Senate proposes municipal health insurance reform plan

The fiscal 2012 state budget bill released by the Senate Ways and Means Committee today includes a proposal that would give cities and towns the ability to make changes to their employee health insurance plans, or join the state’s Group Insurance Commission, without going through the collective bargaining process.

Under the plan, which is intended to help communities control soaring costs in order to protect services and preserve municipal jobs, municipal employee unions would retain more collective bargaining power over health insurance than state employees have.

Under the Senate proposal (sections 45-49, 51, 109 and 110 of the Senate budget bill), municipalities would accept the new law by a vote of the board of selectmen or by approval of the mayor and city council.

The municipal executive would then propose a plan to modernize the design of employee health plans or join the state GIC, with a guarantee that all municipal and school employees would still have health plans with co-pays, deductibles and other plan features that are the same as or less costly than the median co-pays, deductibles and plan design features offered by the GIC.

The municipal executive’s plan would include the desired plan design changes or proposed entrance into the GIC, the projected one-year savings (or avoided costs) that the plan would generate, and a plan to mitigate or moderate the impact on retirees, low-income employees and those with high out-of-pocket costs (such as through a health reimbursement account, a temporary subsidy of rates, or other proposals).

Communities would then convene a public employee committee, identical to the make-up of the PEC in Section 19 of Chapter 32B. If a community already has adopted Section 19, then that would be the PEC. If a community has not adopted Section 19, then a temporary PEC would be established just for the purpose of negotiating on the proposal offered by the municipal executive.

The community and the PEC would have 30 days to reach agreement on the municipality’s proposal. If no agreement is reached, the impasse would be referred to a three-member “municipal health insurance review panel” that would include a municipal representative, a labor representative, and an “impartial” third party chosen from a list of experts in dispute mediation, municipal finance or municipal health benefits that is provided by the Administration and Finance secretary. If the community and labor representative cannot decide on the third member, the secretary would make the choice.

The review panel would have 10 days to review and decide three matters: whether the changes to co-pays, deductibles and other features proposed by the community are the same as or lower than the median level of the features offered by the GIC; what the one-year savings would be; and whether the proposal to mitigate or moderate the impact of the changes on retirees, low-income workers and subscribers with high out-of-pocket costs is sufficient.

If the municipality’s proposed changes do not exceed the GIC median, the panel would be required to approve the immediate implementation of the plan design changes. The panel would also confirm the projected savings amount and would determine whether the mitigation proposal is sufficient. The panel would be able to require additional savings to be dedicated to health reimbursement accounts, premium reductions, or other arrangements, but in no case could the panel designate more than one-third of one year’s savings for the mitigation plan.

Cities and towns would still negotiate any change in the employee-employer premium share. Any new co-pays or deductibles higher than the GIC median would also have to be approved in collective bargaining.

The reform proposal would also require all municipalities to enroll all eligible retirees into Medicare.

The Senate measure is similar to the plan approved by the House last month, in that it would allow for plan design changes and joining the GIC, but it would set up a process that would provide unions with a more structured framework. Overall, the Senate plan targets the same $100 million reduction in health plan increases that the House targeted.

The MMA will be working with senators and the Ways and Means Committee on the details of the plan over the coming days and throughout the Senate’s budget debate.