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Archive for the ‘OGB, Office of Group Benefits’ Category

Editor’s note: State Rep. John Bel Edwards (D-Amite) sparred verbally with Commissioner of Administration Kristy Nichols and Office of Group Benefits (OGB) CEO Susan West at the Sept. 25 hearing by the House Appropriations Committee on proposed coverage plans for OGB members. Edwards, the minority leader of the House and Chairman of the House Democratic Caucus, is an announced candidate for governor in 2015.  He wrote the following piece in an effort to display his frustration over his inability to obtain definitive answers or public documents and records from the administration—and to explain how the administration, as a matter of routine, conceals information from legislators.

By State Rep. John Bel Edwards

At a committee meeting convened last month to address the fiscal “emergency,” at the Office of Group Benefits, Commissioner of Administration Kristy Nichols testified that the premium reductions in 2013 and 2014 that drained OGB’s $500 million fund balance were fiscally sound.

At that hearing, I repeatedly asked if OGB’s actuary – Buck Consultants – had recommended those premium reductions and if they recommended reducing the fund balance. Nichols and an OGB CEO Susan West repeatedly refused to answer. I, along with other legislators at the hearing, asked for copies of Buck Consultants’ recommendations.

Weeks later and I’m still waiting for those reports.

What I do have is an email from Buck Consultants to the OGB CEO that clearly states: “We did not recommend a decrease of 7% effective August 1, 2012, or an additional decrease of 1.77% effective August 1, 2013. Further, we were not asked to provide any recommended rate adjustments for any fiscal years beyond what we provided for Fiscal Year 2012/2013.”

Of course the actuary did not recommend cutting premiums by almost 9 % while health care costs are rising by 6% a year. The consultants knew that would be irresponsible and cause claims payments to greatly exceed premium revenue and drain OGB’s fund balance.

Clearly, the OGB premium reductions that ran the fund balance into the ditch were not actuarially driven. Those premium reductions were driven by the Jindal administration’s desire to spend OGB’s fund balance elsewhere in the budget. When OGB reduced premiums, 75% of the savings went to the state and the Jindal administration was able to spend that money wherever they wanted.

Now that the fund balance is drained and still hemorrhaging at the rate of $16 million a month, the Jindal administration called this self-inflicted wound an “emergency” and proposed raising costs to OGB members – those working and those retired – by $189 million. These higher out-of-pocket expenses will not be shared by the state.

Our state workers, school teachers, support workers, and university staff and faculty and retirees cannot afford this. They do not deserve this. About 25,000 of our retired OGB members are not eligible for Medicare, and many active OGB members bring home as little as $700 per month.

I asked the Attorney General’s Office for an opinion about the legality of Jindal’s effort to unilaterally impose new plans with the exorbitant out of pocket cost increases on workers and retirees. The attorney general’s opinion shows Jindal failed to comply with the Administrative Procedure Act.

This entire debacle has thankfully been slowed down to ensure public notice, public input and legislative oversight as legally required. It is critically important that the administration act in good faith and genuinely consider the testimony and the plight of affected OGB members as well as its own culpability in needlessly causing the “emergency.”

The Jindal administration must honestly answer subsequent inquiries from the public and from legislators and seek ways to lessen the impact to OGB members. The administration must ditch the ill-conceived plan changes and start from scratch with a willingness to increase premiums reasonably and share in the costs of restoring the soundness of OGB.

The recently discovered $178.5M surplus provides the means to both shore up the fund balance and reduce the cost increases on OGB members. The illegal cost increase forced on OGB members in August must be refunded without forcing members to formally request or sue for the refund.

The legislature must finally assert itself as an independent and equal branch of government to provide exactly the kind of check and balance on the Jindal administration provided by the Louisiana Constitution and demanded by the people of Louisiana. We now have this opportunity as there will be legislative oversight hearings on both the emergency and ordinary rules. We must rise to the occasion.

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Liz Murrill, the texting attorney who advised Commissioner of Administration Kristy Nichols that the Administrative Procedure Act (APA) was not necessary because the changes in the state’s Office of Group Benefits (OGB) plans did not meet the legal definition of “rule,” is gone.

Murrill sparred verbally with legislators during the Sept. 25 hearing on the proposed changes to OGB coverage of state employees and retirees by the House Appropriations Committee, telling them the APA was unnecessary in order that the Division of Administration (DOA) might implement huge increases to co-pays and deductibles that OGB members would be required to pay.

Throughout emotional testimony by OGB members who said their health care expenses might exceed their monthly pensions and others who related problems experienced with MedImpact, the state’s $350 million pharmacy benefit manager, Murrill could be seen texting while seated immediately behind witnesses. One observer said virtually the entire DOA staff sitting in the audience was also texting during testimony but only Murrill was constantly visible on the video being streamed live via the Internet.

