Saturday, August 11, 2007

Dean Werstler: STRS Retiree Health Care Problem

STRS cutting corners? It sounds like a subtle but painful way -- as this STRS retiree is finding out! How many other retirees haven't found out yet by the learning by doing method?
~ John Curry, 8/11/07

Dean Werstler to Dennis Leone, August 6, 2007
Subject: STRS Retiree Health Care Problem
Dear Dennis,
My name is Dean Werstler and I am a retired administrator (with 30 years of service in the STRS system) for six years now. My wife and I live in Tucson, Arizona full time. My wife has 23 years of service and will not receive benefits for another two years. We currently participate in the STRS sponsored health care plan. For the last six years our monthly premiums have increased and it feels like our benefits have decreased. We are currently on the Medical Mutual Basic plan with a very high deductible. We have also had numerous problems with Medical Mutual getting claims correctly paid over the years. Fortunately we are both currently healthy and have chosen the basic plan in order to reduce our monthly premiums. We are trying to be good stewards of our health care dollars. We also visit providers who are "in network." Each year we agonize over which plan will be better for us before making our choice for the next calendar year.
The purpose of this letter is to thank you for your dedicated service to the retirees of the STRS system. I truly believe that you have all of our best interests in mind and have a demonstrated track record to that effect.
I also wish to inform you of a problem that I am facing with the current health care system. I believe that this problem may be the tip of the iceberg and many other unsuspecting retirees may be in for a shock. I am referring to Medical Mutual and their out of state network, PHCS, for us retirees living here in Arizona.
My local in network physician has informed us that she will no longer accept PHCS. I asked her why she made this decision at my recent annual physical. (I appreciate the fact that a preventative physical is totally covered as a wellness item this year). She told me that PHCS has a new owner and they presented the new reimbursement schedule to her for her annual renewal. She states that the rates they are willing to pay her are less than Medicare! In fact she said, " I would rather make my phone calls and then go home in the afternoon than accept what they are willing to pay me." She also said that our new state of the art hospital in Oro Valley, Northwest Medical Center, is also dropping PHCS because of the low reimbursement rates. It seems to me like we have a systems problem here in the making. I wonder how many other providers in the PHCS network will also have the same feelings and refuse the coverage? I also wonder how many of us retirees will be surprised by this new development and be forced to make some very uncomfortable decisions? I also suspect that renewal contracts come up at different times of the calendar year. If this is the case, we will have a delayed reaction to this new development.
I feel strongly enough about this issue that I called STRS today and requested to speak to a Health Care Advocate in hopes that she would understand my problem, see the future potential problems, and champion my (and our) cause. I talked with Kathy Crawford (Health Care Advocate) and explained to her the above. She indicated that she was aware of the change in ownership of PHCS but that I was the first person that she talked with who had a provider drop PHCS due to the reimbursement rate. She also explained to me all that STRS is doing to keep the health care system reasonable. She said that Medical Mutual chooses the out of state provider, not STRS. I kindly reminded her that Medical Mutual works for STRS, not the reverse. She indicated to me that I have other options: continue to see my current physician out of network; choose another physician in the network; or choose a different coverage for next year. Two of these options mean that I could not use my current doctor of the last six years and all three would cost me additional money. (Due to a network change by STRS, I have already had to switch dentists.) She indicated to me that she would approach the subject with Medical Mutual and respond back to me. I was very pleasantly surprised to receive a return phone call from her later in the day. She had talked with Medical Mutual and they do not feel this is a problem at this time. She said, "Medical Mutual feels that there are thousands of in network providers out there to choose from." They will continue to monitor the overall situation. Kathy again reminded of my other options within the STRS health care system. I asked her to specifically check some of the reimbursement rates for PHCS (old and new) and respond back to me.
Dennis, I really feel like I am a very small fish in the ocean on this issue. I do not feel that Medical Mutual sees a potential system problem nor does STRS. I feel like the Health Care Advocate was more supportive of Medical Mutual and the STRS administration line and not very understanding or sympathetic of me, the retiree. I also feel, through no fault of my own, that there has been a mid-year change to my health care plan that I chose in good faith. I am now stuck with this change for the remainder of this calendar year. I will need to know who the out of state provider is for Medical Mutual for Arizona for calendar year 2008 before I make my decision. If I choose AETNA it will cost me more money for monthly premiums. We will also be forced to consider private insurance.
Thank you for your time and consideration. I appreciate all that you do for the retirees of STRS.
John Curry to Duane Tron, August 11, 2007
Duane, Thanks for this letter. I am not referring to all those in the insurance industry..there are a lot of people who work there who are "ground level" employees and who no more share in the insurance industry glut that we do as STRS retirees. And yes....neither can I afford to go to the Sun Belt (New Mexico.. in my case) and establish a dwelling thanks to the spousal subsidy elimination (aka screwing) that STRS bestowed on my family thanks to its lack of planning but instead spending and globetrotting. The "hurt" is finally being felt by a number of STRS retirees and they are starting to feel the squeeze that we have been warning about for years...too bad many of the "actives" don't know what lies ahead in their future. John
Duane Tron to John Curry, August 11, 2007
Subject: Re: STRS Retiree Health Care Problem
I know Dean from my administrative days. I can truly empathize with him and his problems. On the other hand he and his wife were able to move to Tucson to retire. There are a lot of us who CANNOT afford to move anywhere in the Sun Belt, let alone Tucson. My wife and I were given 35 acres in Colorado as a wedding anniversary gift, by our daughter, and we can't afford to move there. We can't afford to build a small house in our retirement. I was planning on building a 1,200 square foot house, not overly big or pretentious by any scale, and we can't afford it. Why? In
2002 they screwed me by eliminating the spousal subsidy. Although I feel bad for Dean, the rest of us will be spending our "Golden Years," freezing our you know what's off here in the Arctic zone. I didn't experience too much global warming last winter and I suspect this one will be colder. Ah! Some of our comrades are finally getting the wake-up call! Imagine that?! Wait until about another 50,000 figure out how bad we have been screwed and we'll sit and listen to them squeal. When I spoke to a lot of these people five years ago they weren't concerned because the you know what hadn't impacted them and they weren't concerned!
And Dean and many other retired after they dropped the spousal subsidy and all of the warnings of doom and gloom had been presented. My wife and I are very good financial stewards as well and we are looking at the stock market right now and getting very concerned. I don't like what I'm seeing with the home mortgage meltdown that is occurring! We have been residing in the Twilight Zone for the past five years and we both continue to work to try and make sure we can survive. At our house we've already figured out that we will retire the day they plant us in the ground. Welcome to the new and prosperous America! Where were all of the voices when we were sounding the alarm? AWOL! Our problem wasn't their problem at that time. Note I said, I empathize but I have exhausted all of my pity! Sorry! When I got tired of fighting I just went back to work! I owe, I owe, so it's off to work I go, and ditto my wife!
For those who think it's better in Corporate America tell that to my wife. She has worked continuously for the past 43 years. When she had 36 years of service her company was acquired, a polite term, for raped and plundered, and she lost all of her benefits and was begrudgingly granted a paltry little pension after we acquired an attorney. No health insurance at all and the cost of a COBRA was more than her yearly retirement check. The grass is NOT greener on the other side for a majority of Americans and we can attest to that! We got screwed twice and as much as sex is supposed to feel good none of this feels good! What industry has my wife worked in during the past 43 years? Insurance!
In a few years I am going to suggest we hold a pity party at STRS for those who followed us out.

