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The Download: Tier drops

Posted in: Current Affairs   Health care   Transportation   Municipal government
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Today’s Boston Globe and WBUR’s Martha Bebinger report on cost-conscious employers queuing up to purchase health plans that have tiered or limited networks that require subscribers to seek care from lower-cost providers or pay added charges. It’s a story we wrote about in CommonWealth in our most recent issue.

Missing in today’s reports is the fact the Legislature last summer passed a bill that requires all health insurers in the state to begin offering plans in 2011 with tiered networks that would cost at least 12 percent less than the lowest-cost product with open access. Despite months of hearings, however, the Division of Insurance still has not issued any guidelines as to what the plans need to look like. And with a mandated 90-day opt out for providers required by the law, the earliest these plans could be offered to the so-called small group market would be in the June renewal and even that is up in the air.

No insurer has yet come to the table with a plan that would meet the Legislature’s guidelines. The Globe story highlights a plan by Blue Cross Blue Shield of Massachusetts that costs 4.5 percent more than similar plans employers had last year but still less than the 10 percent increase many would have seen had they stuck with open access plans.

The state’s Group Insurance Commission has been a leader in tiered networks, where hospitals and doctors are ranked in one of three levels based mostly on cost, and deductibles and copays are progressively higher with more costly providers. The GIC last week voted to offer state employees who choose a tiered or limited plan during open enrollment in July a three-month waiver of premiums, a savings of $800 for individuals and $1,700 for those on a family plan.

Tiered networks are one approach to reducing spiraling costs, but despite what health plans and some state officials say, they are not a panacea for rising costs. Those in limited networks usually have to pay fully out-of-pocket if they go to a doctor or hospital not in their network, and the higher-priced tiered copays and deductibles are still coming out of the consumers’ pockets, even if their premiums go down.

And the way many health plans market the tiers is to rank providers from “excellent” to “standard” or “basic,” saying the rankings are based on “quality and/or cost.” Clearly, with some of Boston’s best teaching hospitals in the standard and basic categories, cost is the driving factor.

Also, the determination as to how and where to rank providers will be left to each insurer, meaning the same hospital or doctor could land in different tiers based on what standards health plans use to rank them.

The move to tiered networks is only one leg of the stool, but it’s one that certainly looks like a money saver in some respects and employers are embracing it as one way to stabilize costs. Unless the Division of Insurance passes the regulations at or near its scheduled Feb. 28 hearing, however, it will be another quarter gone before the small group market will have access to the types of savings the state and its employees are already realizing.

                                                                                                                                                                                --JACK SULLIVAN

BEACON HILL

The Herald spotlights a group of court officers who received help landing jobs from the same Beacon Hill pols named in the Ware report on the Probation Department. The paper previously reported that pols Ware scrutinized were also top recipients of political donations from court officers, and that the public employee union NAGE is on the hunt for court officers who may have lost promotions to lesser-qualified but politically connected candidates. 

Gov. Deval Patrick's planned trip to Israel and Britain, along with his upcoming book tour and campaign 2012 duties, have at least one Beacon Hill observer considering the idea of a "no travel" pledge for Bay State governors.

A Globe editorial minces no words in calling on newly elected state Treasurer Steve Grossman to stop fundraising activities that cast a cloud over his new office.

A MetroWest Daily News editorial casts a critical eye on a recent vote that squashed efforts to post committee votes on the Legislature's website.

Junk food snacks could be on the way out at Massachusetts public schools.

MUNICIPAL MATTERS

Haverhill is putting on-off switches on some streetlights so they can be turned off temporarily to curb electricity use, the Eagle-Tribune reports.

With City Hall crumbling, Gloucester’s City Council votes to use Community Preservation Act funds and borrow $2.6 million for repairs, the Gloucester Times reports.

A Lowell city councilor says a municipal employee took a vacation day and then worked for the city plowing roads. “I think it is wrong,” City Councilor Rodney Elliott tells the Lowell Sun.

The left-leaning Cambridge City Council is up in arms over the expansion of public transportation - specifically, a proposed Worcester-to-North Station commuter rail line that would run past MIT

The Newton Tab calls for a law enforcing snow shoveling near schools.

LAW ENFORCEMENT

The Cape Cod Times wants to see Barnstable County Sheriff James Cummings release a report on former Sandwich representative Jeff Perry's conduct during an illegal strip search when he was a Wareham police sergeant. Perry is now a special sheriff in Barnstable County.

