What’s New; PEIA Takes Away More Benefits

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

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 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 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 2^nd 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 2^nd 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 2^nd 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.