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Archive for the ‘Legislature, Legislators’ Category

“Isn’t there some rule or regulation where you could prevent your employees from leaving and taking jobs elsewhere?

—Rep. Mert Smiley (R-Port Vincent) to Patti Gonzales, Assistant Director of the Office of Risk Management (ORM) on learning that ORM employees were leaving the agency for other employment in the wake of ORM’s ongoing privatization.

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When it comes to twisting his stories and changing direction in mid-testimony, Commissioner of Administration Paul Rainwater, it seems, has no peer.

In yet another legislative committee hearing on the proposed sale/privatization/contracting for a third party administrator (TPA)/hybrid of the Office of Group Benefits (OGB), this one by the Senate Insurance Committee, Rainwater again altered his version of the truth that just doesn’t quite square with public comments he has uttered in the recent past.

Rainwater also got a surprise when his appointee as GEO for OGB admitted that if things remained the same as they are now, he could not reduce his staff. Rainwater has testified before two different committees that the sale/privatization of ORM would reduce the number of employees at OGB by 149, or by about half.

On Tuesday, Rainwater told Insurance Committee Chairman Sen. Dan Morrish that there was no plan to use any portion of the OGB $520 million surplus for the state general fund, nor would any private company that takes over the operations of the agency have access to the fund balance. “That fund is there for the state to pay claims and that’s what it’s going to be used for,” he said.

Barely three weeks ago, Rainwater said that the OGB surplus would be “an attractive selling point” because the private company that ultimately purchases the agency would not have to dip into its own capital to pay claims initially.

And while he steadfastly maintains that OGB is not for sale, his own office’s press release of April 26 describing his appearance before the Senate Retirement Committee repeatedly alluded to his testimony on the “potential sale and privatization of the state’s Office of Group Benefits” and of the procurement of a financial advisor to help the state “evaluate the potential sale of OGB…”

The first paragraph of Rainwater’s press release said that he testified before the Retirement Committee “about the potential sale and privatization of the state’s Office of Group Benefits.”

The second paragraph quoted Rainwater as telling the committee, “The simple fact of the matter is that a sale and privatization of OGB will have no negative impact for those covered. Let me say that again: a sale and privatization of OGB will have no negative impact for those covered.”

If that is not enough, that same press release from his office quoted him as testifying before the Retirement Committee, “The procurement of a financial adviser to help the state evaluate a potential sale of OGB was undertaken in accordance with applicable law.”

Morrish on Tuesday asked, “Is this a sale or a privatization?”

“We’re attempting to bundle our HMO and PPO.”

“Is it a privatization or a management contract?” Morrish asked again.

“It’s a privatization with a five-year contract. We’re taking OGB out of the day to day business of running an insurance company,” Rainwater said.

“We’re not selling OGB,” he said. “We’re not giving up the right to negotiate a contract. This is something that’s never been done before. It is privatization, but we’re not selling OGB.”

A brief but puzzling exchange ensued when Morrish commented that he had not seen the RFP (request for proposal).

“The RFP is not written yet,” Rainwater responded.

The RFP for a financial adviser to conduct an assessment of OGB’s value was issued last Friday giving bidders a deadline of June 6 in which to submit proposals to “assess the market value of the book of business and services provided by OGB and assist in the formulation of alternative methods of benefit delivery.

An earlier RFP was abandoned when the only bidder, Goldman Sachs, who helped in the crafting of the document, was the only bidder but could not agree to a demand that DOA hold Goldman Sachs harmless in the event of litigation.

Throughout the latest RFP, there are references to those submitting proposals having experience in the sale of health insurance entities and of track records in past sale efforts.

Sen. J.P. Morrell (D-New Orleans) asked Insurance Commissioner Jim Donelon about the impact on the state insurance industry if the same company ended up as the third party administrator (TPA) for both the state’s HMO and PPO.

“After Hurricane Katrina visited us,” Donelon said, “Blue Cross/Blue Shield went from having 40 percent of the insurance business in Louisiana to 70 percent. I have tried every way I know how to stop that trend. Blue Cross already has the state’s HMO and PPO, that could be a problem. I spoke to Angel (former Commissioner of Administration Angele Davis) about that when DOA awarded the HMO to Blue Cross over Humana and of course, that’s being litigated right now in the court of appeal.”

Sen. Gerald Long (R-Winnfield) asked Rainwater how he arrived at a value of $150 million for OGB.

