Group Insurance Commission reverses vote to limit carriers

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BOSTON — Scrapping its much-maligned move to cull the number of health insurance carriers available to public employees and retirees, the Group Insurance Commission decided Thursday to go with "Option B."
The new approach gives GIC members six commercial carriers and four Medicare carriers, as opposed to the three commercial carriers and two Medicare carriers under an earlier approach the commission approved in a Jan. 18 vote, according to the GIC. Harvard Pilgrim Health Care, Tufts Health Plan and Fallon Community Health have all been reinstated as GIC insurance carriers.
The board voted 12-2 to switch to Option B. Commissioners Christine Clinard and Tamara Davis, who are both representatives of the public on the commission, voted against the motion and said they continued to favor the earlier approach. Before deciding on Option B on Thursday, the GIC voted by the same margin, 12-2, to reconsider its Jan. 18 vote, with Davis and GIC board chairwoman Valerie Sullivan voting against.
The commission handles health coverage for 436,000 people, and the public employees and retirees who rely on the GIC for care form a potent political constituency. Senate Ways and Means Chairwoman Karen Spilka said Wednesday that the commission's prior vote "generated more outrage and consternation from constituents than any issue that I can remember over the last, literally, many, many years."
Dozens of angry state employees gathered at the Berkshire Athenaeum in Pittsfield last week to rail against the change, noting the hardship it potentially would cause for employees in the Berkshires, who would have had to choose among only two providers. A third does not extend coverage to the Berkshires.
Tricia Farley-Bouvier, D-Pittsfield, said Thursday she was glad to see the GIC heard the people of Berkshire County.
"I'm very pleased that they reversed course," she said. "Our voices were joined in with people across the state." 
Still, Farley-Bouvier said, questions remain about what comes next. The core issue moving forward, she said, is to look carefully at making sure health insurance is affordable for everyone. She said she'd also like to see employees better represented on the commission itself.
"We still have some issues," she said. "It's not like all the problems have gone away because of this one vote."
One group of GIC enrollees will see still their options curtailed under the new plan. Several thousand mostly elderly members, including retired teachers, who are in Pool 2 have six carrier options right now, but will only have one — Unicare, a subsidiary of Anthem — when the changes voted on Thursday take effect July 1. About 950 of them will need to move to Unicare plans because their current carriers did not submit bids, according to the GIC.
GIC officials said they would work with Unicare on structuring plans to give members in Pool 2 options in price and levels of coverage.
There is also not an ironclad guarantee everyone will be able to both keep their doctor and their current insurer under Option B.
"Option B presumes that people who are in a plan — provided that same exact product is offered — will have whatever network is there. What I can't say for certain, because no one will know, is whether there hasn't been any changes in a network," GIC general counsel Andrew Stern said.
Jim Durkin, a lobbyist for the American Federation of State, County and Municipal Employees, cheered the commission's reversal Thursday.
"I think it was a major step forward and a big victory for organized labor and for all the men and women who rely on the GIC for quality care," Durkin said. He said, "If there's a silver lining in this catastrophe, it's that we finally have decision-makers paying attention to a myriad of problems that we've had with the Group Insurance Commission for many years now."
While the earlier approach to consolidate commercial plan offerings would have saved about $21 million, according to the GIC, Option B will save about $1 million. The new approach means the vast majority of members will be able to keep their health insurers, according to GIC officials. The previous plan would have required about 200,000 members to switch carriers.
Tim Sullivan, who holds the Massachusetts Teachers Association slot on the GIC board, said the most important work will take place at the commission's next meeting when it takes up plan design.
GIC Executive Director Roberta Herman on Wednesday acknowledged in testimony at a Senate oversight hearing the "concern, confusion and havoc" that followed the commission's earlier decision. Even those who favored sticking with the Jan. 18 vote said the commission had fallen short.
The commission failed to communicate that the prior approach would save money for members and the state while guaranteeing they maintain access to their health care providers, Davis said.
"You get the lowest cost. You get options of a variety of plans, and you get to keep your doctors and hospitals at a lower cost, even specialty care at a lower cost. And I'm talking about deductibles also," Davis said. "I don't think we've explained it to our members that changing a plan doesn't mean that you're not going to have as many options. It doesn't mean that it's going to cost you more. It's guaranteed that you're going to keep your doctor. It's guaranteed that you're going to keep your hospital. Who's paying your bill — so the insurance company — might be different, but I don't care who's paying my bill."
Union officials have claimed coverage would have been affected under the earlier approach. SEIU Local 509 President Peter MacKinnon on Wednesday told lawmakers about one member who learned her children's autism treatment at a Wakefield clinic would not be covered by the three plans the GIC decided to retain in its Jan. 18 vote. Another member's teenage son would not have received the same health coverage under the change for his hypoplastic left heart syndrome, MacKinnon said.
The commission on Thursday also announced the hiring of Mike Berry as legislative director and Linnea Walsh as communications director. Berry, who ran for state Senate as a Republican last year, was previously legislative director for the Massachusetts Department of Transportation. Walsh was interim executive director of the Massachusetts Women's Political Caucus, and she has worked at the public relations shop Denterlein and for the Patrick administration.
Eileen McAnneny, who abstained from the Jan. 18 vote, said she supported Option B because people were uncomfortable with the GIC's planned consolidation and "in order for it to be successful you have to buy-in."
"To me it just speaks to that we need more education and communication about, certainly, how health insurance and benefits work," McAnneny said. She likened the earlier change that members faced to a switch in credit card companies, where the purchasing power would remain but it would be made with a different payer.
Gov. Charlie Baker, who controls the GIC and is running for re-election this year, is aiming to change the payer for another group. The Republican governor wants to shift 140,000 MassHealth enrollees who are above the poverty line off the state's Medicaid plan and onto subsidized plans through the Health Connector at no cost to the enrollees. The Legislature last year rejected a similar proposal. Those MassHealth enrollees would still be able to access health care for free while the federal government would pick up more of the cost, according to the Baker administration.
"I think it's similar in the sense that what we're talking about in that instance too is the payer," McAnneny said when asked if she saw a parallel between the two Baker administration proposals.

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