County eliminating group insurance plan due to 'unsustainable' costs

Oct. 17—MORGANTOWN — The Monongalia County Commission is making a dramatic change in the way it offers health insurance to its employees.

In successive votes Friday, the body unanimously approved the cancellation of its group health insurance through Highmark WV in favor of an Individual Coverage Health Reimbursement Arrangement, or ICHRA, through Take Command Health.

The switch will take effect on Dec. 31.

The commissioners explained the move will decouple the county's overall spend on insurance from its group history, which is driving steep increases year over year. Embedded within the group plan concept is the inevitability that a small percentage of plan members will push costs up for everyone.

According to information presented in June, Blue Cross /Blue Shield paid out 23 % more than it collected in premiums from the county's group plan in the most recently completed cycle. As a result, the company informed the commission that renewal of the plan would come with a 34.8 % increase.

That number was ultimately negotiated down to a 20.48 % increase by bumping up deductibles and co-insurance costs on the employee end — some of which was absorbed by the county. Overall, the change represented a $1.1 million cost increase, bringing the county's total insurance spend to $6 million in a $43.6 million budget (13.7 %).

That percentage, the commissioners noted, will inevitably become unsustainable—and sooner rather than later.

Through the ICHRA setup, the commission will provide each employee an allowance based on age, insured family and other factors. The employee will then work individually with an advisor through Take Command Health to shop from available plans — currently 37 offered by Blue Cross, The Health Plan and CareSource.

The bottom line, Commissioner Sean Sikora said, is that the overwhelming majority of county employees will be able to use the allowance provided to get the same insurance they have now for less money, if that's what they choose.

"So based off the model that we used — and the model we picked was the plan that was closest to what we had with the previous plan year that just ended — based on that model, of our 265 employees, 250 of them would see lower premiums or no premiums at all with the same essential coverage, " Sikora said. "So that is an overall benefit to our employees. They can go in, and rather than someone paying a premium that's based off the group penalty, they can go in and pick a premium that's based off of their circumstances and what they want to do ... The allowances are all right there. You pick the premium, you know what your allowances are and you know where you're going to be at that moment."

He went on to say that if every employee upgraded to a premium "Cadillac plan " with zero deductible, roughly a quarter of the county's employees (64) would still pay less than they're currently paying, "and 51 of that 64 would pay zero."

Not everyone is convinced.

County resident Mindy Holcomb said she thinks the commission is "gaslighting " the public about what she believes is a disastrous decision.

"What you're doing, if people can't afford the insurance on the [Affordable Care Act ] plan given the stipend that they would receive through this ICHRA plan, they're either going to be priced out of insurance totally or forced to choose a plan that does not meet their needs or their family's needs, " she said. "And as someone who has had insurance that was less than stellar and had to pay as much as her mortgage for insulin for a year, I know what that's like. I know what it's like to have to choose between food, housing and medication."

While Holcomb said she's not a county employee, or related to a county employee, her comments were applauded by a small number of individuals attending the meeting.

The commissioners said the resistance, while not unexpected, is based on uninformed rumors, disinformation and intentional misinformation pushed by a "very tiny vocal minority."

Commission President Jeff Arnett noted the commissioners are subject to the same insurance options provided to all county employees.

He later explained that while the county's employees were central to the decision-making process, the commission is also answerable to every resident of Monongalia County.

"To assume that we don't do what we can in the best interest of the employees, I think it's misguided. I think, as Sean mentioned earlier, our history with the changes in the plans we've made each time ended up being a positive over what it was before, " Arnett said. "The idea that whatever the increase is has to be absorbed and just paid for 100 % is not sustainable. Based on the increases that we were seeing each year, and projected out for the next five years, it was very probable that within a five-year period over 25 % of our overall budget would have been paid for health insurance. It's just not a sustainable model, and it would never have an end."

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