Latest news with #StateHealthPlanBoardofTrustees
Yahoo
20-05-2025
- Health
- Yahoo
State Health Plan Trustees advance benefit changes with employees shouldering higher costs
The State Health Plan Board of Trustees has a $500 million deficit to close. As a result, new premium hikes are on the way for employees, retirees and their families to close the gap.(Stock photo by) State Treasurer Brad Briner has been sounding the alarm for months. Faced with a $507 million deficit, North Carolina's State Health Plan will require a combination of strategies to address the fiscal cliff and ensure the long-term care of the plan's nearly 750,000 teachers and state employees. On Tuesday, the State Health Plan's Board of Trustees gave its initial approval to a series of actions that would reorient the plan, incentivizing members to use 'bundled' participating providers or facilities. State employees and teachers would also be asked to do their part by paying higher health insurance premiums starting in 2026. 'We began this conversation in January around premium increases for the first time in eight years, a tack that nobody wanted to take,' said state Treasurer Brad Briner. 'But buried in the materials here, you'll see that what was going to be a $20 (monthly) premium increase at the lowest tier. It's now a $5 premium increase at the lowest tier.' Briner said significant time has been spent trying to insulate North Carolina's lowest compensated employees from increases as much as possible, while determining the highest and best use of the dollars that are available. Out-of-pocket maximums would not change substantially, he pledged. The State Health Plan is also taking steps towards eliminating all prior authorizations for independent primary care, another incentive for plan participants. Thomas Friedman, executive administrator of the State Health Plan, said state employees who are members of the plan can expect several changes in the months ahead. For starters, the names of the most common plans will change. The 70/30 plan will become the 'Standard PPO plan' with annual deductibles rising from $1,500 to $3,000 for individuals, and families seeing their deductibles rise from $4,500 to $9,000. The average monthly premium would jump from $25 per month to $40 per month and could be adjusted higher based on the employee's salary. The 80/20 plan will be known as the 'Plus PPO Plan' with annual deductibles rising from $1,250 to $1,500 for individuals, and from $3,250 for families under the current plan rising to $4,500. Those on the 80/20 plan would see their premiums jump from an average of $50 per month to $100. Higher income earners could see a monthly premium of $130. While the numbers may not be popular with state workers or teachers, trustee Dr. Brad Miller noted that on the private insurance market, individuals are paying an average premium of $119 a month, with families paying a premium of $532. What members pay for prescription drugs would also rise next year and in some cases substantially. Specialty medications (Tier 5) would increase from $350 under the current 70/30 plan to $600 under the new Standard plan. Friedman noted that manufacturer coupons exist for many high-end, specialty drugs, allowing patients to pay little or nothing at all. 'Why not have the manufacturers pay more if they're willing to do it?' Friedman offered. Coverage of the popular GLP-1 weight loss drugs remains 'under development,' but nutrition and weight loss coaching would be available to everyone. Moving forward, the State Health Plan is working to make it attractive to members – both financially and in terms of access – to engage with preferred providers. Tuesday's meeting of the Board of Trustees came as members of the state House advanced their own budget blueprint. Friedman said that both the House and Senate budget proposals have fully funded the requests of the State Health Plan at a 5% premium increase per year. 'Given everything going on in the state and how little the budget increased, we are a substantial portion of that, and we are very grateful that they listened.' Treasurer Briner also offered praise for the budget proposal emerging from the House. 'The House proposal fully funds the pension plan and increases funding to the State Health Plan to help in our effort to provide affordable, high-quality health care for state workers. Investments made in salary increases and cost-of-living bonuses will help ensure that the state can retain top talent.' But Tamika Walker Kelly, president of the North Carolina Association of Educators, said that the legislature should step up its funding, rather than ask school employees and state workers to shoulder higher health care costs. 'It's not only unfair, but it is unsustainable,' Walker-Kelly told the trustees. 'We are already facing a critical staffing shortage, more than 8,000 school positions were vacant at the start of this year and one-in-five teachers left the classroom over the past two years. If we increase the cost for those who stay, how will we fill the gaps and who will be there for our students?' Walker-Kelly said the decision is not simply about numbers on a spreadsheet; it is about the people who keep our schools and state services running. A vote by the board to set the premiums for 2026 is set for Mid-August. Open enrollment with the new 2026 rates will be October 13-31. Click here to view the full presentation to the State Health Plan Board of Trustees.