But as embarrassing as that should have been to the administration, it was probably her advice that the APA was legally unnecessary.

Even an attorney general’s opinion released on Sept. 23, two days before the Appropriations Committee hearing failed to convince Murrill of her shaky legal position.

The opinion said the Jindal administration simply ignored the APA which requires a certain amount of publicity, public comment and legislative review before policy changes can be adopted.

But Murrill was quick to voice her difference with Assistant Attorney General Emily Andrews who authored the opinion at the request of State Rep. John Bel Edwards (D-Amite).

“We fundamentally disagree that the schedule of benefits meets the legal definition of ‘rule’ in the APA,” she said, “because it does not apply to the general public or any subset of the regulated public.”

Both Nichols and Murrill were grilled by a procession of legislators at the hearing, many of whom were not members of the Appropriations Committee but nevertheless had questions they wanted to ask on behalf of constituents.

At the times the exchanges became tinged with poorly concealed animosity as Nichols and Murrill fielded questions from one legislator after another once OGB members were finished with their testimony. The pair allowed their contempt for legislators surface from time to time while Legislators let it be known that they were losing patience with Jindal and his minions.

Murrill, while at the witness table, adamantly refused to concede that APA was required to be adhered to but on Tuesday (Oct. 14), once DOA had been called out on the matter and Murrill was out of the picture, APA notices of intent began going out toe legislators.

Once away from the table and back in the audience, she resumed her texting.

Now she has all the time she needs for texting.

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You have to hand it to Commissioner of Administration Kristy Kreme Nichols. When she has something to do, she is completely One Direction-al about it.

As the minutes ticked by during the House Appropriations Committee’s seven-hour hearing on the Office of Group Benefits on Sept. 25, and as Division of Administration (DOA) Executive Counsel Liz Murrill and the rest of the DOA pack occupied themselves by texting during heart-wrenching testimony from those who will be adversely affected by rising deductibles and co-pays, Kristy fidgeted.

She continued to fidget and to be as evasive as possible with her answers to questions from legislators until she suddenly “got an important phone call” and left the committee room. She did not return before the meeting finally adjourned.

In fact, it was not a telephone call that pulled her from the meeting at all.

One Direction, the latest boy band to make little girls squeal, was playing in the Smoothie King Arena in New Orleans and Kristy and her daughter (and possibly some of her daughter’s friends) watched the concert from the special Arena luxury suite assigned to Gov. Bobby Jindal (R-Iowa, R-New Hampshire, R-Anywhere but Louisiana).

Kristy Kreme at the Smoothie King. Has a certain ring to it, doesn’t it?

Kristy Kreme could have told the audience the truth. Certainly OGB members, mostly retirees, who had traveled from all over the state to testify and to get answers would have understood that a teeny bopper band was more important to Kristy Kreme than the medical coverage of 230,000 state employees, retirees and dependents.

But you see, telling the truth simply is not her style.

Witness her repeated claims that the OGB $500 million reserve fund was reduced to only about half that amount because of Obama Care and rising health care costs. She made that claim repeatedly, blaming those two factors and those alone for the drawdown of the reserve fund when everyone on the committee and those in the audience knew better.

Everyone in attendance knew that three consecutive years of premium reductions in the face of rising costs was the reason the fund has been all but depleted. She would never admit that even though everyone knew that Jindal lowered the rates so that the state’s 75 percent contribution to member premiums would be reduced also, thus leaving money that would have gone to premium payments for Jindal to use to plug gaping holes in his budget.

Remember when Kristy Kreme’s predecessor, former Commissioner of Administration Paul Rainwater wrote that comforting letter to OGB members in April of 2011 in an effort to debunk all those rumors about increased costs and raids on the reserve fund? No? Well, we have it right here: https://www.groupbenefits.org/portal/pls/portal30/ogbweb.get_latest_news_file?p_doc_name=4F444D324D5441344C6C4245526A51344E7A413D

In that letter, Rainwater said members would continue to receive quality service and coverage, benefits would NOT change, and OGB’s administrative oversight would continue, “securing the continued success of all the plans.”

“As for the allegation that OGB’s surplus will somehow be ‘stolen,’” Rainwater continued, “let me be absolutely clear: this claim is categorically untrue.”

But that was yesterday, as Chad and Jeremy sang back in the 60s, and yesterday’s gone. Let us return to the AWOL Kristy Kreme.

Even as she was invoking her super powers to convince legislators and audience members that she had only the best interest of OGB members at heart and that the depletion of the reserve fund was beyond the control of the administration, the report of Buck Consultants, hired by Kristy Kreme said on page iii of its summary: IMG_9230

  • It is our understanding that the Plan premium rates, used both to determine contributions from the various employer agencies, and to set contributions required from the retirees, were set artificially low to draw down the OGB’s reserve fund, and it is our further understanding that this is a temporary deviation from the Plan’s substantive plan, which continues to provide for the legislated 75-25 cost-sharing under a “full subsidy” from the State. Our valuation anticipates that the 21 percent premium deficiency will be gradually eliminated on a uniform basis over five years from fiscal year 2015 through fiscal year 2019 through increases in retiree premium rates in excess of the underlying assumed health trend. The actuary notes that in the prior valuation at July 1, 2012, the plan incurred a loss of $388 million associated with premium rates lower than anticipated.

