State commission rules against Health Alliance's protest
SPRINGFIELD — The state's Executive Ethics Commission has upheld the Illinois Department of Healthcare and Family Services' contract awards for group health insurance for state employees and retirees.
The decision, announced Tuesday evening, means the commission has ruled against Health Alliance Medical Plans and Humana, both of which filed protests after their bids to continue covering state members with their HMO plans were rejected.
Health Alliance's bid just wasn't competitive, and the company declined to lower its price or reduce its service territory when given the opportunity, said Todd Swim, a partner with the Mercer consulting firm that analyzed the bid.
The Health Alliance HMO would have cost the state $800 more per person a year, he said.
He and HFS Director Julie Hamos said they are confident Carle doctors and other providers will become providers for the open-access plans that will be available to state employees, and the market will adjust.
"This is what's happening every day in the private marketplace," Hamos said.
She also said she is confident state employees will continue to have access to the medical care they need and their doctors come July 1.
Health Alliance spokeswoman Jane Hayes said the ruling wasn't entirely a surprise.
"It's been evident from the start that this was going to be the result of the protest," she said.
Hayes said Health Alliance will wait to decide its next move after Wednesday morning's meeting of the Commission on Government Forecasting and Accountability. COGFA will discuss whether the insurance contracts should be rebid.
Hamos contends COGFA doesn't have the authority to halt this year's contracts.
More"Healthcare and Family Services spokeswoman Stacey Solano said the agency never said cost savings were the only reason for the selections, because cost savings were not a factor in evaluating the bids. All bids were evaluated on two factors, price and technical responsiveness, she said." -- Reported by NG 05/07/2011
Except we now learn that cost savings really were the deciding factor. Sounds like HFS was against it before they were for it. Sounds deceitful! When called on the carpet, why not just make up some BS and feed it to the public. After all, now everyone has been told what should have happened from the get go after a denial was made. A new set of facts emerge. Hardly surprising!
Isn't "cost savings" just another way of saying price? I mean, if you select the plan with the lowests price, isn't that by definition the one that will save the most money? Don't get me wrong, there is plenty to fault over this deal but I don't see "cost savings" being one of those. The fact that BCBS didn't have a network in place on Jan 1 like they were supposed to is the most glaring issue to me. I don't care if they will respond to the market needs, the fact is they did not satisfy the REQUIREMENT that they have a network IN PLACE at the required time.
Sure, cost savings is the same as price EXCEPT initially, and this is what caused legislators to file protests, is that the state said initially they didn't consider price (or whatever you call it). The line was that Humana and Health Alliance didn't have networks in place (though they have networks in place now!). Ok, ok, but now we are back to, no, the matter is really about price. You are the one now saying that they did not meet the requirements. I hate to tell you this, but the state's argument now claims that this was really this: "Health Alliance's bid just wasn't competitive." Where did you come up the the requirements thing? I'd be interested, and it would be helpful if the state was saying what you apparently know (instead of the matter is really about money all along after saying it was never about money).
Obviously, taking on the risk of self-insuring will create additional chaos in the lives of State employees who are plan members of Health Alliance / Humana, not to mention the physicians of other health care organizations who will NOT be able to absorb the THOUSANDS of people that HAVE to switch providers and scramble to their doorsteps pleading for assistance. Christie Clinic's CEO stated so himself, and that's just ONE health care organization out of how many that will be trying to take in the "straglers?" If you're not a State employee currently covered by Health Alliance / Humana and you live in central or downstate Illinois, you WILL still be touched by this. It's a fact that cannot be denied.
On May 18th, Attorney General Madigan rendered her opinion of COGFA's request of the meaning of the phrase "with the advice and consent of the Commission." Her opinion states: ". . . the Act confers upon the Commission the authority to review and approve or disapprove the recommendation that the State act as a self-insureer, in whole or in part, for health benefits. . . however, does not authorize the Commission to approve or disapprove individual health benefit provider or administrator contracts."
In a nutshell, COGFA can't just run in and tell Gov. Quinn, CPO Matt Brown, and Direction of HFS Julie Hamos to rebid the contracts again. It doesn't work that way. COGFA can say, "this Committee does not APPROVE of the State's recommendation to award the managed care contract to BCBS." COGFA cannot say, "this Committee requires the contracts to be rebid."
So what am I missing here? The State of Illinois' Executive Ethics Commission, who is supposed to be making sure that the State of Illinois' own ethics laws were not violated, denied the protest..... even though the Commission VIOLATED their own laws regarding having providers in place by July 1! What does that say about the state when the so-called Ethics Commission says nothing about the violation of their own rules? How is that possible?
