younger person. Then they pull the IV, and the prediction becomes a self fulfilling prophecy.

    Step 3 is the stopping or use of  life prolonging intervention..

    So if steps one or two are not done correctly, then step 3 could be jumped to prematurely

    Apparently the law allows an End of Care Directive that only requires one physician! (See link to web site below about this). A murder get a jury of 12 , but for granny one poor physician has to decide all on his own. Who would want that legal liability or exposure.  And why for the important decision of your life would you not want a 2nd opinion. I do research to buy a car, or before starting a new medicine etc.  Also consider that your attending physician at any given time in the hospital might not be your regular  physician. You came in at night though ER. Your physician is out of town. You needed a specialist in a field that you had never needed before. You were traveling and are in a hospital out of town. People used to get at least 2 estimate before a car repair under insurance, but one doctor!  Medicine is a science, but it’s not perfect. It’s hard. And who should pick  which physician will provide the 2nd opinion, or specialist, some would want this to be their family in consultation with the doctor?

    Step 4   But what is life prolonging treatment?

    Who defines what is life prolonging in such a situation.

    Unfortunately, some people have found that once the decision is made that someone is terminal, most everything is considered life prolonging, and only the barest palliative care is given, and even routine maintenance medicines you’ve been on for years are stopped. But there’s a big difference in not putting someone on a ventilator, and not giving routine medication.

    At  West Virginia Center for End of Life Care

    http://www.hsc.wvu.edu/chel/wvi/resources/changes.html

    The site says that the law says, “Only one physician is required to certify that the patient is in a persistent vegetative state or terminally ill on the Living Will form.”

    But on something so serious most would want a second opinion, and probably a consultation with more than one specialist. Insurance companies often want you to get 2nd opinions before having surgeries such a  hysterectomy,  but the law doesn’t ensure  you get a second opinion or a specialist consultation or two before ending the very measures that could save your life. Broiler plate advance directives don’t have this in them.

    The site does have some discussion of some changes in the law, but some would feel that these changes don’t necessarily protect you.

    The site states with regards to definitions and the law.

    Life-prolonging intervention has been expanded. It now includes, among other things, nutrition and hydration administered intravenously or through a feeding tube.”

    What other things?

    And  isn’t there  a world of difference between and IV and a ventilator??

    Site also says that the law was modified to:

    remove the specification that death occurs “within a relatively short time.” The new definition reads as follows, “Terminal condition means an incurable or irreversible condition as diagnosed by the attending physician or a qualified physician for which the administration of life?prolonging intervention will serve only to prolong the dying process.” ”

    Notice that’s or incurable OR irreversible. Why not AND.

    But how imminent must this death be? Without any relatively short time limit, or specific time limit, they could stop a glucose IV.

    The fifth consideration, is the Medical Power of Attorney. Someone has to be able to make medical decisions if you can’t. Say you have surgery and are still sedated and a medical emergency comes up. If you’ve names a medical power of attorney they can ask for a consult, or a specialist, or help choose between 2 possible treatments, to pick the best, or in consult with doctor and specialist, help make decisions about IV’s or more heroic measures. This is why one really needs to have long talks with their medical power of attorney and other family members etc., so they will know how to interpret your wishes in various situations. Also if you medical power of attorney for what ever reason isn’t available or  can’t serve, is there a backup??

    If  legally possible, why not a group of  two to four relatives (named by patient in their legal document) in which all have to agree that there is no hope and to stop life support, as well as the physicians, and if any one feels more information/consults are needed, or more time then the End of Directive is not enacted.

    Need for an attorney: For something so serious as an advance directive, one would hardly want just what you can get in a broiler plate form. This is especially true because what is considered life prolonging is not only a ventilator, but often and IV, or maybe even and antibiotic. Many if not all prudent people would need a lawyer to help you decide such things as  how this kind of generic advance directive would play out if you were 80, recovering from hip surgery, and say had a severe allergies reaction or choked on food and needed to be resuscitated.

    Haste: At the public hearing today, someone with PEIA or the board gave an example, of the danger of a person being in the hospital and a relative not being located or with a living will, and that person being hooked up to a ventilator. The point being that with a living will already available, they would not have to hook them up. But why the haste to enact a living will? How can you be sure that you are terminal if no relative has had a chance to select a physician you and or they trust, or maybe even get you primary care physician or specialist. Have you never shopped around for a doctor, or had problems getting a proper diagnosis or treatment that worked?  That comment by the person with PEIA  and similar attitudes is just what scares some.

    Some people spend more time researching the lens material for their glasses (did you know there’s  a  newer material 6 times stronger than polycarbonate and optically superior) than the time allowed to relatives to get information and consultation before they enact End of Care Directive,  at  least the way some entities interpret the directives

    Who Holds the Medical Power of Attorney: Personally, I would want an End of Care Directive that doesn’t put it routinely in the hands of  a third party other than family and/or my lawyer, and would not  want it given routinely, to the hospital upon every admission, or every series illness, or crisis, but would want relatives to hand it over, only when they are comfortable with the diagnosis, evaluations,  treatments, and second opinions that have been rendered and provided, and they truly feel all hope is gone.  This to insure that it’s not misinterpreted or used prematurely.

