Jan. 1 rang in a major change for more than 650,000 members of the state employees’ health plan. And on Jan. 2, the wife...

Jan. 1 rang in a major change for more than 650,000 members of the state employees’ health plan.

And on Jan. 2, the wife of a Cherokee County teacher started a Facebook page to voice complaints about the 2014 changes to the State Health Benefit Plan.

In just days, the Facebook page has exploded, with thousands joining the group.  The governor’s office has been deluged with phone calls. Preparations are under way for a rally against the new plan.

State employees’ leading complaint is the lack of choice of health plan providers, said Ashley Cline, creator of the Facebook group, called TRAGIC, or “Teachers Rally Against Georgia Insurance Changes.’’

Ashley Cline and her family

Ashley Cline and her family

A single vendor, Blue Cross and Blue Shield of Georgia, is providing medical care for the plan, which covers public school teachers in the state.

Cline told GHN on Wednesday that the family’s cost for occupational therapy for her 4-year-old daughter has soared to $130 a week under the plan. The deductibles and premiums are high as well, she said.

“I get upset and angry about our situation,’’ Cline said. “People always had options in health care.’’

The controversy over the State Health Benefit Plan erupted after the agency chose Blue Cross to provide a statewide health plan for members of the SHBP, which covers
state employees, teachers, other school personnel, retirees and dependents.

The award was quickly appealed by UnitedHealthcare, which called the contracting process “state-sponsored bid-rigging.’’ The Department of Community Health, which runs the SHBP, strongly denied that characterization and dismissed the appeal. (United still has a complaint pending in Fulton County Superior Court.)

And in September, the Community Health board unexpectedly rejected a proposal to offer an HMO option to state employees in seven metro Atlanta counties. The vote by the board reflected opposition to offering a choice of health plans in metro Atlanta but not in other areas of the state.

Blue Cross, meanwhile, emphasized at an October hearing that its contract will save the state more than $1.5 billion overall. Community Health told the Marietta Daily Journal that the plan will save an estimated $200 million this year.

Yet medical providers expressed concern that they would get lower payments if there is a single statewide insurer for the SHBP, especially given the level of savings that the state expects.

‘It’s unfair’


SHBP members were given a choice of Bronze, Silver and Gold plans under a Health Reimbursement Arrangement.

Sue McDonald, a newly retired Forsyth County teacher, told GHN on Thursday that she can’t afford the new cost for physical therapy after her December hip surgery.

“There are so many stories out there,’’ McDonald told GHN. “It’s unfair we don’t have more choices.’’

And Jamie Wills of Canton, a schoolteacher, said Thursday that she is being forced to switch pediatricians because the one who has seen her daughters from birth doesn’t take the Blue Cross plan.

When Blue Cross confirmed that the pediatrician wasn’t in the network, Wills said, “I started crying. I broke down. I was just dumbfounded.’’

“For all state employees, their health care choices are being made for them,’’ she said.

Sasha Dlugolenski, spokeswoman for the governor’s office, told the Marietta Daily Journal that the office’s phone lines were inundated with calls Monday, Tuesday and Wednesday.

“The governor’s office always keeps a detailed list of people who call in, and the appropriate people are informed regarding the volume and nature of the calls,” Dlugolenski said Wednesday. “In total, we have received around 600 calls.”

Community Health also said Thursday it has heard from SHBP members. “We’ve heard a wide range of opinions from people who have questions and concerns,’’ said a Community Health spokeswoman, Pam Keene, in an email to GHN.

“Fiscal and regulatory challenges continue to contribute to the increased costs experienced by both the plan and the members,’’ Keene said in the email. “The SHBP strives to be member-focused and fiscally sound by continuing to offer health benefits coverage that is high-quality, efficient and affordable health insurance options to its members.”

The 2013 plan offered state employees a choice of two different third-party administrators, United and Cigna, that offered the same set of plan options, which included a High Deductible Health Plan, a Health Maintenance Organization option and a Health Reimbursement Arrangement, the Daily Journal reported.

Bert Kelly, a spokesman for Blue Cross, said Thursday that more employer groups are using a single insurer to save on health costs.

“We’re working with DCH to make health care as affordable as we can,’’ Kelly said. The HRA helps “put patients in control’’ of their health spending, he added.

Kelly said Blue Cross is aware of the Facebook page. “We understand folks have some concerns,’’ he said. “We’re trying our best to educate our membership.’’ The company has created a website for SHBP members.

The TRAGIC group is planning a rally at the state Capitol on Feb. 18.

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Andy Miller

Andy Miller is editor and CEO of Georgia Health News

  • While I empathize with the concerns of this group, teachers are not the only ones impacted. The SHBP is for state employees. Municipal and school districts have the option of participating in SHBP or establishing their own plan.

    The big thing that is missed in all this is the impact of ACA (Obamacare) on the 2014 plan design. The prior plans were not ACA compliant and would have been required to change in 2014 regardless of the administrator.

    Richer plan designs (including lower deductibles and copay’s) could have been used but the result would have been much higher premiums shared by the employer and employee alike.