Now that the barriers against talking about this are down, it will be interesting to see who is portraying the situation accurately. Is Health Alliance an innocent victim of political maneuvering or was it so confident in the scope of demand for its services that it felt it was "too big to fail" and it could dictate terms without impunity? Is the State Of Illinois an honest crusader for fiscal responsibility (at last) or are they simply wrapping themselves in that shroud (again) to hide a stumblebum effort to create an illusion. The truth is likely somewhere in the center of all the extremes.
I also feel the concern should also ultimately be about the State being self-insured. Typically this is not done well by most employers and they decide what medical procedures they will choose to cover for their employees not the insurance company. If the real issue is cost saving my understanding is that there is only a couple ways to cut costs for the state under a self insured system....it's to either limit the medical procedures they will cover for the employees to keep costs low or perhaps not cover some of them at all. If a person needs the best medical treatment or needs to have a more expensive but less invasive procedure done is it really in this persons best interest to be in a self funded plan with the State of Illinois?...who can't pay it's own bills and is looking under every nook possible for ways to save money!
Disgraceful. Despicable. More flagrant words come to mind to describe the situation and all of the "key" players in this sham, but I can't post them here.
Thank you, Gov. Quinn, CPO Matt Brown, and Director of HFS Julie Hamos for screwing me, my family, and all of the State employees, retirees and their dependents who have and continue to serve this state and its citizens. I give you a tremendous pat on the back for going down in the history books as the most spineless, self righteous, and pigheaded individuals our state has probably seen to date.
Lincoln is surely rolling over in his grave right now.
Gee, Health Alliance would cost the state $800 more per employee over an HMO that offers zero physicians in their network? That's some new math they use in Springfield. This whole mess is unbelievable. The only way it makes sense is when you realize that only downstate workers are affected by the change. Once again Chicago is served. It is getting harder every day to work at the University. No raises, furlough days, disruptive reorganization of dubious value, and now this health insurance (and dental insurance!) debacle. The final insult is that it is almost impossible to escape because the economy is so dreadful that you can't sell your house or find another job. How low can morale go?
Oh, a word about the dental insurance. That's changing too. I saw my dentist this morning. He told me to consider dental insurance when deciding when to get a crown I need. The new insurance is a PPO plan, but he said he didn't think many dentists were joining because reimbursements were far too low. If you can find a dentist in the network the cost will be super cheap -- but what kind of dentist will be willing to work for that fee? My thought is -- a new, inexperienced one. More joy all around. (My opinion only. My dentist informed, rather than advocated.)
There are a FEW private practice dentists that are in the lower two tiers of Delta Dental. Unfortunately, my current dentist isn't signed up with them. I did find another private dentist in Champaign that has come highly recommended. Good luck in your search if that's what you decide to do ;o)
What is wrong with you people? Why should the state pay more for your health insurance? As a fellow Health Alliance member through the state I certainly don't want to change plans, but I do think that Health Alliance should play by the rules. What ever happened to a competitive market, and if they can't deliver, they aren't chosen? Maybe Health Alliance should give up their little self-referral monopoly they have with Carle. Time to negotiate with carriers other than just Health Alliance, eh Carle?
And by the way, Carle docs ARE in network for one of the Open Access Plans – it is just tier 2. So you can go to your Carle docs still. Pay attention and read your materials before you make uninformed comments.
Right, tier 2, the pay out your rear end plan! More out-of-pocket expense by the university employee who's had zero raises for 4 years, served five furlough days, and can't get reimbursed for dental work from September 2010. You're right we should all stop our crying...
Yes, the way to get our raises is for the State to spend tons of extra money on overpriced health insurance. Definitely!
The tier 1 OAP provides the exact same coverage as the Health Alliance plan, and they do it at a more affordable price for the state. This is the reality for a for-profit health care sytem.
No, Tier I does NOT provide the same coverage as the current Health Alliance HMO plan. If that were the case, I wouldn't be scrambling to find 5 pediatriac specialists for my son's diagnosis. Again, do your research before making extremely subpar comments that are only embarrasing you.
Sounds extremely myopic and uninformed to act like this is really "the exact same coverage." Wrong! That is why the state senators and representatives started a legislative inquiry because the coverage is so disparate for those that live south of I-80. Do your research! No one, not even HFS, is making your claim.
