Saturday, December 31, 2011

COSA's ERRP: Dance Around Strings

Images sum up the City of San Angelo's approach to health insurance.  The following picture shows City Manager Harold Dominguez highlighting how the city planned to save $483,000 in health insurance costs.

It's not the city's new low cost mammography service, but how employees will go from two local providers to one.  San Angelo Community Medical Center is the new exclusive provider for city workers and retirees.  Shannon Medical Center will be shut out.

As a result, the city will squeeze retirees a little less than last year.  A small portion of the $483,000, roughly 29%, will go to lower employee/retiree dependent premiums. Council made this decision in a November meeting.

The second shows how the city plans to utilize $343,000 in Early Retiree Reinsurance Program (ERRP) funds, a decision made December 20th.

It involves shifting money from one sack to another to avoid requirements, something generally frowned up by funders. 

The council ended up voting 5-1 to apply the $343,287 to pay 2012 (i.e. current, immediate) claims and then take a comparable amount out of the city's self insurance fund and put it into the fund balance (i.e. the savings account fund within the health insurance fund), so that there are not "federal strings" attached to how that money can be used in the future. The motion approved stipulated that the money will be used for rate stability or possible catastrophic claim experience.

Oddly, for all the talk of federal strings, City leaders failed to identify ERRP's sole requirement.  An employer must use ERRP money to offset increases in health insurance premiums/costs.

One might expect Human Resources and Risk Management Director Lisa Marley to clearly state the city's intended use of funds and federal requirements.  She didn't.

While City Finance Chief Michael Dane dubbed his "avoid federal strings" strategy "compliant", I have serious doubts about substituting federal money for local.

City leaders state health insurance costs will go down in 2012.  Federal money cannot supplant local, such that an employer spends less on health insurance than the prior year.  Yet, that's exactly COSA's plan. 

"We believe we've been betrayed."  Russell Smith
When Retired Police Chief Russell Smith finished his public testimony, even the Rushmores' (faces sitting on high perches) were speechless. It echoed Council Chambers the first time Smith uttered the dreaded "ERRP" in November 2010.  In between, it's been a black comedy of incompetence and/or mendacity.

My guess?  It's a bit of both, given a number of city leaders wish to eventually tap the health insurance fund surplus for capital items.  As of 11-30-11 the health insurance fund surplus stood at $1.3 million, up from nearly $1 million two months prior.  These amounts do not include the $343,000 in ERRP cash. 

The rush to implement a multi-stage plan, amidst ignorance of ERRP requirements, could imperil the money intended to help soften future blows for city retirees.

Every picture tells a story and the City offers a hapless ERRP tale.  Fortunately, it's all on tape, even the convoluted motion which failed to make the meeting minutes.

Update 3-9-14:   Sponsors must comply with record maintenance requirements and provide records upon request in connection with audit or other ERRP integrity related activities. The Sponsors must maintain records for 6 years after the expiration of the plan year in which the costs were incurred, or longer if otherwise required by law. The records that must be retained are as follows— (1) All documentation, data, and other information related to the regulations, and (2) Any other records specified by the Secretary. The Secretary may issue additional guidance addressing record keeping requirements, including (but not limited to) the use of electronic media. The sponsor must require its health insurance issuer or employment based plan, as applicable, to maintain and produce records upon request.

Friday, December 30, 2011

ASU Cats without NIne Lives

Leaders at Angelo State University expressed willingness to work with volunteers proposing a safe, effective and humane way of dealing with the university's feral cat problem.  Somehow the word didn't get to workers charged with trapping.  Early this week seven ASU cats were taken to the San Angelo Animal Shelter.  Today, two more trapped cats arrived at the shelter. 

Texas Tech University has a feral cat program, headed by a former Marketing employee.  Oddly, ASU has two marketing employees who've gone to great lengths to save university cats in peril.  One relocated most of ASU's cats during a prior trap/kill/starve program, which occurred under Dr. Jim Hindman.  After a costly rodent infestation, this effort was judged a mistake.