Shirlee Zerkel re: A chart in the SERS newsletter

Shirlee Zerkel to John Curry, August 11, 2007
Subject: Interesting tidbits concerning a chart SERS has in their newsletter
John, I hope this is not the plan that STRS staff proposes to the Board next week. In the July SERS Focus newsletter, they explain their new Medicare Health Plans. They are forcing all of their members who have both Medicare A and B to go into their Advantage Plan. In the newsletter, they explain improved benefits and, on the first look, it seems good. Upon closer scrutiny, in my opinion, there are problems and members may not have such a good deal after all. Their chart is divided into 2 columns Current 2007 Plan and 2008 Medicare Private Fee for Service Plan. Under their Current 2007 column, they list only the coverage their supplement pays, NOT WHAT REGULAR MEDICARE PAYS thus making it look like you are getting a lot more in 2008 than you did in 2007. I don't, in all cases, think that is true. The news letter does NOT state the cost to the member for premiums for this plan (imagine that)!
Their chart mentions that in their Advantage Plan there will be no yearly deductible ($340 for 2007); then further down the chart, it is listed that there will be a fee of $250 called hospital admit deductible. It is a one time charge or each time a member is admitted?
The #340 deductible is reduced to 0, but the Out-of-Pocket max ($1,500) has been removed. So if you have some expensive medical situations, your co-pays could really add up.
Let's look at regular doctor office visits, which is what the majority of us use the most. SERS says that members are covered at 80% in 2007. What we are looking at is the fact that Medicare pays 80% of what they call customary and that leaves 20% for SERS and the member to pay. We will say that Medicare approved a $50. office visit and so Medicare pays $40, leaving SERS and the member to divide the remaining$10. Under the new SERS ADVANTAGE PLAN the member will PAY A $25. CO-PAY each time a $50 office visit is needed. For the members that is far more than they are presently paying. Is this a better plan than what the SERS member had now under the regular Medicare plan with SERS supplement? But the SERS supplement will be NO MORE, all in the SERS plan will be FORCED to take the Advantage plan or leave SERS. A note, this plan does not cover prescription drugs. Separate plan!
Their chart also states some preventive Care as not covered. Many of the items listed are covered by regular Medicare in 2007; some examples are: Immunizations, colorectal cancer screening, PSA, Annual Pap and Mammogram.
If an Advantage plan is presented to the members of STRS, we must look very carefully at what it offers us. We must educate ourselves as what we already have with Medicare A and B plus the present STRS supplement. The only members this will affect are those who have the regular Medicare A and B.
These are the personal opinions of
Shirlee Zerkel.

Friday, August 10, 2007

Divestment Push Gains Support, August 9, 2007
The legislative push to divest from both Sudan and Iran has seen a flurry of activity in statehouses across the country, and has now gained some traction on Capitol Hill.
On July 31, the House passed the Darfur Accountability and Divestment Act sponsored by U.S. Rep. Barbara Lee (D-Calif.). The measure is similar to one enacted by the City of Philadelphia last year, as well as one passed last month by the Pennsylvania House of Representatives, which is headed for the State Senate.
The congressional bill calls for the establishment of a federal list of foreign-owned companies that do business with Sudan, and are deemed "culpable" of contributing directly or indirectly to the government sponsor of Janjaweed militia groups.
Alongside efforts to isolate Khartoum, there's been momentum to utilize economic tools to hamper Iranian nuclear progress.
To that end, the House passed the Iran Sanctions Enabling Act, which, if it becomes law, would require the U.S. government to publish a list of foreign-owned companies that invest more than $20 million in Iran's energy sector.
"We can put the squeeze on Iran using this tool," said U.S. Rep. Tom Lantos (D-Calif.).

Thursday, August 09, 2007

John Curry: Why those lists mysteriously disappeared from the Internet

From John Curry, August 9, 2007
Remember when that list (the "nasty" companies) mysteriously disappeared?

Remember when the Ohio Retirement Study Council suddenly (and without explanation) removed the list (the "nasty" list) of companies who supposedly had some business dealings with "terrorist" countries? I then wrote the director of ORSC (Aristotle Hutras) and asked him "why?" Well, I didn't get an answer back. It might have had something to do with the fact that Honda was on that list or that Rolls-Royce was considering building a factory in northern don't suppose these were the reasons it was "jerked" do you? Honda is no more a "terrorist" related company than my pet cat WAS on that ORSC premature list, wasn't it?
Well, now we have another list that was "jerked!" This time, the good folks at the SEC did have the courage to explain "WHY" they did...unlike the good folks at the ORSC! Imagine that!! In case anyone wants to see that "premature" list that the ORSC put on and then "jerked" from their website..I have it and would be glad to furnish you with it. Bottom line...the ORSC and a whole lot of other organizations have suffered from a "knee jerk" reaction from people with good intentions but bad intelligence. The link below will explain (unlike ORSC) why the SEC list was removed. In short, let the terror list be made by the U.S. government and not by individual orgnizations or state legislators with good intentions. John

Dennis Leone and a question re: STRS Board's June vote on divestment

Dennis Leone to John Curry, August 8, 2007
Subject: RE: Ohio HB 151 divestment
John – Regarding your email below: Section 137.08 of proposed HB 151 is the key. In my eyes, this demonstrates how wrong the board was in June. How can the board voluntarily engage in divestiture when HB 151 acknowledged that we needed fiduciary liability protection in the event we reduced investments in Iran and Sudan. (Interesting, too, that no STRS staff member told the board about this language in HB 151.) Actually, Section 137.08 of proposed HB 151 is an admission that such divestiture is a violation of the board’s fiduciary role, which is why the liability protection was stuck in there. Problem is, however, is that HB 151 hasn’t passed, so why did the board vote in June as it did, especially when the board had no liability protection (proposed in HB 151) and when the board knew the matter was headed back to a legislative sub-committee for reconsideration? Anybody know? The motion (that passed 6-2) was made by Jeff Chapman and was seconded by Steve Puckett. Maybe they should answer this. Please feel free to forward this them. I intend to ask them publicly, so this email will give them a heads-up.
Dennis Leone
Cheryl Flagg to John Curry, August 8, 2007
Subject: Re: Ohio HB 151 divestment
If anyone just happens to want to know more about HB 151 and fiduciary duty and exemption of defined contribution plans, they can be referred to Sec. 137.08, Sec. 148.04, and 3305.02. HB 151 is attached for quick reference. [Click here to view text of HB 151.] Kept this information from my research earlier this year.