    Problems with ability to afford attorney and discrimination: Many state employees don’t earn much and don’t have extra funds for attorney and many more retirees have very little income. Yet if the provision of an end of care directive is tied to lower premiums, this very lack of income, will coerce them into signing a broiler plate directive, to save on premium. This kind of policy discriminates against the poorest, oldest, and disabled. This also in a way discriminates against women and minorities. To this day the average income for women and minorities is lower than the average Caucasian man. But as seniors earned their salaries (on which their pensions and Social Security are based) long ago, when these income differences were even greater, so due their lower income this policy is even more discriminatory. They are more likely to simply not  be  to afford an attorney.  As usual, as with the justice system, those that are both richer may fair better, as for if they have concerns  they will go to their attorneys have the best directive drawn up, the best that money can buy, and the rest of us, will try to fill in the blanks in the generic broiler directive form and hope for the best.

    Dangers of Not Having an End of Care Directive:

    Think you’d rather just go without an End of  Care Directive.  If you don’t have one you’re governed by state law. Some states require only one physician to decide. Some name the order of who, can make medical decisions in your behave, and it may not be who you would think would be automatic like a spouse, and some states say something like the doctor can appoint whoever they think is best. So you go in through a ER, and a physician who doesn’t know you or your family picks. And they don’t even have to appoint a family member. A  lawyer in passing mentioned to me that WV requires just physician, and that they can appoint someone to make medical decisions, and it doesn’t have to be the closet  relative or even a relative. Is this true? In any event,  whatever the law is, you may not like it.

    From not Being Allowed to End Treatment to Being Pressed to End Prematurely: In the past people had to fight to refuse certain types of care. People fought long and hard for this right of choice. Those that were opposed, worried about misuse of End of Care Directives. Now the pendulum seems to have swung the other way toward the opposite extreme.  Not only do we have the right to refuse certain treatments, but some fell these documents are too broad and are being interpreted too broadly, and too soon.   When it’s literally a matter of life and death, one should err on the side of caution. Regulations are needed to ensure patient/family decision-making and  stricter guidelines are needed increase patient and family controls and ensure that too broad interpretations not used.

    Most of us will never be in a brain damaging accident, where we are placed on life support and will not recover. We will get cancer, or be in end stage diabetes/liver failure, or one of the rarer chronic life ending illnesses (MS, ALS, emphysema, or advancing congestive heart failure) and we will have weeks, months, or years to make, or alter our living wills to suit our illness. It is almost impossible to make a living will to cover all possible contingencies. On the other had you could be that person with the brain injury or severe stroke. Many people have  come out of a coma from which no one thought they would recover, and lived many quality years and even subsequently returns to work, or recovered from other things when not expected to. There have been people that come out of hospice and live for years.

    Summary: Whether or not to have an Advance Directive, what form it takes, what wording and what loved ones will have access to it, in a private matter, and is NOT the business of insurance company bureaucrats, whom we do not know, and who work for companies whose bottom line is the bottom line. Insurance companies  have said that the last 2 years are the most expensive for insurance companies. Are we as a group want to give up 2 years on average, after we worked all our working live for  the state. How much more will the CEO’s  and other executives of the insurance companies with PEIA contracts,  get in bonuses due to this plan?  PEIA should not be providing End of Care Directive Forms. Due to their suggestion about tying the Provision of an End of Care Directive to premiums, they should not be giving us advise about the pros and cons of making an end of care directive, or even referring people to groups or agencies etc. for advise. They should not be doing those things in relation to something in which they have a conflict of interest. They could easily direct to some third party that presents a point of view they like. Unfortunately, most of us (unless we are already in the final stages of a specific disease) will be faced with researching these issues though numerous sources, applying this knowledge to all possible scenarios and then unfortunately for our pocketbook, consulting an attorney, or at least making some educated  choices on what to write in on  a form.

    End of Car Directives, Can’t live with them, can’t die without them.

    Please send emails with recommended sites, examples, and concerns.


    Board Votes on Premiums – AFT Responds

    December 8, 2008

    The Board has voted on increases in premiums for all but Medicare retirees, but the Medicare retirees get a higher out of pocket, a 50 % increase, again hurting the poorest when they are the sickest.

    PEIA is also planning to request bids for Medicare Advantage as a PPO, which probably and most assuredly will be a more restrictive network. Not on Medicare yet? What PEIA is doing with the Medicare will affect you when you get to Medicare age and for your whole life.

    Due to the thousands of calls, letters, petitions, faxes, and emails, the additional copays are off the table at present !!! All the contacts with the legislature didn’t hurt either!! It was always going to be the decrease in benefits, increase in premiums, or a combination this year. Since the copays still don’t apply to deductible or out of pocket or our 20/80 match on premiums, they tend to over look this cost shifting.

    The groups affected the most are those already with high premiums, families, employees with children, retired non Medicare.

    The PEIA’s projected increase in premiums over the next 4 years totals 57% for active employees & 64% for retirees (a little less for Medicare retirees as they have the increased Out of Pocket Maximum this year instead).

    The unions, retiree groups, and thousands of individuals working on their own and with their groups, did wonders, especially as they had little notice and such a short time frame. Now is the time to continue your efforts. Express your concerns. The interim committees in legislature meet Sunday, Dec. 7, 1 pm to 7 pm, Monday, Dec. 8, 9am to 7pm, and Tuesday, Dec. 9, 9am- 4 pm. Remember every voice helps.

    See summary of changes below next paragraph

    If you are concerned about the constant erosion of benefits and ever increasing premiums, support your retirees group or union. PERSA would be a good place for retirees to start. PERSA is $1 a month. It’s open to actives too. Go to www.peiawatch.wordpress.com to find various groups. Go the rallies in Feb. Call & write all the delegates, not just your own, as many are on a number of committees that can help. Legislative interim meeting dates December 7 – 9. Benefits are being shredded away bit by bit, year by year & the plan bears little resemblance to the under which most were hired. With ever increasing copays, increasing drug copays ($50 on some), escalating premiums, loss of traditional coordination of benefits, & forcing Medicare retirees of Original Medicare, while the private Medicare companies reap the profits, has eroded benefits beyond recognition. Many can not afford to even use the insurance due to copays with no cap, that do not apply to deductible or Out of Pocket Maximum.