Talking about the State spending "tons of extra money," they do when they want. For example, the state is broke yet sends lots of money to build a new Lincoln's Challenge Academy. The question isn't whether this is valuable or not, but why would someone spend on a new project when acting like they can't meet their current obligations? If everyone were treated like Quinn's personal staff, everyone would get huge raises. My point is that it is pure lies to act like they don't have the money but can spend for whatever they want. Politics as usual.
No, it is that you are typically online poster in that you didn't do your research. There is still no proof that losing HA will save the state money. Also, in reference to your above uninformed post, state workers would likely be willing to take a plan that cost the state less if that plan had a network in place in downstate IL. The plans they chose do not. Their only option is tier 2 of an OAP which is a very bad situation for young families. The out of pocket costs would very likely crush anyone who has any even moderate medical issues. Please learn to do research (or at least read NG articles) before posting. It saves you embarrassment and me keystrokes.
What about all of the uninsured young families in Illinois who are paying for your health care? In 2008, only 63% of employers offered health care benefits (http://webcache.googleusercontent.com/search?q=cache:IyCTKZb9bEwJ:cdn.pu...).
And you're complaining because yours will cost you more? Please learn to do some research. http://www.pjstar.com/free/x1225327341/Do-public-employees-get-a-better-...
I am paying for my health care along with you. ME!!!! I'm a flippin' taxpayer, too, if you haven't noticed!!!!! I soooooo wish people who don't work for the State would stop blaming State employees for the State's financial mess and saying that State workers have for too long been riding a gravy train. I gave up $10k a year to work at UIUC so I COULD have good benefits, so don't anyone try to tell me that I have it so great. STATE EMPLOYEES DIDN'T DO THIS!!!!!!! OUR FRIGGIN' GOVERNMENT DID IT!!!!
Also, if you're going to refer people to "research" you'd better make it an actual article that's been studied by people who know what the he*& they're doing. Seriously? Basing your facts on the links you provided? GIVE ME A BREAK!!!!!
What concerns me is that I already have to pay for my dental work up front. Now we will have to do the same for medical. The state has never paid on their self managed policies on time. They are just wanting to use our money (we pay out of every paycheck for our insurance) and they won't worry about paying these bills either. I hate these crooks!
Hamos might have to put up with the same insurance. We don't know. I'm sure at $142,000 per year, it will be difficult for her to meet the new obligations. (Source for income: http://www.sj-r.com/top-stories/x1661777609/Quinn-names-Rep-Hamos-state-... )
The benefits for tier 1 on the OAP are the HMO benefits that state employees currently enjoy. The only current difference is that the providers locally do not include Carle Clinic. The benefits for tier 2 on the OAP are a $200 deductible and 10% coinsurance up to an out of pocket maximum of $600. Tier 2 does include Carle Clinic physicians. I empathize with the employees who have not gotten raises and have to take furlough days but also realize that across the nation that most group health plans are moving to much higher deductibles ($1000 and up) and those employees are not seeing an increase in wages to compensate for that either. My point being that it is not just State employees having to make changes.
Yes, on paper the benefits for Tier 1 on the OAP are the same as the HMO. But you can't talk about benefits without talking about networks. Tier 1 benefits from a provider network that can't reasonably provide those benefits isn't an equitable option. At least twice as many State members locally get their care at Carle vs. Christie. So this plan is pushing twice as many members into a network that is half the capacity. Even Christie management has said they are not capable of supporting the number of members that will be funneled to them through this change.
Members can still continue their care with their Carle physicians by paying a higher premium for HealthLink and then higher out of pocket costs. Thankfully, I can afford to absorb that extra cost so that's exactly what I'm going to do. But not everyone can absorb that budget increase. If this were simply a matter of asking State employees to face the reality of the ever-increasing cost of health care/health insurance, I'd be fine with it. But this doesn't seem like just another case of rising health care costs restricting an employer's ability to provide quality insurance. None of the explanations given for WHY this change has to occur have made any sense to me. For care received at Carle, there is no insurance carrier who will get better discounts than Health Alliance. With Carle treating the lion's share of the area's members, how is it possible that they weren't competitive on costs? I see from today's article that HAMP execs are asking the same question.
The only logic I can find is that the State is betting on the Carle physicians eventually signing on to the Tier 1 OAP network. I don't know enough about their business to guess if this will happen or not, but it seems like a pretty big gamble and ultimately the State employees in the C-U area are being forced to assume the risk of that gamble.
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