Why does ASU seem unable to learn in this regard, either from their or others' experience?  Sixteen years ago the University of Texas enacted their feral cat colony.  It safely and dramatically reduced their cat population from 115 to 15. 

For some reason a sixteen day reprieve couldn't be enacted, at least effectively.  Such a hold would've allowed community and university animal organizations to assist ASU.  Of the nine, two have been euthanized.  The other seven were saved by a concerned citizen. 

Was Winston, a gray and white cat who hung around the UC, one of the victims?  If so, the university lost an icon. 

Many worked to hard in short order to save ASU's cats.  The list includes area citizens and employees.  Let's hope word gets up and down the chain of command and that ASU becomes the latest Texas university with a vibrant, effective feral cat program.

Saturday, December 24, 2011

Deja Vu: ASU Plans to Kill, Starve Cats

Angelo State University's feral cat misery-go-round spins again.  Under President Jim Hindman all feral cats were removed.  Within months the university had a major rodent infestation.  Mice and rats caused significant damage to wiring in several buildings.  Facility Manager John Russell knows the story.

For a period of time, volunteers trapped, spayed and neutered ASU's feral cats.  Employee turnover meant most of these volunteers left ASU.  Nobody managed the pet store.

The result is ASU's feral cats, untrapped and not fixed, multiplied.  ASU announced a plan is to trap and take the majority of these cats to the San Angelo Animal Shelter.  This is a sure death sentence given the Shelter's policy of euthanizing wild cats.

Cats left at ASU are to be starved.  Anyone caught feeding university cats can be disciplined.  Because humans didn't manage the problem, many cats will be exterminated. 

Trap, spay/neuter, release and regular feeding works to reduce cat populations without euthanasia.  One San Angelo feral cat colony went from 27 to 10 under conscientious management.  One might expect a university to be at the forefront of feral cat care, not repeatedly retreating into the dark ages. 

Knowledge is sorely lacking, profound and otherwise.

Update 12-30-11:  ASU trapped and took seven cats to the San Angelo Animal Shelter, where they were exterminated that same morning.  This occurred despite efforts by area citizens and the head of Texas Tech's feral cat colony.  There is a chance ASU will move away from their plan to kill and starve cats on campus.  However, it will take a concerted community effort.

Later update 12-30-11:  The Animal Shelter employee charged with euthanization was off, thus not all of ASU's cats were exterminated.  Of a total of nine brought in, two were euthanized.  Seven will be saved by interested citizens.

Latest update 2-2-12:  Local citizens and ASU employees proposed an ASU feral cat colony, which was approved by administration.  As a result, remaining campus cats get a reprieve.  Kudos to all who cared for ASU's cats and worked hard to get the university on a different trajectory!

Friday, December 23, 2011

Spirit of Christmas: All Aboard

My connecting flight boarded late and I stood at the end of the line.  Surely there would be no room in the overhead bin for my luggage.  Bah humbug, I checked the bag at the gate.

After stowing my laptop beneath the seat, I envisioned a nap.  To my surprise the flight attendant didn't deliver the usual safety spiel.  She offered her version of The Night Before Christmas (which I'll post if it's shared with me).  This inspired my derivative version:

Twas two nights before Christmas
and all through the plane,
weary travelers expected the usual inane.
But this safety briefing rang with humor and heart
that no corporate script could ever impart.

Travelers perked up their ears, smiles broadened wide
as Stewardess #1 delivered line after line.
The pilot announced he and the first mate
would hold up the trip, making us a little late.
Important packages were destined for the hold.
Gifts for our loved ones, young and old.

These acts took place on one solitary flight 
of an airline in bankruptcy, what a terrible plight.
Pay will be cut and pensions obliterated,
so executive bonuses can be liberated.

