11-06-2011, 01:26 PM
In the Tallahassee Democrat today AND IT DIDNT COST YOU $9.95. Okay, its a long article but its an important issue. If you have any marketable assets and I dont it is time for you to begin looking else where for a career. I see the suggestion that in the near future you will be paying thousands more out of pocket for health care for you and your family. Canceling Christmas 2011 is a start.
A state job used to mean you wouldn't get rich but could count on three things — job security, a paid-up pension and pretty good insurance.
"How are we doin' so far?" Department of Management Services Secretary Jack Miles said sympathetically, with a rueful chuckle.
State government shed about 6,900 jobs in Gov. Rick Scott's first nine months in office and extracted 3-percent contributions from paychecks for the Florida Retirement System. Now, faced with spiraling health care costs, Scott and legislative leaders want state employees to have more "skin in the game" for their insurance.
That will mean money, probably in the form of higher insurance premiums and new coverage limits written into the budget adopted during the 2012 legislative session. But it also means giving employees some "carrot and stick" incentives to take control of their own insurance choices.
"It seems like every time we make a change in government, it's massive. We don't make incremental change," Miles said. But, like the private sector, state government's health care costs have become "unsustainable" — the word used by Scott, Miles and legislative leaders in separate interviews — and the revenue shortfall of the 2012 session will force budget writers to catch up in big bites of money and policy changes.
"We're behind and there's not enough money to continue to do what we want to do, so we're forced into making changes quickly," Miles added. "Almost anyone you talk to has been moving more toward consumer-driven health care and having to make choices, getting involved in their health care."
'Consumerism'
Scott, a hospital executive who got his political start battling President Obama's national health care plan, and Miles, a former Cigna Insurance manager, speak of "consumerism" like insurance was a house or car. They figure that you take care of what you've got, shop around and maybe trim a few frills — unless somebody else is paying most of the cost.
"Health care is really driven by what provider costs are, what hospital costs are, what physicians charge, all those things, and utilization," Scott said in an interview aboard his plane last week. "The big focus has to be on how do you make sure you're not wasting money."
One consumer-based option has been around since Gov. Jeb Bush's second term, but only about 1 percent of employees are using it. That's the low-premium, high-deductible plan, with an attached health-savings account, in which the state will annually deposit $500 for single coverage or $1,000 for families, and employees can let it pile up over their healthy years.
But when they have claims, they're on the hook for $1,250 or $2,500 in deductibles, depending on single or family coverage limits. The theory is that they save when they're healthy and shop for cheaper care when they need it.
Currently, only 1,409 employees — out of 135,900 with state-provided health insurance — opt for the health-investor plan.
Big changes
The math is stark and simple in a detailed report by Buck Consultants that was presented to the Legislature last month. The cost of the state health insurance plan, including the preferred-provider plan and HMOs, was $1.9 billion last fiscal year and will rise to $3.1 billion in fiscal 2014-15, if nothing is done.
A month after taking office, Scott proposed capping the state's share of costs at $5,000 per year. That would have meant 60,101 Career Service employees with family coverage — now costing them $180 a month — would pay about $7,100 more per year. More than 47,000 employees with single coverage, costing $50 a month, would have seen their costs rise by $1,000 annually.
And the senior managers and elected officials who used to get free coverage, and now pay $360 for family insurance or $100 for single coverage, would have had increases of $9,500 and $1,500, respectively.
Recoiling from such a shock to the system, in a year with no general pay raises and the 3-percent retirement contribution, the Legislature ordered up the Buck study. The consultants called the current system "paternalistic" — saying it allows "employees to be passive and perhaps even entitled, with little concern about costs" for their health care.
Compared to workers in the private sector, state employees get a bargain on health insurance. A Kaiser Family Foundation study said the average American with employer-provided insurance pays $900 for single coverage and $3,996 for family insurance. That compares to $600 and $2,160 paid by Florida Career Service employees for single and family coverage.
The employer share — paid by taxpayers — is $5,998 for individuals and $12,760 a year for family coverage in Career Service. In Selected Exempt and Senior Management, as well as elected officials coverage, the state pays $6,498 for singles and $14,560 a year for family insurance.
Buck didn't make recommendations for 140,000 active employees and thousands more retirees and dependents. But they costed out a Goldilocks list of three options in each category so Scott and lawmakers can decide what's too hard, too soft and just right.
For instance:
• Instead of having two tiers of insurance, single and family coverage, the state could add some layers, like raising premiums for single, married, married-with-one or married with multiple children.
• Copayments and deductibles could rise.
• Prescription drug fees could be adjusted.
• Smokers could pay more and, as some states and private employers are trying, obesity and even alcohol use could be factored into premiums. Buck calculated that the state could save $28 million if just 35 percent of smoking employees kicked the habit.
• Enrollment in high-deductible, low-premium health-investor plans could be encouraged.
• "Wellness" incentives could be offered, like weight-loss and smoking-cessation programs, with premium reductions.