Wednesday, August 08, 2007

Meet Cheryl Flagg, a savvy friend in Colorado

August 7, 2007
I am a Colorado public school retiree who has been networking with John Curry and Kathie Bracy regarding Sudan and Iran divestment of public pension funds. My interest was sparked when a Sudan divestment bill was introduced in Colorado this past January. I contacted a sponsor of that bill asking why only our public pension fund was targeted and received a totally unsatisfactory answer about the legislature having this power to divest public pension funds so they're using it. Why weren't private individuals, legislators, businesses, and other types of pension funds being asked to divest? How can divestment work if everyone doesn't divest? We contributed to our public pension fund all our working lives and suddenly there is a threat to our retirement investment.
Then I started reading Sudan divestment bills from other states and...they all looked the same. They are modeled after one written by the Sudan Divestment Task Force and contain two clauses which stand out. These bills only target the pension plan defined benefit portion but leave the defined contribution plan intact. And secondly, a "safe haven" is created for pension fund managers and trustees by releasing them from their fiduciary duty to teachers and public servants. This definitely sent a message that these divestment bill may not be all they are touted to be. How could their divestment proposal work if only part of the pension fund is targeted? And no other individual or entity divests? And it's unethical, and maybe even illegal, to eliminate fiduciary duty to investors.
And then here comes Iran divestment. The source of this one is the Center for Security Policy. It seems our salary and public pension fund contributions are considered to still be their monies since we are paid through state and local taxes. It then became obvious that these divestment initiatives are also smokescreens for the destruction and elimination of public pension funds and the redistribution of our invested retirement money. Netanyahu has also been lobbying over here for Iran divestment on the basis that this will control Iran. Well, it won't impact Iran because any divested stocks from our defined benefit plans will still be listed and sold on the stock market so anyone can purchase these money makers. And, of course, Russia and China are there to pick up the slack for Iran.
These divestment initiatives have spawned a huge lucrative market for "genocide and terror" lists. There are several companies providing these lists for large fees to pension fund managers. Here's the problem: The State Department and SEC already have sanctions in place and publish a list of companies conducting business directly with the countries on their terror list. These lists are free to everyone at the State Department and SEC web site. What these other private terror lists do is list companies that have some tangential business relationship to Iran. In other words, if a business sells a screw to a business that produces a part that is then sold to another business that has a product that they market through another company that also markets a product from a company selling directly to Iran, then they all make these new terror lists. It's like playing the game "Six Degrees of Separation"; in this era of globalization, everything is just that connected. Another problem? None of these terror lists match up, since numbers range anywhere from 40 to 485 companies. And these "terror lists" companies are not transparent so we don't know the criteria they use to select companies to put on their terror lists.
Certain politicians are using divestment to gain publicity and further their political careers as is pointed out in the Forbes article below. There are also other links to articles that might be helpful. Some of these are "stealth" articles which must be read all the way through to get the true message. Going to and scrolling through to the divestment articles and letters is also an excellent source of information. Unfortunately, there is not one single article that covers this current divestment initiative in depth from the beginning to present time. A final thought: We should all remember that sanctions and divestment hurt people, not government leaders.
Cheryl Flagg
PERA Retiree

RH Jones to Dennis Leone: AMEN!

From RH Jones, August 8, 2007
Re: Leone to STRS Board re. Curtis letter & "the whole thing smells bad"

Dr. Dennis Leone:
As usual, you are absolutely correct in your thinking concerning this divestment matter at our STRS OH. Count me as another retired teacher in your corner on this. I, having seen this bill 151, and I agree that it will take tons of time away from the STRS employees to fulfill the legal obligations of this hurtful bill.
Personally, I would like for all concerned retired teachers to confront these terrible politicians and STRS board members that are putting our STRS at risk. The sponsors and co-sponsors of this awful bill definitely need to make a provision in it that new state taxes be imposed on the public to make up for the loss bill 151 will cause, not only to STRS OH but to all the public pension funds of the State of Ohio. Most certainly, all the Ohio public pensions systems will be severely impacted by this investment take-away.
If they are so adamant about making foreign policy for the Executive Branch of the U.S. Federal Government, may I suggest that all of these so-called "super patriots" join the U.S. Marine Corps, or the U.S. Army? That's my opinion.
RHJones, U.S. Army vet, and STRS OH retiree