“OGB collects $1 billion a year in premiums and currently has a $520 million surplus and we took variables of those figures and arrived at a price of $150 that we expect a company might pay us to manage that volume,” Rainwater replied.

Sen. Eric LaFleur (D-Ville Platte) asked Rainwater if the $150 million was recurring or one-time revenue and Rainwater admitted it would be a one-time payment. “But there would be a $10 million-a-year savings in staff reduction savings,” he said.

“Doesn’t the $500 million surplus help the state?” LaFleur asked.

“It does, but we need some balance,” Rainwater said.

“Isn’t what he’s supposed to do,” LaFleur asked, referring to Scott Kipper,
newly-appointed CEO of OGB following the April 15 firing of Tommy Teague

“It is. That’s why we brought him in.”

LaFleur then asked Kipper, “Is that impossible for you to do, to streamline the agency and make it more effective?”

“It’s not impossible,” Kipper said. “The trick is to try and get an apple-to-apple comparison in order to get the reserve where it should be.”

“What is a good reserve?”

“That’s a good question.”

LaFleur then dropped a bombshell when he asked Kipper, “Let’s assume this RFP doesn’t go anywhere and we’re right back where we are right now, who…how many people would you cut from OGB?”

“If we continue to operate as we do now, there would be no significant cuts,” Kipper said. “There’s not a lot of excess now.”

Rainwater, visibly upset at Kipper’s answer, interrupted to say, “The only way to reduce the number of employees by 149 is to privatize.”

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The Senate Retirement Committee held its third consecutive week of public hearings on the Jindal administration’s proposed privatization of the Office of Group Benefits (OGB). The only things missing were witnesses and a second request for proposals (RFP) that was substantially different from the first.

Commissioner of Administration Paul Rainwater, Deputy Commissioner Mark Brady, and new OGB CEO Scott Kipper all were no-shows for the hearing, choosing instead to snub their noses at legislators.

Rainwater, who already has been grilled by legislators during the first hearing two weeks ago, vowed to staff members that he would not attend another of the hearings being conducted by committee Chairman Sen. Butch Gautreaux (D-Morgan City), according to sources within the Division of Administration (DOA).

Mark Brady has not attended any of the hearings and Kipper reportedly has been told to stay away from Gautreaux’s committee meetings.

Only DOA Chief of Staff Dirk Thibodeaux bothered to show up for the administration. The only other witness was former OGB CEO Tommy Teague, who testified at length on the history of OGB, the latest RFP which appears to conflict with testimony by Rainwater last week, and of the disadvantages of privatizing the agency or contracting with a third party administrator (TPA).

Teague also disputed administration claims that privatization of OGB would save the state some $10 million per year be reducing the number of OGB employees by half.

The latest RFP was released late last Friday and if anything, appears to reinforce the administration’s determination to sell OGB outright despite claims to the contrary by Rainwater a week ago who said the state would retain control of OGB. “At the end of the day,” he told the committee last week, “we will still have the Office of Group Benefits with 149 employees.”

Teague’s testimony, however, shed considerable light on the language of the RFP that he indicated was misleading and which he said provides insights into the administration’s not-so-well-hidden agenda to keep certain information from the public as well as possibly forestalling any financial audits for a period of three years after signing of a contract with a financial advisor.

He said OGB was created in 1969 by executive order of then-Gov. John McKeithen. “Up to then, each agency more or less shopped for its own health coverage,” he said.

Nine years later, in 1978, OGB was sold. “Overnight, state employees became employees of AdServ Corp., a California software company,” Teague said. “One day they worked for the state and the next day for an out-of-state company.”

The following year OGB was brought back in-house and placed within the Department of the State Treasury and in late 1979, an executive director was hired.

In a scenario that has become all too familiar of late, an employee of the California company testified before the Appropriations Committee and the next day was fired, he said. “Of course he was immediately re-hired by OGB,” Teague said.

Teague’s wife, Melody, was fired in October of 2009 one day after testifying before the Commission for Streamlining Government but it took her six months to get her job back. Then, less than a month ago, on April 15, Teague himself was fired as OGB CEO by Brady. Rainwater attributed the decision to Teague’s lack of leadership even though the agency flourished under his six years as director.

Teague said in late 1980, the decision was made for OGB to go self-funded. “That means that OGB was on risk for all claims,” he said. “With a TPA, you simply pay a third party to answer the phones. The state is still on the hook for risks.”