'Skin in the game'
The whole idea is to save money, but to do it by shifting costs to employees, with some escape hatches. Senate President Mike Haridopolos, R-Merritt Island, likened the concept to bronze, silver and gold medals in the Olympics, saying employees might shop for an HMO or health-savings plan that would be entirely covered by the state, or pay for more.
"It gives the state employees some skin in the game," Haridopolos said. He said most employers in his Brevard County district — if they offer insurance at all — provide employees a choice between an HMO or a tax-exempt medical savings account.
"We don't want to kill the state worker but let's put it on par with what's happening in the private sector," Haridopolos said. "Their benefits should not be superior to what we're going through in the privat
Even without the cost spiral projected in state group insurance, legislators start the session Jan. 10 with revenue shortages approaching $2 billion.
Scott, Miles and legislative leaders have not made any dollar decisions on raising premiums or cutting benefits. But they are committed to the "consumerism" concept in patient choices.
One quirk of the insurance system that's sure to go away is the ultra-low rate for elected officers, Senior Management and Selected Exempt employees. They used to get free coverage but the 2012 Legislature decided to charge them one-sixth of what Career Service employees pay — $30 a month for families and $8.34 for single employees.
"I think everybody ought to have the same plan," said Scott. "Whatever plan we end up with, everybody ought to be on the same plan."
Taxwatch weighs in
State Rep. Michelle Rehwinkel Vasilinda, D-Tallahassee, met with Scott late last week. Among other issues, she said, they discussed the administration's interest in getting employees into the health-savings accounts.
"State employees have been hit again and again and again to balance the state budget. Frankly, this same pattern is going on in the private sector.
"If you want folks to have more skin in the game, to take more responsibility for the state of their health, that's a laudable goal," she said. "But the questions then become, are state employees over-using the health care system? Are they unhealthy as a group?"
Florida TaxWatch, a business-funded policy study group, makes annual recommendations to governors and legislators on cutting costs and enhancing revenue collections. This year's TaxWatch study recommended switching employee health insurance from the defined-benefit model to a defined-contribution system — just as the state is trying to get employees to switch from traditional pensions to 401(k)-style retirement investment accounts.
TaxWatch estimates such a move would save $344 million to $440 million a year. Its study also called for more "wellness" programs, with incentives and disincentives, estimating that every 1 percent of health care costs saved through smoking cessation or weight loss works out to $12 million for the taxpayers each year.
While the Buck consultants didn't make recommendations for bringing in more revenue or cutting costs, TaxWatch did. It said bringing the state employee premium share up to the national average — $900 a year for single coverage, rather than $600, for instance — the state would reap $206 million.
It also seconded Scott's belief that all classes of employees should pay the same, whatever the new rate may become.
"The Legislature should modify current health insurance subsidies and employee annual health insurance premium payments to align with national averages and reflect equality across all employee classifications," TaxWatch said.
A state job used to mean you wouldn't get rich but could count on three things — job security, a paid-up pension and pretty good insurance.
"How are we doin' so far?" Department of Management Services Secretary Jack Miles said sympathetically, with a rueful chuckle.
State government shed about 6,900 jobs in Gov. Rick Scott's first nine months in office and extracted 3-percent contributions from paychecks for the Florida Retirement System. Now, faced with spiraling health care costs, Scott and legislative leaders want state employees to have more "skin in the game" for their insurance.
That will mean money, probably in the form of higher insurance premiums and new coverage limits written into the budget adopted during the 2012 legislative session. But it also means giving employees some "carrot and stick" incentives to take control of their own insurance choices.
"It seems like every time we make a change in government, it's massive. We don't make incremental change," Miles said. But, like the private sector, state government's health care costs have become "unsustainable" — the word used by Scott, Miles and legislative leaders in separate interviews — and the revenue shortfall of the 2012 session will force budget writers to catch up in big bites of money and policy changes.
"We're behind and there's not enough money to continue to do what we want to do, so we're forced into making changes quickly," Miles added. "Almost anyone you talk to has been moving more toward consumer-driven health care and having to make choices, getting involved in their health care."
'Consumerism'
Scott, a hospital executive who got his political start battling President Obama's national health care plan, and Miles, a former Cigna Insurance manager, speak of "consumerism" like insurance was a house or car. They figure that you take care of what you've got, shop around and maybe trim a few frills — unless somebody else is paying most of the cost.
"Health care is really driven by what provider costs are, what hospital costs are, what physicians charge, all those things, and utilization," Scott said in an interview aboard his plane last week. "The big focus has to be on how do you make sure you're not wasting money."
One consumer-based option has been around since Gov. Jeb Bush's second term, but only about 1 percent of employees are using it. That's the low-premium, high-deductible plan, with an attached health-savings account, in which the state will annually deposit $500 for single coverage or $1,000 for families, and employees can let it pile up over their healthy years.
But when they have claims, they're on the hook for $1,250 or $2,500 in deductibles, depending on single or family coverage limits. The theory is that they save when they're healthy and shop for cheaper care when they need it.
Currently, only 1,409 employees — out of 135,900 with state-provided health insurance — opt for the health-investor plan.