Yahoo
11-02-2025
- Business
- Yahoo
NC prepares to sock it to teachers and state employees yet again
The State Health Plan Board of Trustees has a $500 million deficit to close. As a result, new premium hikes are on the way for employees, retirees and their families to close the gap.(Stock photo by) In 2010, the year North Carolina Republicans won control of both houses of the state legislature, Site Selection Magazine — the self-described 'leading publication in corporate real estate, facility planning, location analysis and foreign direct investment' — ranked North Carolina as the nation's fourth 'most competitive state.' It was a familiar accolade. Throughout most of the previous decade, things like solid infrastructure, low-to-moderate tax rates, forward-looking state leaders, rapidly improving systems of K-12 and higher education, good public services and an agreeable environment had kept North Carolina near the top of numerous 'best for business' rankings. Unfortunately, you know what happened next. Upon winning power — a victory they quickly cemented through multiple episodes of extreme partisan and racial gerrymandering — GOP lawmakers commenced a war on all things public by repeatedly slashing taxes in a regressive fashion. The result: today, a decade-and-a-half later, most public structures and systems in our state have been reduced to pale shadows of their former selves. In 2009-10, state and local public spending was equal to 6.2% of the total state economy. This amount was actually down somewhat from the last few decades of the 20th Century — another period of rapid growth and progress in the state — when the figure was often close to 7%. By 2020-21, however, repeated tax cuts cut this important measure down to 4.3%. That's a decline of more than 30% in core public investments in just a decade. And while, by 2024, things had rebounded slightly to 4.9%, this number still reflects a massive hit to public structures and systems. Of course, the results of all this bloodletting are not hard to find. They can be readily seen in the massive job vacancy rates that plague so many places of public employment in our state — from public school classrooms to the institutions that serve people with mental and physical disabilities to prisons to highway road crews. All across our state, lousy pay that has failed to keep up with inflation has driven thousands of people who once happily accepted stable, middle-class lives as career public servants, to abandon government employment in search of living incomes. In North Carolina, the public sector-private sector pay gap — that is the gap between what someone with the education it takes to be a public school teacher can earn in the public and private sectors — is among the nation's largest. Even states like Alabama and Mississippi can rightfully claim a much higher 'funding effort' when it comes to teacher pay. And now, as NC Newsline's Ahmed Jallow reported last week, it looks like the situation is going to get even worse. Thanks to the never-ending cost surges that plague America's madly overpriced health care system, and the General Assembly's refusal to provide adequate funding, the State Health Plan Board of Trustees has a $500 million deficit to close. As a result, the trustees have made clear that they intend to impose significant new premium hikes on employees, retirees and their families to close the gap. While the trustees have expressed an admirable desire to spare the state's lowest paid employees from some of the pain, the premium hikes under consideration in a 'moderate increase' scenario for middle and higher paid employees still figure to cost already struggling workers hundreds of dollars per year. Such increases would be one thing if employee pay had been keeping up with the cost of living, but they're quite another in a situation in which veteran schoolteachers with decades of experience are bringing home half what they could make in the private sector. As Tamika Walker Kelly, president of the N.C. Association of Educators observed, the increases are but the latest in seemingly endless series of actions by state leaders that are '…pricing our educators out of the profession.' Of course, as noted, there are other maddening factors at work in this situation. In addition to the legislature's cheapskate funding practices, soaring health care costs are another contributing factor. As Ardis Watkins, executive director of the State Employees Association of North Carolina, has argued forcefully and persuasively of late, costs are an area in which lawmakers and State Health Plan leaders could be doing much more to demand greater transparency and cost control in provider reimbursements. As Watkins detailed in a recent interview for the NC Newsline radio show/podcast, News & Views, under current law, the Health Plan hires a third-party administrator — an insurance company — to negotiate deals with health care providers, but in the end, all negotiations are kept of hidden from public view as 'trade secrets.' Her quite plausible conclusion: the deals end up including big, underreported profits for providers and insurance 'middlemen' that contribute mightily to State Health Plan costs. Not surprisingly, however, in a legislature in which corporate interests play such a dominant role, the prospects for reform are scant. In short, North Carolina teachers and state employees — public servants for whom decent benefits have long been one of the few perks they supposedly enjoy as compensation for low pay — are preparing to absorb yet another financial blow. And sadly, the war on all things public in North Carolina continues apace.