For the entire Buck Consultants report, click here. http://www.doa.louisiana.gov/osrap/library/afr%20packetts/2014OGB_OPEBValuationReport.pdf

State Rep. John Bel Edwards (D-Amite) said he had received a copy of the Buck report earlier. “Nothing in this supports Kristy Nichols,” he said.

Edwards has been a vocal critic of the proposed OGB changes, claiming that the increased co-pays and deductibles will create unnecessary hardships on retirees, some of whom are facing co-payments and deductibles higher than their monthly income.

The entire OGB affair has become so confusing that many OGB members were turned away from the first meeting held in Baton Rouge on Monday to explain the changes. Jindal fired about two dozen OGB workers in the last round of firings and Kristy Kreme immediately found it necessary to contract with Ansafone of San Diego, California, and Ocala, Florida which has been trying to hire 100 people in each state to man telephone banks to answer questions about Louisiana’s plan.

Kristy Kreme has already found it necessary to dispatch one OGB employee to San Diego to train Ansafone employees and now $107,000-a-year OGB Chief Operating Officer Bill Guerra is in San Diego conducting training sessions on how to answer questions from OGB members.

DOA, by the way, is supposed to be strapped for cash and there is a statewide freeze on out of state travel but apparently found it necessary to send Guerra to California for a month.

So, let’s recap:

  • Jindal fires most of the OGB employees, including director Tommy Teague, and turns over a perfectly smooth-running agency to Blue Cross/Blue Shield (BCBS) with promises of no changes in benefits or premiums.
  • Less than two years after BCBS takes over, the OGB reserve fund is depleted by one half.
  • The administration fires two dozen more employees because of a lack of work and then enters into a $1.3 million contract with a California company to respond to questions from Louisiana residents.
  • Kristy has to hire two executives from BCBS to help OGB CEO Susan West who apparently is not up to the task. One of those, who ostensibly serves under West, is paid a higher salary than West.
  • Kristy Kreme Nichols attempts to mislead legislators and OGB members by repeatedly saying Obamacare is responsible for rising health costs and the depletion of the OGB reserve fund. No one buys her story.
  • Kristy tells State Rep. John Bel Edwards that the OGB actuary, Buck Consultants, recommended a decrease in premiums but a single paragraph from the Buck Consultants report summary contradicts that claim.
  • Two OGB executives have been sent to California to attempt to teach Ansafone employees how to respond to questions from Louisiana residents.
  • Kristy Kreme ducks out on legislators near the end of the Sept. 25 hearing by the House Appropriations Committee to take her daughter to a One Direction concert in New Orleans where she and her daughter occupy Jindal’s suite at the Smoothie King Arena.
  • A survey of employee job satisfaction conducted in 21 agencies in the Division of Administration reveals widespread dissatisfaction and distrust of the administration. Understandably, the survey has never been released and its contents were not divulged until LouisianaVoice recently obtained a copy.

And now, Jindal is offering foreign policy advice to President Obama with the release of a “policy paper” that calls for more defense spending. http://www.nola.com/politics/index.ssf/2014/10/bobby_jindal_takes_on_obama_fo.html

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You wouldn’t ordinarily expect to see the names of two prominent former congressmen bob to the surface when discussing a health care benefit program for state workers in Louisiana.

But when Office of Group Benefits (OGB) switched to MedImpact, a San Diego company, to provide its prescription drug benefit management services on Jan. 1, the state awarded an 18-month, $350 million contract to a company tied to the 2007 Republican presidential nomination quest of former U.S. House Speaker Newt Gingrich. http://hl-isy.com/Products-and-Services/Pharmacy-Benefit-Evaluator/PBE-Abstracts/2012/MedImpact

And those who listened to testimony last week before the Louisiana House Appropriations Committee learned that the company has proved to be less than satisfactory in handling claims for pharmaceutical benefits.

Gingrich launched the Center for Health Transformation as part of an ambitious consulting and communications conglomerate to let consumers, not health maintenance organizations (HMOs), choose their doctors, medical treatments and hospitals.

While the concept might be a good one on the surface, Gingrich failed to reveal that his idea would greatly benefit drug manufacturers, health insurers and other health care professionals who paid up to $200,000 annually to participate in the center’s operations.

MedImpact was one of those companies who ponied up the big bucks for that privilege.

Sid Wolfe, director of health research for the watchdog group Public Citizen, called Gingrich’s taking money from organizations like MedImpact and then using the weight of his name to advance the interests of those organizations “a massive financial conflict of interest.”