Shirlee Zerkel to STRS Board re: Medicare Advantage

From Shirlee Zerkel, August 8, 2007
Subject: Health Care Concerns for the August Meeting
Dear STRS Board Members:
I am a five year retiree member of STRS and am now 65 years old. I have some concerns about some of the plans, as I and other Medicare covered members can be greatly impacted financially by decisions made next week. Our health benefits can also be greatly affected.
After emailing Ms. Knoesel about the Advantage Plan, she tells me that all of the Board Members will have information by this Friday concerning the MA Plan. She also stated: "Information on Medicare Advantage will be presented at the Board meeting. It will be up to the Retirement Board to decide if it wants to take action on this matter." I am asking you to look over all information provided by STRS carefully and also read other articles concerning the MA Plans so that you can make a decision which is in the best interest of the retirees and their health. I am including one such article about a certain type of Medicare Advantage Plan that really frightens me.
After reading many articles on MA's, my sister's personal experience with such a plan, and then the newsletter, called FOCUS distributed by SERS of Ohio, I have concerns about STRS entering into this venture.
SERS newsletter says that the Medicare age SERS retiree who has both Medicare A and B will automatically be put into their Advantage Plan. SERS members will not have the option of choice as do other Americans! If SERS members do not want this plan, then they will not have any SERS coverage even as a supplement or for prescriptions. Quote from that newsletter: "SERS will be transferring all Medicare retirees and dependents currently enrolled in the Aetna Indemnity Plan to the Medicare Open PFFS plan effective January 1, 2008. All those now in the Medical Mutual Plan (MMO) will be transferred to MMO's (PFFS)." (The PFFS plans are the MA ones) Also another quote: "If you do not want this coverage, then you will not have any medical or drug benefits from SERS and will only have the traditional Medicare benefits." I am upset by such a plan because it leaves the retiree no choice.
In the beginning, the private MA plans looked good; then as the private plans continued members had to pay increased premiums, some more than traditional Medicare, coverage decreased, and lists of providers were given out and that list kept shrinking.
Articles tells us that these Advantage Plans are not cost effective for the Medicare finances. The government pays on the average 12% more or about $1,000 more per beneficiary per year than it would cost to cover these same people in regular Medicare. Where is that going to leave the Medicare funds in the future. These overpayments not only weaken Medicare finances, but force tens of millions of people in regular Medicare to pay higher monthly premiums to help cover the cost of the overpayment to private plans.
Please as you go over the information that Ms. Knoesel says you will receive on Friday, look to see if they are requesting a Special Needs Medicare Advantage Plan (SNP). If so, this could even be worse for our STRS retirees than other MA plans! The SNP also provides drug coverage, which sounds good. The catch is that this plan does not have any oversight by the federal Medicare Program once the private provider is approved. The private provider can service the retiree any way it wants to.
That scares me because of a situation two years ago when I helped an STRS retiree who had Aetna through STRS instead of the regular Medicare A. There is no oversight for STRS retirees who havae the STRS version of Medicare A. STRS was content to let this older couple pay over $21,000 in hospital charges for 2004 when the STRS Health Care Program handbook stated that out-of-pocket max for a retiree was $1,500 per year. I pushed and pushed Mr. Russell and used their handbook, letters from Aetna, and previous emails from STRS, to prove what was happening and that it was wrong. Finally about 1 year later, all was resolved and it was resolved according to charts in the handbook. It shouldn't take a year to resolve such an issue. Board Members, no ill elderly STRS retiree should have to endure that kind of hassle. Many of then can't, for they do not have the health and energy to do it. But that is what could happen to all retirees in the Advantage plans if there is no oversight.
Board members, as you think about this decision, please consider the retirees and their well-being.
Shirlee Zerkel
2002 STRS retiree

July 19, 2007
Center for Medicare Advocacy
In 2003, Congress authorized a new kind of private Medicare Advantage (MA) plan called a Special Needs Plan (SNP). SNPs differ from regular private MA plans in that they are intended to enroll, exclusively or disproportionately, only specific high-needs subpopulations of the Medicare population. Such focused enrollment is prohibited for regular MA plans.
SNPs operate with few requirements from the law or from the Centers for Medicare & Medicaid Services (CMS). CMS does not define key terms, allowing SNPs to operate without standards. Nor does CMS collect meaningful data on the services SNPs provide, allowing SNPs to operate without oversight of how or whether they deliver what they promise. The Secretary of Health and Human Services is required to report to Congress by December 31, 2007 about the impact of SNPs on the cost and quality of services provided to enrollees, but, to date, little is known about what SNPs are doing and whether they are meeting the special needs of the medically complex populations they serve.
The authorization for SNPs ends in December 2008. Below is a brief description of SNPs and suggested considerations for Congress in its deliberations concerning whether to extend authorization for SNPs, and, if so, under what terms and conditions.
What Populations do SNPs Serve?
Three groups are identified in law and regulation as special needs populations:
Individuals dually eligible for Medicare and Medicaid, Individuals residing in specified institutions for extended periods, and Individuals with a specific severe or disabling chronic condition identified by the SNP.
The three populations identified are the frailest, sickest, and most disabled Medicare beneficiaries. They are also the highest users of health care services. Dually eligible people, for example, use 24% of all Medicare dollars, but represent only 16% of the Medicare population. While dual eligibles are a separate population for purposes of designing a SNP, the other two populations include many dual eligibles as well.
How Have SNPs Grown Since Their Inception?
The number of SNPs providing services to Medicare beneficiaries has grown exponentially between 2004, their first year of operation, and 2007, due in part to the revenue they generate for plans. In 2004, 11 SNPs were approved by CMS. In 2007, 476 SNPs were approved, enrolling over 800,000 beneficiaries. This represents an increase in plans of over 4000% in four years. The breakdown for 2007, for different types of SNPs, is:
For dually eligible people: 321 plans serving 621,986 enrollees For institutionalized people: 84 plans serving 139,761 enrollees For people with chronic conditions: 71 plans serving 81,093 enrollees
What is, and is Not, Required of an MA Plan to be a SNP?
A SNP must be a "coordinated care" plan, either a Health Maintenance Organization (HMO) or Preferred Provider Organization (PPO), not a Private Fee-for-Service or Medicare Savings Account plan. Unlike other MA HMOs and PPOs, a SNP must provide coverage for Part D, as well as for Parts A and B. Beginning in 2008, SNPs must also state what their "model of care" is; however CMS imposes no requirements for either the content or the performance of the models of care. CMS imposes no other requirements on SNPs. Since SNPs began operating in 2004, CMS has taken no action to enforce any obligations that SNPs meet the special care needs of their members.
Plans serving dual eligibles (regardless of whether they are considered Dual Eligible SNPs) are not required to coordinate care and payments between their members' Medicare and Medicaid coverage, even though the lack of both care coordination and integration of payment systems are the structural "gaps" that promote fragmentation in care for dual eligibles. Plans are also not required to include Medicaid providers in their plan networks, or to inform enrollees of their Medicaid coverage and how to access it.
How are SNPs paid?
SNPs are paid just like other private MA plans: through a monthly amount per beneficiary that is "risk adjusted" to reflect the likely utilization of services of each enrollee. All MA plans receive "bonus" payments for their enrollees who are dual eligibles or institutionalized. As a result, because nearly all SNP members, by definition, fit these categories, SNPs receive a higher average payment than regular MA plans.
What are Considerations for the SNP Reauthorization Debate?
SNPs should be offering care and services that are better at meeting their members' medically complex "special needs" than what is offered by traditional Medicare or by a regular MA plan.
What is, and what should be, required of plans applying to be SNPs? What standards exist and what are needed to measure SNP performance? Many of the needs of dually eligible beneficiaries that are not included in Medicare are covered by their state Medicaid program.
What additional services are Medicare SNPs providing that are not already covered by traditional Medicare and by Medicaid? How can any SNP with dually eligible members provide better care if SNPs are not required to ensure that care is coordinated with their members Medicaid coverage or to include Medicaid providers in its network? Individuals eligible for an institutionalized SNP may reside in institutions that are not subject to Medicare payments, such as Intermediate Care Facilities for people with Mental Retardation, nursing facilities, or in home or community-based settings where they receive primarily Medicaid services.
How can an institutionalized SNP add value for these populations? SNPs should be improving beneficiaries' access to primary care and services and to other providers they need, including specialists and social services.
How do SNPs guarantee that care coordination services already in place will continue after enrollment? How do SNPs guarantee that members continue to receive services from trusted providers? Adequate information should be communicated to potential SNP enrollees and members about all that is or is not covered by the SNP and about how accessing services through the SNP differs from accessing services through Original Medicare or through other Medicare Advantage plans.
Do SNPs accurately explain the interaction between Medicare coverage available through the SNP and Medicaid?
Medicare Special Needs Plans have been a costly addition to Medicare. Because they serve populations whose complex care needs have been a challenge to health care policy makers and providers for decades, it is hard not to conclude that their exponential growth is due more to their generation of revenue than to their success at meeting the challenge of the populations they are intended to serve. Special Needs Plans need to be carefully examined to ensure that any additional costs associated with them translate into valuable additional coverage for the populations they purport to serve.
For more information, contact attorney Patricia Nemore ( in the Center for Medicare Advocacy's Washington, DC office at (202) 216-0028.
Keep Medicare Independent!
The traditional Medicare program is more cost-effective than private insurance It provides secure, easy to access health insurance for older and disabled people. Let your representatives know how much you value traditional Medicare.

