SHBP Protest Groups Misguided

Georgia SHBP protest groups are misinformed and misguided. Teachers Rally Against Group Insurance Changes shbp protest(T.R.A.G.I.C.) formed a Facebook group in early January to express their frustration in changes to the GA State Health Benefit Plan. Obamacare is at the root of their complaints, but they refuse to concede this point and would rather direct their efforts toward the governor’s office.

Members and supporters of SHBP protest groups are certainly vocal but completely misguided in their efforts. They have not connected the dots between changes in the SHBP and Obamacare. TRAGIC and their supporters also fail to accept responsibility for the choices they made during last falls open enrollment.

  • The 2013 SHBP package was not ACA compliant
  • SHBP 2014 was required to be updated to meet Obamacare mandates
  • SHBP fall open enrollment clearly outlined benefit changes for 2014
  • Covered participants of SHBP had a choice of accepting the change or purchasing coverage in the open market

My wife and I are covered under the SHBP. We were given handouts at employee meetings and links to the state website where SHBP plan options were delineated. Yet no one complained at that time. SHBP protest groups did not spring up until AFTER the benefits were active on January 1, 2014.

Did they fail to read the handouts or visit the choices site?

One must assume the whiners never bothered to study the plans and weigh options outside the SHBP. The plan cannot be changed at this point. There is no going back. The Obamacare plans are not popular among individuals who have tried to use the exchange which is part of the reason why enrollment goals have not been met. For the 2 million or so that have selected a plan, estimates that 60 – 80% have yet to pay their first premium.

Over 65 million visitors to healthcare.gov but only 2 million have “signed up” for a plan they are required by law to have. Perhaps fewer than 500,000 have paid for their purchase.

Had the SHBP protest groups followed a similar process and studied the plans many of them may have refused to accept the plan designs and sought other coverage.

But they didn’t.

SHBP covered participants don’t get a Mulligan. Barring a Special Election Period because of a qualifying event, they will need to learn to live with their choice.

We reviewed the plans during open enrollment. We understood there were changes. Premiums were higher. Benefits were lower. Higher deductibles and more out of pocket.

We also considered our health care needs, our budget and looked at options OFF the exchange. (Most SHBP plan participants are not eligible for a subsidy so exchange plans should not even be a consideration).

So what can you do if you are in the SHBP to minimize your cost for health care?

  • Maximize your HRA dollars and go through the wellness steps at BeWell
  • If you have not read your plan, do it now.
  • Go to the BCBSGA/shbp site and look up everyone of your providers.
  • Print it out, especially participating urgent care facilities
  • Register with Express Scripts. Look up all your meds
  • Consider changing to generics
  • Evaluate 90 day mail order options
  • Consider ordering from a Canadian pharmacy such as Blue Sky

Rather than treating your health insurance plan like an “all you can eat” buffet, learn to manage your dollars. The sooner you master this skill the better off you will be. The current plan design is the future of health insurance. Protest groups like TRAGIC will not be able to roll back the calendar to the old days so get over yourself. If you spent as much time educating your members on ways to save money on health care everyone would be better off.

Many chronic health conditions can be effectively managed with a healthier lifestyle. Diet and exercise can do wonders for hypertension, high cholesterol, back pain and type II diabetes.

You can change the way you manage and pay for your health care, or you can join a Georgia SHBP protest group and be miserable. Your choice.

Obamacare Cancels Policies on 650,000

On December 31, 2013 650,000 participants in the GA SHBP (state health benefit plan) lost their old health insurance plan. Why? Because Obamacare cancels policies when they don’t meet federal requirements. obamacare cancels policies

The Georgia State Health Benefit Plan provides health insurance for all state employees. Municipal groups and school systems can opt into the SHBP or establish their own plan. TRAGIC, a group started by Ashley Cline, vows to fight the state over their loss of coverage. Teachers Rally Against Group Insurance Changes (TRAGIC) is a Facebook group that has made numerous calls to the Governor’s office and plans a rally at the capitol steps on February 18, 2014 to make their frustrations known.

In spite of the presidential promise over the last four years that you can keep your plan, the fact remains. Obamacare cancels policies.

As pointed out in my earlier post, their cause is noble but misdirected. The loss of their prior plan was mandated by Obamacare and had nothing to do with the new TPA (Blue Cross), the Governor or the Department of Community Health that awarded the contract to Blue Cross.

I tried to explain this to the group and to Mrs. Cline but my counsel fell of deaf ears. Now they are back in the news again.

Cline said the plan to call was the first action step for the group and was posted this week.