And when Gingrich again flirted with seeking the GOP presidential nomination in 2012, one of the men he chose to co-chair his Florida chairman was Alan Levine, former Secretary of Louisiana Department of Health and Hospitals under Gov. Bobby Jindal (R-Iowa, R-New Hampshire, R-Anywhere but Louisiana) and former Secretary of Health Care Administration for former Florida Gov. Jeb Bush.

Even former Congressman Billy Tauzin of Louisiana has entered the picture as co-chair of Medicine Access and Compliance Coalition (MACC), an assortment of health care providers who advocate lower drug prices through the federal 340B Program. http://www.huffingtonpost.com/2013/08/13/billy-tauzin-drugs_n_3719468.html

Section 340B of the Public Health Service Act requires pharmaceutical manufacturers participating in the Medicaid drug rebate program to provide outpatient drugs at discounted prices to taxpayer-supported health care facilities that provide care for uninsured and low-income people. http://www.aha.org/content/13/fs-340b.pdf

The program allows eligible hospitals and community health centers to reduce pharmaceutical costs to patients.

That would seem to be a radical departure from Tauzin’s previous position as head of the Pharmaceutical Research and Manufacturers of America (PhRMA).

You may remember how in one of his last official acts as Congressman from Louisiana’s 3rd District Tauzin of Chackbay in Lafourche Parish, pushed through that 2003 bill that prohibited the federal government from negotiating pharmaceutical costs for Medicare patients. http://www.nola.com/politics/index.ssf/2013/08/ex_rep_billy_tauzin_smack_in_t.html

Right after that legislative coup, the Democrat-turned-Republican went to work for PhRMA, eventually earning an eye-popping $11.6 million per year. http://www.bloomberg.com/news/2011-11-29/tauzin-s-11-6-million-made-him-highest-paid-health-law-lobbyist.html

No sooner had MedImpact came forward with its presentation on ways in which hospitals may be missing out on opportunities to profit from 340B. In that presentation, MedImpact promised hospitals that it could work “with any wholesaler, pharmacy or claims processing service,” providing hospitals “with the lowest prices, maximum flexibility and revenue.”

Then, last December, OGB sent a letter to its members informing them that MedImpact would begin providing pharmacy benefit management (PBM) on Jan. 1. CCF10032014_0001

Medicare-eligible retirees and their Medicare-eligible dependents would be covered by MedGenerations, a subsidiary of MedImpact, supposedly under that same $350 million contract given that there was no separate contract listed for MedGenerations.

Horror stories about MedImpact and MedGenerations began emerging almost immediately.

http://louisianavoice.com/2014/09/27/a-nightmare-called-bobbycare-prelude-to-healthcare-ruin-alternate-headline-the-time-has-come-to-privatize-jindal/

Henry Reed, a retired State Fire Marshal’s office employee, testified before the House Appropriations Committee on Sept. 25 that he fought FEMA for hurricane recovery money on behalf of the state but has experienced nothing but frustration with the state’s pharmaceutical management service. A victim of both epilepsy and narcolepsy, Reed said he has to take one medication that costs $2,000 per one-month supply.

His doctor prescribed two pills per day of that medication but “Medimpact informed me they would pay for only one pill per day. Apparently someone sitting at a desk in California knows more about my condition than my doctor.

“I thought I had a good health plan,” Reed said. “I called OGB and they referred me to Medimpact.”

The company simply refused to even approve prescription medications for the son of OGB member Dayne Sherman until he was forced to jump through all types of bureaucratic hoops to get the prescription approved.

So, what is the motivation for Medimpact to arbitrarily cut medications in half or to refuse them outright? Does it get to keep that part of the $350 million that isn’t spent on medications? Does it receive some other incentive to deny or reduce claims? Has it taken lessons from the McKinsey Group, which taught Allstate and State Farm how to delay, deny and defend claims stemming from Hurricane Katrina?

And for that matter, what do MedImpact’s employees think of their employer?

A sampling of postings on a web page that lets employees rate their employers anonymously is not kind to the company:

  • “They can pay you well and give good benefits in exchange for your soul.”
  • “No one is encouraged to think about what they are doing and try to make it better. The leadership team is completely disconnected.”
  • “Great people to work with; lousy leadership.”
  • “Strange, secretive leadership. A lack of clarity, vision and generally poor downward communication.”
  • “Lack direction, unorganized and management sucks.”
  • “Upper management tends to chase bright shiny objects. Burnout is high.”

