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Connecticut union deal includes increased copay for “unnecessary” emergency room visits
Tucked inside the concessions package negotiated between union leadership and Gov. Dannel Malloy is a provision which would implement a $250 copay for “unnecessary” emergency room visits.
The provision would not affect retirees and was included in the section labelled “Design Changes to Save Money and Improve Health.”
The 2011 concessions deal instituted a $35 copay for a trip to the emergency room. That fee is waived if the patient is admitted to the hospital or if there were no reasonable medical alternatives.
The same waiver will apply for the increased amount of $250 but the copay may actually violate state insurance regulations.
The Connecticut Insurance Department limits the copay amount an insurance company can charge for medical services. For a visit to the emergency room, the maximum allowable copay is $200.
It is unknown at this time, how the concessions deal would bypass the copay cap imposed by the Insurance Department but union contracts often contain supersedence provisions which override state law.
State employees have a choice between two insurance companies – Anthem Blue Cross Blue Shield and United Healthcare. Both only require a $15 copay for doctor visits or walk-in clinics and there is no copay for preventative care.
United Healthcare offers a list of reasons an individual should seek emergency care such as chest pain, major broken bones and large open wounds. For other medical issues the company suggests the use of a primary care physician or urgent care centers.
A 2013 national study found that 10.1 percent of emergency room visits were classified as non-urgent but said that there is no standard definition for non-urgent. The authors concede that some studies place the figure as high as 32.1 percent.
In 2011, it was revealed that one state employee visited the emergency room 150 times in a single year, an average of three times per week. Union officials refused to reveal the employee’s name but used that example to show how the 2011 concessions deal would save the state money.
The overuse of emergency rooms for non-urgent medical issues helps drive up the cost of healthcare. The typical emergency room visit costs thousands of dollars as opposed to your typical doctor’s visit. High copays are often used as a way to prevent people from using emergency rooms unnecessarily.
Whether or not such a provision will result in savings is unknown. State employees enjoy top of the line medical benefits and have ample access to doctors and preventative care.
Employees can also enroll in the Health Enhancement Program, which was instituted in 2011. Under HEP, state employees pay lower monthly premiums and no deductibles if they actively engage in regular check ups, screenings and wellness exams.
If employees do not enroll in HEP their premiums cost an additional $100 per month and their deductible is $350 for an individual or $1,400 for a family.
Employees with particular chronic conditions such as diabetes or hypertension can get a $100 cash payment for enrolling and participating in the program.
Preventative care is meant to limit the number of emergency room visits and hospitalizations due to illnesses that could be treated through early intervention.
Past concession agreements between the governor and union leaders have not always resulted in the savings they hoped for.
The 2011 union concessions deal was meant to save Connecticut $4.8 billion and was negotiated by Malloy in an effort to close a $3 billion budget deficit.
But an analysis by the nonpartisan Office of Fiscal Analysis conducted in 2012 found those savings would only amount to $1.7 billion because a portion of the savings were “mutually exclusive.”
The 2011 concessions deal also included a “suggestion box” in which state employees would offer suggestions as to how the state could save money. The list of suggestions has never been made public and both union leaders and the governor’s office have refused to release them.
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