Thursday, November 24, 2011

City Employees Get Health Insurance Turkey

City Leaders and Council failed to inform the public of drastically lower health insurance costs for the year ended 9-30-11.  The City expected to pay out $7 million but costs came in at only $5.88 million.  As nearly 200 people dropped health insurance in January 2011, premium revenue fell short, coming in at $6.83 million.  The difference resulted in a $950,000 windfall to the City.

For the third year in a row the city will provide roughly $4.7 million in contributions to the health plan.

Employee/retiree contributions nearly doubled over the five year period, only getting a slight break in 2012.
The City took $950,000 in savings without a public mention.  To the city's credit it added roughly $600,000 of that amount to the health insurance fund balance.  Add in nearly $500,000 in ERRP funding and $300,000 in 2012 expected Aetna EPO savings and the total comes to $1.4 million. Of $1.6 million in two year savings, COSA shared $200,000 with employees/retirees, a mere 12.5%.  The City is keeping 87.5%.

For two years the City acted like it had empty pockets on health insurance.  That wasn't true in 2010, despite Council's gross mischaracterization.  In November 2011 Mayor New made a motion to take health insurance savings and buy a fire truck.  While New later withdrew his motion, shifting benefit money to purchase capital items needs to be watched.

Update 12-7-11:  The Standard Times ran a piece by a dependent of a city worker.  Two days later, the paper published another letter.

Saturday, November 19, 2011

Cost of Changing Health Insurance

San Angelo City Council approved a new plan design with much higher out-of-network costs for employees and retirees.  Changes will produce $483,000 in expected savings for 2012.  The City chose to share $197,000 with employees and hold the rest for a rainy day fund. 

During the discussion Mayor New clearly expressed his desire to move a portion of the savings to the City's capital budget.
After much discussion, New withdrew his motion.

Councilman Hirschfeld, happy to push 76% of increases to employees/retirees last year, motioned for the lion's share of this year's savings to remain with the City for future health insurance increases.

Councilwoman Farmer dressed down the Employee Committee for not informing council that employees face costs for new histories when they move to SACMC physicians.  As a "businesswoman" she should be embarrassed for raining on volunteer employees/retirees, when paid city management and HR staff steered key aspects of the RFP and council set budget parameters.  HR built the RFP in conjunction with City hired consultants.  Farmer let Harold, Lisa and Holmes Murphy skate, going after the little people.

City Manager Harold Dominguez controls what information goes on the agenda and what information is presented.  It's so orchestrated, that Harold has a separate room with employees yet to present, with an on deck circle. 

HR's Lisa Marley couldn't manage to file an ERRP claim, while other Texas cities got millions in reimbursement.  Her delays led to the City's current ERRP reimbursement uncertainty. 

Summing up, benefits did not stay the same.  The cost of changing doctors is significant from both an emotional and economic standpoint.  While they didn't go as far as taking health insurance savings and buying a new fire truck, Council once again looked uninformed and insensitive to the plight of employees and retirees.

Maybe they'll strike the right combination next year.  They'll have roughly $1 million to put to bear.

City of San Angelo Cuts Health Insurance Benefits

City leaders gave the impression that the only change needed to save $483,000 was an exclusive provider arrangement with San Angelo Community Medical Center.  It turns out benefit cuts were needed to achieve the savings.

Out-of-network changes include:

Physician Office Visit for Primary Care/Specialist was 70% after deductible.  For 2012 it will be 50% after deductible, a 20% benefit reduction.

True Emergency ER visit copays were equal in 2011.  In or out of network provided 80% coverage after a $300 copay, waived if the y were admitted to the hospital.  Neutral true emergency care is history.  Any out-of-network ER visit gets 50% coverage, a decline of 30%.

Skilled nursing, home health and hospice out-of-network benefits fell from 70% coverage to 50%.  Outpatient mental health did likewise.

The City of San Angelo cut out-of-network benefits to get savings.  Either city workers/retirees will change doctors or they will bear a heavier burden through increased out-of-pocket costs.

Feel free to compare 2012 benefits to 2011 via the documents below:

COSA Approved Plan Design 2012

COSA Health Benefits 2011

Wednesday, November 16, 2011

Bad News Day for ASU

The Standard Times played a critical role in egging Angelo State University with two stories.  The paper picked up an Associated Press piece on Dr. James Limbaugh's leaving as ASU's Vice President of Strategy, Planning, & Policy. 

