In the event of a health emergency, Jorge Luis Castillo will soon have a nail-biting choice: Go to the hospital in town and face shouldering as much as 20 percent of the costs, up to several thousand dollars, or spend about an hour in the car to get to a hospital that’s fully covered by his insurance.
Castillo is not alone. At the same time as the Affordable Care Act is being rolled out, providing more access to health coverage for those without it nationwide, the University of California system is unveiling new health plans for employees that some say will unfairly affect those at certain campuses.
The new flagship employee health plan, UC Care, relies heavily on UC Medical Centers, so it may be harder for those who live far from such facilities to get affordable care.
“For those at the Medical Centers, I think it’s probably a very good plan,” said Dan Hare, chairman of the system-wide Academic Senate Committee of Faculty Welfare and a UC Riverside professor of entomology. “The question is, what about the campuses without Medical Centers?”
To try to solve this problem, the health plan administrator, Blue Shield, tried to find providers that offer similar quality for a similar cost in areas without Medical Centers, Hare said.
The system’s Medical Centers are located at UC San Francisco, Davis, Irvine, Los Angeles and San Diego. UC Berkley, Merced, Santa Cruz, Riverside and Santa Barbara don’t have a Medical Center on campus.
UC Care was able to contract with enough providers near Santa Cruz, but offerings at the four other campuses without Medical Centers appear to be thinner, Hare said.
His office has received the most complaints from UCSB employees, as well as a number from those at Riverside. Employees at Berkeley seem to be experiencing a “mixed bag” depending on where they live, and Hare has yet to hear from Merced employees, who may not be aware of the changes yet, he said.
The plan appears to create the most hardships fro UCSB employees, because no agreement has been reached with the two main providers in the area, Cottage Hospital and Sansum Clinic.
“Basically this plan creates unequal conditions for UCSB employees,” Castillo said Thursday at a town-hall meeting on the health-care changes at the seaside campus, where he is a professor of Spanish American literature.
“For people who are handicapped, like myself, for people who have serious health issues, this actually verges on discrimination of disabled people.”
Castillo was among about 300 UC Santa Barbara professors and staff members who attended the meeting Thursday — the first of several planned at campuses across the state — to get information on the new coverage and voice their outrage.
Both the UCSB Academic Senate and the Faculty Association also spoke in opposition to the changes and said they’re working to create an electronic petition to try to convince the UC system to improve the plan.
The system-wide Academic Senate is encouraging each campus’ senate to record complaints and send them to the UC’s human resources department in the hopes to making changes to the plan at local levels, but it is not actively working to change the plan as a whole, Hare said.
Representing the UC system at Thursday’s meeting, Dwaine Duckett, vice president of human resources, called the plan the best option the statewide university system has been able to negotiate so far.
“It is not cost, it is value and effectiveness that is our primary concern,” he said.
Under the new health benefits package, four of seven current health plans will be eliminated, said Trish Hiemstra, director of human resources at UCSB. In their place will be a Blue Shield health savings plan and the new UC Care plan.
UC Care subscribers will be able to select any doctor, clinic or hospital, but they’ll have to pay a portion of the costs if the providers aren’t in the plan’s Tier 1. When the employees see Tier 2 and Tier 3 providers they’ll pay 20 or 50 percent of the costs, respectively. The maximum out-of-pocket charges, which would be incurred seeing Tier 3 providers, are $9,000 for individuals and $15,000 for families annually, according to preliminary information Hiemstra has received.
The UC system has yet to release a complete list of which doctors, clinics and hospitals will be covered by insurance under the new plans, as well as the full pricing details. Those documents will be released next week, Hiemstra said.
Trying to help UCSB employees, UC Care has come to agreements with hospitals in Ventura, Lompoc and Santa Maria. But those hospitals are at least 45 miles from the campus, a distance that isn’t convenient for many employees and their families, said Kum-Kum Bhavnani, chair of the UCSB Academic Senate and a sociology professor.
There are 4,171 faculty and staff members enrolled in medical plans at UCSB, and at least 1,115, or 27 percent, will be affected by the changes because they are enrolled in plans that are being discontinued, Hiemstra said.
The university system was also criticized this summer when it revamped its health plan for students and at first included a cap on the amount it would pay for serious medical problems. Because the student plan was self-funded, it wasn’t required to comply with provisions of the Affordable Care Act that ban insurance caps.
However, after pressure from state legislators, the university decided to eliminate the caps voluntarily.
Hiemstra said she believes the new UC Care plan for employees, also a self-funded plan, will likewise voluntarily comply with the Obamacare regulations, but because the complete documents haven’t been released, she can’t say for sure. The university system did not return calls seeking comment on this issue.
California Assemblyman Richard Pan, a physician and chairman of the Assembly’s Committee on Health, said he hopes the university system doesn’t try to impose caps again. “It would be a tragedy if UC imposed these limits on the UC faculty, staff, and students who fought so hard for these health insurance reform in the ACA,” he said.
The changes to the UC health plans for both students and employees aren’t a direct byproduct of the Affordable Care Act’s implementation, but changes in the insurance marketplace over the last several years, including rising costs, have forced the university system to offer new options, Duckett said.
Meanwhile, UCSB employees are trying to figure out their options before signups for the new health plans begin later this month.
Castillo, who has had three operations on his knees and has trouble standing for more than a few minutes, said he’s also worried about his family maintaining access to care. His 17-year-old son has autism.“We’re going to be forced into UC Care,” said Castillo’s wife, Christine Thomas, a UCSB religion professor. “We’re going to live in fear of a hospitalization.”