    Below is quote from AFT site

    http://www.wvft.org/legislationpoliticalaction/default.as

    “ PEIA Plan as Passed by the Finance Board

    December 4, 2008

    Your efforts paid off! The PEIA Finance Board adopted a plan today that addresses many of the concerns raised by WVSSPA and AFT-WV. For example, the new plan which will take effect July 1, 2009 will not include any:

    • Benefit reductions;
    • Prescription co-payment increases;
    • Out-of-pocket maximum increases (for active employees);
    • Change in out-of-state coverage (you will not be penalized for going out-of-state).

    However, the Board adopted the following premium increases:


    I.
    Active employee premiums will increase, on average, 6% for non-tobacco users.

    Examples for Single Coverage/Family Coverage for non-tobacco users (PPB Plan A)

    Salary Range Current monthly Rate New monthly Rate

    20,001 – 30,000 $37 single, $136 family $39, $144

    30,001 – 36,000 $44 single, $160 family $47, $170

    36,001 – 42,000 $50 single, $187 family $53, $198

    42,001 – 50,000 $64 single, $233 family $68, $247

    50,001 – 62,500 $86 single, $294 family $91, $312

    62,501 – 75,000 $99 single, $324 family $105, $343

    Actives and retirees who use tobacco products will see an additional monthly increase of $10.00 for those who have a single plan and an additional monthly increase of $25.00 for those who have a family plan.


    II.
    Retiree premiums will increase, on average, 11% for those under 65. Retirees who do not use tobacco products will see a premium increase of less than 11%. Those over 65 will not have an increase but their out-of-pocket maximum will increase from $500.00 to $750.00.

    So what is our next step?

    • We will aggressively lobby the legislature during the 2009 session and ask that they provide additional funds to PEIA in order to offset the increases. WV Code 5-16-5 specifically states that the
      • Aggregate premium cost-sharing percentages between employers and employees, including the amounts of any subsidization of retired employee benefits, may be offset, in part, by a legislative appropriation for that purpose.”

    WVSSPA and AFT-WV believe that during these difficult economic times, the legislature should use this provision of the code to stop the premium increases.

    • We will be meeting with the Governor to respectfully request that he include funds in his budget to offset the proposed increases.

    Finally, we will work with our members to contact their legislators and ask that they support the AFT-WV and WVSSPA position – No Premium Increases!

    Again, your efforts paid off. Thank you for your involvement as the Board heard your concerns. As a result, the plan is much better than originally proposed. We will keep you informed as we continue to lobby for health care dollars. ”


    WVEA Angered by Finance Board Actions FY 2010 adopted plan

    December 5, 2008
    PEIA Finance Board Adopts PEIA 2010 plan The PEIA Finance Board adopted the FY 2010 plan. It includes premium increases for plan participants under age 65. For more information …click.
    (Note this leads to President Dale Lee’s inspiring “I Am Appalled” WVEA testimony


    Item below is also from WVEA site. Also be sure to go to this great site and read President Dale Lee’s inspiring “I Am Appalled” WVEA testimony at Public Hearing.

    WVEA angered by Finance Board actions

    http://www.wvea.org/leg_action_ctr/peiaadopted.aspPremium Increases

    “Active Increases

    Single – $2 to $19*

    Family – $9 to $57*

    (*per month depending on participant’s salary)

    WVEA angered by Finance Board actions WVEA is angered by the actions of the PEIA Finance Board. They have once again chosen to balance PEIA’s budget by shifting costs to employees and retirees. Hundreds of employees and retirees attended the public hearings and their concerns seem to have fallen on deaf ears. “I believe the Finance Board had a plan in mind all along and the public hearings were just an exercise they were required to go through,” stated WVEA President Dale Lee. “It appears they had a direction they intended to go and they held firm.” For active employees and retirees under the age of 65 premiums will increase – an average of 9% for active employees and 11% for retirees under age 65. The tobacco differential for smokers was increased $10 for a single plan ($15 to $25) and $20 for a family plan ($30 to $50). Medicare eligible retirees saw no premium increase; however, their out-of-pocket maximum was increased from $500 to $750 in a plan year. These increases come at a time when many participants have seen a reduction in their income and have dipped into their savings as the national economy continues in a decline. Meanwhile, PEIA has a revenue surplus of over $20 million. This is more than enough to offset benefits or premium changes; yet it is not being used to assist employees or retirees. Because our members voiced their opposition to the proposed plan, we were successful in eliminating the new drug formulary, eliminating the proposed 70/30 split for out-of-state network providers, stopping increases in co-pays and Tier II drugs and stopping the increases in the out-of-pocket maximums. By holding back those changes, employees and retirees were able to mitigate a portion of the cost shifting. In addition, premium increases were eliminated for retirees over 65 years of age. “The continued chipping away of benefits and increasing premiums is not acceptable. Retirees and employees should not have the PEIA budget balanced on their backs,” states WVEA President Dale Lee. “We understand that health care costs are a source of concern for all employees, employers and retirees in our state and nation. Shifting costs to employees and retirees while PEIA is experiencing a surplus is the reserve account is unacceptable.” “When you look at the plan in total (premiums, co-pays and deductibles) employees and retirees contribute nearly 40% of the overall cost of the plan. WVEA will continue our efforts to amend the current 80/20 legislation regarding PEIA,” concluded Lee.”


