U faltering on health-care benefits

Measures taken tocontrol University health-care costs threaten employees' health.

The University’s Benefits Advisory Committee is seeking comments from employees about the 2006 UPlan health benefits. If the feedback that American Federation of State, County and Municipal Employees Local 3800 is getting is any indication, there are problems with the UPlan that threaten the health and well-being of University faculty and staff members.

The measures the University has taken to control health-care costs are not only hitting staff harder in the pocketbook, they threaten our health. RxAmerica’s formulary for drugs at the $10 co-pay is highly restrictive. Many employees are finding their prescriptions are costing them at least $35. Staff members who have opted to use RxAmerica’s mail order service have experienced long delays on the phone, lost prescriptions, wrong dosages filled, letters and reimbursements sent to the wrong people (a violation of the Health Insurance Portability and Accountability Act) and more.

Information on how to use our drug benefits, which we requested as soon as the problems came to our attention at the beginning of February, just now has been sent to staff – a 4-page legal-size newsletter dated April 2006 – three months after this program began. In the meantime, the confusion often has meant long and sometimes life-threatening delays in receiving needed medications.

And what about the University’s health-improvement program, Health Connections? We can make $130 (pre-tax) if we take a survey sponsored by Harris Health Trends and then, based on the results, sign up for telephone coaching, online health courses or University-sponsored wellness actions. “Online resources and coaching over the phone to create a personal health-improvement program that will help you live better, longer.” Sounds good, right? The reality is altogether different.

We have heard from employees, both unionized and civil service, who have been telephoned at work by Harris, asking intrusive questions about their medications and diseases based on insurance claims that have been shared with Harris. Many of these employees had not taken the survey or consented to a follow-up.

I thought certainly this was illegal – a violation of privacy. But upon further investigation into the UPlan summary of benefits, I learned that Health Connections was not a choice. The summary states, “Your chronic condition or disease may also have been brought to the attention of Harris Health Trends because you submitted claims against your UPlan Medical Program. Based on the nature of the claim, you will be invited to participate in over-the-phone counseling from registered nurses and disease management professionals.” We have heard from employees who have been called multiple times after declining to participate. Some employees have been counseled not to take drugs for their conditions against the advice of their own doctors.

Certainly a wellness program with financial incentives to help employees improve their health should be helpful. But the problem with this program is that its purpose is to save the University money more than anything else. And it’s hypocritical, because the University’s other measures restrict our access to health care. The higher prescription co-pays force many employees to opt out of needed medication, choosing between necessities like rent or mortgage, food, etc. and filling prescriptions or going to the doctor.

The model that employers increasingly advocate is the health-care savings account, in which we pay cash for everything up to a certain maximum, which is usually very high (they deposit a certain amount in an account to offset it, but it’s not enough). The argument is that we will be better “consumers” if we see how much things really cost. But heath care should not be a commodity to be shopped for like shoes or car insurance. Health care is a basic necessity of life. We are not “consumers” when it comes to health care. We are patients.

We should reject the idea that we are responsible for the rising cost of health insurance. That is what is implicit in the kinds of programs like the one here at the University. No equally aggressive effort is made to go after pharmaceutical companies, corporate executives of nonprofit health providers and insurers that make millions of dollars a year. No, it’s our behavior that is targeted as the cause of the exorbitant rise in health care costs. Hence our behavior is targeted for change.

The University is heading down this road with increasing speed. These latest programs and its successful creation of four-tier premiums based on family size (a divisive step that puts greater burden on those with greater health care needs) are clear examples. Next time maybe employees with chronic conditions that did not improve with the “wellness” program will have to pay more. Or maybe the insurer simply will decide to cancel your insurance altogether, like car insurance companies do if you file too many claims! Most likely the University will attempt to move away from a defined benefit plan to the health-care savings-account model.

Tell the University you cannot tolerate health-care benefits that impose higher costs on us. Refuse to participate in the Health Connections survey that permits people other than your own health-care providers to intervene in your life. I urge everyone to contact the Benefits Advisory Committee and Employee Benefits with your experiences.

Sandi Sherman is a University staff member and member of AFSCME Local 3800. Please send comments to [email protected]