Commentary

Anne Judson: Comparing teacher health care plans

Editor’s note: This commentary is by Anne Judson, of Burlington, who is Ward 4 commissioner on the Burlington School Board.

One of the outstanding negotiation issues still facing the Burlington School Board and teachers union for the fiscal year 2018 contract is health care coverage.

For decades, Burlington teachers’ health insurance benefits were purchased through the self-funded insurance pool Vermont Education Health Initiative, or VEHI. The VEHI board of directors and management staff are made up of school district and Vermont-NEA representatives. Presently, over 95 percent of Burlington teachers are on the 23-year-old VEHI-sponsored plan called the Vermont Health Partnership.

As a result of the 2010 Affordable Care Act, on Jan. 1, each teacher will select from one of four new plans offered through VEHI for their health insurance coverage: Platinum, Gold, Gold Consumer-Driven Health Plan, or Silver Consumer-Driven Health Plan. All four plans were designed and approved by the labor and management representatives on the VEHI board of directors. VEHI made sure each new plan would provide high-quality benefits to school employees, while reducing the cost of premiums. Premiums on the new plans are lower due to design tradeoffs between premium costs and out-of-pocket costs typically found in most modern health plans. Premiums are lowered, but out-of-pocket costs are increased, as a means to incentivize individuals to economize on health care expenditures.

The board’s proposals ensure that teachers do not pay more for health care under the new plans than under the old plans and reflect the view that any health care savings should be used to help fund teacher salary increases and other district needs.

 

Below, we provide some information that compares the old and new plans.

• Premiums for the new plans are approximately 30 percent less costly on average than the old VHP.

• The new plans offer the same BlueCross/BlueShield of Vermont state and national provider network as before, along with an expanded international network.

• There is no change in medical service coverage. All medical services covered under the VHP plan will also be covered under the four new plans.

• The new plans will have the same prescription drug formulary as the VHP with two minor exclusions approved by VT-NEA representatives on the VEHI board: sexual dysfunction and infertility drugs. This change is consistent with the Vermont Health Connect formulary.

• The new plan options will not require referrals to see a specialist and, as with the VHP, pre-authorization will continue to be required for certain procedures like MRIs.

The board’s overarching goal in developing its health care proposal was to ensure teachers continue to enjoy high quality affordable health care insurance. The board’s health care proposal to the Burlington Education Association in large part parallels the benchmarks in the recent teacher health care compromise just passed by the Legislature, called Act 85. This legislation set a premium cost contribution target of 20 percent for teachers, along with requiring them to cover $400 per covered life of out-of-pocket costs. School districts will be assessed a financial penalty if their negotiated plan does not at minimum conform to the state benchmarks. The union’s position is that the teacher contribution remain at 17 percent of the premium cost.

Provided teachers pick up some of the initial out-of-pocket costs as they presently do with the VHP (about $400 on average, according to VEHI), the board has proposed to contribute between $400 to $1,600 depending on household coverage levels into a health reimbursement account to significantly limit additional financial risk to teachers.

The board’s proposals ensure that teachers do not pay more for health care under the new plans than under the old plans and reflect the view that any health care savings should be used to help fund teacher salary increases and other district needs.


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  • Tory Rhodin

    How are medications to treat infertility a “minor” exclusion from the formulary? Infertility affects 15 percent of the population (although many people never seek treatment due to the expense where it isn’t covered by insurance.) Having children — for people who want to be parents — is a pretty fundamental life activity.

    • Matt Young

      Do most Vermonters (the taxpayers paying the bill) have this in their plans?

      • Tory Rhodin

        I think you’d have to look at the individual plans. There are some states (Massachusetts and I think New York, and some others, not Vermont) that require that *all* insurance plans cover infertility *treatment* (ie drugs and everything else involved.) What this article says will be dropped is coverage for the *medications* (and what I’m taking issue with is calling this “minor” — for the 15 percent of the population directly affected, this is not “minor.”) When I worked at the fertility clinic at DHMC, it was common for insurance plans to cover infertility medications, although many didn’t cover treatment (thus putting it out of the reach of many families who desperately wanted to have children.) More to the point, I repeatedly saw people leave jobs at employers that didn’t offer this coverage and take their skills to employers that did.

  • Paul Richards

    If GM employees want to band together, hold a gun to management’s head and get all they can that is one thing. None of us are bound to buying a GM product and thus not forced to pay for whatever it costs GM for labor to build their products. It’s quite a different story with public sector monopoly unions. There we are forced to pay for whatever largess there is after having virtually no say in the matter. We are forced to provide pay and benefits for others regardless of how much we must struggle to provide the basics for our own families. Enter the political pay to play aspect of it between the democrats and the unions and the importance of teaching our children and it’s all wrong. Time to break up this corrupt monopoly and make public sector unions illegal once again. They should have never been allowed legal status.

    • Susanna Rodani

      Paul,
      I agree with you 100%, however I don’t see where you offer an alternative solution that will support a successful outcome, keeping in mind that total rejection and anarchy are not solutions.
      Would you consider equal health insurance coverage for all citizens including “All” government employees, teachers, public employees, etc.
      That would include our Federal and State Reps. and Senators,
      all treated the same as you or me.
      Not for profit health coverage for all modeled on Medicare. It works so why not expand it?
      Keep fees low by restructuring the way medical schools get paid for turning out doctors, and pay doctors well but not more than POTUS.
      Tough fixes take real guts.
      Write letters to your lawmakers.