Saturday, September 22, 2012

City Council Decimates Withering Health Department

A City of San Angelo press release informed citizens of public health service cuts.  Immunization availability will be reduced 80% come October 1, when services go from five days a week to one.  The City's HIV and sexually transmitted disease clinic will close on September 28. 

These are significant curtailments to very limited services offered by the City.  Council eliminated two nursing department positions or 40% of the department's staff.  A physician testified before council, begging for the Rushmores (stone faces up high) not to further decimate what little public health infrastructure remained.  The Rushmores were unmoved, not a surprise given their history.

Below is information from the 2010-2011 budget on public health services.

Council cut one position in 2010, going from 6 staff to 5.  In 2002 public health nursing had 11 staff members.  For the coming year, they'll have 3 positions.

The City also tried to generate more revenue through health department services.

Nursing staff's worry came true as volumes for immunizations dropped by 2,000 after fee increases were imposed.  STD treatment volumes rose despite higher fees.  

The Standard Times let the City Health Services Manager soft pedal the impact of service cuts in her use of half year figures on immunizations:

From a general comparison of patients from January to June of this year, Villarreal estimates that about 2,500 to 3,000 patients will be affected by the cut in immunization offerings, and at least 700 to 750 patients will be affected per year by the elimination of STD testing services.
Annualizing immunizations, the number is 5,000 to 6,000 adults who face considerable hurdles in disease prevention.  Nearly half of the AIDS/STD clinic's encounters related to education and prevention.  With those gone and STD testing unavailable through city channels, it's predictable San Angelo's sexual disease burden will rise.

Here's the final oddity.  City Council expects the health department to make 50% of the revenue it budgeted last year for injections, STD clinic and immunizations.  The amount isn't significant, but I find it odd an 80% reduction in availability should only reduce revenue 50%.  I'd expect revenue to drop more than 80% as the public writes off the city for any form of primary or preventive health care services.

I wonder how long the health services manager job will last given council already decimated the health department.  Here's what the city offered when Mayor Lown started:

That's a two thirds drop in boxes (from twelve to four), with Pharmacy, Primary Health and Social Services eliminated.  Not every city department faced a similar beating..

The City's love affair with economic development continues as leaders emphasize prospective employers, developers, and tourism.  Individual citizens are on their own. 

I wonder how many tourists and prospective employers would want to come to a city with the highest STD rate in Texas?  We're not near there, but with City Council's vision, we could be...

City Has Nearly $2 Million Health Insurance Kitty

City staff finally came clean on San Angelo's banner health insurance year, well almost.  An astericks showed the data to be year to date and not incorporating federal early retiree reinsurance program (ERRP funds) .Adding $343,000 in ERRP funds and nearly $60,000 to round out the year, the City of San Angelo has nearly $2 million in its health insurance kitty.

For those interested in the city's health experience, July budget numbers showed they spent 83.9% of premiums on medical care.  That's below the "medical loss ratio" rule required by health reform.

For large businesses purchasing coverage, the standard is 85 percent. If insurers fail to meet the requirement, they must rebate policyholders the difference.
As a self insured entity the City isn't bound by the rebate requirement.  City Council seemed excited about the prospect of moving "excess" health insurance funds to other uses.  There was no mention of the need to set funds aside to meet GASB requirements for retirement and retiree health care in 2014.

It's been my experience that City leaders and Council repeatedly offer the general public minimal information on health coverage or provide it late in the decision making game.   I'll give the city higher marks for responding to direct questions, but on some issues it's a challenge

As for city leaders disdain for public health, I'll explore that in an upcoming post

Tuesday, September 18, 2012

City Finds $645,000 in Health Insurance Money

What a difference two weeks made.  On September 4th City Council approved a budget amendment that equally offset health insurance revenue and expense declines of roughly $1.1 million each.  This effectively maintained a projected increase of $2,292 in the health insurance fund balance for the current fiscal year.

I projected an excess of $1 million, which I later adjusted to $500,000 based on a second look at draft budget numbers.  My projected range is pictured above (black numbers)

City staff shared a number today that pegs the excess at $645,000.  Added to the prior balance of $915,000 and the fund balance topped out at $1.56 million (red number pictured above).

The ending balance for the self-insurance fund was $1,560,857 according to presentation materials from Human Resources Director Lisa Marley.
After asking numerous times for health insurance budget updates, the information came fast and furious.  Most arrived at the close of the budget approval cycle via City Council presentations.  At least the information came.

