For the first time, the most popular plan for covering people through the Oregon Educators Benefit Board will be a high-deductible health insurance plan.
For the 2014-2015 plan year, about 27,000 Oregon lives will be covered under Moda Medical Plan “H,” which pairs the thinnest Moda Health plan with a tax-deductible health savings account that consumers are going to need to pay for higher out-of-pocket costs.
Last year, the plan with the most enrollment was Moda Medical Plan “C,” which is a more traditional health plan that relies on premiums for a relatively large share of healthcare expenses. The popularity of that plan fell from 30,000 to 25,000 covered lives for people who participate in the Oregon Educators Benefit Board. Not including family members, this plan was still the most popular, with 10,300 educators versus 9,900 for the high-deductible plan.
The third-most popular plan was Kaiser Permanente’s standard HMO plan, which netted nearly 20,000 members, spouses and dependents, down about 1,100 from the year before. The fourth most popular option, at 15,000 lives, was a high-deductible Moda Health Plan that comes without a health savings account. There were 15,800 individual OEBB employees who chose one of the two Moda high-deductible plans.
The transition likely results from increased pressure for teachers to share in healthcare costs as Oregon school districts whittle away at the benefit because of increased costs, which, at least in the case of OEBB, continue to grow at a rate of two to three times that of inflation.
Kaiser Permanente raised its rates for OEBB members by 6 percent and Moda Health increased the premium price for its health plans a whopping 9 percent, although some OEBB members were able to reduce this hike to 1 percent by signing up with Moda’s coordinated care models, Synergy (available in the Willamette Valley along with Jackson and Josephine counties) or Summit (available in Eastern Oregon).
As OEBB Board Member Nancy MacMorris-Adix noted at a different point in Tuesday’s monthly meeting, the past five years have not been easy on teachers, with layoffs of their colleagues and volatile budgets limiting educational opportunities. Diminished health benefits add an extra layer to that malaise.
The shift to catastrophic plans set off alarm bells for board member Dave Fiore, who represents the state teacher’s union, the Oregon Education Association.
“My fear is that we‘re pushing people and squeezing them into these high-deductible plans. These migrations are beginning to scare me,” Fiore said. “I cringe every time I hear someone say they may have to go bankrupt to pay for healthcare.”
The specter of bankruptcy for teachers may be a little remote, however. As OEBB Deputy Administrator Denise Hall confirmed for The Lund Report, the Affordable Care Act places caps on the maximum amount someone can expect to pay each year for healthcare, and OEBB sets those thresholds lower -- $5,000 for a single person and $10,000 per family. There are no limits on the amount of money OEBB members have to pay for drug costs until the 2015-2016 plan year.
A growing number of people have been saving on up-front costs by declining the additional optical and dental benefits. A full 20 percent of OEBB members turned down the optical benefit and 13 percent rejected dental care, which were both record numbers compared to previous years. To discourage this practice, OEBB limits the coverage for people who skip a year and then come back. They can’t, for example, get major dental work until they’ve been covered for a year.
The OEBB enrollments include a handful of local government employees who work outside education, including Josephine and Klamath county employees, the Coquille Valley Hospital in Coos County and workers at the Oak Lodge Sanitary District in rural Clackamas County.
Employees of these governmental entities were able to enter OEBB for their health insurance needs due to House Bill 2279, which was passed in the 2013 legislative session with support from the American Federal, State, County and Municipal Employees Union.
Transgender Care
In better news, OEBB has followed the Health Evidence Review Commission’s lead to cover the special cost of care for people whose gender identity does not conform to their anatomical sex. The medical treatment includes psychological counseling and cross-sex hormone therapy along with gender reassignment surgery.
The transgender healthcare policy takes effect Jan. 1, and does not change the premium cost for this OEBB plan year but may be a point of negotiation next year.
Hall said teachers who want to undergo hormone therapy or a sex change would have to wait a year to switch from a high-deductible plan to a high-premium plan to keep down costs to the employee.
Chris can be reached at [email protected]
Correction: The original article mistook covered lives for the number of employees who signed up for health plans. While more people are now covered by a high-deductible plan than ever before, this includes family members. The most popular single choice for individual employees remained a richer plan, although the combined total of two Moda Health catastrophic plans had more employee sign-ups than the traditional plan.
