Judge issues order stopping some insurance enrollment
Editor's note: There will be more on this story in Saturday's News-Gazette.
SPRINGFIELD — Acknowledging “significant disruption” is on the way, a Sangamon County judge has effectively shut down at least part of the health plan enrollment process for state employees and retirees set to end June 17.
After a hearing in Springfield Friday afternoon, Judge Brian Otwell ordered the state Department of Healthcare and Family Services and its Director Julie Hamos to stop any further action in awarding or signing the self-insurance Open Access Plan contracts to PersonalCare and HealthLink that were intended to provide health coverage for a East Central Illinois and many other counties.
That order is pending the ultimate determination of a lawsuit filed by Health Alliance Medical Plans and Humana, both of which are seeking to overturn the Open Access Contracts.
Humana is also seeking to undo the HMO contracts that were awarded to Blue Cross and Blue Shield.
Health Alliance and Humana were in court Friday seeking a stay or temporary restraining order to halt the enrollment process until their complaints about the state’s bidding process and managed care contract awards are heard.
Otwell denied Humana’s request to temporarily stop the state’s award of HMO contracts to Blue Cross and Blue Shield while the lawsuit is pending.
A spokesperson for Healthcare and Family Services said the agency plans to address the ruling later Friday.
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I'm a bit confused. Where does this leave people currently on Health Alliance? Does this mean we stay with Health Alliance until this is all figured out? I know people who have already sent in paperwork to change to HealthLink or PersonalCare. Does this mean they also stay with HA?
And this can be appealed, right?
That is what I'm wondering? Will people be forced into BCBS and Quality Care? This almost sounds like now you can't go into Health Alliance, PersonalCare or Healthlink! At least before there were some options that were affordable, and good plan benefits - that did allow access to both Christie Clinic and Carle Clinic at a reasonable rate and with still low deductibles and good benefits! This, on the surface, just sounds ridiculous! I'm not sure - more CLEAR information needs to be available.
Yes, this entire thing needs to be clarified. Sounds to me like we do not have access to any to the OAPs but cannot keep HA. That only leaves us with BC/BS or Quality Care, both of which are much more expensive.
I also know people that already have paperwork in place to change to PersonalCare or HealthLink as of July 1st. What happens to them? Are they safe since they've already turned in their paperwork or are they in the same boat as those who were waiting until closer to the June 17th deadline?
Hopefully we'll have some answers on Monday or Tuesday.
It can be appealed and likely will be, but overturning a temporary order would be very, very unusual unless it can be shown that the lower court ignored facts, so not likely to happen.
The Department of health is supposed to say something later.
The best thing to do is just stay informed on the issue at this point.
The following post just appeared on the Health Alliance facebook page:
"Part of today's ruling is that all current insurance contracts are extended until everything can be settled and an agreement can be reached about who new contracts will be awarded to. You will be able to keep your current coverage for the time being."
Now let's see if this is overturned. I sure hope not.
Uh oh! Sorry I posted the above because now HA has posted THIS on their facebook page:
"We apologize, but we misspoke in earlier comments. The judge today ruled to stop enrollment in open access plans, but he did NOT extend current contracts. This means that our current state members can only continue with Health Alliance through June 31. We still think today's ruling was a step in the right direction and hope to work out a solution in the next 3 weeks. Things are changing quickly, so please stay tuned."
all of the available plans will cost more. that's the rub. and on top of that, the doctors and hospitals in the oap networks are basically agreeing to not get paid for a year due to how self-funded plans work. moving away from a locally available hmo like health alliance will cost the state more, the members more, and allows to state to get a long-term loan on the backs of doctors and hospitals. the last part is why the state is pushing so hard for these changes...it's about working very hard to ignore financial realities and avoiding doing their jobs.
This is the email I received from Chapin Rose:
Dear Friend,
On Friday a cicuit judge in Sangamon County issued a temporary restraining order (TRO) against Gov Pat Quinn's administration - ordering them to stop implementation of the Open Access Plan (OAP) contracts while the Court litigates the underlying claims made by Health Alliance and Humana. So what does this mean? It means as of now, and until further order of the Court, the state's group insurance offerings include only Blue Cross's HMO offering and Quality Care.
The Governor has indicated that he intends to appeal the decision of the circuit court. Oddly enough, however, while the Governor was represented by the Attorney General's office in this matter, the circuit court relied heavily on an opinion issued by the Attorney General just last month in coming to its conclusion that a TRO was appropriate.
Should the appeal either fail to be heard by the deadline for enrollment in group health on the 17th or if the appelate court upholds the trial court's decision, then the only choice for most downstaters will be the aforementioned Quality Care plan. Quality Care, it should be noted, is the most expensive option to both the employees AND the taxpayers!
I would also note that AFSCME has filed a formal grievance in this matter and I would anticipate that having only Qualtiy Care would strengthen AFSCME's legal argument because the group insurance act was intended to provided employees with quality access to affordable care and only having one choice would appear to violate the act.
All the legal mumbo jumbo aside, SB 178 is on the Governor's desk. Rather than waste even more taxpayer money on attorney's fees appealing the circuit court's TRO - he could simply sign the bill and start this process over! If the appelate court upholds the TRO, then SB 178 represents the only option to provide affordable choices to both employees and the taxpayers and avoid even more litigation over the group insurance act's "access to care" provisions.
While your calls to the Governor's office to date have fallen on deaf ears, I'd ask you to call one more time and tell him to sign SB 178. Here is the contact info:217-782-0244 Governor's office
As always, I will update you as information becomes known.
Best Regards,
Chapin Rose
State Representative
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