Saturday, September 15, 2012

ERRP Funds to be Used in 2013

After a two year wait the City of San Angelo will finally use a portion of its Early Retiree Reinsurance Program funds.  San Angelo was approved for ERRP in August 2010.  Council discounted the use of expected ERRP funds for calendar year 2011.  Instead, it passed on draconian premium increases to retiree and employee dependents, such that nearly 200 people dropped health insurance altogether.

City Council changed its stance on ERRP funds after approving an exclusive provider arrangement with Aetna.  Council specified ERRP funds be used in 2012 to "avoid federal strings."

The City expected $483,000 in EPO savings, but got double that amount, over $1 million.  Note the minutes from the last City Council meeting:. 

Line Item 310 $1M decrease in the City’s Health benefit due to positive impacts of the plan’s changes

These savings preclude the use of ERRP funds, which can only be used to ease the pain of health insurance cost increases, not decreases. 

Staff will provide an update of the self-insurance fund performance during calendar year 2012. Projections for 2013 indicate an increase in health insurance premiums would be required. Staff is recommending the use of $142,000 from the $343,288 Early Retiree Reinsurance Program (ERRP) to offset the projected increases for 2013.
Problems arise in talking about health insurance due to the difference between the city's fiscal year budget and calendar year health plan.  Yet, Council did not approve a budget increase in health insurance in their last meeting.  The budget shows a decrease of $50,000 in 2013.

The above information came as surprise announcement to Council on September 4th, given not one prior budget document showed this revised health insurance number.

The City's $1.1 million health insurance budget amendment is dated July 5th.  The draft budget was produced on July 26, then revised per council direction and included in Council's agenda packet in August and early September.

City brass and staffers clearly knew of big savings, yet waited until the last minute to inform Council and the public.

There is one huge oddity in this budget amendment, revenue and expenses went down by the exact same amount.  Expense savings came from lower utilization and better pricing under Aetna's EPO.  Revenue tends to be more predictable, given employees and retirees pay a fixed amount per paycheck for insurance and the City commits to paying X dollars per employee per pay period.  Generally, the only variable for the city is the number of employees and retirees it's funding.

For the 2012 plan year Council lowered employee, retiree and dependent contributions, effectively sharing a portion of $483,000 in predicted EPO savings.  Yet, savings are double what was predicted. 

Does the city plan on rebating premiums to employees, retirees and dependents?  Will it hold the funds for the coming year (fiscal or plan)?  Will it set the money aside to meet GASB requirements?  Or will it pocket the money in the General Fund and spend it elsewhere?  

I look forward to hearing the update on the Self-Insurance Fund performance.  It could well provide answers. 

ASU's Nothing Doing

The Standard Times editorial team stated:
Upon his arrival five years ago as ASU was integrating into the Texas Tech system, Dr. JosephRallo identified four key areas needing emphasis — retention, recruitment, residency and reputation.

ASU's Rampage offered:
According to the SACS website, institutions provide two documents as part of the reaffirmation process: the Compliance Certification and the QEP.

The Compliance Certification, which should be submitted about 15 months before reaffirmation, is a document that demonstrates the level of compliance with core requirements, comprehensive standards and federal requirements.
Dr. Rallo called it like he saw it.
SACS wrote up ASU in 2002 for not having learning outcomes, President Joseph C. Rallo said.  "They gave us years to fix that, and we did nothing," Rallo said.

January 2012's Faculty Senate minutes produced the following:
Department Head evaluations have not been done in the last two years. 

It's a different form of nothing. The question is its impact on accreditation.

Wednesday, September 12, 2012

ASU's Presidential Finalists Shall Not Be Named

Texas Tech University reported:
The search to name the sixth president of Angelo State University (ASU) is proceeding on schedule according to Kent Hance, chancellor of the Texas Tech University System. The eight-member ASU president search committee has narrowed the initial field of more than 60 candidates down to four recommended candidates for the position.

“This has been a thorough search and I commend the committee for the job they’ve done to get us to this point,” Hance said. “We will be fortunate to have any of the recommended candidates as our next president at Angelo State.”

The names of the four candidates will remain confidential.

Hance will crown ASU's next president, pending a Regent's rubber stamp.

The four recommended candidates will be interviewed by Hance and members of the Texas Tech University System Board of Regents later this month. The final selection will be made by the chancellor, who will make the appointment with the prior approval of the Board of Regents.
This Presidential search is anything but open and transparent, especially for a publicly supported university.  A corporate dominated search committee will ensure no Theresa Sullivans make the cut.

