One Single Isolated Incident

Senior administration officials hit Capital Hill to explain enhanced security measures, including naked body scanners and genital manipulating pat downs.  CNN reported:

"I feel bad for the girl they put in front of 50 people when they were doing a pat down," said one Republican senate staff member about the female TSA employee who was part of the demonstration, reflecting the concerns of many passengers about being touched in their private areas by security agents.

A Congressional staffer noted the public's focus on one single isolated incident. :

For all the things they are trying to do to get the word out, one single isolated incident gets a lot more press than all the efforts they're trying to do.

The staffer didn't elaborate on the single incident, of which there have been many.  So far, there's only one underwear bomber.  In that single isolated incident, his parents notified authorities of their son's terrorist status.

Note:  No Congressional staffer experienced an enhanced pat down.   Did any publicly object?  If so, we might have a domestic extremist in the U.S. Capital.

Leadership by Example on Enhanced Pat Downs

I've yet to hear a elected official, government representative or expert say they've experienced "enhanced pat downs" citizens are getting in America's airports.  Those yet to be molested (or to share their experience of having their genitals fondled) include:

President Barack Obama
Secretary of State Hillary Clinton
Frances Townsend
Michael Chertoff

I believe citizens traveling for Thanksgiving are on a pilgrimage, one as dignified as work performed in the U.S. Capital Building.  Therefore, I ask that C-SPAN show every member of Congress going through an enhanced pat down.  After TSA molests members of Congress, it can head over to the White House.  Leadership by example, it'd be a nice change. Tell the Obama girls they can keep their shirt on.

Update 11-23-10  Congressman Ron Paul (R-TX) said he experienced the enhanced pat down and was crotch grabbed.  Instead of knee implants, Paul should carry a diplomatic pouch.  Those don't get fondled.

December Wind Unkind to City Retirees

Nearly one year ago, San Angelo's City Council discussed wellness initiatives and employee/retiree health insurance.  These topics were reflected in the December 1, 2009 minutes.

Wellness initiatives relate to the CareHere LLC proposal to operate the employee health clinic.  City staff cited the health risk assessment as a key reason for recommending CareHere.  One year ago, HR Manager Lisa Marley reviewed "how the clinic could be used to promote wellness initiatives."

Mr. Dominguez disclosed as staff develops the wellness initiative, it is highly likely that the City may move towards rates based on wellness initiatives. Therefore, rates would be based on the health and condition of the employee. Mr. Dominguez provided an example how a reinsurance provider may set a higher stop loss amount on an individual, increasing the City’s liability for that particular employee from $150K to $250K based on claims experience.

The second relates to health insurance and any baseline number.  Mayor Alvin New and City staff said on November 16, 2010 they can't spend a penny more than $6.4 million.  Last December:

Mr. Dane informed the City’s budget for the self insurance health fund is $7.2M and the retiree portion of that amount is $1.5M.  

Mayor New noted the city's good experience under the health plans at the recent Council meeting.

2011 budget (city portion)--  $6.4 million  
Additional employee/early retiree portion-- $1 million
2011 budget total-- $7.4 million

What accounts for the $800,000 difference?  That wasn't addressed at the recent meeting.  Last year, the City tried to pass $800,000 in costs to retirees and permanently cap the City's contribution at a fixed amount.

Mr. Dominguez noted the proposed plan would take three years to recoup related expenditures under the proposed benefit. By adoption of this plan, he informed changes will cover the self-insurance fund $680K shortfall and add an additional $289K to stabilize the fund balance. He advised by freezing the Per Employee (or retiree) Per Month rate (PEPM) at $332.22, any future increases would be covered by the retiree.

What Council declined in 2009, Mayor New and City Manager Harold Dominguez operationalized in 2010.  Albeit, Dominguez found money to help with health insurance increases (August 3, 2010 minutes):

City Manager Harold Dominguez explained the $318K health insurance proposed amount would allow the City to buy down the employee’s contribution amount, thereby keeping increases as low as possible.

A "no new money" wind blew into Council Chambers on health insurance.  It echoed hollow, given the City's acceptance into the Early Retiree Reinsurance Program (ERRP).  City Consultants, using the same claims experience cited by City Manager Dominguez, project $650,000 in reimbursement for early retiree claims from June 1, 2010 to May 31, 2012.

ERRP funds associated with 2010-2011 total $515,000.  That money can be applied toward the $1 million shortfall.  Keeping insurance coverage affordable for early retirees is the aim of the federal program.  ERRP arrived at the wrong time for City leaders, intent on implementing long range plans.  That's why leaders stammered and stuttered when challenged by Retired Police Chief Russell Smith.

