House Panel Asks for Extra Time in Health Care Change

Posted December 3, 2008 at 3:58pm

Staffers may get some extra time to decide whether to change health insurance plans after Members got wind of a few significant changes to a popular Blue Cross Blue Shield plan.

Right now, federal workers are in “open season,” which allows them to freely switch to a new insurance plan. But “open season” ends Monday — little more than a week after many learned of increased premiums and surgical co-pays for Blue Cross’ popular Standard Option.

Starting Jan. 1, federal employees under that plan will have to pay for nonemergency surgical procedures, up to a $7,500 co-pay, if they go to an out-of-network physician. After $7,500, the insurance company picks up 100 percent.

The plan’s premiums will also go up by 13 percent, and an emergency visit could cost $350.

Some doctors and patients have railed against the change, arguing that by making it costly to go to an out-of-network doctor, officials have effectively turned a preferred provider organization into an health maintenance organization.

On Wednesday, the Oversight and Government Reform Subcommittee on Federal Workforce, Postal Service and the District of Columbia tackled the issue in an emergency hearing.

For more than two hours, Members grilled officials from Blue Cross and the Office of Personnel Management on the changes and asked that “open season” be extended.

But one issue concerned the subcommittee more than anything else: the fact that most federal workers have been unaware of the plan’s changes.

“I think the thing that bothers me more than anything else is when people think they have one thing in regards to coverage and then find out they have something else,” Rep. Elijah Cummings (D-Md.) said.

All the changes were outlined in a 137-page brochure distributed by the Office of Personnel Management, but many federal workers — including staffers — are unlikely to read through it.

But after news articles, including a piece in Roll Call, detailed the changes last week, subcommittee Chairman Danny Davis (D-Ill.) said he started receiving “numerous calls from Congressional staff, Members’ offices and plan participants.”

On Wednesday, OPM officials tried to explain the reasoning behind the new surgical co-pay — a change initiated by the federal agency, not by Blue Cross.

The potential $7,500 co-pay is meant to help those workers who, in the past, were stuck with even larger bills in the tens of thousands of dollars for some out-of-network surgeries.

With the new plan, those workers will pay much less, while employees with bills of less than $7,500 will take up the slack by paying for their out-of-network surgeries in full. The same reasoning is behind the $350 emergency room charge.

The decision to change the plan was years in the making, said Nancy Kichak, OPM’s associate director for strategic human resources policy.

“This was not a simple ‘How about this and let’s do it,’” she said. OPM has long received disputed claims from workers who are caught off guard by a large bill for surgery, she said.

Some Members weren’t convinced. D.C. Del. Eleanor Holmes Norton (D) suggested that the change was made partly for bureaucratic reasons, without considering other options.

“I don’t think protecting enrollees from $60,000 and $70,000 costs is bureaucratic,” Kichak said. “They were totally at risk before.”

Still, Blue Cross officials said they now want to drop the surgical co-pay and renegotiate with OPM, a federal agency tasked with representing the interests of federal workers.

That seems unlikely. On Wednesday, Kichak reiterated OPM’s support of the surgical co-pay and said it’s too late to make changes for 2009.

The agency and Blue Cross are now sending out clarifications to the plan’s members on the changes. If the plan were to change again, OPM would have to re-educate the federal workforce on what the plan offers, Kichak said.

She was also resistant to extending “open season,” noting that OPM only has a small window in which to get coverage information to their carriers before Jan. 1.

But by the end of the hearing, most of the Members present were pushing for an extension, saying they weren’t convinced that it would be prohibitive for OPM.

The changes appear to have “some logic,” Davis said, but “even if there is, individuals need an opportunity to decide.”