Key activist group sees flaws in state health plan

Last week, when upcoming changes in the state employee and teacher health plan were announced, they drew a generally positive response.

Healthcare Cost

Members learned that the 2015 plan would include an increased choice of insurers, which was welcome, and officials presented information showing that many members would see no premium increase.

But after studying the proposed rates in greater detail, a group representing teachers, employees and retirees is voicing concern. It says many of the new options will be unaffordable for members looking to switch from their current plans.

Most State Health Benefit Plan members will see a significant increase in premiums if they choose to move from the current Health Reimbursement Arrangement (HRA) to one of the new HMOs, especially the one run by UnitedHealthcare, said Ashley Cline of the group Teachers Rally to Advocate for Georgia Insurance Choices (TRAGIC).

“They’ve brought back options –- that’s a huge win,’’ Cline, founder of TRAGIC, told GHN on Monday. “But if you have choices that are unaffordable, there’s no benefit.”

Cline added, “The deductibles and out-of-pocket maximum are still way out of line with the salaries of SHBP members, and out of line with comparable plans offered under the University System of Georgia.”

The SHBP covers 650,000 state employees, teachers, other school personnel, retirees and dependents. With so many Georgians affected, dissatisfaction with the plan can become a political issue.

The 2014 plan was the target of complaints from the time it took effect Jan. 1, largely because of its change to a single health insurer and plan type. Cline founded TRAGIC as a Facebook group in response, and it grew to thousands of members and staged public protests.

That uproar caused the Georgia Department of Community Health, which runs the SHBP, to act swiftly, adding a co-pay system to the 2014 plan. It also promised more choices for 2015.

Community Health issued a statement Monday that said, “The department listened to the concerns presented by our SHBP members last year and is offering more options that provide members with a choice of vendor, plan design and associated costs for 2015. We will strive to clearly communicate and educate members about these options.

“We encourage members to review all benefit information from SHBP regarding the 2015 plan designs, as it becomes available prior to Open Enrollment, and choose an option that meets their individual and family needs.”

Last week, the Department of Community Health said that not only would those staying in the Blue Cross and Blue Shield HRA not see any increase in premiums for next year’s plan, but that members who had Gold plans and were looking to switch would see reduced premiums.

But Cline said Monday that she is most concerned about the difference in cost between the Blue Cross HMO and the one run by United – more than $140 a month. Many members are unhappy with their current Blue Cross plan, she said.

Blue Cross and Blue Shield of Georgia is currently the only insurer providing medical plans, but that will change in 2015.


Next year, Blue Cross will give SHBP members three HRA choices and a statewide Medicare Advantage to retirees, along with a statewide HMO option. UnitedHealthcare will offer members the options of a statewide HMO, a high-deductible health plan and a statewide Medicare Advantage plan. A second new insurer, Kaiser Permanente, will offer an HMO plan in metro Atlanta, Community Health said.

A TRAGIC member, John Palmer, said in a statement Monday, “Continuing to cut the take-home pay of teachers and state employees through higher insurance costs will drive good teachers and state employees away, and make it harder to recruit and retain highly qualified candidates to state agencies.’’

Palmer also raised questions about increased premiums for state retirees in the Medicare Advantage plans.

Community Health, though, said the Medicare Advantage premiums depend heavily on the rates proposed by the insurer.