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Health insurance increase partly due to ACA

November 13, 2013
The Crawford County Board of Commissioners will meet in special session tomorrow (Thursday) at 11 a.m. to discuss, among other things, renewal of the county employee health insurance.

The commissioners, who already had planned on having the special session, added the health insurance, which has a Jan. 1 renewal date, to the agenda during their regular monthly meeting on Oct. 31 after being addressed by the county's health insurance representatives.

Brett Busick from Busick Insurance of Orange County said renewal of the county's policy with Anthem Blue Cross Blue Shield, as is, would see a premium increase of 20 percent. However, a portion of that is due to fees associated with the federal Affordable Care Act, explained Natalie Gavin of Anthem.

"All groups have to pay for the Affordable Care Act — 2.68 percent of your premium and then $5.25 per covered person. So, that's every employee, spouse and dependent child that's on the plan has to be remitted to cover the Affordable Care Act," she said. "We will remit those fees on your behalf, which is why it is being billed into the premium.

"So, about 4 percent of your increase is strictly for that. It's not Anthem premium that we're keeping. So, your true net increase is 16.4 percent. And that is to keep all your benefits the same," Gavin said, adding that Anthem is working with its underwriters, based on updates from Busick, to see if the increase can be reduced.

The county council has appropriated $660,000 for its share of the health insurance premiums for 2014, up from $651,512 in 2013.

The county's two current plans ­— one featuring a $500 deductible and another with a $1,500 deductible — are grandfathered under the ACA. Other plans are available at a lower premium, Gavin said, but they would be subject to ACA requirements.

"Right now, there are certain things you don't have to conform to, because you haven't changed your benefits since this was rolled out," she said.

Randy Gilmore, president of the board of commissioners, asked what those changes would be.

Gavin answered that some of the changes — such as providing coverage to persons with pre-existing conditions — were required of all plans, grandfathered or not. Changes that would take effect with new plans include no co-pays for preventive or wellness procedures — they would be paid at 100 percent — and an increase to the pharmaceutical co-pay, she said.

Another way the county could reduce the increase, Gavin added, is to keep the higher deductible plan while either eliminating the lower deductible plan or replacing it with another plan.

However, while the county could replace the $500 deductible plan with a less expensive plan with a $2,500 deductible, it would greatly increase other costs, such as injectable medications, Busick said. For example, while he doesn't know who, because of confidentiality, he said there is an employee taking one prescription that costs almost $13,000 per month. Currently, the employee only pays $30, with Anthem picking up the balance, Busick said. Under the higher deductible plan, instead of paying $360 per year, the employee — even with the amount they would have to pay being capped — would pay $1,200, he said.

"So, now, if that person moved over to that other plan, they're going to see a huge spike in what it's going to cost them to get that shot," Busick said.

Drug costs do not count toward the deductible.

Gavin said eliminating the $500 deductible plan and moving everyone to the $1,500 plan still would result in a premium increase of 13 percent, including the ACA costs.

Busick said that, right now, "with all that's going on in this health care thing," his goal is to get all of the groups he represents as close to the amount they paid in 2013 "and get them through 2014."

"Let's just see what's going to happen with this thing, because we don't know," he said. "We can't get on the (ACA) website, our phones are ringing off the hook, people coming in. … We can't tell them anything. Right now, it's a mess."

Busick said, what he does know, is "come Jan. 1, all these rates are going way up just because of the Affordable Care Act."

District 3 Commissioner Jim Schultz asked if Busick was referring to the 4-percent ACA costs.

"I'm not talking about that," Busick answered. "I'm talking about the companies — Anthem as an example — now, all of a sudden, they have to take everybody. They can't decline anybody. So, you know, what are they going to do? They're going to raise their rates. So is UnitedHealthCare, so is Humana, so is everybody else."

But some low-income people will pay less because of subsidies, Gilmore said.

"I haven't found one yet," Gavin answered, adding "that's what's supposed to happen."

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