Insurance board may reverse plan changes

Jan. 28--BOSTON -- Sherri Sodre spent years searching for adequate medical care for her two autistic children, and even longer to get her health insurer to cover speech, occupational therapy and other treatments.

So she was outraged to learn that, without notice, her family's longtime insurer was one of three health plans being dropped this year by the state's Group Insurance Commission as part of a controversial, cost-cutting decision.

"My son and daughter are going to lose their health care providers because they're dropping our insurance," said Sodre, 44, of Tewksbury, who is insured by Harvard Pilgrim Health Care. "Even if we find another provider that will take one of these other plans, we'll have be waitlisted and reassessed, which could take months or years."

Sodre, who has worked for the state Department of Children and Families for nearly two decades, is among hundreds of thousands insured through the Group Insurance Commission who could be affected.

The 17-member commission decides which health insurance packages to give state employees and municipal employees within participating cities and towns. The entire system insures about 442,000 public workers, retirees and their families.

With no public hearings and little, if any, input from state officials, the commission voted 8-5 Jan. 18 to drop three of six health plans -- Tufts, Harvard Pilgrim and Fallon -- in a move its staff says was aimed at lowering costs and improving coverage.

The board decided to contract with three health insurance carriers -- UniCare, Neighborhood Health and Health New England.

Legislative leaders, public employees' unions and even Gov. Charlie Baker blasted its decision, calling on the commission to reconsider.

Attorney General Maura Healey opened an investigation into whether the board violated the state's open meetings law by not providing enough notice.

RECONSIDERING DECISION

That political pressure, not to mention upcoming House and Senate hearings, appears to be changing the commission's mind. On Thursday, it announced plans to reconsider, and vote again, at a Feb. 1 meeting.

In a statement, the commission's chief of staff said the changes, set to go into effect in July, were intended to "provide members with continuous coverage in a comparable plan while retaining their networks and doctors, and simultaneously controlling out-of-pocket and premium costs."

But, Ashley Maagero Lee added, the commission "recognizes that there is opportunity to better engage stakeholders more directly and robustly in the strategic process moving forward."

Officials have said the restructuring will save the state more than $20 million and keep insurance rates from rising faster than wages.

Besides mounting pressure from state leaders, Tufts and Harvard Pilgrim -- which will lose about 90,000 enrollees as a result of the change -- warned that the decision would lead to job cuts in their offices. Baker is a former CEO of Harvard Pilgrim.

Unions that represent state and municipal workers and retirees were fuming over the decision.

Shawn Duhamel, legislative director for the Retired State, County and Municipal Employees Association of Massachusetts, said the changes were a major concern for thousands of government retirees who don't qualify for Medicare and depended on the health plans that were being dropped.

"Anytime there is change to health care people are rightly concerned," he said. "The way this was handled ... they needlessly frightened folks."

WIDESPREAD OUTRAGE

Lawmakers, who've been bombarded with calls from government employees over the decision, have been gearing up to block the changes.

The Senate Ways and Means Committee had scheduled hearings for next week, while House Speaker Robert DeLeo, D-Winthrop, had created a committee to review the decision and make recommendations for legislation to reverse it.

Sen. Barbara L'Italien, D-Andover, said her phone has been ringing off the hook from public employees and retirees worried about the changes.

She said the way the commission handled it -- taking a vote and then scheduling public hearings -- was a textbook example of "poor planning."

"There was no opportunity or time for input by those who would be most affected," she said. "People were really blindsided by this decision."

Rep. Paul Tucker, D-Salem, whose state-backed health plan was one of those to be dropped, said he too was caught by surprise by the decision.

"This was kind of dropped on us with little warning," he said. "It made a lot of people upset, and I don't blame them."

Peter MacKinnon, president of the Service Employees International Union Local 509, which represents health care workers, said he was relieved that the commission is "preparing to undo their incredibly misguided decision" and heaped praise on state leaders for pressuring the commission.

He said in a statement the decision "would have forced working people and their families to find new doctors and other medical providers, go to the back of waiting lists for their children's treatment, and spend valuable time trying to preserve the quality of their healthcare."

Both DeLeo and Senate President Harriette Chandler, D-Worcester, issued statements on Thursday welcoming the commission's decision to reconsider while seemingly not backing down on plans to hold legislative hearings.

"I'm pleased that the (commission) is going to be more thoughtful about proposed changes that would impact several hundred thousand residents," DeLeo said.

Sodre said she hopes the commission will reverse its decision.

Her son Sam, who just turned 8, needs speech and feeding therapy every week. Her daughter Maren, who is 6, also needs speech and occupational therapy.

Both go to a clinic in Wakefield that doesn't take the other three insurance plans approved by the board.

"Losing our provider would be devastating for my family," she said, noting that she's even willing to pay more for coverage, if it will allow her family to keep the current plan.

"I don't understand why they won't just let us pay a little more to keep our plans?" she said. "They should be giving us more options."

Christian M. Wade covers the Massachusetts Statehouse for North of Boston Media Group's newspapers and websites. Email him at [email protected].

___

(c)2018 The Eagle-Tribune (North Andover, Mass.)

Visit The Eagle-Tribune (North Andover, Mass.) at www.eagletribune.com

Distributed by Tribune Content Agency, LLC.