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Bargaining Health Care. Under ESSB 5940. Paying for Benefits: A Variety of Concepts. State Allocation Pooling Employer pays HCA “carve out” Employer contributes to the pool Employer pays % of premium Depends on philosophy: Everyone’s need is equally met, or
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Bargaining Health Care Under ESSB 5940
Paying for Benefits: A Variety of Concepts • State Allocation • Pooling • Employer pays HCA “carve out” • Employer contributes to the pool • Employer pays % of premium • Depends on philosophy: • Everyone’s need is equally met, or • Everyone gets the same amount in dollars
Immediate Issues • HDHP • HSA • Plan with Premium Share Not Above That of State Employees
Other Issues • Minimum premium share • Richer plan subscribers pay more • Bids
When to Bargain • Law has been in effect since July 2012 • Items are required to be offered • No phase in language • State agencies say happens when contract expires • Some items require reporting of progress to the state in 2013
Current Key Provisions • Minimum deductible: • $1,200 individual • $2,400 family • Out-of-pocket maximum: • $6,050 individual • $12,100 family
HDHP – Different than Traditional Plans No first dollar coverage (except preventive care) All services, except preventive care, are subject to deductible Prescription drugs are subject to deductible
Health Savings Account (HSA) • An HSA is a tax-sheltered savings account • Only available to people with an HDHP • Employer or employee may contribute • HSA annual contribution limits (from any/all source): • $3,100 individual • $6,250 family
HSA Overview – Continued • Medical and prescription drug services are subject to plan deductible • Individually owned account • Portable • Unlimited rollover of unused dollars (not “use it or lose it”) • Eligible expenses: • deductible, coinsurance, prescribed medications, vision and dental expenses
HSA – Special Eligibility Criteria You’re eligible to open a health savings account if you: • Are covered under the high deductible health plan • Are not enrolled in Medicare • Don’t have coverage under another health plan (spouse’s plan, spouse’s Flexible Spending Account, etc.) • Are not claimed as a dependent on someone else’s tax return • Can not participate in a Health Care FSA and HSA simultaneously
HSA Recordkeeping • You must keep records to show that: • The distributions were exclusively to pay or reimburse for qualified medical expenses • The qualified medical expense had not been previously paid or reimbursed from another source • The medical expenses had not been taken as an itemized deduction in any year
Disadvantages • Strict eligibility criteria, can’t be in regular Flex Plan • Cost-shift to employee • “Race to the bottom” concerns • Money going into an HSA decreases the Pool • Unclear whether state funds can be used for HSA • Because it accrues to the benefit of the employee • State agencies say yes; law is less clear
Adverse Selection • Attractive to the healthy or wealthy • Damages traditional plans
Recommendation • Negotiate a specific plan into your contract • Provide no employer payment into the HSA; direct money into the Pool instead • Create no incentive for your members to move to HDHP/HSA plan • Inform your members about the dangers of these plans
Plan with Premium Payment not Greater than that of State Employees
Definition • School districts will offer at least one health plan that has monthly co-premiums that do not exceed premiums paid by state employees • Roughly 15% of premium cost • State plans are not all the same • State employee benefits are also negotiated • Pre-conditions our bargaining on the bargaining of their unions • Difficult to say exactly what this means
Recommendation • WEA Select EasyChoice Plan • Already exists, and you have it! • Similar in out-of-pocket costs (composite rate) • Or, bargain that employer will pay 85% of premium cost of one or more plans
Does Everyone Have to Pay? • Required only if district pays for benefits beyond the Basic Five • Health, dental, vision, LTD, group life • Not everyone reads the law literally on this point • Implied by the 3:1 Ratio, however
They already do. • “Richer” is not defined in the law • Again, this is required only if district pays for benefits beyond the Basic Five
Recommendation: • As you move toward 3:1 ratio… • Members on family plans will pay less • Members on single plans may pay more • Increase employer payment toward benefits
Moving Toward the Ratio • “Progress” rather than instantaneous • Applies to all offered plans • Does not describe what occurs to employee/child or employee/spouse rates • Shifts costs from families to singles (unless more money comes from employer)
Bargaining Options for 3:1 • Wait • Increase employer payment toward benefits • Shift costs through rate structure • Shift costs through bargaining a premium payment by Singles that will be applied toward Families’ premiums
Not So Much… • Statement in law applies to insurance trust agreements, not to collective bargaining agreements. • RCW 41.59 (certs) and 41.56 (classified) allow multi-year contracts. • One management law firm has been attempting to bargain one-year insurance deals. • Just say no. • Don’t agree to re-open to bargain insurance as a single issue
Open Competitive Process • Subject to bargaining • Who determines criteria for plans and bids • Who receives the bid information • Which bid is adopted • What justification is adequate to determine that, “…an open process would compromise cost-effective purchasing, with documentation justifying the approach.” • Assistance with justification
Recommendation • Do not rely on district-hired brokers • They have their own self-interest and profit motive • They are employed by the district and are influenced by the administration • They should not control issues that should be bargained by you • You do not have to take bids each year • State plans bid every 5 years only • Look at exception: May avoid bidding process if it will be likely to produce disadvantageous results
Examples of WEA Plan Innovation: • Dependent eligibility audit • Health Risk Assessment • Wellness Coaching • Biometric screening pilot • EasyChoice • Care/Case Management • Specialty Pharmacy
Recommendation • Bargain good insurance plans that contain elements of innovation
Part of “Obamacare” • Will change how insurance is marketed • May change how we bargain over insurance • Another reason not to do anything too drastic too soon
Questions mmcnett@washingtonea.org