CoGFA hearing held on Health Alliance

Today, the Illinois Commission on Government Forecasting and Accountability met to hear an update on the group insurance and Medicare Advantage programs.  Over the last several weeks, I heard from thousands of you with concerns about Governor Quinn’s changes to the available provider network and his administration has put out very little information on these changes.  So the hearing today was an attempt to get some straight answers. While the hearing did yield new information, many questions remain.

First, if you are a Carle patient, you will be eligible through United Healthcare’s PPO to retain your Carle docs.  There will be no difference between “in-network” or “out-of-network” charges as regards the PPO – however, this will be different than the HMO rates.  For those outside of Carle who elect the PPO instead the HMO (where offered), we are told that you can go to any physician that accepts Medicare under the same system.  Additionally, Coventry HMO will be offered in several counties.  An HMO product will be available in about half the counties in Illinois.

For those currently in Health Alliance who intend to switch to the PPO – depending on your circumstance in life – you may enjoy a reduction in cost or see an increase.  This is individual specific and almost impossible to answer in general terms.

Second, your “co-insurance” under the PPO will be subject to an annual maximum “out of pocket.”  There was some concern under this system as to whether you would have to pay up-front for all services costs and then wait for reimbursement. I personally talked to Carle yesterday and they said that they would not make you pay up front and instead would bill United direct.  HOWEVER, the director of CMS could not guarantee that this would hold true for all physicians across the country – while many will, this is an individual medical practice decision on how to bill.

Finally, for those of you who have asked if you will receive credit towards your maximum annual “out of pocket” for expenses already incurred, all CMS would commit to was that it was “their intent to hold retirees harmless” when the switchover occurs.  How that is done, they would not say other than “they are working on it.”

Now for the shocking part of today’s hearing.  We learned that Health Alliance’s bid actually ranged from 24% – 124% LESS than the winning bidders!  Further, neither the Chief Procurement Officer, nor CMS ever scored Health Alliance’s bid to compare costs because they admitted today writing into the original bid request requirements that made it impossible for Health Alliance to win!

To recap: the Quinn administration, with the concurrence of the Chief Procurement Officer, included bid specifications that guaranteed Health Alliance could not win under any circumstances.  And now, three weeks later, we find out that had they been allowed to actually fairly bid, they would have been the cheapest bid!  

To say that the taxpayer’s left savings on the table is an understatement – “outrage” is more like it.  Had the administration not structured a bid so it was impossible for Health Alliance to win, none of the last three weeks of confusion, obfuscation, and nervousness by those with serious medical conditions would have been necessary.

Frankly, the administration’s ridiculous assertions about why they put these criteria into the bid specs in the first place were ludicrous on their face.  To that end, I believe that substantive committees of the House and Senate should be convened with full subpoena powers and place these same people under oath, in order to get to the bottom of this bidding process.

It is flat out wrong that people’s lives should be toyed with in such a cavalier fashion.  And as if that wasn’t morally wrong, the fact that additional savings were left on the table by the administration is a breach of the fiduciary duty the Governor owes the taxpayers of Illinois.

Here is a link to the News-Gazette story from this morning detailing the fact that Health Alliance was the low bidder.  Additionally, audio of my questions to the administration can be found here (p.1) and here (p.2).

Best Regards,

Chapin Rose
State Senator

Chapin Rose

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