You can read more here: http://www.glassdoor.com/Reviews/MedImpact-Reviews-E40035.htm

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Even as the Jindal administration was announcing that it was capitulating to the desires of the attorney general and state legislators to delay implementation of new proposed health coverage plans for state employees and retirees, the Office of Group Benefits (OGB) was quietly issuing a request for proposals (RFP) for actuarial services beginning Jan. 1, 2015.

https://www.groupbenefits.org/portal/pls/portal30/ogbweb.get_latest_news_file?p_doc_name=4D7A4D774E4445794D793551524559334E444531

Greg Cromer (R-Slidell) and John Bel Edwards (D-Amite) asked several times during the hearing the identity of the actuary who recommended three consecutive years of premium reductions in the face of rising health care costs and it wasn’t until the fourth time the question was asked that an answer was forthcoming.

“In fiscal year 2012 there was a 3 percent erosion of the fund balance,” Edwards said. “Yet, in fiscal 2013, there was a 7.11 percent reduction in premiums followed by 1.8 percent even though health care costs were going up by 6 percent. What actuary told you those reductions were sound?”

“Buck Consulting recommended a 2.25 decrease for calendar 2012,” Commissioner of Administration Kristy Nichols said.

Edwards then asked if Buck Consulting was still under contract to the state.

“That contract is being bid,” Nichols said.

“I would hope so,” Edwards responded.

State records indicate Buck had a $2.1 million contract with OGB to provide actuary and consulting services. That contract ran from Dec. 1, 2009 through Jan. 1, 2012. Additionally, Buck had another $600,000 contract from June 1, 2011, to June 1, 2013, “to assist in advising the Division of Administration with regard to public retirement systems and insurance benefits for public employees, actuarial services” at $250 per hour and per diem payments of $165.

Buck Consultants is a subsidiary of Affiliated Computer Services which in turn was purchased by Xerox in 2009. Jan Cassidy, sister-in-law of 6th District Congressman and U.S. Senate candidate Dr. Bill Cassidy, worked as Regional Vice President of Business Development for ACS and Xerox for nearly four and one-half years before going to work for DOA in December of 2012 as Assistant Commissioner in Procurement and Technology at a salary of $150,000 per year. A search of state contract records in March of 2013 by LouisianaVoice turned up four contracts with ACS totaling $45.55 million.

ACS contributed $10,000 to the campaign of Gov. Bobby Jindal (R-Iowa, R-New Hampshire and R-Anywhere but Louisiana) in 2003 ($5,000), 2008 ($4,000), and 2009 ($1,000), Jindal’s campaign records show.

LouisianaVoice, in March of 2013, noted several contracts between ACS and other states, cities, and even the federal government which drew sharp criticism over problems experienced by the company as well as questionable contracts in Texas and Alabama.

http://louisianavoice.com/2013/03/15/doa-hires-jan-cassidy-sister-in-law-of-cong-bill-cassidy-at-150000-previous-employers-records-are-less-than-stellar/

But ACS wasn’t the only entity in that organization with problems. Buck Consultants was sued by Providence, Rhode Island in 2013 because, the city claimed, Buck miscalculated $700,000 per year in savings the city anticipated through pension reform. Instead, Mayor Angel Taveras said, the cost to the city was expected to be $10.8 million over the next 28 years.

http://www.google.com/url?sa=t&rct=j&q=&esrc=s&frm=1&source=web&cd=1&ved=0CB4QFjAA&url=http%3A%2F%2Fwww.pionline.com%2Farticle%2F20130226%2FONLINE%2F130229899%2Fprovidence-ri-sues-buck-consultants-over-pension-savings-calculations&ei=0sIsVMTAE4OOyASQpIKIBQ&usg=AFQjCNEiIVz3kvxYoTszpqnKeonAQGq_-A&bvm=bv.76477589,d.b2U

In California, Buck Consultants was also accused of making several mistakes in its actuary for the Mendocino County retirement system, prompting the county to cancel its contract with the firm in March of 2011. Buck Consultants paid the county nearly $600,000 as a settlement of its dispute in September of that same year. http://www.ukiahdailyjournal.com/ci_17656902

http://www.ukiahdailyjournal.com/ci_18951388

In a case that should sound familiar to OGB members who have been following events since the privatization of the agency, retirees in Stanislaus County, California, in 2009 sued the county retirement board over its decision to shift $60 million in reserves to ease the county’s pension obligations for fiscal year 2009-10. http://www.modbee.com/2009/12/24/984878/retirees-challenge-stancera-over.html

And now OGB “is seeking proposals from actuarial and consulting (actuary) providers for a contract that will allow for benefit design, rate development, RFP scoring, and other analytical and financial support activities for the state health insurance plan,” the RFP says.

The actuary chosen for the contract “will provide methods for, and calculation of, health plan premiums for OGB health plans and other support services.”

So while Kristy Kreme continues to insist that the current plans for OGB do not call for increased premiums, only higher co-pays and deductibles, it’s interesting to note that the contract being sought by OGB certainly leaves the door open for premium adjustments down the road and it isn’t difficult to guess which way those adjustments will go.