A comment from a retiree

August 8, 2007

Did read your blogs and was absolutely shocked at the stance (and vote) that the STRS Board took. Poor Dennis!. How he can keep going with all the nitwits that keep getting on that Board is beyond me!

Tuesday, August 07, 2007

Shirlee Zerkel to Dennis Leone re: response from Sandy Knoesel

From Shirlee Zerkel, August 7, 2007
Subject: Questions about August Health Care vote
Hello Dennis,
This is the email I received from Sandy Knoesel this morning, Thanks to your pushing them to really answer my question. It looks as if her answer is still vague, for she says it will be up to the board to vote.
I have some very great concerns about the Medicare Advantage Plan after reading articles sent to me by John Curry, my sister's experience with such a plan, and then the newsletter from SERS. SERS newsletter says that the Medicare age SERS retiree who has both Medicare A and B will automatically be put into the Advantage Plan. If they don't want it,then they will not have any SERS coverage even as a supplement. quote: "SERS will be transferring all Medicare retirees and dependents currently enrolled in the Aetna indemnity plan to the Medicare Open PFFS Plan effective January 1, 2008. All those now in the Medical Mutual Plan (MMO) will be transferred to MMO's (PFFS) plan." (The PFFS plans are the Medicare Advantage ones). Also quote: "If you do not want this coverage, then you will not have any medical or drug benefits from SERS and will only have the traditional Medicare benefits."
Dennis, I am upset by such a plan because it leaves the retiree no choice. In the beginning the private Medicare Advantage plans look good, then as the private plans continue, premiums sneak upward, coverage is less, and there surely will be in the future a list of approved providers.
Dennis,One thing to look out for as you go over the material that Sandy says you will have on Friday before the Board meeting. Look to see if they are requesting a Special Needs Medicare Advantage Plan called SNP Plan. If so, that could be even worse for the retirees! The SNP also offers drug coverage, which sounds good. The catch is that this plan, once the private provider is approved by the government, does not have any over site by the federal Medicare Program. The private company can service the retiree any way they want to. That scares me because of the situation two years ago when I helped a retiree here in Lima who had Aetna through STRS instead of Medicare A. STRS was content to let this older couple pay over $21,000 in hospital charges for 2004 when the STRS handbook for 2004 stated that out-of-pocket- max for a retiree was $1,500 per year. I pushed and pushed Mr. Russell and used their handbook to prove what was happening. Finally about 1 year later, all was resolved and it was according to the handbook. No elderly ill (Alzheimers) retiree should have to endure this kind of hassle.
Thanks for listening and please let me know if you do get the information this Friday about the health plans.
I will not be at the meeting next week as our son and family will be here from Kansas and also we have an ill family member (my sister, Donnie) who has stage 4 lymphoma.
Take care and keep you chin up,

Dennis Leone to STRS Board re: Curtis letter; "The whole thing smells bad"

Dennis Leone to Tom Curtis, August 5, 2007
Subject: FW: 080507 Curtis To Leone, Divestment
Tom -- I agree with you that any decision for a divestment plan is contrary to the spirit of 3307.15. What the Board majority will say, however, is that since the official Board resolution states that our ultimate divestment plan will not compromise the total assets at STRS, this is supposed to make it okay. In other words, even though tons of staff time will be needed to find different investments to make up for divestment changes, the Board majority will tell you that their fiduciary role also has not been compromised because total STRS assets have not be compromised. That’s similar to the philosophy that existed when pension money was spent (in the past) on “team building” – you know, for Kings Island, concerts, baseball games, the Columbus Zoo Light Show, parties, booze, super-expensive dinners, etc. The Board can always find a way to say that their actions (like spending pension money on the private legal fees of staff members) are proper for staff morale or staff retention, etc.
What is difficult for me to accept about the Board’s divestment resolution is that when the decision was made, the Board knew the matter was headed back to a Senate subcommittee for reconsideration and additional discussion. This was stated publicly by Mary Ann Cervantes BEFORE THE VOTE. Did this slow down the Board? No. Full speed ahead. Why? Because the staff wanted a vote to be taken. The whole thing smells bad.
Dennis Leone

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Ron Catron to Board members and legislators

From Ron Catron, August 6, 2007
Subject: Re: 080507 Curtis To Leone, STRS Divestment
Dear STRS Board Members and Legislators,
Let it be known that as a fellow retired educator I am with Tom Curtis' stand on these two issues all the way. His points express my feelings exactly! I read about all these wonderful new bonuses being paid to STRS investment staff, but we still don't have a solid means of financing Health Care for retirees and their families. And the legislature has the nerve to use our investment money as a ploy to further their own legislative agenda! Come on people, do the right thing for the people you are supposed to be serving.
Ron Catron

Monday, August 06, 2007

Honored guests at Warren County RTA meeting 8/6/07

The Fonz

The Chillicothe Chiller

(You don't want to meet up with either one of these characters after a trying Board meeting!!! Trust me.)

