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Local Educators Are Facing Health Insurance Cuts

By Staff | Feb 10, 2016

At the Monday, Feb. 1 meeting of the Wetzel County Board of Education, Elliott Kendle, co-president of the Wetzel County Education Association, shared concerns about the future of educators’ health insurance.

Kendle informed the board that last fall the Public Employees Insurance Agency announced impending cuts. West Virginia Governor Earl Ray Tomblin, during his State of the State speech, proposed actions that while would not prevent the cuts, would soften the blow.

According to a Jan. 14 article published in the Wheeling Intelligencer, Tomblin proposed a 45-cent-per-pack increase in the state’s cigarette tax to fund the Public Employees Insurance Agency.

“Recently the PEIA board has given details of an amended plan that would take effect if the governor’s proposals were passed by the state legislature,” Kendle explained to the board at their Feb. 1 meeting. However, he added, “Since then, I have found that many people believe the cuts have been rescinded and the problem is fixed.”

“Unfortunately that is not the case,” Kendle stated.

Kendle explained that for four years in a row the governor and legislature have not contributed any new money to PEIA, which means the “entire burden falls on the backs of employees.”

Kendle stated that PEIA participants would face the following changes on July 1:

– Active state employees will face a $500 increased deductible for single coverage or a $1,000 increase in family coverage. Maximum out-of-pocket costs would increase by $1,500 for a single employee or $3,000 for family coverage. This is in addition to prescription drug changes.

– PEIA members in Plan B also would need to pay 30 percent for all services requiring coinsurance, up from 20 percent.

– A teacher who earns $45,000 a year and is in Plan A will see single-employee deductible increase from $275 a year to $775 a year and maximum out-of-pocket cost increases from $1,750 a year to $3,250 a year.

– If the same employee has family coverage, the family deductible will increase from $550 a year to $1,550 while the family’s maximum out-of-pocket cost is increasing from $3,500 annually to $6,500.

– An education support professional who earns $26,000 annually and is in Plan A will see the employee-only deductible increase from $175 to $675 and the maximum out-of-pocket cost increases from $1,100 to $2,600.

– The same ESP with family coverage will see a family deductible increase from $350 to $1,350. A family’s maximum out-of-pocket cost will increase from $2,200 to $5,200.

Kendle then explained cuts retirees would face.

– Non-Medicare retirees under age 65 will see an 8 percent premium increase, deductible increases of $300 for one person or $600 for family coverage, and maximum out-of-pocket costs increasing by $1,500 for a single person or $3,000 for a family.

– Medicare retirees will see an 8 percent premium increase, their deductibles increase by $50 and their maximum out-of-pocket costs increase by $350.

Under the proposal, some prescription drug costs also would increase significantly for active employees and many retirees. Deductibles, maximum out-of-pocket costs and some cost sharing for prescription drugs will go up.

Kendle said one area of concern deals with the proposed 30 percent or 35 percent cost sharing that most PEIA members would have to contribute toward “preferred brand drugs.” The current cost limit is $25. Under the PEIA’s proposal, a preferred brand drug that costs $600 total would require $180 from a person is Plan A.

Other benefit cuts or adjustments approved by the PEIA Finance Board include an increase in urgent pay copay to $50, increasing members’ costs for out-of-state services, and reducing reimbursements to medical providers (such as hospitals and clinics).

Kendle stated that should the legislature come through with the funding, higher out-of-pocket costs and deductible increases would not happen. Also, a change in the prescription drug contract will save substantial dollars and will not require a 30 percent copay on Preferred Brand drugs. However, “a new formulary means that certain drugs may change tiers,” Kendle noted, adding that the PEIA would send letters to participants informing them of the new drug formulary.

Kendle noted that if the state adds additional dollars to the plan “premiums will go up in order to achieve the 80/20 split.”

“This would mean a 12 percent premium increase for all categories (active, non-Medicare retirees and Medicare retirees.”

Also, “the Face-2-Face diabetes program will become a two-year program. After two successful years the members will graduate.”

The proposed increase in Urgent Care copay would also stay at $50. Also the proposal to remove the Living Will discount would be kept, as well as the proposal to remove non-network out-of-state benefits. Also, a proposal to add $500 ER co-pays for high risk behaviors (no helmets, no seatbelt, alcohol, or drug related accidents) would stay.

Kendle reported that these changes do not become a reality until “the legislature passes the tax hikes on tobacco products and implements the proposed telecommunications tax.”

“Many legislators are resistant to any type of increase regardless of the intended use of money,” Kendle noted, stating that Senate President Bill Cole(R-Mercer) and Speaker of the House Tim Armstead (R-Kanawha) have indicated that they do not support increasing revenue to fund PEIA. Kendle noted that at a Wheeling PEIA public hearing, Delegates Dave Pethtel (D-Wetzel), Michael Ferro (D-Marshall), and Shawn Fluharty (D-Ohio), along with Senator Jeff Kessler (D-Marshall), all indicated they would do “what it takes to fund PEIA.”

Kendle noted that the issue has appeared to “become a political game to some of our elected officials.” Kendle stated that it was recently reported that traditionally, the Governor’s bills are sponsored by the Senate President, House Speaker, and minority leader, without regard to the bill’s content. Kendle said that Senator Cole has taken his name off of at least five of the Governor’s bills, including the telecommunications and tobacco tax (SB 355 and SB 420) bills, while Speaker Armstead has removed his name off of one of the Governor’s bills – the telecommunications bill (HB 4220). Kendle said the tobacco tax has not yet been introduced in the house.

“Sadly some of our elected officials do not seem to care that, for us, this is not game, or a vote, or a partisan issue. It’s more important that that,” Kendle stated. “For us, it’s about our lives, our health, and our well-being.”

Kendle later noted that the PEIA issue affects more than just teachers. “It affects every state, county, and municipal worker who is a participant in PEIA,” Kendle stated.