The RFP says that OGB projects medical plan expenditures of almost $1.284 billion in fiscal year 2015, which begins next June 1. Of that amount $56.9 million will be in administrative costs, the RFP says, adding that OGB will require “ongoing consulting and assistance with benefit development, rate setting, risk adjustment determinations, financial analysis, analysis of claims and encounters, evaluation of expenditures, budget projections, trend calculations, causes and discovery of trend, evaluation of multiple benefit options, and financial and other reporting requirements as may be necessary to administer” the health plan.

Should Buck Consultants submit a proposal and should it be the low bidder, someone other than Kristy Nichols might wish to talk to the folks in Providence, R.I., Mendocino or Stanislaus counties in California to do a little vetting before a contract is awarded.

This consultant-happy administration has made a horrible mess of things with OGB since 2011. There’s no need to continue down that same road of bad decisions.

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Listening to Commissioner of Administration Kristy Kreme Nichols’ responses to questions during last Thursday’s House Appropriations Committee hearing over changes to the state Office of Group Benefits (OGB) health plans, one word kept coming to mine: bromides.

Bromide is defined by Merriam-Webster as “a statement that is intended to make people feel happier or calmer but (which) is not original or effective,” and by Wikipedia as “a phrase or platitude that, having been employed excessively, suggests insincerity or a lack of originality in the speaker.”

No matter which definition one might choose, that is precisely what legislators and members of the audience were treated to during the seven-hour hearing at the State Capitol.

Keep in mind as you read this that subsequent to the hearing last Thursday, the administration of Gov. Bobby Jindal (R-Iowa, R-New Hampshire, R-Anywhere but Louisiana) retreated from its plans of the gang rape of 230,000 state employees, retirees and dependents so that the administration can follow the law for a change and proceed through the legal process of obtaining approval of the proposed benefit changes for OGB members. http://louisianavoice.com/2014/09/30/in-need-of-aloe-vera-after-being-burned-by-appropriations-committee-last-week-ogb-announces-enrollment-extension/

Katrina Jackson (D-Monroe), for example, sparred with Nichols on the issue of the $1.3 million contract with Ansafone, Inc. of San Diego and Ocala, Florida to field phone calls from OGB members. “Where is the project work plan?” Jackson asked. “No one at OGB knew what it was when I called. No one on the committee has received any project work plan. We have a $1.3 million contract for phone service. Is this something that Blue Cross/Blue Shield (BCBS) should be doing?”

“We had no other choice but to ramp up our customer service for open enrollment,” Nichols said.

Jackson again asked if fielding questions from members should be something BCBS should be doing to which Nichols responded, “OGB has always retained a customer service component.”

Jackson said legislators were told three years ago that privatization of OGB “would be helpful to members, not harmful. We fixed something that was not broken and now it’s broken. We were doing pretty good but then for some reason we offered the business to BCBS, everyone shifts to that and our utilization costs go up.”

Jackson finally got Nichols to concede that utilization is a major issue. “Vendors have to 100 percent accountable for managing utilization with us. To the extent that the request for proposals (RFP) and current contract did not explicitly mandate that, we need to in the future.”

We’re glad we could clear that up for you.

Kenny Havard (R-Jackson) asked Nichols why the Administrative Procedures Act, which lays out a step by step procedure for the adoption of rule changes. For a complete list of APA requirements, click here: apa

“We are,” Nichols said.

“You’re doing that now,” Havard countered. “But you didn’t before. If you’d done it before, we wouldn’t be here now. Who decides what laws we have to follow and which ones we do not have to follow in this?”

“The legislature sets laws and we try to follow,” Nichols replied.

“Everything we do lately ends up in court and that’s exactly where this is heading,” Havard shot back. “We’ve created a problem that we’ve put on the backs of state workers. We have people making $500 a month and you’re about to raise their insurance (costs) and somebody needs to answer for it because we’ve created a problem and blaming it on somebody else. I don’t support Obamacare but I also don’t support Jindalcare.

“We lowered premiums so the state would not have to put up its share and now the fund balance is dwindling,” he said. “I just want to know who made the decision that we didn’t have to follow the APA.”

“We are following the APA,” Nichols continued to insist. In our opinion, the plan of benefits does not have to be promulgated because it’s in the OGB authority.”

State Sen. Ed Murray (D-New Orleans) attempted to question Nichols but soon grew frustrated at her evasiveness and gave way to Rep. Greg Cormer (R-Slidell) who asked but did not receive a definitive answer: Did an actuary give the opinion on the rate decrease of 7 percent? Cormer told OGB CEO Susan West, “If you were a private insurer, the Department of Insurance would have already taken you over” because of the agency’s mismanagement.

Jack Montoucet (D-Crowley) asked Nichols, “Where would OGB be today had we not made all the changes, if we’d left them alone and let them do their job? To me, it wasn’t broken. I never got a call in six years (prior to privatization) complaining about OGB. Today, I gotta tell you, Jesus Christ, I’m getting phone calls every day and this (new plan) hasn’t even been implemented. That’s scary.”