Chancellor Hance wants someone who understands who's in charge and is willing to take orders, be it from the Board of Regents or the Texas Legislature.

I can picture the interchange.  "Chancellor Hance, may I?"  Hance replies, :"Yes, You, May!"

Update 9-16-12:   ASU's Provost and Athletic Director searches were far more open and transparent. 

Sunday, September 09, 2012

Health Insurance Budget Amendment & ERRP

City Council learned about a $1.1 million budget amendment in their September 4th meeting.  I found this surprising given my direct questioning of city staff on this issue over the last year.  It's unusual to amend a budget so late in the game, effectively the day council approved the next year's budget.

I've asked city staff for more specifics on the budget amendment, but a question arose in my mind.  Did the City's actions jeopardize their federal Early Retiree Reinsurance Program (ERRP) funds?

To ensure that ERRP proceeds are not de facto used as general
revenue, sponsors must maintain their level of financial effort in
supporting the applicable plan or plans. To the extent a sponsor decides
 to use the reimbursement for its own purposes, it can do so only to
offset increases in its health benefit premiums or health benefit
. The sponsor must explain in the program application how it will maintain its level of effort for the plan.

Recall the City's history after qualifying for ERRP money.  It acted like ERRP money wasn't real and passed draconian premium increases to early retirees and employee/retiree dependents.  That cast some 200 people from the City's health insurance rolls.

After $343,000 in ERRP cash arrived, Council members asked that it be applied in 2011-12 so as to "reduce federal strings."  It had the temerity to specify uses different than required by ERRP.

Over this two year period Council passed on 75% of cost increases to those covered, while keeping 70% of the savings.  Head's the city wins, tails employees and retirees lose. You get the picture.

Tuesday, September 04, 2012

Hiding $1 Million in Health Insurance Cash

The Standard Times reported on today's San Angelo City Council meeting:

City council briefly were told of the health insurance fund, which was reduced by about $1.1 million because of changes made to the plan throughout the year and lower costs.
While the health insurance budget for the coming year is over $1.1 million lower than the current year, city leaders never revised their existing budget to reflect such dramatic savings.  How does this move impact the budget council approved today?  It hides nearly $1 million.

Here's what council approved today.  It's based on a budget Council obliterated in November 2011 when it inked an exclusive provider arrangement with Aetna and Community Medical Center:

Here's the picture based on the City's health insurance experience in 2012:

Council approved a budget that hides $980,000 in health insurance cash.  This doesn't include the $343,000 in federal ERRP money.  Adding ERRP funds and the city is sitting on an extra $2.25 million. 

These actions must chap early retiree and employee dependents cast off insurance rolls by this band of Simon Legrees in January 2011.

Update 9-9-12:  While health insurance expenses are down $1.1 million in the current fiscal year, revenue is off roughly $600,000 (based on the city's draft budget numbers).  That turns the above excess into $1.4 million vs nearly $1.9 million.  It's still a sizable pot of money, one the city's not being transparent about.

Saturday, September 01, 2012

MedHab-ulous San Angelo!

MedHab's had a logo a year since 2010:

MedHab CEO Johnny Ross markets himself as a rainmaker.  The City needs a rainmaker, the kind that produces green on the land:

One MedHab Angel investor is San Angelo City Manager Alvin New, an elected official.  Johnny Ross inked a $3.6 million economic development agreement with the City of San Angelo.  Ross failed to disclose this relationship in his thank you letter to San Angelo citizens.

Johnny Ross bragged of MedHab getting a StepRite patent in summer 2011. I could find no sign of it on the U.S. Patent Office web site (but a commenter did):

City leaders voted to enrich MedHab and its equity investors in return for jobs. It remains to be seen how good a deal this is for citizens. It could be very lucrative for Johnny Ross and Mayor New. They may well be rainmakers, just not the right kind.

Update:  Thanks to the commenter who supplied the link to Janice and Johnny Ross' patent.  Somehow the link changed.

Obama's Katrina Squared?

The Hill reported:
As much as 1 million barrels worth of oil from the BP incident could be tied up in sediments and water that Hurricane Isaac pushed ashore
Will Hurricane Isaac and B's Oil Spew interact to deliver Obama's Katrina Squared?  Time and vigilant residents will tell.

Update 9-20-12:  NOLA reported on the Coast Guard's spat with BP over Hurricane Isaac oil from BP's 2010 oil spew.