SPRINGFIELD, Ill. (WCIA) — As thousands of retired state workers breathe a sigh of relief this week knowing a pending contract will allow them continued access to their Carle Health doctors in the new year, state lawmakers ease up on the pedal to force legislation through in the next month aimed at ensuring retirees don’t have to fear choosing between losing their doctors or losing their state-sponsored health benefits again in the future.
The bills were filed by Rep. Mike Marron (R-Fithian) and Sen. Chapin Rose (R-Mahomet) on the eve of the first day of open enrollment for roughly 140,000 state retirees and just hours before Carle Health and Aetna — the CVS-owned company contracted to provide the new, sole health plan option for retirees — announced an agreement on financial terms.
Both state legislators represent areas where Carle Health is the major provider. Its five-year deal with Aetna to keep seeing roughly 11,000 affected retirees solved the most immediate issue.
At least dozens of retirees remain vocal about a desire for more than one plan option to choose from in the years to come, and they would like input when the Illinois Department of Central Management Services (CMS) is in the process of choosing those plans. Mandating either one of those requests would require legislation.
“But the point of this is, people deserve choice,” Sen. Rose said in an interview Wednesday summarizing the purpose of the bill he filed Monday (Senate Bill 4236).
“What happened here, where you have a package that works for some people, but not all people isn’t right.”
Rep. Marron was first to file legislation (House Bill 5831) Monday to be debated during the Illinois General Assembly’s annual 6-day veto session beginning Nov. 15. It would mandate that CMS offer at least two health insurance plans for retirees to choose from.
“Whatever makes sense to expand choice,” he agreed with Rose. “So that the next time this comes up ten years from now, we don’t go through the same heartache that happened this time around.”
If passed the way the legislation is written, CMS would, effective immediately, have a (currently unspecified) timeframe to provide at least one other plan option.
“It doesn’t go into many specifics other than that, at this point,” Marron said. “This is the first form. I’m sure it’ll undergo changes and amendments before we see a final product.”
Legislation filed hours later by Rose would also go into effect immediately upon passage. Instead of requiring CMS to contract more options, it would offer retirees a monthly voucher to cover the cost of any Medicare Advantage plan they choose from the private marketplace.
“All we want to do is give retirees choice,” he reiterated. “Let them pick whatever plan is best for them.”
Rose hasn’t yet firmed up what pool of money would be allocated to cover the cost of the vouchers, considering Aetna signed a contract requiring $0 in premiums from the state for at least five years and according to CMS deputy director of communications Cathy Kwiatkowski, all enrollees “will see a significant decrease in their contribution amount” as well.
The financial incentive is in stark contrast with the previous decade when roughly $3 billion dollars from the Health Insurance Reserve Fund (HIRF) was spent each year on a handful of plans.
Rose agrees it would theoretically cost the state more to let retirees pick individualized options, but he contested that anything less than some form of options would be a violation of the Constitution of the State of Illinois.
“That was the agreement that was made. And the Illinois Supreme Court would say, 7-0, Kanerva [v. Weems], you can’t diminish healthcare benefits. So, you know, you’re kind of stuck on that one,” he said referencing a 2014 state Supreme Court Opinion that reversed a circuit court decision that allowed the state to alter how much it should pay to subsidize health insurance for its retired employees.
The Supreme Court’s ruling was based on language in the state constitution that states the benefits of members in “any pension or retirement system…shall not be diminished or impaired.”
“Certainly I’m not a constitutional attorney, so I’m somewhat limited. But I think that that’s something that’s worth looking at,” Marron said last Tuesday when WCIA 3 asked if the state cutting plan options from two (or in some cases three) down to one is a diminishing of benefits under the State Constitution.
“I would absolutely agree with that. I think that is a diminishment of benefits,” Cindy Cunningham, who is running against Marron as the Democratic candidate for the District 104 State House seat, said in an interview outside of the Vermilion County Democrat Party headquarters in Danville Wednesday.
“I met a lady at a door. She has multiple sclerosis. All of her healthcare has been through Carle, she doesn’t have relationships with physicians outside of the Carle network. And if she had lost benefits to do business with Carle, she would have lost a significant portion of her ability to care for her health,” Cunningham continued.
“And that is clearly a diminishment of benefits for this particular retiree. She’s a retired teacher.”
The only remedy? “Well, you would have to sue,” Cunningham said. “The contractees would have to sue the state of Illinois. But we can avoid that,” she added in support of a legislative solution that includes but goes beyond expanding options.
John Marlin is president of the University of Illinois Urbana-Champaign chapter of the State Universities Annuitants Association. He’s also a retiree and with Carle Health and Aetna in agreement, he’s enrolling again.
