Thursday, 02 October 2014 18:02

Bromides for Jindal's state health insurance heart burn

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bankruptby Tom Aswell, publisher of Louisiana Voice

Listening to Commissioner of Administration Kristy Kreme Nichols’ responses to questions during last Thursday’s House Appropriations Committee hearing over changes to the state Office of Group Benefits (OGB) health plans, one word kept coming to mine: bromides.


Bromide is defined by Merriam-Webster as “a statement that is intended to make people feel happier or calmer but (which) is not original or effective,” and by Wikipedia as “a phrase or platitude that, having been employed excessively, suggests insincerity or a lack of originality in the speaker.”

No matter which definition one might choose, that is precisely what legislators and members of the audience were treated to during the seven-hour hearing at the State Capitol.

Keep in mind as you read this that subsequent to the hearing last Thursday, the administration of Gov. Bobby Jindal (R-Iowa, R-New Hampshire, R-Anywhere but Louisiana) retreated from its plans of the gang rape of 230,000 state employees, retirees and dependents so that the administration can follow the law for a change and proceed through the legal process of obtaining approval of the proposed benefit changes for OGB members.

Katrina Jackson (D-Monroe), for example, sparred with Nichols on the issue of the $1.3 million contract with Ansafone, Inc. of San Diego and Ocala, Florida to field phone calls from OGB members. “Where is the project work plan?” Jackson asked. “No one at OGB knew what it was when I called. No one on the committee has received any project work plan. We have a $1.3 million contract for phone service. Is this something that Blue Cross/Blue Shield (BCBS) should be doing?”

“We had no other choice but to ramp up our customer service for open enrollment,” Nichols said.

Jackson again asked if fielding questions from members should be something BCBS should be doing to which Nichols responded, “OGB has always retained a customer service component.”

Jackson said legislators were told three years ago that privatization of OGB “would be helpful to members, not harmful. We fixed something that was not broken and now it’s broken. We were doing pretty good but then for some reason we offered the business to BCBS, everyone shifts to that and our utilization costs go up.”

Jackson finally got Nichols to concede that utilization is a major issue. “Vendors have to 100 percent accountable for managing utilization with us. To the extent that the request for proposals (RFP) and current contract did not explicitly mandate that, we need to in the future.”

We’re glad we could clear that up for you.

Kenny Havard (R-Jackson) asked Nichols why the Administrative Procedures Act, which lays out a step by step procedure for the adoption of rule changes. For a complete list of APA requirements, click here: apa

“We are,” Nichols said.

“You’re doing that now,” Havard countered. “But you didn’t before. If you’d done it before, we wouldn’t be here now. Who decides what laws we have to follow and which ones we do not have to follow in this?”

“The legislature sets laws and we try to follow,” Nichols replied.

“Everything we do lately ends up in court and that’s exactly where this is heading,” Havard shot back. “We’ve created a problem that we’ve put on the backs of state workers. We have people making $500 a month and you’re about to raise their insurance (costs) and somebody needs to answer for it because we’ve created a problem and blaming it on somebody else. I don’t support Obamacare but I also don’t support Jindalcare.

“We lowered premiums so the state would not have to put up its share and now the fund balance is dwindling,” he said. “I just want to know who made the decision that we didn’t have to follow the APA.”

“We are following the APA,” Nichols continued to insist. In our opinion, the plan of benefits does not have to be promulgated because it’s in the OGB authority.”

State Sen. Ed Murray (D-New Orleans) attempted to question Nichols but soon grew frustrated at her evasiveness and gave way to Rep. Greg Cormer (R-Slidell) who asked but did not receive a definitive answer: Did an actuary give the opinion on the rate decrease of 7 percent? Cormer told OGB CEO Susan West, “If you were a private insurer, the Department of Insurance would have already taken you over” because of the agency’s mismanagement.

Jack Montoucet (D-Crowley) asked Nichols, “Where would OGB be today had we not made all the changes, if we’d left them alone and let them do their job? To me, it wasn’t broken. I never got a call in six years (prior to privatization) complaining about OGB. Today, I gotta tell you, Jesus Christ, I’m getting phone calls every day and this (new plan) hasn’t even been implemented. That’s scary.”

Nichols, as she did most of the day, stammered and fumbled for an answer. “All public employee health plans are experiencing the same thing,” she finally said, but then said that the cost increases “could have been prevented if we’d structured the HMO correctly in the beginning.”

Joe Harrison (R-Gray) went further than the others in calling for a special legislative session to deal with the OGB crisis and noted that there were no problems with the agency during the tenure of Tommy Teague, who was fired as CEO on April 15, 2011.