He said it has taken OGB 30 years to build a network that now includes contracts with every hospital in the state except one. “The most critical component of a TPA is to assess the value of their discounts with medical providers. But all discounts come back to OGB. The TPA is simply paid an administrative fee,” Teague said. “OGB pays the TPA a per employee fee each month, in this case, we pay Blue Cross/Blue Shield $26 per month per employee member.

“With OGB, there are no taxes and no profit and there is no need for a TPA because we have already built our network,” he said.

Teague said he first to OGB in 1980 as an OGB attorney. “I was with the department for eight years and was acting director for one-and-a-half years,” he said. “In early 1990 I was named special counsel for the board and helped set up the PPO network. I left in 1995 to run the Pennsylvania state plan.”

He returned to OGB as CEO in 2006 when former Gov. Mike Foster moved OGB back under DOA. DOA took all power from the OGB board and now it only serves in a planning and policy capacity and the CEO served at the pleasure of the governor.

He said that prior to 2006 OGB was fully insured by Ochsner Health Plan, meaning the insurer (Ochsner) assumed all risk.

“When I was named CEO in 2006, there was a negative fund balance of $36 million,” he said. “As a result of becoming self-insured, we now have a $520 million fund balance because we beat the actuary projections every year.

“Had we stayed with the fully-insured plan in 2006, we would not have the fund balance we now have.”

Teague also debunked the $10 million in savings that Rainwater said the state would realize with the reduction in payroll that would accompany privatization. “We already pay Blue Cross $26 per member per month. A similar arrangement for a Preferred Provider Organization (PPO) with its 41,825 actual employees and retirees would more than offset the $10 million savings realized by cutting staff,” he said.

Sen. Ben Nevers (D-Bogalusa) asked about the other states cited by Rainwater as being more efficient than Louisiana by providing benefits to more people with lower costs and fewer staff but Teague was quick to say it is impossible to fairly compare Louisiana to other states “because we don’t know what the other states are providing. We’re not really seeing what it costs other states. OGB, for instance insures levee boards 50 school systems.”

He said OGB deals with 110 different payroll systems and various commissions. “OGB does a big part of the TPA work because only OGB can. A fully-insured plan is always going to cost more and OGB has some of the best contracts out there right now because of the network we’ve established over three decades.”

Teague questioned the intent of the administration when he said, “If you’re going to remain self-administered and the $520 million fund balance is staying as Mr. Rainwater claimed last week and if you’re looking for a TPA to administer the program, then why do we need an RFP to assess the benefits of OGB? It’s irrelevant. If you need a TPA, why do you need to know the net worth?

“The RFP attachments are all OGB financial statements. A TPA doesn’t need to know the financial statement. A TPA needs to know the monthly call volume, the monthly claim volume, monthly correspondence volume, how eligibility is transmitted, and the vendor payment schedule. The net worth is immaterial.”

“You would want to provide that if you were looking for a buyer,” Gautreaux interjected. “I asked Mr. Teague here today because I don’t understand why we need to hire a financial advisor to contract with a TPA.”

Teague also said one part of the RFP grading system for bidders said cost of services would be worth 25 points but in another section it said the lowest cost proposal would be awarded 30 points. “Which is it?” he asked.

He said the current RFP also left unanswered several questions about when proposals would or would not become public record and that the wording of the RFP would appear to prevent the legislative auditor from examining records for a period of three years following the signing of a contract with a financial advisor.

“It’s really not clear just when the legislative auditor would have immediate access to records,” he said.

Legislative Auditor Darryl Purpera last week testified that Rainwater had refused to provide documents that Purpera’s office is constitutionally entitled to have in order to conduct proper assessments.

The latest version of the RFP was written completely in-house with no assistance from outside as was the first version when Goldman Sachs was heavily involved in the drafting of that document.

The new RFP, however, contains no fewer than four separate references to the sale of OGB and bidders’ experience in sales.

It also provides that OGB’s acting actuary, personnel in the governor’s office, DOA, and the Office of Contractual Review may review any of the proposals and that if contract negotiations exceed 15 days, OGB may cancel the award and award the contract to the next-highest-ranked proposer. Extension of this and other deadlines may be extended at the discretion of OGB.

Conceivably, if the administration does not want the contract to go to the highest-ranked bidder, it could draw out negotiations beyond the 15-day limit as a ploy to awarding the contract to the next-highest-ranked bidder.

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Some would call it bureau-speak but to those sitting through Monday’s Senate Retirement Committee hearings on the privatization of the Office of Group Benefits, it was more like gooney-babble.

