Monday, April 26, 2010

Apparently the State Still Has Money for Foolishness

Posted By on Mon, Apr 26, 2010 at 10:30 AM

I hear this is the new unofficial State of Tennessee Motto
  • I hear this is the new unofficial State of Tennessee Motto
State employees have gone years without even a cost-of-living pay increase. They've seen their responsibilities increase as their colleagues were let go. And this year, politicians are considering cutting their pay by 5 percent. In the face of all that, in exchange for cheaper health care, they're learning about an exciting opportunity the state is giving them to let a bureaucrat inform on them if they are not trying hard enough.

It sounds like something out of a dystopian satire of Cold War Russia when you put it that way, so let me explain.

Next year, state employees are getting all new insurance. There will be four premium tiers with different price levels — one for individuals, one for individuals and children, one for individuals and spouses, and one for individuals, spouses and children. This replaces the current system in which there's one tier for individuals and one tier for families.

People can save money on their insurance if they agree to take a "Partnership Promise" — in which they promise to know their health histories, know their health risks and work to reduce those risks. They will give their health histories to a state-paid bureaucrat. They will then have access to a "health coach," who will help them meet their goals (maybe). The health plan will pay for these health coaches. Which means, really, that the state employees will be paying for these health coaches, but let's not quibble.

Instead, let's look more closely at this "meeting their goals" portion. The emphases are mine.

In one section, the newsletter reads:

Anyone can enroll in the Partnership PPO even if you smoke, don’t exercise or have a chronic health condition. In fact, we encourage you to enroll. You do not have to commit to quit smoking or run a marathon. You just have to commit to be serious about your health and do what you can to stay well or get better.

On the next page, it says:

There will not be a surcharge for tobacco use. However, the Partnership PPO will require you to try to stop using tobacco. It will also offer incentives and resources to help you quit.

So which is it? Do you have to try to quit, or do you not have to try to quit? Or is there some difference between "trying" and "committing" that I'm just not getting. You have to try, but not very hard?

What does "trying" look like anyway? How will this bureaucrat-for-hire judge whether you are trying hard enough? The newsletter says, "The vendor will collect your data—but, by law, it will never release any identifiable information about you to either the State or your employer without your permission."

But this seems like it has to be a lie. You only get the discount if you participate in all three portions of the promise. If you botch the third, the vendor would have to alert someone that you've failed to keep your promise, right? And that would mean releasing identifiable information about you to someone. How else could it work?

Otherwise, you could just say you promised, get your discount, and carry on exactly the same as the chumps who didn't sign up for the discount. The vendor has to be able to release identifiable information about you to someone if you fail. That's how you'd enforce this nonsense.

Plus, what law would protect you? There's nothing to indicate that these vendors would be covered by HIPAA. They're not providing employees with health care. Why, they're just helping you help yourself.

In fact, a person might be suspicious that an intended consequence of this is to get around HIPAA, by requiring you to give your medical information to a vendor who is neither your health care provider nor your insurance company, in exchange for lower rates.

If this isn't an intentional end-run around HIPAA — in other words, if the state really does think that HIPAA applies to non-health care providing vendors — that makes me uneasy. I hope they've had the state's lawyers consider that. Otherwise, if the state is telling employees that the medical information the employees are required to give these vendors is legally protected when it's not — well, my friends, there will be lawsuits. Ugly, ugly lawsuits.

You can take a look at the HIPAA standards yourself and tell me if you think these vendors would somehow be covered by it. But they're not a health care provider and they're not a health care plan.

State employees I've talked to are angry and concerned and feel like they are being pressured financially into participating in something they don't really understand, but suspect is not as benign as is being claimed. They are also, obviously, not willing to go on record to say so, times being what they are and new jobs being hard to come by.

The question I have is this: Where is the money to pay for this coming from? It's not a part of the new deal with the new insurance company. The state hasn't decided on a new insurance company.

So, is this something Tennessee taxpayers are footing the bill for — bureaucrats who decide if state workers are trying hard enough? State employees have lost their jobs, and we now have money to hire people to snitch on those left?

It'd be funny if it weren't so galling.

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