Dr. Limbaugh, by far the longest tenured ASU VP with almost four years' experience , will become Chancellor at Montana State-Northern. Limbaugh's new job might wash away the bad taste from having ASU's strategic plan blow up from state budget cuts.

The paper's second story, highlighting Navajo Code Talker Samuel Tso, drove nearly a thousand people to ASU's CJ Davidson Center.  Rick Smith's outstanding piece had the public expecting to hear World War II stories.  Instead Tso eviscerated the government that lied, cheated and stole from his people, one that repeatedly failed to honor its promises.  That same government funds the Center for Security Studies at ASU, and provides grant money to Multicultural Studies.

Intentional or unintentional, eggs splattered on ASU, courtesy of the Standard Times.

Tuesday, November 15, 2011

City Council Stiffs Employees Yet Again on Health Insurance

San Angelo City workers and retirees must be tired of the beating from this City Council on health insurance.  Last year this mendacious crew forced the lion's share of $960,000 in 2011 cost increases on employees, early retirees and their dependents.  Workers bore 76% of the total $1.2 million in projected increases.

At the time key City leaders knew of a projected $550,000 in federal Early Retiree Reimbursement Program (ERRP) funds, but chose to keep it secret.  When challenged by Russell Smith and myself, elected leaders sat on their ERRP, passing draconian premium increases for dependent coverage.

As predicted, scores of city workers/retirees dropped health insurance.  Nearly 200 fell from the rolls of the insured, saving the city $190,000 in 2011.   Council never mentioned these savings in a public meeting.

The city has $1.15 million to put to bear on health insurance.  Here's the breakdown:
1) $190,000 savings from city workers and retirees dropping health insurance for 2011. (Unless they already spent it on something else)

2) $480,000 in ERRP money, of which $330,000 from 2010 early retiree claims sits in a city bank account.  (This can only be spent on health insurance, reducing premiums or increasing benefits)

3) Expected savings of $483,000 from Aetna plan with SACMC EPO for 2012.

Council met today to talk about using these funds.  City leaders reneged on their prior intent to use ERRP funds in 2012, instead sticking them in a rainy day fund with earliest use in 2013.

Fast forward to 2012 where Council plans to pocket most of any $673,000 in elective savings.   The City plans to return a mere $197,000 (29%) to employees/retirees, keeping 71% for the city's "plan fund balance, which at nearly $1 million is about $400,000 short of its 75-day goal."

Is the "plan fund balance" for health insurance or capital budget items?  I would bet the latter, given Harold Dominguez's propensity to hide things with obtuse language.  Here's how fair this council has been to employees/retirees:

Increased costs:
76% employees/retirees
24% city

Cost savings:
29% employees/retirees
71% city

The city dishes out three of four lashes to workers/retirees, then takes three of their four potential prizes.  Those who make the rules win the game.

Sunday, November 06, 2011

Angelo State's "Bad Tooth" Nursing Program

The headline ran "ASU Nursing degree may be extracted."  The story went on to detail poor student performance on the Registered Nurse exam for ASU's associate degree RN students.  Passing rates plummeted in 2010 and 2011, according to university officials.  This occurred after ASU received a grant expanding its nursing programs.  One could conclude the university lowered its admissions criteria to increase enrollment.

To address the poor test performance ASU added an entrance exam and raised admissions standards"

"We elevated the admission criteria, the minimum ACT score and GPA (grade-point average)," said Susan Wilkinson, head of the Department of Nursing and Rehabilitation Sciences.

ASU's  AD RN program has 192 students.  When the AD program is pulled, students will need to get a Bachelors of Science in Nursing.

Nursing is one of ASU's "programs of distinction."  Expansion came with negative side effects.  What lessons carry over to the wider ASU "grow at all costs" mentality?

Quality problems are the last thing Angelo State needs as it heads into SACS accreditation, when the university is already on dicey grounds. It'd likely be better if the Texas Tech board axed the program than an accrediting body.  Appearances matter, even when quality doesn't.

Update 12-14-11:  The Texas Tech Board of Regents will take up the extraction issue.

Update 2-13-12:  ASU's Associate Degree RN passing rate fell to 60% in 2011.  Quantity does not mean quality.

Absent City Workers Heard Anyway

San Angelo City Manager Harold Dominguez devised a net-less tight rope for city workers on his Employee insurance Review Committee.  They had but one thin line to walk, given City Council's secret charge to spend no new money on health insurance.

The committee received this charge in early 2011, the public not until a June City Council meeting.  "No new money" was reinforced in summer budget meetings, despite concerns by members of the public. 