“Mr. Teague had a solvent plan and I’ve yet to hear any in the administration tell me why we moved away from that plan,” Harrison said.

“I would ask that we have a special session on this,” he said. We have more than 200,000 lives we are adversely affecting. There are other options to this. Many in the insurance and health care industry have looked at this and (have) said there are better ways to go.”

The hardest questions, however, came from Rep. John Bel Edwards (D-Amite). Following up on a question asked earlier by Rep. Greg Cromer (R-Slidell), Edwards asked if the recommendations for premium decreases three consecutive years were made by an actuary.

“I was not with OGB then,” West said. “I don’t have that information with me…”

“It’s been three hours since that question first came up,” Edwards said.

“I don’t have that information with me,” West repeated.

“It’s been three hours since that was asked,” Edwards said again. “That’s three hours in which those reports could have been brought over here. Who made the decision to reduce premiums by 9 percent total in fiscal years 2013 and 2014?”

“Ultimately, the administration,” Nichols said.

“The OGB director?”

“I wasn’t at DOA in fiscal year ’13,” Nichols said. “I don’t know where the recommendation came from.

When Edwards elicited testimony from Nichols and West that the OGB policy board had not met in more than a year even as the OGB fund balance was dwindling by $16 million per month, he asked, “Was there a lack of a quorum because there weren’t enough members appointed to the board (by the governor) or that they weren’t showing up for meetings?”

“A combination of both,” West said.

“So we have a situation where (the decision was made) to reduce premiums by 2.25 percent in 2012 which drained the fund balance by 3 percent knowing costs were going up 6 percent, and an additional reduction of over 7 percent the next year and an additional reduction of almost 2 percent the following year all the while with costs of health care going up and we were surprised that the fund balance went down?

“This is a self-manufactured crisis that you are now saying is an emergency because we had a fund balance that was healthy,” Edwards said. “We had OGB members who were relatively happy with the plan and today we have an unhealthy fund balance and OGB members who are very unhappy. In fact, I would not that not a single OGB member came to testify today who support any of those plans—not a single one of them.”

Edwards if there was to be discussion of stability for OGB, “we can’t leave it in the hands of whoever’s been running it for the last two years…”

He then asked Nichols when the decision was made to follow the rule of promulgation as mandated in the APA.

“The general counsel advice to OGB,” Nichols said, “was a plan of benefit changes should not be required to be promulgated…”

DOA general counsel Liz Murrill stopped texting long enough to interject, “We had the conversation at the beginning of September.”

“When was the decision made?” Edwards repeated.

“At the beginning of September,” Murrill said.

“The (OGB policy) board looked at what you wanted to do in July so you knew what you wanted to do by July 30. If you had started the rule promulgation process by August 30, you could get through the entire process before January 1. You didn’t do that.”

Nichols, in a weak attempt to defend the emergency rule procedure in lieu of promulgation, asked, “Why was OGB allowed to implement 41 emergency rules in the past?”

“I suspect because nobody challenged it,” Edwards shot back. “Typically, youdon’t follow the law unless you get challenged and that’s the real precedence that you’re following.”

Saying a Pew Survey shows that Louisiana is the third stingiest state in the nation in providing health coverage for public employees, Edwards said there is a “tremendous disconnect between saying we had an inflated reserve fund that it needs to be right-sized and today saying we have an emergency because the fund balance is not enough and it’s on its way (from a high of $520 million) to $8 million.”

He then again asked the question that no one had answered to that point. “In fiscal year 2012 there was a 3 percent erosion of the fund balance. Yet, in fiscal 2013, there was a 7.11 percent reduction in premiums followed by 1.8 percent even though health care costs were going up by 6 percent. What actuary told you those reductions were sound?”

“Buck Consulting recommended a 2.25 decrease for calendar 2012,” Nichols said.

“If you don’t have an emergency, then what you’re going to start on January 1 is invalid and you’re causing a bigger problem than if you simply go through the ordinary rule making process,” Edwards said. “Anyone who’s adversely impacted by having to pay a higher deductible or higher co-pays by an invalid emergency rule has a right to have that money returned to them.

“The safest thing to do if you are really worried about the taxpayers of the state of Louisiana is to give very serious thought to stopping the emergency rule making process, go forward with the ordinary rule making process and have whatever plans survive that process implemented in a year that doesn’t start until they (the rules) become final.

“Public meeting notices, meeting requirements, and oversight by the legislature are all very, very important. We had people today saying this was the first opportunity that they had to come and voice their objections. That’s an important part of this whole process.”


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