Legislature To Reconvene To Tackle Medicare Advantage

(Charlie Megginson/Delaware LIVE)

In response to protests by state government retirees who say they were left in the dark over a significant change to their health insurance, the General Assembly unveiled a bill Monday aimed at creating additional oversight.

The House of Representatives and Senate will hold a special session in Dover on Oct. 26 to debate and vote on the bill.

Pensioners began organizing last month after learning they’d have to switch from original Medicare to a new, “specially tailored” Medicare Advantage plan, privately managed by Highmark Blue Cross Blue Shield.

Many retirees don’t trust the state’s assurances that they’ll be able to keep their doctors and access the same level of care without paying more.

The legislation introduced Monday would create a new subcommittee composed of state retirees, lawmakers, union representatives and other state officials who would “monitor Highmark’s performance during the three-year life of the current contract,” according to a press release from House Democratic and Republican leadership.

Specifically, the subcommittee would monitor compliance with the Medicare Advantage contract, solicit public input about patient experience and provide quarterly reports to the General Assembly.

If passed, the bill would also create a Medicare Advantage ombudsperson in the Department of Human Resources who would assist state pensioners with the transition.

“As pensioners who both receive healthcare benefits from our former employers, [House Speaker Pete Schwartzkopf] and I are acutely aware of how much retirees and their spouses depend on the benefits they earned through their years of dedicated service,” said Senate President Pro Tempore Dave Sokola.

Sokola said he’s confident the Medicare Advantage plan will provide the same level of care to pensioners at no added cost, but that he understands why the change in benefits is concerning.

“We owe our state retirees as much assurance and oversight as we can provide to ensure this transition fulfills the obligation we made to thousands of dedicated public servants,” Sokola said.

According to the news release, the General Assembly “does not have the power to undo the Carney Administration’s contract with Highmark.”

That’s not good enough for Rep. John Kowalko, D-Newark, who has spearheaded a campaign against the plan’s implementation.

“I find this bill to be an attempt by the [General Assembly’s] leadership to avoid their responsibilities to retirees and position themselves as absolved of any responsibilities in this matter,” Kowalko said.

He listed a series of concerns with the bill, including that it:

Doesn’t define the switch to Medicare Advantage as privatization of Medicare,
Doesn’t attempt to reject the proposal,
Doesn’t attempt to delay the plan’s implementation,
Doesn’t address transparency concerns surrounding the plan’s adoption,
And more, which you can view at this link.

Kowalko, retiring from the General Assembly in November, will now take his seat in the House Chamber one last time, where fellow lawmakers will undoubtedly hear his concerns loud and clear.

Senate Republican Whip Brian Pettyjohn, R-Georgetown, said it’s evident that state retirees need “a seat at the table” for this and future decisions regarding their healthcare.

“They dedicated their careers to serving Delawareans and we must do what we can to ensure their retirement healthcare is the best it can be,” Pettyjohn said.

House Republican Leader Danny Short, R-Seaford, said he believes the proposed bill will address many of retirees’ major concerns.

“Our state retirees have dedicated their years of service to Delaware citizens and, with that, the state should fulfill its obligation to ensure their health benefits will remain top-notch,” Short said.

Schwartzkopf said lawmakers were able to “win several concessions that will improve the current deal for retirees.”

Included in that list of concessions, according to House and Senate leadership, are:

A four-month delay in the implementation of pre-authorization for outpatient services,
Quarterly reporting on denial rates and other aspects of the pre-authorization process,
An expansion of out-of-network access,
Additional customer service staffing at Highmark and the Delaware Department of Human Resources,
A commitment to add a number of performance guarantees to the final contract.

“After several conversations and negotiations, we have crafted a bill that will add several layers of oversight to the process to protect the current agreement and assist retirees during this transition,” Schwartzkopf concluded.

A group formed to oppose the change, Retirees Investing in Social Equity Delaware, plans to hold a rally at Legislative Hall Wednesday, Oct. 12 at 12 p.m.

The group isn’t just organizing protests. It’s also suing the state.

A complaint filed in the Delaware Superior Court alleges that the State Employee Benefits Committee — the public body responsible for the switch to Medicare Advantage — “quietly adopted a regulation” to overhaul retirees’ insurance without following necessary open-government laws and procedures, “and without input from those most affected.”

The group is asking a judge to stop the plan’s implementation.

Legislature to reconvene to tackle Medicare Advantage

Medicare Advantage oversight bill

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