Health Benefits

1
Health Benefits

• Whats in our contract?
• Premium portion (currently the state pays 80
  and workers pay 20)
• Health benefits cost nearly 60 billion
• Health benefit costs reduce wage increases

2
Everything else about health benefits is not
discussed in our contract including

• Our premium amount
• What our co-pays will be
• What procedures will be covered
• What health providers we can use
• The cost of providing health care, doctors,
  hospitals, prescriptions, lab, X-rays, etc.
• Whats wrong with this picture?

3
How Things Work Now

• All State employees are mandated by Government
  Code to participate in CalPERS
• CalPERS Board sets policy, including
• Choosing health care plans
• Negotiating with insurance companies HMOs on
  health care for all participants
• Local agency employees have voluntary
  participation
• School employees have voluntary participation

4
CalPERS Staff Deals Directly with Insurance
companies and HMOs

• Behind closed doors (Jan-May)
• Develop overall plan design
• Set rates for new plans
• Design co-pays for plans
• In open meeting
• Recommendations were made to CalPERS Health
  Benefits Committee in May and June.
• Full CalPERS Board takes action on Health
  Committee recommendations in May and June.

5
What We Know and Dont Know

• What We Know
• The total premiums for current plans offered by
  CalPERS and what those plans cover

• What We Dont Know
• Claim data or other components that make up our
  premiums
• How hard CalPERS is negotiating with the
  insurance companies
• Whether there is real competition in bidding for
  our business

6
Rates for plans compared to CalPERS

• Kaiser North

7

• Think About These Questions
• Where does that leave us in bargaining? What
  can we do about it?What do we need to do better
  in bargaining our health benefits?

8
What Do We Want?

• We want access to information about how our
  members use their health plans
• We want to bargain about all healthcare issues,
  including plan design, co-pays, etc.
• We want to have an impact on the upcoming
  decisions being made about our healthcare plan
• We want real competition between insurance
  companies and HMOs for our business

9
Some Solutions

• Get access to full and complete information
• Increase competition among providers at CalPERS
• Directly negotiate with healthcare providers
• This requires
• Agreement from CalPERS
• Statutory changes that the Legislature would have
  to make

10
What Were Doing

• Demanded full and complete information needed to
  effectively negotiate our benefits.
• Sent thousands of emails and letters, and
  delivered petitions to CalPERS board members
  demanding that premiums be held down, no increase
  in co-pay and no reduction in coverage.
• Testified in March and April demanding full
  disclosure and no cost shifting to employees.

11
CalPERS Response to Local 1000

• PPO plansPERS Choice and Carewill have no
  premium increases or plan design changes.
• PERS select premiums reduced by 3 percent with no
  plan design changes.
• CalPERS agrees to disclose most of the
  information Local 1000 has demanded.

12
What We Still Need to Do

• Keep the pressure on so that CalPERS HMO
  plansBlue Shield Kaisermirror the PPO plans
  for 2009.
• Continue to pressure CalPERS to provide all the
  information requested by Local 1000.

13
Discussion

• What do we need to do to educate and mobilize
  our members around this issue?