In a recent letter to members of the Maine Education Association, MEA Benefits Trust Executive Director Christine Burke said many aspects of the Affordable Care Act, also known as Obamacare, “may not make [teachers] happy.” These include “aspects” that will cause many active members and retirees to lose their current coverage.
Wrote Burke, “Time marches on! And with the passage of time, more aspects of the–Affordable Care Act (ACA), also known as Obamacare, roll out. While we have enjoyed many aspects of the ACA (being able to keep our adult children on until their 26th birthdays, removing restrictions on pre-existing conditions, and removing lifetime maximums, to name a few) in the ensuing months, we will see other aspects of the law implemented that may not make us happy.”
Burke goes on to disclose the policy details of their concern with Obamacare: “The Federal Department of Health and Human Services (DHHS) and the Maine Bureau of Insurance are requiring Anthem to remove all small groups (groups with less than 50 employees or full-time equivalents) from the MEABT and cover them under Anthem’s small group “pool” effective July 1, 2014. Per the new law, retirees are not included when Anthem calculates how many members are in a group. The MEA ad the MEABT Trustees and staff members are trying to fight this mandatory move, but we aren’t having much luck (yet).”
Translation: Teachers cannot keep the insurance plans they liked.
More from Burke: “The insurance product for the small groups will probably not be a plan comparable to the MEABT Standard Plan or the Choice Plus Plan, although we are trying to determine whether Anthem could offer our plans to these small groups. If we are able to offer them, however, the plan’s pricing would not be our pricing. Instead, the DHHS and the Bureau require that Anthem evaluate each individual within the goup pursuant to geography, age and tobacco-use status. The pricing will be based on those factors. The small group can then offer a composite rate by adding up all the individual rates, and dividing by the number of participants. Without creating a composite rate, schools would have several different rates for people within their district. With the composite rate, the district would have an easier time determining what its contribution will be, and an easier time administering the plan, but it would necessarily make some people subsidize others.”
Translation: Health insurance costs are going up thanks to Obamacare.
More from Burke: “The ACA also affects retirees covered by MEABT and retirees that are non-Medicare-eligible. As you may remember, retirees must be covered under the same plans as the active employees from the district they worked for at the time of their retirement. So, if a retiree is from one of these small districts that are now forced to leave and go to Anthem’s small group pool, the retirees from that district must go there as well. If they stay with the district, they will face the same pricing formula listed above. It is unclear yet whether they would still receive the State’s 45% contribution to their insurance premium, since State law says that they have to be with a ‘teachers’ group’ to receive the State contribution. We just don’t know whether the state will consider them as being with a ‘teachers’ group’ if they are part of a larger small group pool. We are trying to get a determination of that issue, and will inform you as soon as we know.”
Translation: We don’t really know what’s going to happen to retirees.
“However,” writes Burke, “if the retirees decide not to stay with the district and to go to the ACA “Exchange”, where they can purchase plans as individuals, they will definitely lose the State’s 45% premium contribution. In addition, they would have to choose plans with far fewer benefits. There would be a far higher out of pocket maximum ($6350.00 per year). While their income may qualify them for a federal subsidy toward their premium, they would not be part of a plan that offers the kind of coverage MEABT plan offers them. Nor would they have any of the plan enhancements that the MEABT plan offers.”
Translation: If you retirees think you’d be better off on the exchange, your wrong (and not because the Web site is busted).
Here’s the best part, again from Burke: “We are working with our Senate delegation and with the National Education Association to see if we can either change the law or get an exemption from this part of the ACA. We do not see the purpose behind this provision, and feel strongly that this was an error or oversight in the ACA that survived enactment only because the law did not get the full vetting it should have. However, if our endeavors are unsuccessful, the districts with fewer than 50 FTEs will be moved to Anthem’s small group pool in 2014, and groups with fewer than 100 FTEs will move in 2016. It is a dismal prospect and one that we feel would severely impact the active members and particularly the retirees.”
Translation: We’re trying to pull strings and get favorable treatment, because this part of Obamacare is unfair, and if we can’t, we’re screwed.
That the teachers’ union is now wary of Obamacare is ironic, of course, because the union is one the largest supporters of Democratic U.S. Reps. Chellie Pingree and Michael Michaud, who both voted for Obamacare.