Yet this crew set aside the cards they face,
giving great joy to the human race.
Keep this a secret, whatever you do.
Corporate PR would never approve.

Christmas flickers in each heart's light,
especially in those facing challenges of blight.
Many thanks to the creative word stew,
the pilot, first mate, the whole inspired crew.

They brought me home for Christmas,
long before the plane finished its flight.
Love and joy to all,
and to all a good night!

This message can be reproduced by anyone except corporate lawyers intent on finding my identity, which bankrupt airline I flew and what crew worked the flight, which was actually a sleigh ride.  Legal beagles, that means reindeer tracking!

Update 2-9-12:  Reuters reported "AMR filed for Chapter 11 on November 29, citing a need to trim uncompetitive labor costs. The company told employees last week that it aims to cut expenses by $2 billion a year, slash about 13,000 jobs and terminate pensions. AMR also intends to generate $1 billion per year in new revenue."  It also stated "American already has plenty of cash, a strong domestic route network and service to Europe and Asia as well as related oneworld alliance partners in London and Tokyo."

Wednesday, December 21, 2011

Federal Strings vs. San Angelo City Promises

When the City of San Angelo applied for Early Retiree Reinsurance Program (ERRP) funds in July 2010, their application stated:

The City of San Angelo is self-insured for health coverage.  Early Retiree Reinsurance Program Reimbursement proceeds will be deposited in a dedicated account for insurance funds.  These funds will then be used to offset increases in premium contributions and increases in participant costs.
In their last meeting Council decided to use $343,000 in ERRP money in 2012.  The problem is the city will use the funds in a year when premium contributions and participant costs are going down.  Council members want to avoid federal strings, however in doing so, the City breaks the only string associated with the program. 

One might conclude city leaders have forgotten their promise made eighteen months ago.  One could wonder if they aim to purposefully violate the only ERRP rule, that money be used to cushion cost increases.

Forgetful or twisted?  Neither are the least bit inspiring, but that's the abysmal state of leadership.

Grinch COSA on Health Insurance

San Angelo City Council decided to use Early Retiree Reinsurance Program (ERRP) funds in 2012, a year where the city already expects significant savings (of which only a small portion is being passed onto employees/retirees and their dependents). There is no sharing of ERRP funds to decrease premiums or improve benefits, as promised and required. I believe Council's move could endanger the funds given ERRP's requirements:

Last year's present to employees/retirees?  'Twas a lump of health insurance coal via draconian premium increases. The City turned Grinch this Christmas, taking nearly all the goodies for itself. Wahoo, wahoo....

Tuesday, December 20, 2011

City Council Jeopardizes ERRP Funds

The Standard Times reported on San Angelo City Council's designated use of Early Retiree Reimbursement Program funds:

The council ended up voting 5-1 to apply the $343,287 to pay 2012 (i.e. current, immediate) claims and then take a comparable amount out of the city's self insurance fund and put it into the fund balance (i.e. the savings account fund within the health insurance fund), so that there are not "federal strings" attached to how that money can be used in the future. The motion approved stipulated that the money will be used for rate stability or possible catastrophic claim experience.
ERRP states funds can be used to increase benefits or reduce premiums.  Under their vote Council will not use funds for either purpose. noted:

To the extent a sponsor decides to use the reimbursement for its own purposes, it may use the reimbursement only to offset increases in the sponsor's health benefit premiums or health benefit costs.
Council's November decision on health insurance ensured the city's portion would decline.  Benefits did not increase.  They decreased dramatically for "out of network" care.  While employee/retiree premiums will decrease in 2012, the source of that premium break is not ERRP funding.

Since qualifying for ERRP in August 2010, the City funded a consistent $4.77 million for health coverage.  Council's decision knocks down the city's contribution from $4.77 million to $4.43 million for budget year 2011-2012.