    Welcome!

    November 30, 2008

    Be sure to see petition above to print, alter (if wish) and send or FAX to 304-558-2516 (and then mail to be sure). No FAX, then email to peia.help@wv.gov and then mail the signed original. FAX or email before board meeting at 1:00 today. See 8 key points for important issues to address, will post results of board meeting today. Also see 6 Ways to Help , and there is a petition you can sign and FAX. If you do nothing else, please ***write a letter to the PEIA Finance Board by Dec. 4 *** for the most immediate effect. It can be faxed too, but I’d still mail the hard copy to be sure. Below are announcements of Save PEIA Benefits Meetings in Huntington, followed information about PEIA Finance Board Meeting you can attend Dec. 4, then an article about the Premium Increases up to 64%, Benefits Decreases, and some Anticipated Negative Changes to PEIA Medicare. Please check back frequently, we are adding links etc. daily. Also though it’s best to write your own letters to the Finance Board, sample letters will be posted Sun. or Mon. We will have samples at the meetings. Be sure to check above at 8 key points and 6 Ways to Help/ Fight Back – it has links to find legislators, support groups, all newspapers in the state and the media, and also ways you can help anonymously. Lastly, please email you sample letters (you sent to the PEIA Finance Board and delegates) to savepeia@live.com. Also, email savepeia@live.com to be added to an email list. We’ll post a few (minus all identifying info) to lend inspiration to some, and help others with writer’s block. This is your site too, and you have much to contribute. Thanks for all the emails.


    Premium increases up to 64% in 4 years and/or benefit decreases

    November 28, 2008

    The PEIA Public Hearing Presentation shows proposed premium increases, benefit cuts, or a combination, with increases for retirees of 11, 17, 13, and 12 percent over 4 years. These increases compound from year to year, and therefore would add up to a 64 percent increase in premiums ! With little computation one finds for a non-Medicare retiree currently paying $208 monthly, premiums would increase to about $341 per month ( $1692 more yearly by the beginning of the fourth year), for yearly premiums of about $4093 (higher for fewer years of service). Premiums for Medicare retirees increase by the same percentages.

    For active employees the increases are 9, 14, 13, and 12 percent, a total premium increase of 57 percent by the start of 4th year. Active employees with incomes at just over 20, 30, 36 and 42 thousand in PEIA PPB Plan A Family Preferred Plan see increases over the 4 years of up to $930, $1094, $1279, $1593 more per year respectively, for compounded yearly total premiums of about $2362, $3012, $3516, and $4389. The monthly premiums would have gone up in each income bracket as follows: from $136 to $213, $160 to $251, $187 to $293, and from $233 to $365 per month. Those in the lowest part of each bracket will be paying over 10 percent of their income just for the premiums!

    There are about 17 proposed benefit decreases. Proposals include increasing specialist visit copays to $25, Tier Two ((Preferred Brand Name) medication copays to $25, possibly moving some drugs to categories requiring higher copays, and increasing OPP (Out of Pocket) family cap by 50 percent. Non-Formlarly (Nonpreferred Brand-name)medications would no longer be covered. Also Nexium, Prevacid, Aciphex, Clarinex, and Xyzal will no longer be covered. (Though these can now be purchased over the counter, they sometimes cost a lot, and PEIA has not made any provision to reimburse, or supply the over the counter version, even when the medication is prescribed by the physican. Coinsurance for Network Providers Outside of WV increases to 30 percent. Note copays, do not apply to the Out of Pocket maximum for either retirees or employees. They are regressive putting the heaviest burden on the sickest, poorest, and oldest.

    In addition, for Medicare/PEIA retirees copays will be added for urgent care, out patient mental health care, durable medical equipment and prosthetics, hearing exams, and outpatient rehab (physical therapy, etc.), again putting the burden on the oldest.

    The Presentation also proposes increases in copays for Non-Medical Home physician visits. However, all primary care physicians and internists in the PEIA network, are not considered medical home physicians. So if you see an internist or family practice physician in the WVPEIA network, but who is not a “Medical Home Physician,” you will have to change to and Medical Home physician or pay the increased copays.

    Any proposed changes that are approved will take effect July 1, 2009. They have proposed so many decreases in benefits and increases in premiums, that it is almost impossible to determine how much it will cost the participants.

    Not mentioned in the Public Hearing Presentation was that PEIA as early and Jan. or spring could be issuing a Request for Proposals for bids for the Medicare Advantage, and probably will be switching from the Private Fee for Service (PFFS) to a Preferred Provider Organization (PPO) which would probably and most assuredly be a smaller, more restrictive provider network both within WV and when going out of state, when compared with Traditional Medicare. This more restricted network, if viewed with regards to West Virginia’s Omnibus Health Care Act (which was referenced in a previous bid proposal), might mean that any WV physicians/providers outside the network but within WV must accept the in-network rate, and can not balance bill the patient. Apparently you might be unable to see Medicare physicians in WV who don’t take the Advantage rate, even if you’re willing to pay the difference. These are physicians that seniors could still have seen, had PEIA not forced them off Traditional Medicare onto Medicare Advantage (if it becomes a PPO plan). Medicare Advantage is really a Dis-Advantage when compared to Traditional Original Medicare with PEIA as a supplement.