Commissioner of Administration Paul Rainwater, just as he did last week, tried to convince legislators of the wisdom of privatizing the agency that has amassed a $500 million surplus and which has an administrative cost of only 3.5 percent.

As if that were not enough, Legislative Auditor Daryl G. Purpera testified that Rainwater has refused to provide documents that his office is constitutionally entitled to have in order to conduct proper assessments. “We requested certain documents, particularly those pertaining to the Chaffe contract we were told by Mr. Rainwater that those documents would not be provided,” Purpera said.

“We also tried to get specifics of the proposal but I received a letter from Mr. Rainwater saying those would not be provided under exceptions. My office cannot do its job if we have scope limitations,” he said.

The proposal to which he alluded was the proposal submitted by Goldman Sachs to conduct a financial assessment of OGB and to market the agency for a buyer, according to the RFP. The Chaff contract was a $49,999.99 contract with Chaffe and Associates of New Orleans to conduct an interim assessment. The contract amount was one cent less than the amount that would have required concurrence by the Office of Contractual Review.

Rainwater started his testimony by comparing Louisiana to other states, zeroing in on the staff sizes of the other states as compared to OGB’s 300 employees.

At times appearing to talk down to committee members and once even admonishing committee Chairman Sen. D.A. “Butch” Gautreaux (D-Morgan City) to not interrupt while he was speaking, Rainwater said the $500 million surplus “is not for sale. It will not be diverted for any other use other than to pay claims.”

What he did not say on Monday but did say a week ago was that while the surplus would indeed be used to pay claims, it would no longer be OGB surplus funds paying the claims because the surplus would go over to the buyer who would use the fund to pay claims.

It was only a couple of weeks ago that Rainwater said the OGB $500 million reserves are an attractive selling point because the private company that ultimately purchases the agency would not have to dip into its own capital to pay claims. His own office’s press release of April 26 describing his appearance before the Retirement Committee repeatedly alluded to his testimony on the “potential sale and privatization of the state’s Office of Group Benefits” and of the procurement of a financial advisor “to help the state evaluate a potential sale of OGB….”

On Monday, however, a casual observer would have had difficulty in believing Rainwater was talking about the same proposal. Suddenly, it turns out that OGB is not for sale after all, that the RFP will instead be for a third party administrator of the state’s PPO (Preferred Provider Organization).

“At the end of the day,” he told the committee, “we will still have the Office of Group Benefits with 149 employees.”

“I’m not getting answers to my questions here,” Gautreaux said.

“You are getting answers,” Rainwater shot back.

Gautreaux said if the agency is privatized, “There will have to be rate increases and/or benefit reductions. There’s no way to avoid that with a private company trying to turn a profit.”

Division of Administration (DOA) Chief of Staff Dirk Thibodeaux, who had earlier promised the committee that a new RFP would be completed by week’s end, said Gautreaux was incorrect. “The legislature will have to approve any contract” for a third party administrator, he said, so lawmakers would have the opportunity to examine the rate structure.

Rainwater said there would be a five-year contract with a third party administrator. “At the end of the five years, we’ll take a look at it.”

“What’s going on here?” Gautreaux demanded. “Last week we were talking about selling OGB and now we’re talking about a contract with a third party administrator. You three (Rainwater, Thibodeaux, and OGB newly-appointed CEO Scott Kipper) may know what you’re talking about but the rest of us surely don’t.”

Rep. Hollis Downs (R-Ruston), sitting in as a guest for the second week in a row, said, “The state’s HMO is self-insured but administered by a third party, in this case, Blue Cross/Blue Shield, am I correct?”

“That’s correct,” Rainwater said.

“The state’s PPO is now self-insured and self-administered with the state paying all claims but you’re proposing that it become self-insured but administered by a third party?”

“Yes, sir.”

“And my understanding is you may combine both the HMO and PPO into one, am I correct again?”

“Yes, we could conceivably bundle the two for greater efficiency.”

“So, you’re just selling a block of business and the state would continue to have oversight?” Downs asked.

“That’s correct,” Rainwater said.

Following Rainwater’s departure from the committee room, Travis McIlwain, director of the General Government Section of the Legislative Fiscal Office spoke briefly on efforts by his office to analyze the administration’s proposal.

“Frankly, we have nothing in hand that would allow us to analyze this proposal,” he said. “Until today, we have heard only that the administration wants to sell OGB and now, Mr. Rainwater says it’s not for sale but is for lease to a third party administrator. I’m as confused as you, Mr. Chairman,” he said to Gautreaux.