City leaders plan to bank ERRP funds for 19 months before using any savings to offset their portion of increases.  That may be the only clear thing in this turbid issue.

San Angelo's ERRP Bank

The City of San Angelo's estimated Early Retiree Reimbursement Program Savings are pictured below.  They cover a two year period, June 1, 2010 to May 31, 2012.   Data comes from several sources, city officials and national benefit consultants.

Holmes-Murphy (San Angelo City HR data)

Low --  $193,836
Expected  --  $653,404
High --  $805,819

Hewitt Associates (national projections)

25% of early retiree plan --  $841,935

$3,000 per retiree @250 under 65 retirees --  $750,000

The five projections can be seen in the blue bars.  The City will bank 80% of ERRP funds before sharing any savings with early retirees or employees.  This is represented by the red bars.

There is "new money," contrary to Mayor New's assertion. The City is choosing not to use it until 2012.

San Angelo's Square Dance with Early Retirees

In the last City Council meeting, Mayor Alvin New choreographed his health insurance moves.  New said he wanted to recombine the City's two health insurance plans, one for current employees and the other for early retirees.  GoSanAngelo reported:

A a year ago ..., when the council voted to split retirees and employees into two separate insurance pools to help the city comply with a federal law. That split resulted in higher insurance premiums for retirees this year.

Retirees face a second year of premium increases under the proposal.  It's not clear from the public presentation how much of the $1 million increase comes from the employee vs, early retiree side.

On August 31, 2010 the City learned of its acceptance in the Early Retiree Reinsurance Program.  Consultants project ERRP reimbursement of $650,000 over a two year period.  ERRP.gov speaks to the issue:

Q.  Can retiree-only plans participate in the ERRP?

A.  Yes. The Affordable Care Act does not prohibit retiree-only plans from participating in the ERRP, provided the employment-based plan and its sponsor satisfy all applicable requirements.

The City's having two plans could be a constraint under ERRP.  Guidance states:

(F)or purposes of ERRP, a sponsor may consider multiple health benefit arrangements as one employment-based plan, unless (1) it is clear from the instruments governing an arrangement or arrangements to provide health benefits that the benefits are being provided under separate plans, and (2) the arrangement or arrangements are operated pursuant to such instruments as separate plans.

Until the two plans are combined, the City may be constricted in using ERRP money outside the early retiree plan.

(F)or purposes of ERRP, a sponsor may consider multiple health benefit arrangements as one employment-based plan, unless (1) it is clear from the instruments governing an arrangement or arrangements to provide health benefits that the benefits are being provided under separate plans, and (2) the arrangement or arrangements are operated pursuant to such instruments as separate plans.

Q.  If a sponsor combines plans during or at the end of a plan year but after it has submitted its application to participate in the program, does the sponsor have to submit a new application?

A.  If plans are being combined into an existing plan that has been certified for ERRP purposes, the sponsor should not submit a new application. The sponsor will need to make HHS aware of the change in plan structure through a process that will be developed and announced by HHS.

ERRP funds have to used to stem cost increases inside the approved plan.  This makes the City's stated use of ERRP funds in the HHS application critical.  That information should be made public.

It's clear City leaders want to hold onto ERRP funding until 2012.  The Mayor's desire to combine the two plans could be driven by the aforementioned information.

Separate..., Combine...,  Do-Si-Do.  Watch to see what New calls next..

Federal Health Money Displaces Local Funding

The City of San Angelo joins Tom Green County in using federal health money to displace local funding. Tom Green County's Indigent Health Care Program leverages Upper Payment Limit (UPL) monies, while the City has Early Retiree Reinsurance Program (ERRP) funding. Both substitute federal dollars for local.

I had the opportunity to ask Mayoral candidates about health care in October 2009:

Jesus healed the people, not just his people. Health care reform legislation is front and center. Yet, national solutions to Texas’ legions of uninsured are at least four years away. Texas passed New Mexico as having the most uninsured years ago, clearly a badge of dishonor. In Tom Green County 23,000 people have no health insurance coverage. The vast majority reside in San Angelo. That data came from 2006, when our local unemployment rate was 4%. It’s now 7%.  How many are uninsured today? 25,000. 30,000?

The uninsured are at greater risk for debilitating deterioration from chronic disease, even for early death. Our country stands by as tens of thousands die every year, merely from their lack of health insurance coverage. Yet, at a recent candidate session held by Bishop Michael Pfiefer, health care was not identified as a critical local issue.