    Why were participants not told of the probable plan to switch to a PPO, before and during the last Public Hearings, so they could discuss it before the new request for bids is posted? This wasn’t even in the PEIA Public Hearing Presentation; even through they plan to rebid it soon. I suppose their logic is that it won’t go into effect until July 2010, and there will be public hearing in Nov. 2009. However, by then it will be almost a done deal. Shouldn’t it have been discussed before it’s let out for bid? Something as important to the Medicare retirees as the possibility of changing from a PFFS plan to a PPO plan should be discussed ahead of the bid request not at the last minute!

    Consider the legal concept of detrimental reliance. Most state employees were extremely low paid. They were told that we had the insurance instead. Retirees worked for 30 to 40 plus years, and now that they live on small pensions, the insurance bears no resemblance to the original plan. It’s like buying a house (our labor for decades), making some of the payments (the low wages they gave us), and then deciding to keep the house but only paying a part of what is owed. We couldn’t do that, so why can the state. The health insurance is deferred compensation for labor provided for decades. These negative changes and all the negative changes over the years, amount to a decrease in pensions and salaries.

    This is to be voted upon by the Board Dec. 4. If you are concerned about the erosion and loss of benefits write PEIA Finance Board and all state delegates and senators. Failure to relate your concerns and objections could be interpreted as tacit support for all these negative changes.

    Marilyn Howells, retiree

    Note 1: With regard to the comments above about Medicare Advantage. The phrase that I quoted was in the first request for bids 2 years ago. Since they finally contracted it as a PFFS there wasn’t a network, but if they make it a PPO network, just how will this apply. It was on page p. 18 of the request for bids that year in Section 2.15.4 Prohibition of Balance Billing and reads “ The Omnibus Health of Care Act enacted by the West Virginia Legislature in April 1989 applies to the PEIA and its primary members. The law requires that any West Virginia health care provider who treats a PEIA insured must accept assignment of benefits and cannot balance bill the insured for any portion of charges over an above the PEIA fee allowance or for any discount amount applied to a provider’s charge or payment, this is know as prohibition of balance billing. Any provisions regarding balance billing and assignment acceptance from CMS shall also be enforced by the MAPD Plan.” This probably doesn’t bode well – for any provider out of state who is not in the Advantage plan, being willing to see to see you. Is that what the phrase about CMS provisions means??? Probably doesn’t bode well – for any provider out of state who is not in the Advantage plan, being willing to see to see you. Is that what the phrase about CMS provisions means???

    Note 2: This last note only applies to a few people, but constituted another take away of benefits that applies only to couples, where the spouses both worked and carried insurance on themselves and each other, one through PEIA and the other through another employer related plan that was not PEIA. With Traditional Original Medicare when they retired Medicare of course is the primary payer and pays first, and then through a Traditional Coordination of benefits, the private plans through the employer pays second, and the spouse’s plan pays 2nd’’ if there is anything left to pay. (This reverses for your spouse). This situation continues even after both are on Medicare. In other words, Traditional Original Medicare allows 2 supplements. However, Medicare Advantage does not allow 2 supplements so you are forced to drop either your spouses insurance or the PEIA. So after both have worked a lifetime for their employers, and earned both supplements, Medicare Advantage won’t let you have the 2nd supplement.

    So just by forcing retirees on to Medicare Advantage, PEIA (a supplement) has not only changed its benefits, but denied participants the right to participant in Traditional Original Medicare, and for those who had a 2nd supplement (for which their spouse worked) forced them to lose it. They messed up 2 to 3 insurances for each participant, with the stroke of a pen.


    Retiree lobby day is Wed. Jan 20. 2010. If you can’t attend please send emails Wed. or any other day this week.

    January 20, 2010

    Phone calls are also helpful, especially on Thursday and Friday as those attending will be lobbying on Wed. ( Please remember that as well as calling your own legislators, call all the rest as they  all serve on various committees and vote on things ( See newspaper article below for reasons to contact lots of legislators and delegates).
     
     
    All retirees are welcome regardless whether or not they belong to a group.
     
    Parking in certain spots is free and they are providing breakfast.
     
    Where: Food Court in Capitol Basement
     
    When: Wednesday, Jan. 20,  2010
     
    Time: 8:30 am to noon
     
    Parking: park free at Laidley Field parking lot and ride the free shuttle to Capitol.
     
     
    “Again this  year there will be a free breakfast for retirees and guests. We can sit an enjoy breakfast while listening to our Legislators and Special speakers. Also as in past years you can park free at Laidley Field parking lot and ride the free shuttle to Capitol. If we do not show up in large numbers we cannot expect the needed help in our PENSIONS, HEALTH CARE OR TAX EXEMPTIONS!!!!! SEE YOU THERE” 
     
    On January 20, 2010 our coalition of WV retired public employees (CORPE) will rally at the State Capitol in Charleston West Virginia This is the time each year the different retiree groups come together as one . The CORPE group  meets with our legislators and Governor to lobby for increases and protection for our retirement benefits.
     
    ” breakfast is free  … and will consist of eggs, bacon, sausage, biscuits and gravy, coffee, and tea” etc.
     
    ” The governor and legislators are invited to attend and, if they wish, to make a presentation to the group. This is a chance for retirees to talk to their legislators both during and after the Rally. Each retiree organization ( WVAFT, WVEA, AFSCME, NARFE, WVARSE, and PERSA) will have a table for displays and literature. As a bonus for PERSA members, when you sign in at our table you will receive a free PERSA t shirt.””
     
     
     
     
    Notes on some concerns of mine that affect retirees.
     