A message to all vets from RH Jones

August 6, 2007

To all vets:
According to my local American Legion Post #449, all veterans can now hand salute the American flag. The Women's Marine Corps Assoc. says that federal legislation was just passed.
My opinion is this is great. This will separate vets from civilians. Civilians are to hold their hands over their hearts; vets are to salute -- and that is a great show of respect for vets as it is for the active duty military personnel.

Shirlee Zerkel to Sandy Knoesel: Questions about the HC vote

From Shirlee Zerkel, August 6, 2007
Subject: Questions about August Health Care vote
Dear Ms. Knoesel:
Does the Board vote on the Health Care Plans, premiums, etc. for retirees this August meeting? If so, do they receive the information in advance of the meeting day so they can research the plans if they so choose? Thanks for addressing my questions,
Shirlee Zerkel

Thank you, Craig Brooks! From Jim N. Reed

From Jim N. Reed, August 6, 2007
Gratitude for A Strong Vote against Divestiture And for Retirees

Mr. Brooks, I just want to express my appreciation to you for your willingness to speak up and out and against the divestiture issue as an STRS Board member. I do not know if you can understand how magnificently refreshing it is to see someone on this Board concur with Dr. Leone and Mr.Lazares. (I actually believe there are Board members who would oppose Dennis and John without full consideration of the issue just to be confrontational.) All we ask as retirees and actives is that our representatives demonstrate independent thinking and are not bullied or socialized into registering a vote without due research and strict observance of ORC 3307.15.

Your vote against divestiture is reason for HOPE among retirees. HOPE has been in short supply, a rare commodity during the past six-seven years for many dedicated, career public educators. There has been an absence of understanding, an appreciation for the circumstance in which many retirees find themselves due to the shameful increases in heath care premiums, stagnant COLAs and embarrassing pension fund waste.

Thank you for your stance against the further erosion of STRS pension funds through the unsubstantiated expenditure of divestiture. How much of our hard-earned savings will be spent for the STRS Staff to "study" the strategy and logistics of divestiture? How much will go down the rat hole to money managers eager to accommodate the General Assembly's fiscal bullying in their desperation to convince constituents they are real patriots? And, even if divestiture happens, who actually gets hurt in those countries that have been "targeted," their extremist-radical leaders or the already suffering, common people who are trying to scratch out a living and survive each day?

Mr. Brooks, you have given us cause to believe there is light at the end of this STRS nightmare. There are so many people whose well-being hinges on the decision-making of our Board. We are in need of some heroes who will stand up and be counted as genuine representatives of Ohio's retired and active public educators.

Jim N. Reed

For some actives....reality is about to "sink in!"

STRS retirees are far too familiar with finding out the 3% COLA is often offset by the increased healthcare premiums they have to pay. Now, some actives are about to get a real learning experience called "learning by doing." I certainly don't want to see a wedge driven between actives and retirees but, don't say we retirees didn't tell actives that things were getting bad. Hopefully....this will open up some certainly will lighten up some paychecks! It may even convince a few that the concept of "universal healthcare" might not be such a bad idea after all!! John

"Teachers historically have been required to pay little or none of their health coverage. Now, with school finances stretched thin by rising costs and flat or decreased state funding, district leaders are telling unions they can't continue to absorb the cost.

In many districts, the raises proposed to teachers would be offset by higher payments for health care. Teachers in the Rootstown school district, which took a strike authorization vote last week, would end up with a pay cut under the district's proposal, said Todd Bragg, the union's president."

Source: Akron Beacon Journal

Health Costs Drive Talks with Teachers

In many local districts, educators are being asked to foot more of the bill, often offsetting raises

By Stephanie Warsmith Beacon Journal staff writer

Teachers are being asked to take on more of their health costs in negotiations locally and across Ohio.

Medical coverage is the key issue in talks in several area districts, including Akron, where district and union officials are working feverishly to settle before the new school year.

Teachers historically have been required to pay little or none of their health coverage. Now, with school finances stretched thin by rising costs and flat or decreased state funding, district leaders are telling unions they can't continue to absorb the cost.

In many districts, the raises proposed to teachers would be offset by higher payments for health care. Teachers in the Rootstown school district, which took a strike authorization vote last week, would end up with a pay cut under the district's proposal, said Todd Bragg, the union's president.

''We want to avoid a strike,'' Bragg said. ''We are hopeful we can reach an agreement without that happening.''

Other districts in negotiations with teacher unions include Cuyahoga Falls, Field, Stow-Munroe Falls and Tallmadge. School begins in these districts between Aug. 28 and Sept. 4.

In Akron, where school Please see Talks, A8

starts Aug. 29, a special school board meeting is scheduled for this evening to discuss negotiations. No official action is expected.

Some unsympathetic

Many in the private sector have little sympathy for teachers because they already have been shouldering a substantial portion of their health costs.

Until recently, some teachers have referred to their health insurance as ''free'' because they weren't required to pay for coverage.

When Renee Fambro became deputy director of labor relations of the Ohio School Boards Association (OSBA) 21/2 years ago, she was surprised to see the benefits of the teachers unions she was negotiating against. She had previously worked for the Ohio Department of Public Safety, representing the state in negotiations with the troopers union.

''I was shocked that they had the sort of coverage that they did,'' Fambro said. ''There were still districts (where teachers) . . . paid nothing.''

Fambro said districts, which are facing health costs rising an average of 12 percent to 15 percent annually, are pushing for employees to contribute 5 percent to 10 percent of their premiums and to help pay for office visits and prescription drugs. She said this is ''more in line with what other public-sector and private-sector employers offer.''

Michele Prater, a spokeswoman for the Ohio Education Association (OEA), the state's largest teachers union, said the raises teachers are being offered aren't keeping pace with additional health costs.

''That's the main bone of contention with bargaining this summer,'' she said.

Teachers also have extra expenses, including school supplies and education toward a master's degree, that they mostly pay on their own, Prater said.

''This is eating away at teachers' salaries,'' she said.

The result, Prater said, is ''a lot of difficult bargaining going on'' in Northeast Ohio and across the state.

Tense negotiations

Negotiations are tense in Cuyahoga Falls, Stow-Munroe Falls and Rootstown, where teachers have authorized their teams to issue a strike notice.

A federal mediator is involved with talks in Stow and Rootstown and has been requested in Cuyahoga Falls.

Teachers recently held informational picketing on busy streets in Stow and at a school board meeting last week in Cuyahoga Falls, where one of the signs said, ''Where will your kids be on Aug. 28?'' referring to the district's first day of school.

District and union officials are hoping to avoid strikes. State law requires public school employees to give a 10-day strike notice.