Rather than use ERRP money to impose a less draconian burden on employee and retiree dependents in 2011, COSA plans to "pay claims" in 2012, when it supposedly will save $483,000 under an exclusive arrangement with Community Medical Center, this after coming in $1 million under budget in their self insurance fund.

One could argue the fairness of the city passing on the vast majority of premium increases in 2011, while holding the lion's share of savings in 2012.  That seems patently unfair, a scorching of employees, retirees and dependents.  However, a greater issue is the City's compliance with ERRP regulations.

In this citizen's mind this clearly fails ERRP's maintenance of contribution requirement.  Might the feds ask for their money back?

The city has been evasive and obtuse on this issue since getting approval from the feds. If the city has the feds snooping around their use of funds, it's earned and well deserved.

Monday, December 19, 2011

City Plays Hard Ball with Shannon

Shannon Medical Center sent a letter to City employees explaining how they can serve the 70% who utilized Shannon's services in 2012.  Click on the image below to make it larger:

The odd thing is not considering Shannon "out of network" for hospital care.   COSA employees using Shannon for nonemergency acute care are like Stripes customers, cash & carry. That's alot of ka-ching, even with a 50% discount.

Mayor New and City Council may drive San Angelo's safety net hospital into the arms of a tax paying entity.  Big money men shop for distressed health care assets.  How long before Shannon goes for cheap?

While health care is frequently the cause of crisis, the City of San Angelo manufactured one to push this move. 

Thursday, December 15, 2011

City Council Finally Will Hear ERRP Presentation

City staff will make a presentation on the Early Retiree Reinsurance Program, nearly 16 months after being approved by Health & Human Services.  ERRP went from:
--invisible to 
--hush-hush to 
--iffy to
--too complex to
--nearly $350,000 in cash
It's item # 11 on the agenda:

Consideration of the following matters related to the Early Retiree Reinsurance Program (ERRP) reimbursement funds
a. Consideration of accepting said funds
b. Discussion and possible action regarding allocation for use of said funds received in the amount of $343,287.50 and based on the 2010 health insurance claims (Presentation by Human Resources and Risk Management Director Lisa Marley)
The city is restricted in its use of ERRP money.  Eventually it will be used to lower premiums for workers/retirees or improve benefits.  The city did not use ERRP funds for either purpose in 2011 or 2012.  Maybe they'll have an impact in 2013...

Wednesday, December 14, 2011

Uncle Sam to Imitate San Angelo on Medicare?

Senators Ron Wyden (D-OR) and Paul Ryan (R-WI) proposed shifting Medicare to a fixed contribution benefit for senior citizens.  The plan is based on the same foundation as the City of San Angelo's fixing their contribution toward employee/retiree health insurance.

Should the Wyden-Ryan plan pass, will Uncle Sam also pass on draconian premium increases in bad years, while taking the lion's share of savings in good years?  That's what COSA did in 2011 and plans for 2012.

I expect San Angelo to eventually dump their health insurance benefit, as most employers may.  Senator Ron Wyden offered pioneering proposals in this arena long ago.  Union leader Andy Stern said in 2006, employer sponsored health insurance is dead and not coming back.   A bipartisan team would be needed to make this a reality.

The race to the lowest global common denominator on worker pay/benefits, including health care and retirement, continues.  Exempt are campaign donations and executive pay.  Gorging must continue at the campaign money trough.

Tuesday, December 13, 2011

ASU's Turbulent Future Includes Two New Alumni Positions

Angelo State University will pay for ASU Alumni Association's Executive Director and Office Manager in an announced move.  These two new university positions will report to ASU's newest Vice President, Jason Penry.

The three new slots came after the Texas Legislature decimated ASU's budget, requiring the elimination of 30 positions.  A companion announcement said ASU would spend $435,000 on two pieces of yard art.  Apparently Texas Tech's budget practice of spending a portion of new construction funding on art wasn't impacted by budget cuts. 