     
    1. 4 % increase in premiums  for retirees – plus more
         (note for some this might be more, as PEIA was talking about for actives not implementing these evenly  in all  salary brackets) and also for all a penalty for not having a living will and they may want to dictate where this is stored!!!!!  That would be another $25 per month/ $300 per year
     
    2.  Through it wasn’t stated in the Public hearing handout or in the papers the added $25 deductible is really a loss of  Traditional Coordination of Benefits between PEIA and Medicare, and a change to carve out. 
    This is the same Traditional Coordination of benefits that they tried to take a way several years ago  when they wanted to add a deductible of several hundred dollars. That was stopped but now they are trying it again with a  smaller amount and not using the terms “traditional coordination of benefits” and “carve out”.  How can they say they had a public hearing on this matter when they didn’t say they were taking away traditional coordination of benefits. How long till this deductible grows to the $300 or so they originally wanted.
    Page 17 of Public Hearing Handout PEIA plans adding a deductible, but they don’t tell us this is a new deductible, or that it takes away Traditional Coordination of Benefits between PEIA and Medicare, going to “carve out coordination of benefits, thus instituting new deductibles which will certainly grow, a major blow to retirees and that PEIA tried before without success due to the large outcry.   Traditional Medicare was the Primary insurance (about 85% of needs and PEIA was the supplement (about 15% of needs) that it’s job to fill gaps in Medicare.  Apparently the hope may be that plan members and seniors will fail to notice this now amid all the other threatened take-aways.  Sadly, every $100,000 in raises recently given PEIA upper management etc. (from PEIA administrative funds ?)  would equal  the amount taken away from 4000 seniors through this loss of coordination of benefits. The state’s chief executive’s $55,000 raise would cover this deductible (this take away benefits) for over 2,200 seniors who worked 30 or 40 + years at often extremely low wages, and don’t receive COLA’s on their small pensions. The goal is probably not just the amount reaped by adding this deductible, but to establish it now, so it can be not only increased repeatedly, but perhaps in case any future federal restrictions might protect against  this take away of traditional coordination of benefits later, as  it was promised in benefit books for years.  This moves this cost outside the PEIA 70/30 match, costing shifting the entire amount to retirees.  This will affect all when they retire. What’s lost now is lost forever, and will hurt those who retire latter more than current retirees, as this increases over years.  It takes it off 70/30 match and costs shift  whole deductible to plan members.   
      
    3.  Increasing  49 drug copays from $15  to $50, affecting  many actives and 33% of retirees. See PEIA Handout pages 14-15, 17-18. This decrease moves these expenses outside the outside the 70/30 match promised.  Many of these drugs do not have and exact generic substitute, and member will have to us entirely different  medications, with a different formulas. Will they not 100 to 200 more drugs to this in future years, and raise the copay to $100. And retirees don’t have cost of living increases. What about those for whom other medicines haven’t worked or have quit working, or have allergies or a medical reason not to take the PEIA suggested substitutes. They should not have to pay this higher rate.   Note the list of drugs in the Public hearings handout is for the actives. They did not give us the list drugs that will increase to $50 copays  for retirees. While they say it is similar it is not the same.  Again how can they have had a public hearings on this unless they gave us the full list.  This unfairly hurts retirees more than actives and affects more retirees than actives. Also as the state gets some reimbursement from the Medicare on medications, why are they  targeting seniors?
     

    4.   PEIA on page 26 of Presentation is also proposing to financially force end of care directives though financial incentives (which effectively raise premiums $25  per month/costs for those not complying – a financial penalty) and dictating with whom to store (physician, in effect whole practice, – for electronic storage and faxing with any general release?). Let’s see an agency run by a former insurance executive, (that contracts with private insurance companies to provide our benefits and Medicare, private for profits  corporation where the bottom line i s the bottom line, and CEO’s and other executives,  make millions more the more they cut our benefits. WANT TO SET A PRECEDENT THAT THEY CAN DICTATE WHERE WE STORE  OUR PRIVATE LEGAL PAPERS. SOUNDS LIKE A CONFLICT OF INTEREST.   Some feel this is an invasion of privacy, conflict of interest, financial coercion and  many feel that this should only be in the hands of their lawyer/trusted relatives until needed. In a recent spring/summer board meeting  PEIA proposed tying premiums to providing  END of Care Directives. Now they are talking about incentives that really just raise others premiums- the same effect.  Will we have to sign them for our children and babies, will mothers have to sign them for their unborn babies. Will grown children at college  but under PEIA have to sign. Will be enacted before to the parents even make it to the hospital and get a chance to say ask for a neurological consult? This sets a dangerous precedent.  If their goal were only to “make sure someone knows their (members) wishes”  PEIA would let members choose this someone, not dictate this.  Once we start down this road of PEIA having a say in End of Care Directives,  where will it end. It is a matter of trust. We can not trust PEIA the way it has been run the last few years to leave it at this.  They will continuing add requirements around this issue. Whether this very personal document is stored maybe 30 years before needed with PEIA or  third party registry with safety issues, or with  physician, it’s financial coercion (through premiums). Will this be like medication, starting with a  $5 reduction in copays for generics, which  became a  $15 copay for brand name, with $50 copays for brand names not on formulary and for  so called “specialty drugs,”   to a proposal last year not to cover any brand name drugs not on formulary? Can we look forward to ever increasing premiums, or even loss of services or coverage for not providing End of Care Directives or providing them to whom PEIA dictates?  Could they later dictate what you have to say in it.  Will they pressure physicians and family (or family through physicians) as to how to interpret them PEIA’s way? Will the insurance company not let the family get second opinions, or consult a specialist? This also puts the physician at risk if the insurance company discourages consults. Insurance companies need to quit playing doctor.  PEIA wants to dictate to whom to give this document. Give it to a doctor you give it to a whole practice and it’s get sent out to hospital under general medical release, and going into hospital on emergency  doesn’t ensure you even get a doctor you know.  Many prefer this document with lawyer and trusted relative.  Once the precedent is set that PEIA can tie  providing insurance company or third party, physician or whoever PEIA dictates to Providing End of Care(End of Life) Directive  to premiums or incentives, where will it end?  This opens the door to possible Civil Rights lawsuits.  Some may contract American Civil Liberties Union  right here in Kanawha county.   Wording in many of these broiler plate documents is vague and generic,  and open to lots of interpretations.   PEIA has one such document in back of shopper’s guide. Many do more research to buy a washer or a house and the loan documents, yet this form is the more important   Many people would prudently want to clarify and want protections and safeguards. However, those who are lower income, and those that need to save a few dollars  will feel financially pressured to sign the form in the booklet, and many might not be able to afford a lawyer right now. Where is 2nd opinion provision, who picks which physician, what about the right to consult a specialist, or fax records to Mayo or Cleveland Clinic etc.  How long in a vegetative state ? a few hours,  a couple weeks/ an month? There are numerous/dozens considerations, and a lawyer could cost several hundred.  Could PEIA end up a party to a wrongful death lawsuit due to this policy and providing form. Some may want to  search “Before you sign on the dotted line” Please see We’re not Dying Fast Enough (attached for details).  Even Joe Smith of the PEIA board is quoted in the newspaper about having concerns about tying this to premiums.  Note most will be on Medicare when this document is needed so costs in newspaper would be mostly Medicare’s not PEIA’s anyway.    Again since on the public hearing handout they did not state where we  were to store these documents, nor exactly how much the penalty would be for not doing things like they want, how can they say they had a public hearing on this?