In Cuyahoga Falls, the district wants to make permanent a host of concessions teachers accepted in 2005, when the district was in a financial crisis. The concessions, which saved about $2 million, included increased co-pays for office visits and prescription drugs, the elimination of a team planning period, no additional tutors in larger elementary classrooms, and raises totaling 3.1 percent rather than the planned 6.1 percent over two years.

''It was always presented to us as being temporary concessions,'' said Sue Bell, the teachers union president.

District officials say permanent contract changes are needed. In a May 31 letter to teachers, Superintendent Edwin Holland said, ''The district cannot afford to return to provisions of the contract established under the former administration.''

In Stow, the two sides have made progress in recent sessions on language issues. Economics are still on the table.

''You always have a pull and tug between salary and insurance,'' said Kent Williams, the OEA representative helping with Stow's talks.

Williams said the proposed raises particularly in the first year would be wiped out by higher health costs.

Stow union members plan to attend a school board meeting at 7 tonight at the high school, 3227 Graham Road, to show their concern over the negotiations.

In Rootstown, new Superintendent Andrew Hawkins jumped into contentious negotiations Friday only his third day on the job. He said rising health costs aren't affecting just school districts, but businesses as well.

''It's unfortunate,'' said Hawkins, Rootstown's former high school principal. ''We have a job to be fiscally responsible.''

Some districts quiet

Talks so far have been quiet in Akron, Field and Tallmadge.

In Akron, the area's largest district with more than 2,200 teachers union members, negotiators from both sides have basically been mum on the process.

A May 16 union bulletin refers to ''outrageous proposals from the board to shift health-care costs to employees.'' A July 25 update sounded more optimistic, though it noted that unresolved issues included salary, health care and contract length.

''To date, we have exchanged some proposals that we believe would fairly resolve most of the difficult issues, and that are not out of line with recent settlements in the public sector, including those in school districts in Summit County,'' the update said.

Districts in Summit County that recently settled contracts with teachers include Springfield and Copley-Fairlawn.

Both Field and Tallmadge are conducting a form of negotiation known as ''interest-based bargaining,'' in which each side brings to the table the issues that are important and a federal mediator acts as a moderator.

Williams, the OEA representative for Tallmadge, said the two sides are supposed to work more ''cooperatively'' with this approach.

''It doesn't always work quite as well,'' he said. ''It gets tested when you get into salary and insurance.''

Field Superintendent David Redd said uncertainty about the district's state funding the state budget wasn't resolved until June delayed talks. The teachers' contract expired June 30.

''When you go to the table to negotiate, you have to know how much money you have,'' he said.

The district ended up with a flat amount of state funding, which Redd considers a cut because of increasing costs for health care, fuel and utilities. He said the result of uncertain state funding and rising costs will be shorter union contracts a trend being seen across Ohio, with an increasing number of one-year pacts.

Field's health costs will increase 9.8 percent this year, while fuel expenses will rise 25 percent to 30 percent, Redd said.

''Some of the costs are spiraling out of control,'' he said. ''Something's got to be done to provide some relief. So it's challenging.''

Sunday, August 05, 2007

Jim N. Reed to Board member Hayden re: Divestiture vote

From Jim N. Reed, August 5, 2007
Subject: Disappointed at the Divestiture Vote
Dear Ms.Hayden,
I must admit to not knowing you nearly as well as I need to as an STRS retiree. No one is more important, more crucial to us than our Board members. As you may know, I have been critical of the past and present STRS Boards. (Some of my angst is personal and some professional.) I am a member of CORE and a supporter and fan of Dr. Dennis Leone and Mr. John Lazares. I do believe both have retirees' best interests at heart. (Their personal sacrifices have endeared them to a sizable audience, numbers that can no longer be ignored as simple "malcontents.") There have been past and are present Board members who I believe had and have very little real understanding of the plight of the average retiree. This gap badly needs narrowing. Its widening could be catastrophic to many career professional educators who are surviving on the edge.
I can only speculate as to your position on this Board. My first impression was that you were understanding, empathetic, and in-touch but your recent voting record has me wondering whether you are headed toward another rubber-stamp position on this Board. Retirees cannot afford another, or a continued, "yes-Damon" Board. I became actively critical of my retirement Board when another notorious Executive Administrator, Herb Dyer, presided over a submissive, corrupt (according to the courts) Board. I fear that retirees, present and prospective, can not survive another era of that kind of obscene misspending and misdirection.
Our hope is that a new generation of Board members, Ms. Hayden, will refuse to be brainwashed and demand independent thinking in their deliberations, be critical analysts of administrative policy, the "Good Old Boy" or written kind. I'm concerned that a continuing STRS "Business as Usual" is a death knell for STRS and its contributing members.
As an example of this continued crooked thinking pattern in the Boardroom, what is the logic that props up the argument that the Board should allow the Executive Director to speak for them regarding the surrender to the General Assembly bullies who insist on the divestiture of my pension funds? How can the ED make that sacrificial (guess who the lamb is) fiduciary faux pas without a formal decision coming from my representatives on my Board? How can the Board rationalize caving into the GA and the ED when the GA doesn't even know what its doing? Is this going to leave my already embarrassed and corrupt Board's legacy with more egg on its face and more feet in its mouth?
Yes, I'm angry , again, and disappointed. Angry and disappointed that some of the recently elected and appointed Board members have not demonstrated more empathy with those within their profession who can not withstand much more adversity in their retirement status. Disgusted that Dr. Leone and Mr. Lazares must stand alone in their efforts to insist on the Board's adherence to ORC 3307.15. What is it about this brief legal statement that cannot be interpreted and followed on every decision-making process?
I just read a letter from a good and wise friend, Tom Curtis, to Dr. Leone about the divestiture issue. I believe the letter was copied to you and other Board members. How do you respond to the issue as identified so clearly by Mr. Curtis? Can you point out to me where his logic and reasoning are fallible? What are Mr. Curtis, myself, and so many other retirees asking from this Board that is unreasonable?
Thank you for listening and hearing. You have impressed me as someone who does not patronize, condescend, nor offer lip service to your constituents. That's why I send you this correspondence.
Jim N. Reed

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RH Jones: Hardball vs. softball

RH Jones to Tom Curtis, August 5, 2007
Re: 080507 Curtis To Leone, Divestment

Tom and all:
Certain politicians (you all know who) are playing "hardball", while my OH STRS, my OEA, and my ORTA are playing "softball". The "Softball" players need to understand the difference in the game they are playing; that is, if they are to successfully play in the major "hardball" league.
My opinion,
RHJones, OH STRS, OEA and ORTA lifer, and a very proud CORE lifer