Early retirees, the ongoing after thought of this council, were added in September to evaluate bids.  This group suffered greatly from Council's December 2010 decision to pass draconian premium increases to employee/retiree dependents.  Nearly 200 people fell from the rolls of the insured, a savings of nearly $200,000 for 2011.

Harold thought he'd boxed the committee in enough to where he could delegate any employee/retiree ill will to them, while claiming credit for budget wins.  Not so.  Steve Wilson showed employees wouldn't take the latest "crap sandwich" from this council lying down.  In return for over 700 employees and retirees having to find new primary care doctors and specialists, the committee strongly requested council give the $483,000 savings (above "no new money") back to employees and retirees:

1.  Reduce premiums for employees and retirees low plan back to zero
2.  Equalize dependent coverage between employees and retirees
3.  Reduce dependent premiums 

Addressing Mayor New's concern for a rainy day fund, Wilson suggested ERRP funds could serve that role.  Harold's secret slush fund of federal money is now in the public eye, The City received $330,000 in ERRP funds and has another $150,000 on the way.

One might expect large numbers of employees at such a meeting.  Making over 700 workers switch doctors seems as important as the city employee health clinic, which had standing room only in 2010.  Why the no shows?

Employees were informed one full work day before that council would address the issue.  Anyone wishing to attend was required to take vacation time. I'd guess Harold issued an edict for managers not to approve such requests, but maybe he's not that evil.

Kudos to Harold's Employee Insurance Review Committee for not swallowing all the castor oil.  It was subtle, but I appreciate spitting some of it back in their face.

A big razzy to elected leaders for the ongoing torture inflicted on city workers and retirees.  When HR staff pass out Medicaid and CHIP applications to workers, something's terribly wrong.

Especially when that Council has over $1 million in health insurance savings to use, over $500,000 of that in cash.

Update 11-7-11:  City kicks retired 73 year old firefighter

Tuesday, November 01, 2011

COSA Drops Shannon, Which Will Drop ?

The City of San Angelo will drop Shannon Medical Center from its health insurance plan beginning January 1, 2012.  Of over 1,100 insured city employees, 70% currently use Shannon doctors and hospital services.  That means 770 must change doctors, primary care physicians and specialists, within 45 days or pay drastically higher out-of-pocket costs for out-of-network care.

The new plan will save the city $483,000 from the current plan.   How else did coverage change in the new plan?  The City didn't say or the Standard Times didn't report, but consider HR Manager's position on increases earlier this year:

Marley said renewal under the current plan design would require a 35% increase, 24% relative to the existing plan and 11% due to health reform requirements.  
What other coverage changes were needed to take a $2.5 million increase and turn it into a nearly $500,000 savings?  That $3 million swing likely required more than a single provider change. 

The other issue is what the city is doing with banked health insurance savings, over $1 million so far:

$190,000 from 192 people dropping health insurance in 2011.
$500,000 in expected Early Retiree Reimbursement Program funds
Some portion of $483,000 in savings from Aetna-Community move

The City didn't say who would file future ERRP claims, as the job is currently contracted to Blue Cross/Blue Shield.  This City Council proved inept in mobilizing ERRP money to help retirees keep affordable health insurance, especially in light of last year's position by city leaders:

One looming question after Tuesday’s extensive city health insurance plan debate — the topic took up much of Tuesday’s City Council meeting — was whether reimbursements from the Early Retiree Reinsurance Program were included in the plan’s $1 million cost increase.

The answer is no, and will likely remain that way until the end of 2011, when the city is discussing its health insurance plan for 2012.
The end of 2011 came and went.  The 2012 health insurance discussion went as I predicted, fast and furious with barely an effected employee in sight.  Who has vacation time to use to get stone-eared leaders to listen?  What happened to management by wandering around?  It became management by stomping on.

As for Shannon, the system will have 770 fewer patients to help cover the burden of the uninsured.  The City's move hurts the Mayor's chances of getting Shannon to contribute payments in lieu of taxes (PILOT funds). It may eventually hurt the area's employment picture as Shannon absorbs a $2.5 million hit from the city, along with another $2 million from Medicaid.  Shannon's UPL and DSH funds from the state and feds will be cut.  It's unknown how much. 

Will tax payments become a future requirement to bid on COSA health insurance?  One thing's for sure, as Shannon is pressed, life will be harder for the area's uninsureds.  The dumping is merely passed on.