     
    5. PEIA’s proposed High Deductible – High Out of Pocket  Plan B for actives will actually undermine retiree benefits and their Plan which is close to actives Plan A by undermining Plan A.
    It also mirrors a High deductible  4th  type of Medicare Advantage Plan (See Medicare and You 2010 pages 56 & 57,    http://www.medicare.gov/Library/PDFNavigation/PDFInterim.asp?Language=English&Type=Pub&PubID=10050). Is this what they eventually want to force on retirees?? !!!.
       PLAN B – Radical Changes to Plan B expose members to Financial Ruin and undermine Plan A, while shifting costs from PEIA to members .  See pages  9, 13 & 16 of public hearing handouts. Could PEIA be planning to eventually drop plan A and force over 60,000 members onto this new Plan B in future years. 

    Note every $300 in premiums saved by plan members going to Plan B results in a loss of $1200 in matching funds form the states under the 80/20 rule or $12,000  over 10 years. Then they get really sick with a long term illness and come back to Plan A under open enrollment depleting  plan A funds,  causing Plan A premiums to go up driving  more people to plan B. It will become a vicious circle eventually causing the demise of PPB Plan A and we’ll all be forced onto a high deductible high out of pocket Plan B. Then they’ll force this on the retirees  since this is all the actives will have.  Make no mistake private insurance companies want to make money off our Medicare. That is why we have Medicare Advantage. As those pages 56 55-57 in Medicare and you show their are 5 types of Medicare Advantage  HMO, PPO ( preferred provider Organization), PFFS ( Private Fee for Service ), Medical Savings Accounts/ High Deductible,  and   Special Needs Plan that can severely limit network and your choice of physicians etc.  Why anyone with Medicare plus a  supplement want the high deductible plan??? Yet we could end up having it forced on us.

    They  only real winner is the state that gets out of the 80/20 match for years on people the difference between the Plan A premiums and Plan B premiums.

      Plan B for actives has traditionally been a plan similar to A where members to save a little on their premium say  288 per yr. single ( salary range 36,000-$2,000 ) to $684 pr. family plan, while assuming a somewhat greater deductible when compared to plan A ( at least double or more in lower salary tier, and somewhat less increase in the higher tiers and higher Out-of-Pocket maximums. Only perhaps 3500 members are on this plan now. But it was a nice alternative.  However, they are now raising the individual deductible by $700 (140%  0n the lower salary tiers, and by $200 (40%) in the upper tiers, and the family plan  by 140% ($1200 ) to $2400 in the lower tiers, and 60% ($900) in the upper tiers to $2400. Clearly this is more punitive on the lowest paid, but is harsh for all.   The changes in Out-of-Pocket Maximum are if possible much worse. All get 125% increase to $4000 for individuals and a whopping $9000 for family plan.  This is not the 80/20 match as promised and expose the lower paid to possible bankruptcy if health problems arise.  This would now be a HIGH DEDUCTIBLE CONSUMER DIRECTED PLAN, and eligible for members to use a HAS account (see below) save to pay the bills that previously been covered by PEIA. Note also that there are limits on what one can put into savings each year, and are lesss than the deductible, so one will not be able to save enough to equal the OOPM each year. Those in the lower tiers would have to earn over 155 % interest in the 1st year  on their invested premium savings to earn the $700 increase deductibles for individuals plus the $36 account fee. For the family plan  they would have to earn about $211 % interest on the $684 premium saving to equal even 1 year’s increase in family deductible increase plus $36. This is an unheard of interest rate in most safe investments. And yes, they could add their tax savings but that would be only about 5 to 15% of the premiums saved and will not help much.  For the extra $4500 in family Plan OOMP  and member in the lowest tier would have to earn 684% in the year. Those in the highest income brackets might fair a little better taking a risk,  by the increase in family deductible + Out-of Pocket maximum is still $5400.  When asked PEIA said Plan B members could return to Plan A on open enrollment dates, without penalty for any health problems developed while on Plan B but will this change.  Plus these members being allowed to come back to the better plan after paying the lowest premiums undermines the financial stability of plan A the better plan. Obviously, some will need and should come back to Plan A when they experience $9000 OOMP’s year after year. Many lower paid will feel pressured to take Plan B to save a few dollars especially as most have not had a raise in years, and some of the best paid ( over 100,000) may be willing to gamble on not needing to meet the $9000 OOMP, but as a whole this radically revised Plan B is fraught with risk.