    The Gold, Silver and Bronze plans were summarized in the decision kit for the 2013 open enrollment. If SHBP covered participants were not happy with the plans at that time they could have opted out and purchased coverage in the individual market. Most employees would not have been subsidy eligible if they bought on the exchange if their employer plan was deemed “affordable”.

    Changes such as these were inevitable due to ACA. It really doesn’t matter if the TPA was Blue Cross or some other administrator.

    Because of ACA 650,000 participants in SHBP saw their old plan terminated. Yet another victim of a broken promise.

    By the way, I should add that my wife and I are also covered by the SHBP so I am not a disinterested bystander.

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  • Bob, it’s obvious you care very little for anyone who actually suffers due to this change. That’s fine. However, I can deal with the HRA concept but it is punitive to families. My wife and I are both teachers. We have 4 children with one being autistic. We share the same “HRA funds” as a family with one child. This plan is crippling to us. So spare me the “Blame Obama” crap. He might be partly to blame but so is Deal and the Republicans . As soon as people wake up and realize they are being screwed on both ends, something might change.

    • Matt, nothing is obvious about my personal feelings. If you read my full comment you would know my wife and I are also covered by SHBP.

      I will state something that is obvious. You and others who do not understand Obamacare rules and attempt to make this political are ignorant of the law and the facts.

      I don’t like the law. Knew it would turn out this way and those with health insurance would eventually figure out that Obamacare was a bad thing.

      Guess I was wrong on that. You and others still haven’t figured out just how bad Obamacare is.

      Since you claim to be a teacher I will admonish you to do your homework on the LAW before protesting and making a fool of yourself.

    • Dot Wiggins

      “He might be partly to blame”. Really!?! I blame you and others like you who voted for this. I feel badly for your children; they didn’t deserve this but you do.

      • I didn’t vote for Obama. Where did I say I did? So stop jumping to your ignorant conclusions. You can get tired of blind partisan crap and not vote for someone. Because you cannot remove your partisan tint from your eyes, I’ll help you out. I don’t solely blame Obama because far more deserve blame. I would put the blame at 50% Obama, 35% Nathan Deal disrespecting education as usual and 15% insurance companies choosing to take advantage of this time. Mark my words, they’ll make record profits again this year. One of my 3 degrees is in risk management. It’s going to happen.. So if that truly bothers you so much to see multitudes of blame, you are the problem. You can save your feeling badly for yourself. Your life is obviously clouded in ignorance.

        • Dot Wiggins

          “Might be partly to blame” and “50 % blame” are significantly different statements. If you indeed did not vote for Obama you defy the stereotype I put you in. (You and your wife are both government workers, right? Did you really vote for Romney or just not vote?)
          I certainly understand there are other entities to blame. Our system has been very broken for a very long time; what is inconceivable that we are going from bad to very much worse.
          For the record I am neither ignorant nor partisan. (I am not a Republican by any stretch of the imagination). But I also feel that this particular law was a move in the wrong direction. Your name-calling was based on only that opinion. My life is not clouded in ignorance; I’ve made good decisions and bad decisions and I’ve learned from the bad ones as well as taken responsibility for them. Again, I feel for your children. Teachers especially government teachers are not fairly compensated and have never been. I don’t understand how raising four is even possible in your situation.

  • Russell D. Hill

    01/12/2014-11:00 am
    Hello Everyone!

    For one thing, I have tried to get on Mrs. Cline’s site but all I get are articles from a bunch of newspapers that all say the same thing.
    I can’t even get a card from BlueCross to show my doctors. I was promised one a week ago. I am finding no one who has gotten their card yet. So I can’t get medical treament. I call one site that was listed and it was a TTY or modem. I called another site and it was buried in calls so wouldn’t answer. I did find a really nice lady, finally. I may get a card, I hope so. No I did not want this change and I wouldn’t trust Governor, “I got to get out of Washington before I was impeached!”, Deal.
    The last time that Blue Cross handled teacher medical insurance, they were so busy trying to gype doctors that some would not even accept my insurance. Blue was sleazy then and so far they are non-communicative, ducking calls? Simply let us pick Blue Cross or United HealthCare. I liked United and did not want my insurance changed!
    Russell D. Hill
    Retired Teacher

    • If you don’t like Blue (or any other carrier) pick a different plan. You are not required to have the retiree plan.

      I am not a fan of Blue either, and share some of your concerns except from a more informed vantage point.

    • Bob’s Just Angry

      Hi Russell,

      You can find the group on Facebook at: https://www.facebook.com/groups/TRAGIC4GEORGIA/. You will need to have a Facebook account to access it, which you can set up here: https://www.facebook.com/.

      I love the “this is Obama’s fault!” (flawed) argument – especially considering the fact that the Governor-appointed DCH Board designed and voted on this plan (STATE agency – not Federal). Plus, our plans from 2013 were 95% “Obamacare” compliant. There was no need for such a radical change in plans this year, aside from “saving Georgians $200 million.” I guess those of us who have been royally screwed by the state are not considered Georgians.