“For the last 30 years, I’ve just pushed the button that says, ‘Keep the existing plan,'” he said, explaining there was comfort for retirees in having a couple (at most a few) state-sponsored plans that assured access to dental and vision to choose from, rather than researching dozens of options in the private-sphere for the first time.
Marlin thanked the lawmakers for their support. He agreed with the need for a legislative response and for options, but he hoped the pending contract between Aetna and Carle means the passage of new laws could be postponed some to allow for additional research.
“This is extremely complicated when you look at all the options and nuances. So having time to look into what CMS did to make its unfortunate decision, as well as evaluate the options, taking enough time for some public hearings. That’s a great thing,” he said in an interview with WCIA 3 Wednesday.
Rose said, particularly given the pending contract, he doesn’t plan to push the bill through during veto session.
“The idea was to force the conversation in veto session so that we could force [CMS] to the table,” he said. “Bring them to a hearing, figure out what to do, and then get a better bill.”
“We’ve called CMS for months now. Nothing right? Nary a peep. So, we need information to do bills.”
CMS is scheduled to testify in front of lawmakers on the Commission on Government Forecasting and Accountability (COGFA) on Nov. 15.
“I think this definitely does change the timeline,” Marron said, also in reference to the pending contract between Carle Health and Aetna. “Because it gives us a little more leeway, a little more of a timeframe to make sure that we put a good solid legislative product up for a vote.”
Passing legislation aimed at protecting retiree benefits should be attainable by the end of the spring session, Rose said.
“But I don’t want to go beyond the spring session,” he added. “Because otherwise, it’ll just go on and on, and then in five years, we’ll be here and this whole thing will happen again.”
“I think that’s a fantastic idea,” Cunningham said when asked if she, like her opponent and Rose, believes retirees are entitled to more than one health plan option.
“Choice is always a good idea, and competition is always a good idea. It just brings out the best, and people competing for subscribers, it makes the whole healthcare system better.”
There “needs to be” a legislative response, according to Cunningham, but that response “needs to go further than just offering a choice of providers or choice of insurance companies.”
The candidate pointed to her career which she said is centered around a business she created, Cobalt Creek Consulting, “to assist others in the creation and running of businesses that provide home and community based services to seniors,” according to Cunningham’s campaign website.
“So I have been dealing with health insurance issues for the last 20 years,” she said. “There needs to be some legislation around how an insurance company builds their network.”
“I think we just need to amend the contracts that the state has with these insurance companies. And so one of the things that the insurance companies would need to prove is that they contract with all willing and qualified providers, rather than just providing an adequate network,” she suggested.
“And adequate is not well defined in the rules.”
In the list of providers Aetna submitted to CMS in its application for the state-sponsored Medicare Advantage PPO plan, the company included a network of 550+ Carle doctors and Carle Foundation Hospital in Urbana. Both were accurately marked as out-of-network, but in the next column on the spreadsheet reporters obtained, the insurer claimed Carle was willing to accept the plan. A month later, we learned that wasn’t the case without a contract, and negotiations ensued in the final weeks and days before open enrollment, meaning decision time for thousands of seniors.
Rose said the state agency should’ve verified Aetna’s doctor network when asked if additional legislation should be considered to hold the insurers accountable for accurately depicting the network they can give their members access to and/or to hold CMS accountable for verifying the networks submitted in the application process.
Well, first of all, it kind of depends on what happens at this hearing,” he said.
“Quite frankly, again, I lay this at the foot of the Pritzker administration…Where’s the accountability for CMS for bungling this in the first place? Now, they’re gonna have a hearing in a couple of weeks, and this will be an issue. I promise you.”
Marron also expects adjustments to his bill and is open to additional legislation.
“Sure. I think that’s part of the motivation for the hearings,” he said when asked if bill discussions include holding health insurers and providers accountable to fair negotiation, or even requiring contracts between a state-sponsored plan and an essential provider, like Carle Health.
“So if that means tightening regulations in a certain area that would prevent something like this from happening, then absolutely,” he continued.
“The process would be to gain as much information as we can to make sure that this doesn’t happen, that a quality product is put on the table for retirees, and we can do without this uncertainty.”
Testimony from CMS on Nov. 15 is scheduled for 9 a.m., and including other annual reports, is expected to last 2-3 hours.
Marron said Wednesday that he will also be introducing a resolution for a separate House committee hearing during veto session, likely in the Government Administration Committee. The plan is to bring Aetna and Carle Health to the table alongside CMS and allow time for retiree testimony as well.
“I’ve been talking with constituents, and I’ve gotten several other really good ideas,” Marron shared.
“They would like to have input in the process when CMS actually makes these decisions, and then doing what we can to also make the process more transparent. So I think I’m open to those changes to amending the bill.”