ASU is also considering a move to Division 1 athletics.  Employee pay was frozen and many educators took on double overloads, teaching more courses with higher enrollment.  ASU is either a conundrum or a tale of two universities.  One side gives, while the other takes.

Earth Bound Art Coming to ASU

Modern art lovers will be excited about Angelo State University's planned additions.The red ribbon piece is budgeted at $60,000, while the stainless steel comes in at $375,000.  Texas Tech requires a portion of major construction projects be dedicated to public art.  The art is intended to enhance the University's ambiance and aesthetics, even add whimsy, according to Dr. Rallo.

One criteria mentioned by Dr. Rallo is the art shouldn't look like aliens dropped it from space.  I'll leave it up to you to judge, but space art beauty is clearly in the eye of the beholder.

Update 1-11-12:  KLST ran a story on Dr. Rallo's new yard art at ASU.

Saturday, December 10, 2011

City of San Angelo ERRP Update

With 90% of federal funds expended, the City of San Angelo nervously awaits $150,000 in Early Retiree Reimbursement Program funds.  So far COSA received  $343,000 from the feds for retiree health claims. 

Nearly one year after ERRP began paying claims, San Angelo made the recipient list.  The City's dragging its feet in filing claims turned Harold Dominguez's "iffy" assessment into reality.  Let's hope Harold didn't leave $150,000 on the table as retirees need the help.  How many will be left when the city decides to share?

Tuesday, December 06, 2011

Rallo & Entourage Head to SACS Annual Meeting

Angelo State University President Joe Rallo recently attended the SACS Annual Meeting in Orlando, Florida.  Rallo serves on the board of the university accrediting body, as ASU sits in a precarious position. 

ASU's future accreditation might be in the hands of a good report writer.  The editor's task is writing a consistent report that presents the university's accomplishments in the most favorable light.

The university's compliance and accreditation committees changed as often as Rallo's Vice Presidents.  The point man for much of ASU's accrediation work was Dr. Limbaugh, headed to North Montana State for a Chancellorship.

There is a game plan.  The question is execution with top turnover and organizational trauma inflicted by the Texas legislature.  Ironically, Dr. Rallo is now Chair of a Texas higher education council, one focused on public universities.  His responsibility is to interact with the Texas legislature.

Rallo failed to publicly fight for ASU in the last budget decimation.  How will he fare representing all public universities in early 2013?   

Also attending SACS on behalf of ASU were:
Nancy Allen - Vice Provost
Crystal Braden - Director of Institutional Planning, Policy Effectiveness
Doyle Carter - QEP Director
Stephen D. Emmons - Faculty Representative
Sarah Logan - Asst. VP Institutional Research & Accountability
Brian May - Interim Provost and Vice President for Academic Affairs
Bradley Petty - Director of University Recreation
Karen Shumway - Director of Student Learning Assessment
Paul Swets - Interim Dean, College of Arts and Sciences
John Wegner - Associate Professor/Director of Center for Innovation in Teaching and Research
Dr. Wegner serves in the English faculty.  I expect he'd know the difference between wording for strength and clarity vs. spinning yarns.  It remains to be seen how ASU will muster the will and competence to pass accreditation given its fractured culture and unceasing turnover. 

How did I know to research this story?  I sat behind Dr. Rallo on American Eagle's 7:00 am flight to DFW.

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.

Sunday, October 30, 2011

COSA's Hollow Health Insurance Promises

Memo dated October 27, 2011 to Mayor Alvin New and San Angelo City Council members:

"At the December 7, 2010 Council meeting where the premium adjustments were approved for calendar year 2011, there was discussion regarding a concerted effort to involve employees and retirees in the process for 2012 rates."  -  City Human Resources/Risk Management Director Lisa Marley

Four days before Council meets on November 1, the public and employees received notice health insurance for 2012 was on the agenda.  The public had to go to the City's web site and pull up the agenda, which lists health insurance as item #11, after an Executive/Closed Session.  Employees received an e-mail, informing them health insurance would be the first item on the agenda.

