MEDICAL ECONOMICS
Cost control State employee health plan sparks debate
BY AMY LYNN SORREL A September report on the sustain- ability of the health care benefits plan for half-a-million state workers and retirees is expected to set the stage for the upcom- ing legislative session and the larger debates over how to keep health care costs under control. Facing an ongoing budget crunch, the legislature under House Bill 1 last session directed the state Employees Retire- ment System (ERS) to study the long-term viability of its health in- surance benefits program for the state’s workforce. On top of a $198 million reserve, ERS plans to ask the legislature for another $382 million to maintain the current level of in- surance benefits. Following a year of research in- volving input from a host of interest- ed parties including the Texas Medi- cal Association, ERS reported back on Sept. 4 on a breadth of ideas on how to better manage the system’s health care costs. The 200-page re- port included everything from alter- native payment and health care de- livery models like accountable care organizations (ACOs) and medical homes, to expanding allied health professionals’ scope of practice, to increasing patient responsibility. To read the report, log on to
www.ers
.state.tx.us/Events/Forums/. Many of those ideas could require legislative changes. Some could spark agreement, while others stir the pot. But wherever the legislature leads, because ERS’ health benefits plan covers 511,000 state workers, their fami- lies, and retirees, and contributes roughly $2 billion annually in health expenditures, the outcome will have no small impact on physicians and those patients. A Legislative Budget Board spokesperson says the report is one of several resources budget writers will analyze when formulating its recommendations to the legislature, set to con- vene Jan. 8.
Physicians agree they have a part to play in keeping health
care costs down. But they also raise concerns that dollars too often come ahead of patients’ best interests. “There is little disagreement the status quo needs to change,”
“The idea that you can put
said Tyler anesthesiologist Asa Lockhart, MD, chair of TMA’s Ad Hoc Committee on Accountable Care Organizations (ACOs). What has not changed, he says, is physicians’ primary re- sponsibility to advocate for their patients. “Our new job is to discern the best use of our limited health care resources. It’s going to require true change, and doctors have to decide if we are going to lead the change or react to it.”
physicians on a salary and that will cure all of the ills of the
world is overly simplistic.”
TMA has no stance on any par- ticular benefit or contribution struc- ture for the state employee health coverage program. But with a quar- ter of Texans uninsured, whatever policies the state implements, “we don’t want to see them compound the problem,” said Lee Spangler, JD, TMA’s vice president of medical economics. The report says few state em- ployees would be able to afford the same coverage they receive through ERS’ group benefits plan on their own. Seventy-five per- cent of full-time state employees enrolled in the program earn less than $48,000 a year. Only 12 per-
cent make more than $60,000 a year, and the average retiree earns a pension of less than $20,000 a year. The study does not include specific recommendations, but instead “reinforces that we are going to look at all the options in the marketplace in determining whether or not they would be of value to our members. It would be inappropriate for us to exclude something that is being discussed in the market- place just because it might be controversial,” said Rob Kukla, who oversees contract management at ERS as the agency’s director of benefit contracts.
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