Nichols, as she did most of the day, stammered and fumbled for an answer. “All public employee health plans are experiencing the same thing,” she finally said, but then said that the cost increases “could have been prevented if we’d structured the HMO correctly in the beginning.”

Joe Harrison (R-Gray) went further than the others in calling for a special legislative session to deal with the OGB crisis and noted that there were no problems with the agency during the tenure of Tommy Teague, who was fired as CEO on April 15, 2011.

“Mr. Teague had a solvent plan and I’ve yet to hear any in the administration tell me why we moved away from that plan,” Harrison said.

“I would ask that we have a special session on this,” he said. We have more than 200,000 lives we are adversely affecting. There are other options to this. Many in the insurance and health care industry have looked at this and (have) said there are better ways to go.”

The hardest questions, however, came from Rep. John Bel Edwards (D-Amite). Following up on a question asked earlier by Rep. Greg Cromer (R-Slidell), Edwards asked if the recommendations for premium decreases three consecutive years were made by an actuary.

“I was not with OGB then,” West said. “I don’t have that information with me…”

“It’s been three hours since that question first came up,” Edwards said.

“I don’t have that information with me,” West repeated.

“It’s been three hours since that was asked,” Edwards said again. “That’s three hours in which those reports could have been brought over here. Who made the decision to reduce premiums by 9 percent total in fiscal years 2013 and 2014?”

“Ultimately, the administration,” Nichols said.

“The OGB director?”

“I wasn’t at DOA in fiscal year ’13,” Nichols said. “I don’t know where the recommendation came from.

When Edwards elicited testimony from Nichols and West that the OGB policy board had not met in more than a year even as the OGB fund balance was dwindling by $16 million per month, he asked, “Was there a lack of a quorum because there weren’t enough members appointed to the board (by the governor) or that they weren’t showing up for meetings?”

“A combination of both,” West said.

“So we have a situation where (the decision was made) to reduce premiums by 2.25 percent in 2012 which drained the fund balance by 3 percent knowing costs were going up 6 percent, and an additional reduction of over 7 percent the next year and an additional reduction of almost 2 percent the following year all the while with costs of health care going up and we were surprised that the fund balance went down?

“This is a self-manufactured crisis that you are now saying is an emergency because we had a fund balance that was healthy,” Edwards said. “We had OGB members who were relatively happy with the plan and today we have an unhealthy fund balance and OGB members who are very unhappy. In fact, I would not that not a single OGB member came to testify today who support any of those plans—not a single one of them.”

Edwards if there was to be discussion of stability for OGB, “we can’t leave it in the hands of whoever’s been running it for the last two years…”

He then asked Nichols when the decision was made to follow the rule of promulgation as mandated in the APA.

“The general counsel advice to OGB,” Nichols said, “was a plan of benefit changes should not be required to be promulgated…”

DOA general counsel Liz Murrill stopped texting long enough to interject, “We had the conversation at the beginning of September.”

“When was the decision made?” Edwards repeated.

“At the beginning of September,” Murrill said.

“The (OGB policy) board looked at what you wanted to do in July so you knew what you wanted to do by July 30. If you had started the rule promulgation process by August 30, you could get through the entire process before January 1. You didn’t do that.”

Nichols, in a weak attempt to defend the emergency rule procedure in lieu of promulgation, asked, “Why was OGB allowed to implement 41 emergency rules in the past?”

“I suspect because nobody challenged it,” Edwards shot back. “Typically, you don’t follow the law unless you get challenged and that’s the real precedence that you’re following.”

Saying a Pew Survey shows that Louisiana is the third stingiest state in the nation in providing health coverage for public employees, Edwards said there is a “tremendous disconnect between saying we had an inflated reserve fund that it needs to be right-sized and today saying we have an emergency because the fund balance is not enough and it’s on its way (from a high of $520 million) to $8 million.”

He then again asked the question that no one had answered to that point. “In fiscal year 2012 there was a 3 percent erosion of the fund balance. Yet, in fiscal 2013, there was a 7.11 percent reduction in premiums followed by 1.8 percent even though health care costs were going up by 6 percent. What actuary told you those reductions were sound?”

“Buck Consulting recommended a 2.25 decrease for calendar 2012,” Nichols said.

“If you don’t have an emergency, then what you’re going to start on January 1 is invalid and you’re causing a bigger problem than if you simply go through the ordinary rule making process,” Edwards said. “Anyone who’s adversely impacted by having to pay a higher deductible or higher co-pays by an invalid emergency rule has a right to have that money returned to them.

“The safest thing to do if you are really worried about the taxpayers of the state of Louisiana is to give very serious thought to stopping the emergency rule making process, go forward with the ordinary rule making process and have whatever plans survive that process implemented in a year that doesn’t start until they (the rules) become final.