Having offered public comment numerous times on health insurance, I would not have shown up at 9:15 am,the time given to employees.  In my mind the City released documents within hours of one another, guiding people to appear at what could be viewed as vastly different times.  Will one group be shortchanged?  Will it be the citizens of San Angelo, supposedly at the top of COSA's organizational chart or employees, required to take vacation to appear and comment?

Here's the heading of the e-mail.  Note the date and time:

Friday, October 28, 2011 2:14 PM
Subject: Fwd: For City-Wide Distribution: New Insurance

Authorized for distribution by the City Manager's Office.

TO: All Employees
(Supervisors: Please print for those employees without email.)
How many employees got the e-mail before leaving work Friday, especially those without e-mail?  How long does it take to process a vacation request?  Are there limits on how many employees can be on vacation at one time?

Council promised to do better on this contentious issue.  More than once leaders said they would involve retirees in the process, an apparent lick and a promise.   

“A lick and a promise” means “a superficial effort made without care or enthusiasm.” To perform a task with “a lick and a promise” is to do the absolute minimum required, and often far less than that. 
Retirees were involved only at the last moment, much like the City's distributing the agenda, agenda packet and employee e-mail.

Major changes are afoot, given the city's plans to spend no new money on health insurance.  One provider will be chosen, Shannon or Community.  Benefits may fall.  Retirees and employees may have to find new primary care doctors and specialists in short order.  While the city surveyed employees on possible changes, it did not include early retirees, once again casting doubt on Council's "concerted effort."

There will be no time to conduct research on options, mobilize city retirees or the general public.  November 1 is decision day, given benefit enrollment is planned the week before Thanksgiving, November 14.  Council won't meet again until November 15.  The COSA health insurance train is gaining steam, ready to achieve ramming speed.  How many employees and retirees will be tossed about this Tuesday?

It's different than casting out 192 covered employees, retirees and dependents, Council's 2010 achievement.  Early retirees have to wonder when the City's promise of "lower premiums or better benefit" will come true.  San Angelo delivers retiree licks better than promises.

Those wishing to read the e-mail can do so below:

COSA HI Emp Letter

Saturday, October 29, 2011

City Health Insurance: Month Late & Dollar Short?

San Angelo Human Resources and Risk Management Director Lisa Marley will present health insurance bids to City Council this Tuesday.  The City's health insurance Request for Proposal HR-02-11, originally specified a council presentation on October 4.  Besides being a month late, the city plans to spend no new money on health insurance in 2012.  Agenda item #11 states:

a. Discussion of proposals submitted for Request for Proposal HR-02-11 for benefits regarding health, dental, vision, basic life/AD&D, voluntary life/AD&D, post-65 retiree health and flexible spending accounts.

b. Consideration of selecting Benefit Providers related to Request for Proposal HR-02-11 and authorizing staff to negotiate a contract, and authorizing the City Manager to execute said contract and any related documents

As the City budgeted no new money for health insurance, bidders had to be creative.  How much did they slash coverage levels?  How much will the City shift in annual medical costs to employees (out-of-pocket)?

Given the city's obtuseness on the Early Retiree Reinsurance Program (ERRP), I don't expect leaders to come clean on such matters.  With Retired Police Chief Russell Smith busy writing a book, someone will have to delve into the details to get the complete picture.  I helped Russell with research in the past, but am severely time constrained for the next month.

Here's my wish:  Lisa Marley would answer questions Russell or I would normally offer.  Russell might ask for the third year in a row, "What's the real agenda here?  C'mon, fess up."  One might expect the city to offer a clear motivation to San Angelo citizens, especially given COSA's organizational chart.
Is Mayor New encouraging more retirees to return to the workforce to garner affordable health insurance for dependents?  Is he using health insurance to get Shannon to provide payments in lieu of taxes, known as PILOT money?