Big changes
The math is stark and simple in a detailed report by Buck Consultants that was presented to the Legislature last month. The cost of the state health insurance plan, including the preferred-provider plan and HMOs, was $1.9 billion last fiscal year and will rise to $3.1 billion in fiscal 2014-15, if nothing is done.
A month after taking office, Scott proposed capping the state's share of costs at $5,000 per year. That would have meant 60,101 Career Service employees with family coverage — now costing them $180 a month — would pay about $7,100 more per year. More than 47,000 employees with single coverage, costing $50 a month, would have seen their costs rise by $1,000 annually.
And the senior managers and elected officials who used to get free coverage, and now pay $360 for family insurance or $100 for single coverage, would have had increases of $9,500 and $1,500, respectively.
Recoiling from such a shock to the system, in a year with no general pay raises and the 3-percent retirement contribution, the Legislature ordered up the Buck study. The consultants called the current system "paternalistic" — saying it allows "employees to be passive and perhaps even entitled, with little concern about costs" for their health care.
Compared to workers in the private sector, state employees get a bargain on health insurance. A Kaiser Family Foundation study said the average American with employer-provided insurance pays $900 for single coverage and $3,996 for family insurance. That compares to $600 and $2,160 paid by Florida Career Service employees for single and family coverage.
The employer share — paid by taxpayers — is $5,998 for individuals and $12,760 a year for family coverage in Career Service. In Selected Exempt and Senior Management, as well as elected officials coverage, the state pays $6,498 for singles and $14,560 a year for family insurance.
Buck didn't make recommendations for 140,000 active employees and thousands more retirees and dependents. But they costed out a Goldilocks list of three options in each category so Scott and lawmakers can decide what's too hard, too soft and just right.
For instance:
• Instead of having two tiers of insurance, single and family coverage, the state could add some layers, like raising premiums for single, married, married-with-one or married with multiple children.
• Copayments and deductibles could rise.
• Prescription drug fees could be adjusted.
• Smokers could pay more and, as some states and private employers are trying, obesity and even alcohol use could be factored into premiums. Buck calculated that the state could save $28 million if just 35 percent of smoking employees kicked the habit.
• Enrollment in high-deductible, low-premium health-investor plans could be encouraged.
• "Wellness" incentives could be offered, like weight-loss and smoking-cessation programs, with premium reductions.
'Skin in the game'
The whole idea is to save money, but to do it by shifting costs to employees, with some escape hatches. Senate President Mike Haridopolos, R-Merritt Island, likened the concept to bronze, silver and gold medals in the Olympics, saying employees might shop for an HMO or health-savings plan that would be entirely covered by the state, or pay for more.
"It gives the state employees some skin in the game," Haridopolos said. He said most employers in his Brevard County district — if they offer insurance at all — provide employees a choice between an HMO or a tax-exempt medical savings account.
"We don't want to kill the state worker but let's put it on par with what's happening in the private sector," Haridopolos said. "Their benefits should not be superior to what we're going through in the privat
Even without the cost spiral projected in state group insurance, legislators start the session Jan. 10 with revenue shortages approaching $2 billion.
Scott, Miles and legislative leaders have not made any dollar decisions on raising premiums or cutting benefits. But they are committed to the "consumerism" concept in patient choices.
One quirk of the insurance system that's sure to go away is the ultra-low rate for elected officers, Senior Management and Selected Exempt employees. They used to get free coverage but the 2012 Legislature decided to charge them one-sixth of what Career Service employees pay — $30 a month for families and $8.34 for single employees.
"I think everybody ought to have the same plan," said Scott. "Whatever plan we end up with, everybody ought to be on the same plan."
Taxwatch weighs in
State Rep. Michelle Rehwinkel Vasilinda, D-Tallahassee, met with Scott late last week. Among other issues, she said, they discussed the administration's interest in getting employees into the health-savings accounts.
"State employees have been hit again and again and again to balance the state budget. Frankly, this same pattern is going on in the private sector.
"If you want folks to have more skin in the game, to take more responsibility for the state of their health, that's a laudable goal," she said. "But the questions then become, are state employees over-using the health care system? Are they unhealthy as a group?"
Florida TaxWatch, a business-funded policy study group, makes annual recommendations to governors and legislators on cutting costs and enhancing revenue collections. This year's TaxWatch study recommended switching employee health insurance from the defined-benefit model to a defined-contribution system — just as the state is trying to get employees to switch from traditional pensions to 401(k)-style retirement investment accounts.
TaxWatch estimates such a move would save $344 million to $440 million a year. Its study also called for more "wellness" programs, with incentives and disincentives, estimating that every 1 percent of health care costs saved through smoking cessation or weight loss works out to $12 million for the taxpayers each year.
While the Buck consultants didn't make recommendations for bringing in more revenue or cutting costs, TaxWatch did. It said bringing the state employee premium share up to the national average — $900 a year for single coverage, rather than $600, for instance — the state would reap $206 million.
It also seconded Scott's belief that all classes of employees should pay the same, whatever the new rate may become.
"The Legislature should modify current health insurance subsidies and employee annual health insurance premium payments to align with national averages and reflect equality across all employee classifications," TaxWatch said.