    Another way to think of it,  you by a $100,000 life insurance policy, and then when you find out you’re terminal  you switch to the million dollar plan raising the  costs for this better plan those that stayed with it.
    Insurance means you and your healthy cohorts along with  your employers or former employer pay into the plan for years to built reserves to cover when someone and eventually you is really sick. While no one would want to see anyone stuck on Plan B,  letting people go back and forth is unfair to those who stay on plan A and pay the higher fees. They  only real winner is the state that gets out of the 80/20 match for years on people the difference between the Plan A premiums and Plan B premiums.
     

    Again,  the  only real winner is the state that gets out of the 80/20 match for years on people the difference between the Plan A  premiums and Plan B premiums.

    6.  Suport  AFT and other union and retiree group  suggestions for revamping PEIA and also see article below for some things legislature can do,  but we need your phone calls, email and support.

     
     
     

     Article from Charleston  Gazette

      

     

    “January 19, 2010
    W.Va. eyes multi-decade approach to retiree costs
     
    Associated Press Writer

    CHARLESTON, W.Va. (AP) – West Virginia lawmakers have identified 17 wide-ranging options for tackling the state’s estimated $7.8 billion funding shortfall that stems from public retiree costs.
    A special Senate Committee shared the suggested ways for dealing with “other post-employment benefit” or OPEB costs during closed meetings Tuesday.
    While declining to detail the recommendations, committee Chairman Brooks McCabe said he hoped to develop a final list of proposals and introduce the necessary legislation during the 60-day regular session that began last week.
    “I think it was well-received,” said McCabe, of Kanawha County, after the caucus of fellow Democrats.
    OPEB costs mostly reflect retiree health coverage. The list, obtained by The Associated Press, includes depositing $200 million between 2011 and 2012 into a special trust fund. A related suggestion would afterward dedicate up to $150 million annually toward these costs over the next several decades. The state has adopted a similar plan for closing a multibillion-dollar shortfall in its main teacher pension fund.
    Other recommendations would have the state assume part of the costs now billed to county school boards. Nearly all of state’s 55 county school boards told the Public Employees Insurance Agency last month that they plan to sue over these billings.
    The committee is also considering upping the retirement age of teachers and most state workers hired after June 2011 from 55 to 60, while also holding off when they become eligible for benefits from five to 15 years.
    Senate Republicans also met to hear the recommendations Tuesday.
    “It is a good work product, and the parts are still moving somewhat,” said Sen. Mike Hall, R-Putnam and a committee member. “This is going to be one of the more heavy-lifting items of the session.”
    Government accounting standards call on public employers to calculate and disclose gaps between on-hand assets and non-pension retirement benefits like health coverage promised to workers.
    Responding to that standard, the Legislature adopted a 2006 measure from Gov. Joe Manchin that has PEIA charge government employers yearly amounts meant to address West Virginia’s unfunded liability.
    School boards question whether the state should instead pay, as PEIA sets retiree health benefits and rates. They also object to having to list as current debt what they don’t or can’t pay toward their “annual required contribution.”
    The committee has suggested that PEIA allow employers to list part of what’s left unpaid as long-term debt, while lowering the annual amount of what must be paid. Each of those proposals would require legislation, as would four others outlined by the committee.
    The recommended cost shifts would apply for the benefits of county school teachers whose salaries are provided by state funds.
    Other suggestions would change the way PEIA calculates premiums for non-retired enrollees, and narrow the gaps between the deductions and out-of-pocket costs that enrollees pay. The list also includes an alternative, cafeteria-style health plan that would charge enrollees based on the benefits they choose.

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    Senate Republicans also met to hear the recommendations Tuesday.
    “It is a good work product, and the parts are still moving somewhat,” said Sen. Mike Hall, R-Putnam and a committee member. “This is going to be one of the more heavy-lifting items of the session.”
    Government accounting standards call on public employers to calculate and disclose gaps between on-hand assets and non-pension retirement benefits like health coverage promised to workers.
    Responding to that standard, the Legislature adopted a 2006 measure from Gov. Joe Manchin that has PEIA charge government employers yearly amounts meant to address West Virginia’s unfunded liability.
    School boards question whether the state should instead pay, as PEIA sets retiree health benefits and rates. They also object to having to list as current debt what they don’t or can’t pay toward their “annual required contribution.”
    The committee has suggested that PEIA allow employers to list part of what’s left unpaid as long-term debt, while lowering the annual amount of what must be paid. Each of those proposals would require legislation, as would four others outlined by the committee.
    The recommended cost shifts would apply for the benefits of county school teachers whose salaries are provided by state funds.
    Other suggestions would change the way PEIA calculates premiums for non-retired enrollees, and narrow the gaps between the deductions and out-of-pocket costs that enrollees pay. The list also includes an alternative, cafeteria-style health plan that would charge enrollees based on the benefits they choose.”

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