Thursday, October 14, 2010

qotd: PPACA isn't protecting UC Santa Cruz

Santa Cruz Sentinel
October 13, 2010
UCSC employees face tough health care decisions as popular plan changes
By Tovin Lapan

UC Santa Cruz employees think they have been unfairly burdened by the systemwide changes to health care coverage made for 2011.

Faculty, staff and unions representing UCSC workers have all raised concerns that one of the most popular plans on the Santa Cruz campus is no longer offered at a discounted rate and is in some cases 150 percent more expensive than the other alternative being offered, which would require switching physicians.

When the details of the new coverage options were released earlier this week UCSC employees immediately noticed that in many cases it would be difficult to maintain their current doctors at a similar cost to years past. The plan that is no longer discounted covered physicians under the Sutter Health Network, which includes the Palo Alto Medical Foundation and Santa Cruz Medical Clinic. Approximately 60 percent of UCSC employees are affiliated with Sutter Health Network, according to UCSC spokesman Jim Burns.

Open enrollment for UCSC employees will begin Oct. 25, at which point many people will have to choose between paying higher premiums or leaving their doctor.

"The staff members I've talked to are pretty furious, and that frustration comes from lack of representation at the level of the office of the president," UCSC Graduate Program Coordinator Marissa Maciel said. "In order for my premium not to go way up I have to leave my doctor of the last 10 years and change my child's pediatrician."

UCSC Campus Provost and Executive Vice Chancellor Alison Galloway called the increases in health care costs "disappointing" and expressed that the UCSC administration has pointed out the difficult situation its employees face to the Office of the President.

"I'm particularly concerned about our many employees who are currently enrolled in the HealthNet HMO plan," Galloway wrote in an e-mail. "While an alternative version of that plan is being made available, it apparently will offer fewer providers. A sizable number of employees will face the prospect of finding new doctors. We've expressed our concerns about these issues - more than once - to UC leaders."

Comment:  When Congress wrote the Patient Protection and Affordable Care Act (PPACA), they did not want to disturb the very large sector of health insurance coverage that seemed to be working well - the employer-sponsored health plans. It was decided that high-quality plans, such as that of the employees of the University of California at Santa Cruz, should be protected so that the plans would always be there when the employees needed them, that is if they wouldn't mind choosing between paying much higher premiums or losing their established physicians.

Jerking around provider lists, dramatically increasing premiums, pumping up deductibles and other forms of cost sharing, and manipulating benefits are all market tools used liberally by the private insurers. They are used to benefit the insurers, even if at the expense of the insured.

Compare that to our public insurance program - Medicare. Medicare doesn't even have provider lists. You can go anywhere and see any physician who is willing to see you. Adjustments in premiums are very modest, unlike the double digit increases typical of the private insurers. Medicare cost-sharing adjustments are also very modest, unlike the financial barriers to care being erected by the private insurers. Medicare benefits do not diminish but have actually increased through the years. Medicare needs further improvement, but at least it's not headed downward in the same direction as the private plans are.

It's interesting to note that more recent releases from the Department of Health & Human Services and other public agencies have shortened the name of the Patient Protection and Affordable Care Act (PPACA) to simply Affordable Care Act (ACA). Just as they gave up on insuring everyone, it looks like they also have given up on patient protection. If we had an improved Medicare for all, everyone would be covered and patients actually would receive the protection they need. It's not too late to change.

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