“This week we’re going to contact the governor in force … we’re also going to turn our sights toward contacting the nine-member board who makes these decisions,” Cline said. “Our goal is to impact decision in the future.”

Cherokee Tribune

The contract with Blue Cross is for 3 years. The plan design is sanctioned by ACA. The benefits they had prior to 1/1/14 are too costly to continue in light of the new ACA mandated Essential Health Benefits and other provisions the federal government believes you should have. If your plan isn’t one the government likes then your policy is cancelled because it isn’t an Obamacare design.

The Cherokee county school district, and any other district that does not like the SHBP plan design should develop their own plan that complies with ACA rules.

Jamie Lynn Wills, mother of two and a teacher in Cherokee County, said she’s just starting to see the impact of the changed health insurance plan.

“The biggest impact so far, is that I can no longer take my children to see their doctor,” Wills said. “I just lost it on the phone, I broke into tears. It’s an emotional thing because they know my children. The doctor was there when one of my daughters was born. She knows my children inside-out.”

Wills said her family was “so attached” to their pediatrician, and now they can’t see her again.

Actually, that Ms. Willis is misinformed.

She and her family members are free to use any doctor they wish. If they use a non-par doctor they will simply pay more for the services.

In making the switch to an Obamacare plan design Blue Cross priced the benefits based on a limited POS network. During the open enrollment period in October, 2013 employees were given summaries of the 3 new plans so there should not have been any surprises on January 1, with one exception.

The materials we received indicated the plan would use a much broader Blue Cross PPO network.

That was a misrepresentation.

My wife and I also have coverage through the SHBP. We selected a Bronze plan and made sure our doctors were in the PPO network.

They were, but they are not in the POS network actually used by Blue Cross. Wonder how that happened?

We know that Obamacare cancels policies and we can roll with the punches. Our medical needs are minimal and changing a few doctors is not an issue for us but I do understand the frustration expressed by Ms. Willis and others in their group. Communication about the new plan design during open enrollment was sketchy at best. Neither Blue Cross nor the consultant for our school system were helpful or knowledgeable. No doubt we would have been in worse shape had we not known the questions to ask and how to properly evaluate the new plans.

I empathize with the members of TRAGIC but they are not the only ones impacted by Obamacare. This scene will continue to play out in the private sector as employees review their new benefit levels and try to use their plan over the next few months. The SHBP impacts not only teachers, but 650,000 Georgia citizens that lost their old plan due to Obamacare.

Obamacare is here to stay and with it comes leaner health insurance plans with higher deductibles and higher premiums. If employers and employees are willing to pay even higher premiums they can get some semblance of their old coverage back, but I doubt many can afford that move. It is time to accept the fact that Obamacare cancels policies.

Georgia SHBP Blues

If things go as expected, state and local employee’s enrolled in the Georgia SHBP might be singing the Blues. Cigna and United Health Care may lose their lucrative contract to provide coverage for the state health plan and Blue Cross muscles their way back in.                    Georgia SHBP

An issue that Reese and his staff (at Community Health) face is the new contract for the State Health Benefit Plan (Georgia SHBP), which covers more than 650,000 state employees, teachers, school personnel, retirees and dependents.

Currently, UnitedHealthcare and Cigna hold the contract, with United covering more than 90 percent of members. Community Health had been expected to announce the winner of the new contract early in July. The winner would begin serving members Jan. 1.

Speculation on the winning bidder has centered on a single vendor — Blue Cross and Blue Shield of Georgia, the state’s largest health insurer.

Georgia Health News

Blue Cross had the Georgia SHBP for years and lost it to United and Cigna about 5 years ago. At the time the transition was not without issues as United scrambled to complete their network in the rural areas of the state. Within a few months hospitals in almost every county were eventually signed up with United and the turmoil subsided.

But some industry officials say they fear that Blue Cross’ reimbursements for services will be lower than the current rates, and lead to a financial squeeze for some medical providers.

Now that it’s mid-July, contract concerns are swirling. Community Health said it anticipates making an announcement on the winning vendor soon. But beyond that, it said, it “cannot comment on open and ongoing procurements.’’

Blue has already thrown their hat in the ring and as of now will be the only carrier offering coverage on the Obamacare exchanges in all Georgia regions.

Individuals seeking a premium subsidy can only get taxpayer assistance if they buy through the exchange and in some areas your choice will be Blue Cross or Blue Cross.

So much for more competition under Obamacare . . .

Doctors and hospitals currently participating in the Georgia SHBP may opt out of the Blue Cross contract if they feel the reimbursements are too low compared to what they have been accustomed to with United and Cigna. This could be bad news for employees who have health insurance through the Georgia SHBP.