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=§ion=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%!!
3．Plan 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.
4．5 % 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 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. 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
- Pass strong drug transparency laws, so we can avoid paying for drug advertizing
- 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.
- Pass menu bills so restaurant foods are well marked.
- Pass laws so food coming into WV are marked if cloned or genetically altered
- 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
- 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).
- 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?
- 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. ***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??}.
- 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.
- 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!!!
- 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
- 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.
- 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.
- 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.
- 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.
- 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.
- 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
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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:
- 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.
- 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
Posted by peiawatch 
PEIA Watch 