Letter to the Editor: Retiree questions Carney’s take on Advantage mandate

Gov. John Carney, at a recent town hall, defended the Medicare Advantage plan. “Ours was an arrangement that we developed specifically for the state of Delaware, not an off-the-shelf Medicare Advantage program. It was intended to provide state employee retirees basically the same approach to health care that an active employee like the governor and others have, where it’s …. more of a managed care system than a fee-for-service system.” He went on to explain that, with rising health care costs, “we thought that this Medicare Advantage plan was a way to (manage such costs). I think there was a lot of misinformation out there about how it would work, and I get that” (“Carney talks pot, retiree health care at New Castle town hall,” April 20).

Wow! That’s a lot to digest!

To begin, “basically the same” is an odd comparison because Gov. Carney and other state employees and retirees under 65 don’t have access to Medicare.

We know about the rising health care costs, but we also know from Willis Towers Watson, the state’s consultants, that the Medicare retiree group generated a $25.1 million surplus that offsets the deficits of active employees ($24 million in deficit) and pre-Medicare retirees ($29.5 million in deficit) (“Retiree health care panel analyzes coverage plans,” March 28).

It makes sense: The Medicare program that pays the bulk of our medical expense is federally funded. The state only pays the Medicare supplemental insurance costs.

The same consultant also noted that 29% of states offer only a Medicare supplemental insurance plan (such as Delaware offers now), 22% offer only Medicare Advantage (the proposed plan), but most, 38%, offer a choice between the two. A choice seems the obvious way to go — who could complain? We know how well “mandates” are accepted (think the Affordable Care Act or COVID-19), yet the state wants to mandate a huge shift in our insurance coverage with Medicare Advantage.

Why are the State Employee Benefits Committee and the Retiree Healthcare Benefits Advisory Subcommittee pushing the Medicare Advantage plan, particularly when there are other options to reduce the state’s insurance liability growth? How would it reduce the costs?

In the same article, Secretary Claire DeMatteis explained the part of the numbers game. “The reason Highmark gives us favorable pricing across active employees, pre-65 retirees and Medicare pensioners is because they’re basing their rates on that 100,000 people mark.”

Giving Medicare retirees a choice might mean missing that 100,000 mark, so the SEBC thinks a mandate is the best option. If the State Employee Benefits Committee is so sure many retirees would decline the Medicare Advantage plan, isn’t that a warning to look at other options?

We also learned that the state would receive a kickback from Highmark. Politely called a “gainshare,” the more profit Highmark makes, the more money flows back to the state (“Analysis raises questions on state’s Medicare stance,” April 9).

Mary Graham, a Retirees Investing in Social Equity Delaware legal liaison, reviewed the public record. She noted that both the Retiree Healthcare Benefits Advisory Subcommittee and the legislature were shown “a slide asserting that active employees ‘subsidize’ through their premium contributions the annual costs of state retirees,” which we know to be absolutely untrue, based on the information from Ms. Graham, as well as the state’s consultants.

So, to return to Gov. Carney’s remarks, there has been a lot of misinformation, and it seems that it’s from the state government itself.

I know how the Medicare Advantage plan would work for me and my spouse. My husband — also a state retiree — has sarcoidosis, a disease that has attacked his eyes, lungs and heart. He receives care locally but also has a team of specialists at Johns Hopkins. Our local doctors all support the need for him to be cared for in this team environment, where his case is reviewed routinely by all of his caregivers. He was referred to Johns Hopkins by his cardiologist, who frankly said, “You need to go somewhere where they specialize in this.” Due to his disease, routine procedures like cataract surgery can quickly spiral into big problems. He had emergency eye surgery on a Thanksgiving Day a few years ago because his eye pressure was so high that vision loss was imminent. The problem was discovered at a JH appointment; he was in surgery early the next morning, and his vision was saved.

I share this personal information because this is how Medicare Advantage will work for us: Johns Hopkins, like a growing number of institutions, does not accept any Medicare Advantage plans. If we follow the mandate and join Medicare Advantage, we’ll have to pay out-of-pocket for his care there or let his care suffer by ending the relationship with Johns Hopkins. If we refuse to join Medicare Advantage and stay on Medicare, we lose our state insurance benefits after 52 combined years of service to Delaware. We’ll have to purchase supplemental insurance out-of-pocket. Either way, if this mandate stands, we’ll have thousands of dollars of unplanned medical expense.

On the bright side, our General Assembly has a bill (Senate Bill 8) in committee to protect patients from unfair medical debt collection practices. Sen. Spiros Mantzavinos, D-Elsmere, sponsor of the Senate bill, spoke of “horror stories” of “coworkers, neighbors or family members who have incurred tens or even hundreds of thousands of dollars in unforeseen medical expenses.” He continued, “This bill is designed to show patients some grace and compassion” (“Marijuana, renters’ rights on docket for General Assembly,” March 26). I wish the same compassion was extended to the state’s Medicare retirees — who will experience increased and unexpected medical bills under the Medicare Advantage plan. We can be glad to know that the state has our back in making the collection process more pleasant.

Compassion doesn’t seem to be present in the State Employee Benefits Committee and the newly formed Retiree Healthcare Benefits Advisory Subcommittee. This second committee was created as the result of Senate Bill 29, intended to provide oversight of retiree health care by monitoring Highmark’s compliance with contractual agreements, such as denial rates or preauthorization turnaround times. It includes three real retirees. This is all good but how can the subcommittee make meaningful decisions if given misinformation about funding and such?

The State Employee Benefits Committee has other options to reduce the state’s insurance liability, including a health care reimbursement arrangement account, where each retiree’s insurance allotment would be available for self-directed insurance choices. Retirees would remain on Medicare and choose a supplemental Medicare insurance or Part D, then be reimbursed from the state. This option was not explored because it was deemed too unwieldy for retirees.

It might be a lot of paperwork for us, but it was an option that would reduce the state’s unfunded liability more than all other options (Retirement Benefits Study Committee report of Nov. 1, 2021, at financefiles.delaware.gov/Reports/Committee/RBSC%20Initial%20Report%20-%20November%202021.pdf). Now consider the paperwork and distress that Medicare Advantage will create for us: waiting for preapprovals and appealing denials; trying to locate new doctors when your current trusted providers are out of network or don’t accept Medicare Advantage; and so on.

I received an annual benefits enrollment package this week. My anxiety level went up, even though I know the Medicare Advantage implementation is delayed until June 2024, due to ongoing litigation. The packet only applies to non-Medicare retirees and was interesting reading. Non-Medicare retirees can choose from four plans provided by both Highmark and Aetna — if the state needs to consolidate all benefits under Highmark to reach that magic number of 100,000 enrollees, why not mandate Highmark to these younger retirees?

Why disrupt the 39,000 Medicare retirees who are currently over 65 and most vulnerable to medical costs? We are not the source of the deficit. We invested our years of service. To be painfully blunt, we will be leaving the state’s care sooner than the other two groups. Why should we pay for the deficits of these other groups?

Is this ageism?

Please stay active in the fight to protect our access to Medicare and to have a choice. Make yourself known to your legislators.

Terry Kansak

Georgetown