PITTSFIELD — It's a problem of access.
That was the message from state employees who gathered Wednesday morning to express their anger about proposed changes to their insurance coverage.
It's also a matter of life or death, said Angelica Paredes, who said she is recovering from stage 4 cancer.
"We give you our lives," she said, tearing up as she spoke.
About 100 employees attended the listening session at the Berkshire Athenaeum to protest a sudden vote last week by the Group Insurance Commission to slash the number of available insurance plans from six to three, eliminating Tufts, which has been widely used among the county's state employees. The decision leaves workers in Berkshire County with two health care options: Health New England, an HMO, and Unicare, a PPO.
The GIC is a 17-member board that decides which health insurance packages to give state employees and municipal employees within participating cities and towns. GIC insurance covers more than 400,000 people statewide.
Officials have said the restructuring would save the state more than $20 million, and help keep insurance rates from rising faster than wages.
The commission is expected to make final decisions on plan details and rates Feb. 22, and those decisions will become effective July 1.
There were barely enough seats and parking spaces to accommodate Wednesday's session, and some said attendance would have been much higher if state officials had publicized the event and held it during a time when teachers and other state employees weren't working.
Attendees said the GIC made a major change brashly, without informing or consulting those it would affect. Many in the room were longtime state workers who already had had retirement plans laid out.
"I've been a state worker for many years," said Liz Recko-Morrison, who works at Berkshire Community College. "The implicit promise has been, `Your insurance will be good; we're always going to take care of you.'"
A PPO, or preferred provider organization, is typically more expensive but allows a patient to choose doctors more freely in and out of state. An HMO, or health maintenance organization, is less expensive but offers fewer provider choices.
Opponents of the GIC plan said an HMO is too restrictive for those in Berkshire County who have to travel for services, and Unicare is significantly more expensive than the flexible plans they've been paying for. Paredes and many others in the crowd urged GIC representatives to reconsider its decision to take Tufts off the table.
For one Eastern Massachusetts employee, it was a matter worth driving for.
Allison Sanders, a teacher from Westwood who took a personal day to attend Wednesday's session, said Tufts only narrowly fell short during the state's bidding process.
"For a tenth-of-a-point difference, we demand that you revisit the Tufts cut," she said, to supportive murmurings from the crowd.
Roberta Herman, executive director of the GIC, assured attendees that her agency would do everything in its power to address concerns raised.
"It's our obligation to make sure everybody lands," she said. "We will not let anyone lose coverage."
For state Rep. Tricia Farley-Bouvier, those assurances were not enough. She said the commission is a long way from convincing the people of Massachusetts that its eleventh-hour decision was well thought out.
"That kind of decision-making is unacceptable," she said, calling the vote a "secretive" one that could have potentially disastrous effects.
"What's going to happen to the family of Berkshire County?" she said. "Time and time again they're told their doctor is not in the plan. Was that taken into account?"
Farley-Bouvier was the first of many to point out "regional differences" that put state employees living and working in Berkshire County at a significant disadvantage. She questioned whether patients and providers in the state's fringes carried water in their decision, or if it was "just the bottom line."
Recko-Morrison said she signed up for Unicare after her grown sons left the state to attend college, as it was the only plan that allowed for interstate coverage. She said she looked forward to switching back to Tufts this year, thereby saving money on her behalf and that of the commonwealth.
She and others said HMO plans aren't desirable in certain circumstances, like when she needed neurosurgery and there were no neurosurgeons available in the county. She said she's skeptical that she would have had as easy a time going to Worcester to get it under an HMO.
Northern Berkshire residents in the crowd were perhaps the most vocal about geographic concerns, asserting that, because of a shortage of providers there, they often have no choice but to cross state lines and seek services in Vermont.
Herman said expanding the geographic offerings might be something she can address between now and Feb. 22, when the commission makes final decisions on rates. With regard to service shortages, Herman and her colleagues said that falls outside GIC control.
"We'll do whatever we can," Herman said, adding that she's unhappy with the industry's state of affairs. "We're in a horrible, horrible state."
Where are the commissioners?
Eleanor Wilkinson, a public defender, said they should have been represented at the session, rather than sending Herman "to do their dirty work."
Herman cautioned the crowd from making assumptions that might not be true, or that could change over the course of the coming month.
"We have to pressure test some of what you're saying," she said.
Emily Herder, a New York resident who works as a public defender in the Berkshires, said her only option is to select the Unicare plan that crosses state lines. But that comes at a much higher premium, she said, which poses a financial strain, given that public defenders in Massachusetts are underpaid.
Representatives from the Massachusetts College of Liberal Arts said their ability to only offer Unicare negatively impacts the college's ability to attract talent that might live in New York or Southern Vermont.
Stacy Evans, a BCC employee, said she used Tufts because of the geographic flexibility it offered her family.
"It's the Berkshires of New York, basically," she said, adding that she already has faced challenges when it comes to insurance. "We are all concerned with these surprises."
Evans also said it has been impossible to react to this decision from an informed perspective, given that they still haven't been told what benefits they'll retain and which they'll lose and what the price will be. They also need to know which doctors under the two plans are taking new patients.
"It's all about geography," Pete White, a city councilor and state employee, said after the session. "We need available doctors, not just coverage maps."
Members of the crowd were unified in pressing GIC representatives not to leave Berkshire County's unique needs out of the equation.
"We're not all digits," Paredes said. "We can't afford for it to get worse out here."
Amanda Drane can be reached at firstname.lastname@example.org, at @amandadrane on Twitter and at 413-496-6296.