In July 2007 the State Legislature enacted a provision to allow municipalities and regional school districts entry into the Group Insurance Commission (GIC) in response to the escalating costs of healthcare premiums. The comprehensive benefits, broad-based provider networks, and lower premium costs provided comparable benefits to municipal employees and retirees resulting in dozens of communities joining the GIC over the next several years. Sadly, the benefits of the GIC no longer compare to those of majority of cities, towns, and regional school districts since there has been significant cost-shifting through deductibles, higher copayments, and restricted access to broad network provider plans.
The American Federation of Teachers Massachusetts (AFTMA) represents a wide-range of members including public employees and retirees who will be greatly impacted by the provisional changes adopted by the GIC. We formally object to these provisions for the following reasons:
1. Closure of broad network providers: Limiting access to healthcare providers denies individuals and families the right to seek care from physicians and specialists in a state that provides some of the greatest healthcare institutions in the country. The fundamental right has been a pillar of the GIC benefits going back decades. Further, the closure of such broad network provider plans violates the good faith promises made to the tens of thousands of municipal employees and retirees of entering the GIC with benefits equal to, if not better than, the health plans they left behind.
2. Increased Deductibles and Copayments: AFTMA opposes any plan design changes of cost-shifting to subscribers. Increased copayments and deductibles are assessed to those who utilize the plans. In other words, those who are sick are those who are penalized. Those families who seek regular specialty care for the child with a rare condition, a spouse with a chronic illness, or a family member suffering from an acute illness are paying hundreds, if not thousands, of dollars out-of-pocket every year. Raising out-of-pocket expenses puts an undo financial burden on public employees and retirees already struggling with stagnant wage increases and increased cost of living.
3. Tier 4 Prescription Copayment: Specialty drugs are a major contributor to healthcare costs. However, individuals who prescribe to these medications rely on their outstanding results to maintain a quality of life. It is unfair to penalize those with the rarest of conditions with the highest prescription drug copayments.
4. Market Benchmarks: We take great objection to the GIC’s reliance on plan comparisons and data provided by Mercer consultants. Comparing the GIC’s benefit structure against states such as Oklahoma, Indiana, Kansas and the like are flawed in that these states have very different economies and significantly lower healthcare costs. Providing the Commissioners these unbalanced comparisons leads to ill-informed decision making.
AFTMA, along with public employees and retirees across the Commonwealth, are equal stakeholders in providing reasonable solutions to escalating healthcare costs. We encourage the GIC to engage members of its subscriber pool in a strategic partnership to develop meaningful solutions to rising costs while maintaining quality, affordable healthcare.