Tom Curtis to Dennis Leone re: Divestment

From Tom Curtis, August 5, 2007
Subject: Curtis To Leone, Divestment
Hello Dennis, Concerning the issue of divestment, I want to thank you and Mr. Brooks for attempting, once again, to educate your fellow board members concerning an issue many of them have little knowledge of.
Further, it would seem that those board members voting for any action moving forward on a divestment plan are in violation of their fiduciary responsibility, according to the ORC 3307.15. I agree with you, not one minute should be spent by STRS staff on this issue.
Where does the STRS attorney stand on this issue? Was his opinion asked and did he make any statement? Why was the Attorney General not consulted and asked for a position statement?
It is my understanding that it is illegal for the Ohio legislature, or any state legislature, to order divestment of funds due to their concerns about foreign policy. Is that not to be done by the Federal government and not state or local governments?
I sent an email on 7.23.07 to the Attorney General asking where he has been on this issue and why he has not issued a ruling concerning such. I did not receive any response to my email, so I sent the same letter by snail mail this past week. I will call his office this coming week and ask if my correspondence was received and again request a response to my questions. Who is representing his office at our board meetings now? Is it still John Patterson?
Dennis, I am so tired of hearing that decisions like this one are made so as not to anger the legislature. That is pure conjecture and fear thinking! If we want HC in the future, then we simply must fund it. That is not a hard concept to understand, yet so much time, energy and money have been spent in trying to resolve this problem. As one young educator stated when speaking to the board last year, stop playing around with this problem and put the full 5% on the actives back and let's get on with it.
I need not remind you, but the STRS/OEA/ORTA have been using the fear issue concerning HC legislation since early 2003, yet still have not gained such. How long must this foolishness go on?
This follows the same rhetoric that has been stated by so many for so many years, that being, that we must find a dedicated source of income for funding HC. That statement was printed in a 1992 STRS Newsletter and yet is still unresolved in 2007. That is unbelievable to me! One would think that with all the money paid those leading the STRS, that would have been resolved by now. It is very obvious to me that it is not in the best interest of the STRS management, OEA, OFT, or ORTA to get the job done. They all have been dragging their feet, when this could have been settled years ago and the funding would be in place. As it stands now, only the retirees are suffering and I for one am damned tired of it!
Tom Curtis
STRS Retiree
CORE & ORTA Life Member

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Former Kansas congressman/physician doesn't mince words re: Medicare Advantage

This former Kansas congressman and retired physician doesn't mince words....he cuts right to the chase!
~ John Curry
"Government willingness to act as premium-collector for private insurance companies — who then do as they see fit with Medicaid and Medicare enrollees and health care providers —explains in part why we pay about 1 1/2 times as much for health care as anyone else in the world but don't get more for it."
~ Bill Roy
Roy: Government is go-between for health profiteers
When I wrote last week supporting renewal and expansion of the State Children Health Insurance Program, I had no idea how determined President Bush and many congressional Republicans are to stop subsidized health care for poor children and to privatize Medicare, the highly successful 40-year program that helps seniors and the disabled get medical services.
But I learned when the Republican-sponsored megaphones opened up. For example, the Wall Street Journal op-ed and editorial pages published five articles in six days warning Americans against expanding "government medicine" and/or "Hillary care" by helping states insure kids and shouting the praises of Medicare Advantage, a taxpayer-subsidized program to lure Medicare recipients into private insurance programs.
The propagandists suffered a temporary setback when health insurance company Humana announced 19 percent quarterly income gains, mostly from its growing Medicare Advantage program.
Today's Medicare Advantage was passed in 2003 as part of Medicare Part D legislation that helps some seniors — and many pharmaceutical and health insurance companies — with expensive American drugs.
Explaining how insidious Medicare Advantage is requires some figures.
We Americans pay an annual average of $7,100 each for health care, a total of $2.2 trillion, nearly one-sixth of the gross national product. Yes, that's right, a family of four is paying an average of $28,000 each year for health care.
A part of this large pie is Medicare, which costs more per person because it covers 44 million seniors and the permanently and totally disabled, about one in seven Americans. In 2006, Medicare cost $374 billion, 12 percent of the federal budget. In addition, Medicare recipients pay several thousand dollars out of pocket each year for physician insurance, supplementary insurance, deductibles and co-pays.
Per-person cost of Medicare's decades-old, traditional fee-for-service program varies across the country. As an example, the cost in Region A is $8,000 per recipient. Medicare Advantage pays insurance companies in this region $9,000, a 12 percent (unconscionable) subsidy intended to be used to seduce Medicare patients into becoming wards of private insurance companies.
The insurance companies place their new profit centers into company-structured HMOs, PPOs or fee-for-service arrangements. They also selectively market, avoiding sick people and finding younger and healthier enrollees. Some companies are being investigated for aggressive marketing and misleading advertising that have resulted in confused purchasers who have to pay bills they never expected.
But, with 12-percent subsidies and time-tested tactics, it is no surprise Humana is reporting great profits. With the subsidies, insurance companies can ignore administrative costs and profits that average 15 percent.
(If companies lose subsidies, they'll cut benefits to pay administrative costs and profits. By that time, it will be too late for enrollees — but not for the retired multimillionaire executives.)
If you are just now becoming aware that Republicans intend to privatize Medicare, let me tell you that while we slept they have successfully privatized 70 percent of Medicaid, the other similarly sized government health program.
Medicaid is a state-federal program for the poor that cost $304 billion and covered 47 million people in 2006. States determine eligibility and administer programs — at least until they turn enrollees over to private insurance companies. (SCHIP builds on state Medicaid programs by adding previously ineligible children.)
What we think of as government programs (add the Veterans Administration) pay for some health care for about one in three Americans, or 100 million people. Add 155 million with employer-based health insurance or individual private insurance, and 45 million with no health insurance, and you have us all, slightly more than 300 million.
But federal and state governments are making suckers of taxpayers by turning their 100 million designated beneficiaries over to private insurance companies that take a 10 percent to 30 percent administrative-profit slice (versus 1.5 percent traditional Medicare administrative costs).
Government willingness to act as premium-collector for private insurance companies — who then do as they see fit with Medicaid and Medicare enrollees and health care providers — explains in part why we pay about 1 1/2 times as much for health care as anyone else in the world but don't get more for it.
Dr. Bill Roy is a retired physician and former member of Congress. He has a law degree and lives in Topeka. He may be reached at
Larry KehresMount Union Collge
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