Editor’s note: LouisianaVoice would like to acknowledge and thank Kay Prince of Ruston for contributing much of the research that went into this article. She has worked tirelessly with former Sen. Butch Gautreaux on this issue and was gracious enough to share this information with us for our use.

A former employee of the Louisiana Office of Group Benefits OGB) has taken issue with several points in the proposed contract between the Division of Administration (DOA) and Blue Cross/Blue Shield of Louisiana (BCBS) that calls for BCBS to take over the operations of OGB’s Preferred Provider Organization (PPO) plan as the plan’s third party administrator (TPA) in January.

The former employee, who is now retired, examined the contract which is scheduled for consideration by a special joint meeting of the House Appropriations and Senate Finance committees on Thursday, Nov. 1 and found several areas in which he said the state will be getting a bad deal if the contract is approved.

Gov. Piyush Jindal has pushing for the transition for nearly two years now in what he insists will be a cost-cutting measure but which will result in the loss of 177 positions at OGB and 111 actual jobs. The other 66 positions are currently vacant.

One of the things the former employees warns about is an obscure clause on page 8 the contract which says the maximum amount to be paid BCBS shall not exceed $1.1 billion for any one year “unless the director of the Office of Contractual Review approves a contract amendment.” (emphasis ours.)

That is an important provision considering what happened with the privatization of the Office of Risk Management (ORM) in September of 2010. Under terms of that contract, the state was to pay F.A. Richard and Associates (FARA) of Mandeville $68 million to be the TPA for ORM but only a few months into its contract, FARA asked for and received a $6.8 million amendment to its contract, increasing the over contract cost to just under $75 million.

Legislators were upset to learn that the amendment was legal because the law allows a one-time contract amendment of up to 10 percent with only the approval of Contractual Review. The FARA contract amendment was exactly 10 percent and legislators had no say in the matter.

The Jindal administration claims that allowing BCBS to become the TPA for OGB will save the state $20 per year. But if BCBS should seek a similar 10 percent increase in its contract, the $110 million in additional contract costs would wipe out any savings.

Administration projects of OGB’s spending 100 percent of budgeted amounts in several areas whereas the agency historically has spent between 65 and 80 percent of budgeted amounts on administrative costs. “This inflates the projected savings by approximately 20-35 percent,” the retired OGB official said.

Projected savings on building rental may also be overstated, he said, because OGB is locked into a 10year lease for its Baton Rouge office space. The cost of that lease is $100,000 per month and will not be reduced unless OGB can renegotiate its lease.

He said it was misleading to compare Louisiana to other states. First, the only other state that self-administers its health benefits program is Utah which has a smaller population. “You cannot compare staffing patterns for completely different ways of doing business” as the administration did with Florida and Mississippi, for example. “You need to compare total administrative costs for the other states, not just (the) number of employees,” he said.

But of even more importance, he said, is the misconception that it was a sound move to reduce premiums by 7 percent last July.

“The program operated at a small deficit for the fiscal year ending June 30, 2010 (before the premium rate reduction) and is almost guaranteed a significant loss for Fiscal Year 2013 with the 7 percent reduction in premium that was approved by the Division of Administration,” he said.

“The only reason that premiums could be reduced was the fact that the program had a significant surplus. For the current fiscal year the program will be operating on its surplus for significant portion of the current year’s operating expenses…but this cannot go on forever.

“It is another example of using one-time funds to pay for continuing operations of the state. Once the surplus is exhausted, rates will need to be increased significantly to cover continuing operations,” he said.

State health insurance programs have varied over the years and remained pretty much in a state of flux until the administration of OGB CEO Tommy Teague, who was fired on April 15, 2011. It took a major political scandal involving a top state administrator and underworld boss Carlos Marcello to pull the state’s health and life insurance programs out of the doldrums.

OGB itself is relative new as a state agency, having been created on Sept. 1, 1979, as a result of the FBI’s Brilab sting operation which resulted in Commissioner of Administration Charles Roemer’s conviction of conspiracy to violate federal racketeering laws over accusations that he and Marcello took part in a scheme to win a multi-million dollar state group insurance contract through bribery.

Roemer served 15 months of a three-year prison term before his conviction was overturned.

Prior to July 1, 1970, each state agency was responsible for procuring its own insurance contract for its employees. This created a multitude of problems since each contract had different dates, coverage, premiums, etc. Plus, when an employee transferred from one agency to another, it forced the employee to switch coverage which resulted in considerable confusion and in some cases, loss of coverage because of different waiting periods among the various contracts.

The Uniform Insurance Act was passed and went into effect on July 1, 1970 and all Executive Branch agencies were brought under one consolidated health/life insurance contract, which was awarded to Blue Cross for health and Pan American Life for life insurance.

In 1973, when Blue Cross proposed a significant rate increase, the contracts with both Blue Cross and Pan American were terminated and the state’s health and life insurance programs became self-funded by the state. Continental Assurance (CNA) was retained as the TPA to handle claim payment functions, an arrangement that remained in effect for the remainder of the seventies.

It was during this time that the FBI began its sting operation after learning of alleged bribes and the legislature subsequently passed Act 749 of the 1979 regular session which created OGB and placed it under the State Treasurer’s office.

On May 1, 1981, the CNA contract was terminated and all employees who were working for CNA were offered an opportunity to become Civil Service employees, effective May 1. The agency operated under this arrangement until 1998 when the legislature was forced to make a supplemental appropriation of $77 million to cover an unfunded accrued liability (UAL) in the program because the OGB trustees had failed to increase rates to keep up with the program’s claims experience.

The program continued to operate with an UAL until the mid-2000s at which time it began generating a surplus each year through FY 2011, going from a $105 million deficit to its current $500 million surplus in about five years.

Here are the links to the committee memberships:

http://house.louisiana.gov/H_Cmtes/H_Cmte_AP.asp
http://senate.legis.louisiana.gov/Finance/Assignments.asp