This Is Health Care Reform?

So Massachusetts passed a law giving cities and towns an enormous amount of power to change the health care plans for municipal employees, essentially bypassing the collective bargaining process. (Individual collective bargaining agreements will still be honored as far as splits are concerned, but unions are pretty much given thirty days to argue their case, and then if the parties can’t agree a panel will look at the plans/changes strictly by the numbers. Hooray!) The AFT has a good summary here, or you can try to wade through the actual text of the law here (fun fact: Worcester County is exempt for some reason).

There’s been a general simmering discontent since the law passed, because none of us knew which cities and towns would go for it, or what it would ultimately mean when they did. Despite allocating $30,000 to study employee and retiree benefits in general, the Selectmen of the town I work for recently decided (before the $30,000 study was complete, I should add) to just go ahead and exercise their new powers.

There’s quite a bit of mystery surrounding the process–we don’t know if the town will seek to enter into a Group Insurance Commission (GIC) plan, or make changes to one of the plans we’re currently offered. We don’t know if we’ll have any choice whatsoever (as we now do). Those of us with spouses may be contemplating pulling out of the town’s insurance all together.

But just for fun, I’ve been trying to do a little research to better understand my (potential) options.

Right now I admittedly pay for fantastic insurance. It’s the best health insurance I’ve had as an adult, and might even be better than what I had as a dependent of my parents. My insurance is accepted virtually everywhere, I have my choice of a wide variety of fantastic doctors, my co-pays are low and my prescription coverage is very affordable (plus I pay into flexible spending, which is another benefit whose future is uncertain).

Let’s just say my town decided to change to Tufts Navigator (since this is pretty much the GIC’s minimum standard; any proposed plan design changes can’t have co-pays, deductibles, or other plan features that exceed the dollar amounts in the most subscribed GIC plan, which for now is Tufts Navigator). How would my life change?

Primary care physician visits: from $5 to $20
Specialist visit: from $5 to $25-$45 (they’re tiered)
Outpatient mental health: from $5 to $20
Inpatient hospital visit: from $0 to $300-$700 (again, tiered)
Outpatient surgery: from $0 to $150
Imaging: from $0 to $100
ER visit: from $25 to $100 (both waived if admitted)
Prescription medications: from $5-25 to $10-$50 (you guessed it, tiered)

So what does that mean for a typical year? Let’s not consider last year, when I paid absolutely nothing for a week-long hospital stay, and another zero dollars for outpatient partial hospital care. Let’s just imagine a year like this one, where all I have to deal with are visits to my therapist twice a month, a visit to my psychologist about every three months, labs done about every three months to manage my medications, a year’s supply of three different prescription medications (which must be in tiers one and two, if I’m reading the chart correctly), and a trip to my doctor for a general check-up.

$120 for therapist visits
$20 for psychologist visits
$0 for labs
$300 for medication
$5 a year for an annual physical with my PCP


$445 a year under my current plan (which doesn’t include my annual premium; I’m having a hard time comparing Tufts Navigator’s premiums)

And after the switch:

$480 for therapist visits
$80 for psychologist visits
$?? for labs (covered in full only after deductible)
$1080 for medication
$0 for a physical (wow!)


$1640 for a year (not counting labs, since I don’t really know how to calculate those)

So disregarding premiums, I could potentially end up paying almost four times more. FANTASTIC.


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