Who will be impacted by decreased coverage levels, by how much?  How many employees will need to change primary care doctors and specialists, once the city picks a side, Shannon or Community, in our divided healthcare town?  How fast will they need to find that new doctor given open enrollment is slated for the week before Thanksgiving?

Will early retirees ever see Marley's 2010 promise of "lower premiums or better benefits"?  Since the city qualified for ERRP, early retirees paid through the nose for dependent coverage in 2011 and face benefit cuts in 2012.

Despite the city's "concerted effort to involve employees and retirees in the process for 2012," retirees weren't involved until bids were ready to be reviewed, i.e. far too late in the game to influence budget policy or benefit design.  The four retirees include Stephen Brown, David Hermes, Curtis Milbourne and Teresa Special.  Maybe they can advocate for the use of ERRP funds to ease last year's severe pain.

Final thought:  Why does the city dangle a new time off benefit around health insurance changes?  Last year, it was a Veterans' Day holiday, a seemingly incongruous offering by Councilwoman Charlotte Farmer given the City's strapped finances.  This year it's time off in return for United Way participation at a “care share”, “double care share”, or greater level.  Why is the city prepared to spend over $57,000 on increased time off but nothing for health insurance?

I find the reference to double "care share" symbolic, as it could apply to 2012 out-of-pocket medical care costs for employees.  Should anyone wish to delve into the agenda packet, it is below.  As usual, it's light on the details.

Wednesday, October 19, 2011

City Health Insurance: Late Addendums

The City of San Angelo planned to present its 2012 health insurance recommendation on October 4.  The topic didn't make any October Council agenda.

With no information I cruised the City's web site for requests for medical coverage proposals.  I found the original, plus a number of addendums.  One started with:

The City is very interested in a single provider option. If you are quoting medical, please make sure to include this option if available.
Of course the City is looking for the best deal, but there are other considerations.  Mayor Alvin New wants Shannon Medical Center to kick in Payments in Lieu of Taxes (PILOT).  Might the city use health insurance to arm twist Shannon?

Last year the city passed on small costs to employees but draconian increases to employee and retiree dependents.  The jury is out on changes for 2012, so says the City:

Q.  Is the City still planning to pay all of the employee's premium except for $16.00, or will there be another scenario?

A.  The City contribution for next fiscal year is unknown. This will be determined based on the bid results. 
The City told health insurance companies not to submit bids with higher premium costs.  That means bids should hold the line on costs, causing coverage levels to deteriorate significantly.

On retiree health insurance (Over 65) the city takes one stand:

Post 65 cost is $301.90 PEPM. That amount is broken down below:

$194.90 Hartford
$107.00 Rx (BCBS)
$301.90 Total

The $301.90 is the amount the spouse is billed if they are Hartford participants – the City makes no contribution to the spouse amount.

$16.50 is what the post 65 retiree pays, so the City’s contribution is $285.40.
Later the city stated:

There is no Post 65 RX plan
Clear? Only the bidders can say for sure.

Employees and retirees know the city wouldn't institute new taxes for 2011, effectively throwing 192 people off city sponsored health coverage.  For 2012 Council budgeted new money, which should cause employees/retirees to face greater out of pocket costs due to deteriorating coverage.  It will be a different kind of hit, but a hit just the same.

Update 10-21-11:  Walmart, where many COSA employees have a second job, announced cuts in health benefits for workers.  

Sunday, October 16, 2011

Walk Today in Memory of Amy Pettit

Today's CROP Walk begins at 2:00 pm at the Pavilion next to Kids' Kingdom Playground.  The walk raises money to alleviate hunger, locally and beyond.  For years Amy Pettit walked, but she did so with special purpose for CROP.

As a young mother in the Depression, Amy and her infant daughter Lois knew hunger.  Times were brutal.  Daily, Amy's husband Al looked in vain for work.  The generosity of a neighbor, a bootlegger, kept the family barely fed.