Congressional Budget Office projections show 25 million people remaining uninsured in 2018. San Angelo could have 14,000 without coverage, even five years after reform is implemented. This large problem is not going away in the coming decade.

The City has a health department and an employee health clinic. It distributes Community Development Block Grant money. Past CDBG funds supported primary care for low income residents. Shannon Medical Center, Community Medical Center, Esperanza Health Centers, ASU’s School Based Clinic, and the Tom Green County Indigent Health Care Program are your potential partners in making San Angelo a healthier place. Where is health care on your radar? What plans do you have in this arena?

Candidate John David Fields actually spoke to health care and the city's role at the WTOS Candidate Accountability Session.  Every other candidate showed a lack of interest or knowledge.  Alvin New fit into the lack of interest category, at least in my recollection.

The Mayoral pool presaged the City's ongoing abdication in the health arena.   Under New's leadership, Social Services joined other eliminated services, Primary Care Clinic (for public), and the City Pharmacy (which once housed pharmaceutical assistance).  All shifted to the private sector.

City leaders recommend contracting the employee health clinic to CareHere LLC.  City Manager Harold Dominguez noted two CareHere employees once worked for the City.  One set up the City's employee health clinic.  The other later ran it.  While CareHere approached the City, it's hardly the only company running occupational health clinics.  How many bids did the city get?

The City plans to pass 100% of health insurance cost increases to early retirees and workers.   Employees and retirees alone will fund the $1 million health insurance increase for 2011.  The City of San Angelo plans to save a projected $650,000 in ERRP funding for 2012.  Leaders will bank 19 months of ERRP funding before sharing any savings with early retirees and current workers.

Health care is a target on local radar, where federal monies displace local dollars.  County Judge Mike Brown is on record suggesting indigent health is a Medicaid, not county, responsibility.  Mayor Alvin New said "there is no new money" for City health insurance for 2011, completely ignoring ERRP.

Bishop Mike Pfeifer called government leaders together in September to discuss collaboration, doing so after sitting next to Mayor New during a flight  The Bishop spoke to the plight of the least of these, as he continues to do.

Currently, the City has 1,211 policies covering some 1,400 people.  How many will there be after the New Year?  How many dependents will join the ranks of San Angelo's uninsureds?

The City shed 100 dependents through greater cost sharing, during my time with San Angelo's Health Access Coalition.  State changes saw Tom Green County's CHIP enrollment fall nearly 50%.  Representative Drew Darby expects more CHIP cost sharing, the very thing that caused rolls to plummet.

How much pain will Round Two bring?  I hope Bishop Mike's Justice Lady is watching.

Early Retiree Posse Will Arrive in 2012

It suddenly became clear why San Angelo City leaders didn't want to discuss Early Retiree Reinsurance Program (ERRP) funding from the federal government during the last City Council meeting.  The light dawned as I read Health and Human Services' (HHS's) statement regarding ERRP:

“For example, for a sponsor that pays a premium to an insurer, if the premium increases, program funds may be used to pay the sponsor’s share of the premium increase from year to year, which reduces the sponsor’s premium costs.”  

The City can use ERRP to pay its portion of premium increases. The City's doing 0% this year, passing 100% of increases to those covered.  Thus, ERRP is off the table.

The City wants ERRP funds to go toward its premium increases, not those passed through to workers or early retirees.  This explains their abject silence, until Retired Police Chief Russell Smith broached the topic.  Once challenged, city leaders stammered and stumbled over ERRP.

Help is available for City employees and early retirees, a projected $515,000 between June 1, 2010 and December 31, 2011.  The City plans to bank 19 months of ERRP reimbursement, before offering improved benefits or decreased premiums.  It seems San Angelo's HR Manager Lisa Marley spoke prematurely, nearly a year and a half early.

The current ruse for not applying a portion of the expected reimbursement in 2011 is a "lack of clarity" regarding qualifying claims.  HHS conducted two webinars on the topic in October. Did the City have anyone participate?

The city remains evasive and non-forthcoming on this issue.  I have compassion for them.  It's hard to publicly state, "we got a gift from Uncle Sam and only wish to apply it toward our share of premium increases."  That could make early retirees angry.

Paid local leaders are clear in their position and show no signs of budging.  How might elected members and religious leaders react?  We'll find out November 30  December 7.  (Two weeks in "City Council time" can be three weeks)