OEBB Enrollment Moving Toward Cheaper Health Plans

State educators and others insured through the Oregon Educators Benefit Board have been migrating heavily toward catastrophic and coordinated care health plans offered by Moda Health. OEBB has encouraged this movement through lower premiums and copayments. Meanwhile, OEBB director James Raussen was suspended with pay last month.

The number of people who signed up for Moda Health’s coordinated care options through the Oregon Educators Benefit Board more than doubled this school year to nearly 38,000, up from 16,000 in 2015-2016.

Meanwhile, the number of people enrolled in OEBB’s health plan options from Kaiser Permanente rose from about 26,000 to 27,000.

The OEBB open enrollment period is during August and September, designed to coordinate with the new school year, even though OEBB now also offers health insurance to a handful of local government employees. The total enrollment was actually down from 132,000 to 129,000, but chief operating officer Heidi Williams said some of these people may have neglected to sign up during open enrollment and would be processed through the end of this month.

The total for the Moda Summit plan -- designed for the high desert of Eastern Oregon -- rose from 2,200 to 3,600 while the Moda Synergy plan, which directs patient care with the help of Salem Health and Oregon Health & Science University clinics, jumped from 14,000 to 34,000.

Moda offers OEBB lower premiums and out-of-pocket costs to members if they choose Synergy and Summit over the statewide Moda plan; the precise share of the costs that a teacher or other OEBB member pays is set by their school district or local jurisdiction. Moda can offer better rates for these plans by limiting networks to providers who agree to its primary care home model and share in the risks and rewards of keeping patients healthy.

For the first time, more than half of OEBB members also shifted away from comprehensive health plans and chose skimpier high-deductible plans as their share of the costs of traditional plans has increased.

While just 2 percent of members chose the Kaiser high-deductible plan, 26 percent chose a Moda high-deductible plan with a health-savings account while 24 percent chose a catastrophic plan without the account.

Only 4.8 percent chose the most comprehensive plan, although that was down from 5 percent last year. The richest plans are often chosen by high-level management employees who do not have to pay any portion of their premiums, while the most expensive plan is only available in Coos and Curry counties. The biggest shift was away from more moderately expensive plans, which fell from 36 percent of members to just under a quarter.

OEBB also made steady progress getting school districts to agree to a tiered-rate structure that sets different premium levels for families and individuals. This shift would help OEBB and school districts avoid the federal excise, or Cadillac tax, although Congress has delayed this punitive 40 percent tax until 2020, and may abandon it altogether.

The number of school districts with a tiered rate structure increased from 33 percent in 2008 to 43 percent in 2015 and up to 45 percent this year.

Director in Limbo

OEBB has been operating with Kathy Loretz as the acting director while James Raussen has been suspended with pay. Loretz is the director of the Public Employee Benefit Board and had been interim director until Raussen was hired last December.

Oregon Health Authority spokeswoman Susan Stigers would not comment on the Raussen situation, although The Oregonian reported that a Department of Justice investigation into Raussen’s activities is a personnel, and not a criminal matter.

Raussen previously came under security at the Chicago Comptroller’s office after the comptroller went to prison for bribery. Raussen was never implicated in any wrongdoing, but he did steer city of Chicago business to a company that supported his political campaigns when he served as an Ohio state representative from suburban Cincinnati.

A report cleared him of ethics violations and found the politically connected company had actually saved the city of Chicago money.

The Oregon Health Authority and OEBB board failed to rigorously vet Raussen and discovered the investigation into the comptroller’s office from The Lund Report.

Raussen’s absence comes at an inopportune time for OEBB, which has been set to embark on a redesign of its contract. The board already delayed a new contract last year until they could hire their new director.

Chris can be reached at [email protected]

Editor's Note: This article has been revised to note more specifically the financial advantages of different OEBB plans.

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