Work eventually came, but Amy and Al never forgot their trials.  They looked for people to help and organizations that did likewise.  CROP fit the bill.

CROP walking became a family affair with daughter Lois and granddaughter Kristin.  The three would frequently raise over $1,000 each in a friendly competition.

Lois will walk today, in memory of Amy, who passed on August 4, 2011 at the age of 96.  Lois raised over $6,000, with $5,000 of that coming from heaven.  Amy, the longtime walker and alleviator of hunger, will walk in spirit with her daughter.  There's no place Amy would rather be.

Thursday, October 13, 2011

Health Insurance Absent from COSA Council Agenda

The San Angelo City Council agenda is out.  Employee and retiree health insurance is absent from the October 18 agenda.  City Manager Harold Dominguez and Councilman Kendall Hirschfeld highlighted promising bids in early September.  The "good news" remains untold.  I remain curious how far benefits will be cut to achieve the city's no new money criteria.

Tom Green County Indigent Health Expenditures

The Tom Green County Indigent Health Program finished the 2010-2011 fiscal year. While no year end report has been filed and shared at a County Commissioners' meeting, a mid-year report was available. Of nearly $2.1 million the county is required to set aside, it spent $128,000 over seven months.  Add in the $1 million used to leverage Upper Payment Limit funds and the total grows to $1.13 million. 

If the first seven month experience held, the County spent $220,000.  That would leave $780,000 to transfer into the general fund.  I'll update the numbers when the County releases actual year end figures.  (Click in the image above to make it larger).

Tuesday, October 11, 2011

TGC Indigent Health: History Rewrite

Texas County Progress has a teaser on Tom Green County's Indigent Care Program, specifically collaborative efforts that helped the county spend money more effectively.  It reported:

In the spring of 2002, Tom Green County staff helped organize a Health Access Subcommittee. The subcommittee met approximately once every six weeks to discuss local health care problems and find resolutions for those problems within the committee. The subcommittee consisted of the local chief executive officers and chief financial officers of the two local hospitals, the administrator to the federally qualified health center, the social services director, pharmacists, physicians, the Health Foundation chief executive officer, county commissioners, the county judge, and the director of indigent health care. Together, the subcommittee was able to remove barriers in communications between organizations and better coordinate benefits for indigent health care clients, in addition to understanding the educational and financial crises of the impoverished of our community. 

Unfortunately, time may have clouded the author's memory of events. San Angelo's Health Access Coalition was formed in 1999.  It had three subgroups, Access & Financing, Health Promotion and Data/Information.  The Access/Financing subgroup offered to help the county, which consistently overspent its budget the prior three years.

Community leaders, especially Shannon Medical Center's Vice President for Legacy Insurance, provided specific recommendations for stretching dollars further.  This included covering nurse practitioners (in addition to physician assistants), paying for outpatient surgery vs. one night surgical hospital stays, and paying FQHC services vs. expensive ER visits.  Leaders also recommended searching for other payor sources for patients who might be retired military or have access to other benefits.

The vision and goal for Tom Green County Indigent Health Care was to provide all eligible clients more primary care and specialist services, as well as additional optional health care services, while lowering Tom Green County expenditures.

My recollection of the vision and goal was to spend money more effectively so more people could be covered with the same resources.  The HAC hoped income eligibility would increase from "the poorest of the dirt poor."  Instead the program has become Tom Green County's cash cow, replenishing reserves on an annual basis.  As the facilitator and minute taker for all HAC subcommittees, I want to be on record with a more accurate version of history.

Tuesday, October 04, 2011

City Misses Health Insurance Milestone

The City of San Angelo planned to present health insurance bids to elected leaders in today's council meeting:

They missed their milestone.  Thus, the public remains unaware of the magic used to keep health insurance rates steady or lower when other employers face 25% premium increases.

How much will benefits fall to hold the premium line? It remains to be seen.