“Public meeting notices, meeting requirements, and oversight by the legislature are all very, very important. We had people today saying this was the first opportunity that they had to come and voice their objections. That’s an important part of this whole process.”

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If anyone—ANYONE—in charge at the Division of Administration (DOA) or the Office of Group Benefits (OGB) knows what they’re doing, please contact us immediately because we have given up all hope that the Jindal administration in its entirety has the first clue.

The following is the latest news release from OGB (through DOA, we’re certain; no one would dare take this responsibility on without the prior blessings of Commissioner of Administration Kristy Kreme Nichols.

But it is ample evidence that these are the people Jimmy Breslin had in mind when he wrote The Gang that Couldn’t Shoot Straight.

After all the planning, all the news releases, all the email blasts, all the expenditure of time and money (we would add talent to the list, but that would generate instant doubt in the minds of our readers), OGB and DOA now suddenly shift gears with this.

Here is the news release (with our comments in boldface type):

The Office of Group Benefits announced Tuesday it would extend the annual enrollment period for its 2015 health plan options through the end of November 2014. The enrollment period will now begin October 1 and last through November 30. The health plan changes are scheduled to begin March 1, 2015 instead of January 1 when the plan year begins.

The enrollment period for supplemental insurance products, including dental, vision and life insurance will be extended through November as well. Those plans will take effect January 1 along with flexible spending plans. Flexible spending accounts allow employees to set aside a portion of their paycheck to pay for qualified expenses before taxes are deducted.

“We take the concerns of our members very seriously (We got our butts handed to us by legislators last week) and want to do everything we can to ensure they have the time and resources necessary to make their plan choice,” said Commissioner of Administration Kristy Nichols. “Shifting our timeline will give people the chance to get accurate information and better understand their options.”

(What she means, of course, is now members will have an extra month to select a method of cutting their own throats.)

In addition to the extended time frame, OGB will allow retirees who are enrolled in an OGB health plan option, either as primary or secondary coverage, to remain in a comparable option without having to re-enroll. Retirees interested in Medicare Advantage plans are still required to enroll by December 7 for the plan year that begins January 1. If no action is taken by the end of the enrollment period, retirees will remain in the option most comparable to their current selection. Active employees who take no action will be enrolled in the Pelican HRA 1000 option, a new choice that offers up to $2,000 in employer funding that offsets out-of-pocket costs. (We hope that will discourage the pitchforks and torches at least until Gov. Jindal can finish his absentee term.)

Several new options with lower premiums and increased employer contributions are available beginning March 1. Members are encouraged to use the additional enrollment time to make the selection that best fits their needs. Most members will remain in their current plan through February 28, unless they choose to make a change. However, members who wish to remain in or select a Vantage plan must make their selection effective January 1.

As health care costs across the country continue to rise (We’re still blaming Obamacare for everything—even the Saints’ poor start), OGB and other employers have had to make changes to benefit offerings in order to continue to pay claims. While OGB maintains a reserve fund that contained more than $370 million in cash at the end of fiscal year 2014, the cost of claims currently outpaces the revenue received through premiums each month (We won’t bring up those premium reductions again; we’ve heard enough about those).

Last week, OGB announced it would begin the process of promulgating the schedule of benefits (but only after Reps. John Bel Edwards and Kenny Havard scalded us in that committee hearing). Sending fiscal and economic impact statements to the Legislative Fiscal Office (LFO) begins the promulgation process that will make OGB’s benefits a part of state law. Once the LFO approves, the rules will be sent to the Office of the State Register, the President of the Senate, the Speaker of the House, and oversight committees. The committees will then send a recommendation to the governor for approval. OGB expects the regular rules to be promulgated by March 1 (We hope legislators don’t remember that we said we couldn’t extend this past the first of the year).

OGB is also issuing emergency rules (Will that be emergency rule number 42 for OGB? We’ve lost count) to publish the formulary and prior authorization changes that took effect in August for active employees and retirees without Medicare. Those changes will take effect in January for retirees with Medicare, in line with the Medicare plan year. Emergency rules have the same effect as promulgation of regular rules, for up to 120 days. They will take effect immediately and continue through the administrative process.

Information on the 2015 plan options is available on OGB’s annual enrollment website at www.annualenrollment.groupbenefits.org<http://www.annualenrollment.groupbenefits.org>. (Or you can totally waste your time by calling Ansafone.) Members are receiving decision guides in the mail that outline each plan in detail. 43 meetings are being held across the state in addition to live webinars for employees and retirees. OGB has also developed a cost calculator tool that allows members to compare plans and out-of-pocket cost side-by-side as well as a one-sheet that compares last year’s plans to the upcoming year’s options. Additionally, customer service hours have been extended to 7 a.m. through 7 p.m. Monday through Saturday.

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