A high number of injuries to Beverly police officers is causing overtime to soar. The cost so far in this fiscal year is more than $100,000, according to a story in the Salem News.

COURTS

Lt. Gov. Timothy Murray had to cast a rare tie-breaking vote to confirm Heather Marie Stone Bradley as a Plymouth District Court judge. Bradley’s nomination drew criticism after The Patriot Ledger and others reported her husband, state Rep. Garrett Bradley of Hingham, made nearly $40,000 in contributions to Murray, the Democratic State Party and at least one member of the Governor’s Council.

BUSINESS

Payday lenders in other states are skirting tough state regulations by setting up shop on sovereign tribal land. Some observers see this as the new casino racket for tribes, the Wall Street Journal reports.

ENERGY AND THE ENVIRONMENT

The Bay State Banner talks to Van Jones, the former Obama administration "green jobs czar" now teaching at Princeton.

A group of maritime industries is asking a federal judge to strike down a Massachusetts law designed to prevent oil spills by requiring ships to use either state pilots or tugboat escorts or face triple damages if a spill occurs.

Brewster residents debate proposals for two wind turbines in an industrial park.

FILM TAX CREDIT

A proposed 10-cent fee on movie tickets in Colorado to subsidize a film tax credit is panned by the American Spectator, which points to the problems and pitfalls other states, including Massachusetts, have encountered in attracting movie making.

GAMBLING

The Springfield Republican calls Sen. Stephen Brewer's proposal for yet another gambling study, a delaying tactic that is "the oldest trick in the government playbook."

TRANSPORTATION

In a scathing editorial, The Patriot Ledger calls on the Attorney General to probe the MBTA’s dealings with the company that sold the authority defective concrete ties after a CommonWealth story detailed court documents showing problems with the bidding and warranty.

Bring it on: House Republicans criticize Vice President Joe Biden's proposal to invest $53 billion in national high-speed rail network. But at least one of them, Transportation's Railroads Subcommittee chairman Rep. Bill Shuster, a Pennsylvania Republican, sees merit in a high-speed rail network stretching from Washington to Montreal, something that Biden, Amtrak's biggest fan, probably could get on board with.

ELECTION 2012

US Rep. Michael Capuano tells his hometown newspaper he's giving himself a summertime soft deadline for deciding whether to challenge Sen. Scott Brown. The former Somerville mayor also explains when it's OK to toss a cup of coffee on somebody. 

Can’t take “no” for an answer: Gov. Deval Patrick emphatically gave just that answer when asked if he’d like to be president but that, apparently, was not enough to dissuade Keller@Large from suggesting the governor did not sufficiently discount the possibility

Virgina Sen. Jim Webb won't run for reelection, and Salon outlines five ways former Sen. George "Macaca" Allen could still manage to hold on to that "former Sen." epithet. 

WASHINGTON

The National Journal reports that President Obama's 2012 budget will cut heating fuel assistance for the poor, a program that has been particularly crucial for low-income residents of chilly Massachusetts. John Kerry and Ed Markey, among others, are not happy. The Journal's Matthew Cooper tries to make sense of the move in an analysis piece under the headline, “Who Wants Grandma to Freeze?”

Under questioning from newly-elected US Rep. Bill Keating, Homeland Security Secretary Janet Napolitano admits the obvious, that a security breakdown allowed a 16-year-old to sneak into the wheel well of a plane at a North Carolina airport. The teen fell out and died as the plane was landing in Boston. NECN has the story.

NECN has the picture that forced US Rep. Christopher Lee of New York to step down.

Congress fears a massive fiscal crisis in the states, but shoots down the notion of a federal bailout, again. 

Meet John Boehner, the GOP's chief cat herder. Related: Utah Sen. Orrin Hatch says the Senate is no place for "nuts." 

EDUCATION

The always thoughtful folks at the Thomas Fordham Institute have a more nuanced take on the much-discussed case of the Akron, Ohio, mother who wound up in jail because she forged residency papers to get her kids into schools in a better, nearby district. 

Attorney General Martha Coakley hears testimony from advocates who believe that the state's anti-bullying law needs to be strengthened, including former Northwestern district attorney Elizabeth Scheibel, who brought charges against the South Hadley High School students who bullied Phoebe Prince.

MEDIA

The Lowell Sun reports that its public records request for the minutes of the School Committee’s deliberations over Superintendent Chris Scott’s contract yielded heavily redacted material.

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