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Commissioner of Administration Paul Rainwater told the Senate Retirement Committee at least half-a-dozen times last week that Louisiana was “one of only two states” to run a completely self-funded Preferred Provider Organization (PPO) that pays claims exclusively from premiums paid in by members who are state employees or retirees.

Rainwater also said the elimination of 149 jobs that would occur if the Office of Group Benefits (OGB) is privatized would mean a savings of about $10 million to the state.

Both comments bear closer scrutiny.

Yes, Louisiana is indeed “one of only two states” to have a fully-funded PPO. Utah is the other.

But what Rainwater failed to say was that virtually all states self-fund at least one employee health care plan. So says the National Association of State Personnel Executives (NASPE) in its July 2010 white paper on the “Challenges and Current Practices in State Employee Healthcare.”

Researched and written by Katie Meyer, Colleen Schlect, and Betta Sherman of the University of Chicago, the publication also directly contradicted claims by Rainwater (and Jindal), that privatization would be more cost efficient than the PPO plan presently being run by OGB.

Quoting “Combined Public Employee Health Benefit Programs,” a March 2010 health care containment and efficiencies brief for the National Conference of State Legislators, the NASPE publication said self-funded plans “can typically save between five and six percent in administrative costs relative to fully-insured plans.”

Rainwater has insisted that the state’s PPO which now operates at a 3.5 percent administrative cost—not paid by the state’s General Fund, but out of premiums collected from members—could be improved upon by a private company even though he admitted in last Tuesday’s committee hearing that private companies generally experience administrative costs of 10 to 15 percent and some even as high as 20 percent.

Several members of the Retirement Committee, including Chairman D.A. “Butch” Gautreaux (D-Morgan City) had some difficulty with the math in Rainwater’s claim.

The “other” of the two states that presently have fully-funded PPOs is Utah and that state’s program has administrative costs of about 4 percent, according to agency Director Jeff Jensen.

Rainwater also did not mention that other states are moving in the direction of self-funded PPOs—a contra-flow, as it were, to the direction Jindal and Rainwater are attempting to force the state health benefits program.

So, what is it that Jindal and Rainwater know that other states do not? Or, rather, what is it the other states know that this administration refuses to acknowledge?

Here’s what some state administrators have to say about self-funded programs—programs like Louisiana’s that Jindal is trying so desperately to sell:

“In return for assuming risk, we get rewarded from favorable experienced, said Frank Johnson, Executive Director of Employee Health & Benefits for the State of Main. “Being self-funded allows us greater flexibility in terms of benefit design and collaborating with providers in partnerships.”

Debbie Cragun, Human Resource Administrative Director for the State of Utah, says, “You are potentially looking at hundreds of thousands, if not millions saved by going self-funded from fully insured.

Anne Timmons, Director, Employee Benefit Division for the State of Maryland, said cost trends have been below the national average and self-funding has been a major benefit. “If we were fully insured, our costs would be significantly higher,” she said.

Paula Fankhauser, Employee Benefits Administrator for the State of Nebraska, said her state’s plan is sufficient self-funded now that that was not always the case. When it first transitioned to self-funding, it did so with sufficient financial resources. “The state was literally waiting for employees to pay their premiums so we could pay their claims,” she said. A major legislative overhaul of the program rectified those problems and Nebraska now boasts a positive account balance that can cover all claims under virtually any circumstance, she said.

Doug Farmer, Deputy Director of the Kansas Health Policy Authority said that state re-evaluates its program on an annual basis. “Every time we re-examine it, we come to the same conclusion,” he said. “When you have the resources to manage your own pool the size of a state, it is a benefit to be self-insured.”

The NASPE study also said that among self-funded states, there is generally a higher level of satisfaction with current funding practices and claims payment. And most state officials seem to agree that self-funding health plans affords greater flexibility in terms of design and administrative cost-savings.

For example, self-funding has helped states implement wellness programs. “Being self-funded provides an incentive to implement wellness programs, since we pay the bills while someone else does the implementation and day-to-day management of the program,” said Daniel Hackler, Director of the Indiana State Personnel Department.

As for the elimination of those 149 jobs creating a $10 million savings to the state, Rainwater also forgot, or neglected to mention that those 149 salaries do not come out of the state’s General Fund. They are paid from the premiums paid by state employees and is part of the agency’s 3.5 percent administrative costs.

And any OGB surplus, by law, “shall not be used, loaned, or borrowed by the state for cash flow purposes or any other purpose inconsistent with the purposes of or the proper administration of the Office of Group Benefits.”

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