      And, guess what? The University System of Georgia (another group of state employees) have stellar rates and multiple options for 2014. Check them out for yourself: http://www.usg.edu/hr/benefits_docs/USG-BOR_Your-HC-Benefits-AAG_10_01_13.pdf

      There goes that tired argument.

      • Dot Wiggins

        So it’s just a coincidence? Nathan Deal just hates teachers? Everyone else’s insurance has been cancelled or premiums doubled because……? Explain all the fall out besides the teacher’s coverage.

    • Dot Wiggins

      Yes, Obamacare took a system that was bad and made it worse. And I have no doubt you voted for him.

  • Russell D. Hill

    Dear Folks,
    You may note that Republicans are using Obama Care on which to blame this mess . This is a local Georgia matter and has nothing to do with Obama Care at all.
    Obama Care is actually aimed at folks who did not have insurance! They were getting free care at emergency rooms for which you and I paid! They can now have a policy and thus pay for their care with help or without post insurance help. This whole idea was brought out by The Heritage Foundation, a REPUBLICAN think tank. I think this is a great idea and that is what Governor Romney was trying to do in his plan.
    Maybe people could try looking things up instead of letting some tv set tell them what to think!
    Russell D. Hill
    Retired teacher

    • Russell, no one except you is making this a political debate. Obamacare is the law and it impacts everyone. This is not just a Georgia or Republican thing.

      If you want to make it political, then you need to understand not a single Republican voted for Obamacare. This law was crafted, voted on and signed into law by only Democrats.

      There is nothing wrong with showing your support for the Democrat party (or any other political affiliation), but you should learn the facts of the law as it applies to everyone, regardless of where they live or party affiliation.

    • Dot Wiggins

      Yes, Obamacare was promoted as being for people without insurance but it has had a huge negative impact on those of us who did have insurance. How can you not admit that? How in the hell did you think people w/o insurance would be “magically” covered with no added cost to anyone?

  • Dot Wiggins
  • Peecee

    Let’s add another layer to this discussion by referring to
    two sections of the ACA (“Obamacare”).

    These two little gems were tucked away in an attempt to create a smoke and
    fog situation and make the innocuous if discovered. And what might these be:

    A bailout of the insurance industry as detailed in part of Nancy
    Pelosi’s admonition to “let’s pass this now so we can see what’s in it.”

    A better and correct statement concerns “Sections 1341 and
    1342 of the ACA.”

    On 12/18, the chairman of the Council of Economic Advisers
    replied to a question (“What happens if Plan A fails?”), simply brushed off
    the question by stating quite equivocally, “There is a Plan A.” What, you say, is that? It is the assumption that young people are going to sign up with the ACA in droves thus saving the Insurance companies from financial problems – like going broke, for example. More youth, more premium income and less
    chance for catastrophic outlays, or few if any outlays at all.

    However, there IS a “Plan B:” Section 1341, The Reinsurance Fund whereby funds ($63 per head) are collected from insurers and self-insured businesses to provide a sort of ‘rainy day fund.” That would yield some 28-30 billion over a
    three-year period to cover, uh, “losses.” (Guess who pays for this?).

    Then, the other shoe that may drop is Section 1342, known
    timidly as the Risk corridor Provision” that mandates a major TAXPAYER pay out that will cover up to 80% of Insurance company losses. Bet you the press (certainly not the AJC) never bothered to post an article about this.

    Yep, the insurance companies are expecting record profits it seems.

    And, of course, we shouldn’t bother to mention politics here; you can take this to the bank: the Republican Party had no part in this whatsoever as they were summarily closed out of all meetings and votes on this monstrosity.

  • Debra Phillips

    Buyer Beware! Humana Dr’s listings are not showing a true
    listing of Dr’s that are on the plans.

    I had just signed up for the Humana
    HMOx plan based on the fact that I was told my Dr’s where on that HOM plan “HOM”
    plan not the “HMOx” plan.. They in fact are
    not on the “HMOx” plan, I called my Dr.s office and they said that they had
    called their Humana rep. and that they are waiting for information on the plans
    and still have not received it. The office said that Humana wanted them to sign
    a contract without the Dr’s office knowing what the plan will pay, they did not
    want to sign for this plan blindly. I finding out that this is the case for
    most Dr’s.

    I live in Cartersville, GA. I also
    live 3 miles from the Dr’s I see now, on the HMOx plan there are no Dr. signed
    up for this plan so now I have to travel all over Georgia just to see Dr’s.

    I looked up on the Humana
    web page and it shows my Dr’s are under the POS plan and the Dr’s offices are
    telling me that they do not take this plan that is listed
    under the Humana web page.

    How can anyone sign up for these plans
    that web page as Dr.’s that are on these plans. I already made my firt payment
    so now I’m stuck with a plan that does not work for me. The “Market Place” will
    not let me change. I need to see a
    Endocrinolgy Dr. and the only one listed that I can see is an hour drive from
    where I live.

    Boy! What a deal I got.

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