Hearing reveals additional coverage gaps

SPRINGFIELD, Ill. (WCIA) — Top officials from the Illinois Department of Central Management Services (CMS) and Aetna insurance company were forced to answer to state lawmakers in the early hours of the opening day of veto session at the State Capitol Tuesday.

In the midst of pressing for an explanation as to why CMS cut health benefits for state retirees down to one new Aetna plan and how both parties planned to fill gaps in coverage, testimony to state senators and representatives on the Commission on Government Forecasting and Accountability (COGFA), led by co-chair Sen. Dave Koehler (D-Peoria), revealed a growing number of medical providers are telling retirees that they won’t accept their insurance come January.

One ‘size’ does not appear to fit all, lawmakers repeated about the Aetna plan that is meant to suit retirees living across vastly different regions of Illinois and those who live in other states as well. Meanwhile, two weeks remain in the open enrollment period for the TRAIL MAPD (Total Retiree Advantage Illinois Medicare Advantage Prescription Drug) program.

When repeatedly pressed, CMS acting director Anthony Pascente divulged that the state agency has no intention of adding plan options as a solution for the coming year.

“You mentioned we’ll talk about other options, but it seems like you’ve decided that the [Aetna Medicare Advantage] PPO is the only option. Correct?” Rep. C.D. Davidsmeyer (R-Jacksonville) asked.

“We believe the merits of the program will reveal itself in the coming months,” Pascente responded.

“The answer is yes. The PPO is the option,” Rep. Davidsmeyer concluded after some back and forth.

“What are we going to do to offer actual choice to these people who worked for the State of Illinois their entire lives? And by the way, the deal was free,” Sen. Chapin Rose (R-Mahomet) said angrily.

The state senator, whose constituents have been more heavily impacted by the expected loss of medical care, placed the onus on CMS.

Carle Health and Aetna reached a deal in the last two weeks to continue treating retirees after reporting from WCIA 3 revealed roughly 11,000 retirees were poised to lose access to more than 550 Carle doctors and Carle Foundation Hospital in Urbana.

“At what point in time did you know, CMS, that Carle hospital was not in this plan?” Sen. Rose asked frustratedly of the panel of three CMS officials.

“The funny thing about that was, at one time, you guys even told me that that wasn’t true despite Channel 3 having done an entire story.”

Testimony from a list of seven representatives from various organizations that advocate on behalf of retired state workers detailed additional facilities and providers that have said they will not accept the state-sponsored plan.

Notably, a retirement community known as the Villages in Florida, that took the previous United HealthCare plan, told Illinois retirees that “there is no way they will accept Aetna,” State Universities Annuitants Association executive director Linda Brookhart said.

“There are 135,000 people that live there. Many of them are from the state of Illinois, and many of them are teachers, but also state workers.”

Brookhart also revealed that, barring action, the University of Illinois hospital in Chicago won’t be an option for retirees for the duration of the state’s contract with the Aetna plan.

“Aetna is one of the worst partners in our management care portfolio,” Brookhart said reading from hospital testimony. “Their reimbursement is amongst the lowest of national payers.”

“I’m sure they will act with the same disregard for our retirees.”

We reported Monday that roughly 200 transplant patients are poised to lose a go-to center at Barnes-Jewish Hospital in January.

Bill Alagna, a retired state fire marshal, testified that he has been waiting his turn for eight years.

“I hate to see people in my position get thrown under the bus to make it more profitable for everybody involved,” he said.

Brittany Salinas, sitting in for Aetna’s vice president of group retiree solutions Rick Frommeyer, told lawmakers the company is “committed to providing, sort of, continuity of care and a smooth transition for those ‘onesie-twosies’ that may be caught in limbo,” apparently referring to at least hundreds of known affected retirees out of a total of roughly 140,000.

Roger Hampton, representing the Illinois Retired Teachers Association, told the committee that many of the association’s more than 40,000 members have not even received Aetna information packets expected in the mail by now, leaving room for a plethora of coverage questions still to come.

DeDe Raybuck, account vice president for United HealthCare, followed testimony from Aetna executives.

United HealthCare lost out to Aetna, losing the chance to keep the statewide PPO contract (which has previously been one plan among a handful of HMO options).

Aetna and United HealthCare both offered the state five years’ worth of $0 premiums. Scoring documents show United HealthCare scored lower on the technical portion of the evaluation, ultimately losing the contract by roughly 15 out of at least 1,500 points over things like quality of care and customer service. Ironically, U.S. Centers for Medicare & Medicaid Services’ annual star ratings place United HealthCare above Aetna Medicare.

“And that is based on quality of care,” Raybuck concluded.

She had one last message before yielding the microphone: “Can I just say one other thing? I’m sorry. Barnes is our network.”

Why not contract with both Aetna and United HealthCare? That was a suggestion from other retiree advocacy group representatives.

“I’m not sure we couldn’t have a second PPO [plan] that would cover a different part of the state better,” John Marlin, president of the University of Illinois Urbana-Champaign chapter of the State Universities Annuitants Association added.

“Is there any drill-down analysis on how this impacts different regions of the state?” Rep. Mike Marron (R-Fithian) asked CMS officials.

The answer, in sum, was, “No there is not.”

“I gave a better part of my life to the students of Illinois and so did all of our members at IRTA,” Hampton said. “I believe that it is not too much to ask that CMS give us a little heads up and involvement in changes that so dramatically impact our lives.”

“Transparency and accountability are needed,” board member Rich Wandling of the Eastern Illinois University chapter of the State Universities Annuitants Association said. “WCIA did great work getting information out, but we should not have to rely on WCIA.”

CMS and Aetna representatives both, by the end of the meeting, made a verbal commitment to work on restoring coverage for retirees still in limbo.

“Whether it’s enough or not, I will find out, but I finally got somebody to listen to me,” Alagna said in an interview after the meeting.

CMS also committed to working with legislators to improve the process of picking plans.

The state agency clarified, when pushed, that there are no rules or laws keeping it from adding options, even under the current contract with Aetna.

Lawmakers, particularly Sen. Rose and Rep. Marron, stood by their plans to propose legislation during spring session that would require options for retirees based on additional information gleaned Tuesday and in the coming months.