Bargaining for Health Insurance
One of a negotiating committee’s biggest challenges is holding on to affordable health insurance. The latest attempt to chisel our coverage is “lower-cost” high-deductible plans and Health Savings Accounts—which make us pay huge up-front deductibles.
The industry calls these “consumer-driven” plans, but that Cadillac we’ve been accused of driving is really just a rusted-out Chevy.
Unions are faced with resisting more restrictive networks, gatekeeper systems, higher and higher co-pays, tiered systems for prescription drugs, deletion of coverage for certain procedures such as chiropractic care, and gigantic up-front deductibles—all offered with the carrot of lower premium costs.
But any lower costs are short-lived. It is the exact same argument the industry used to get unions to switch from fee-for-service to HMOs.
In the United Electrical Workers (UE), workshops on how to grapple with health insurance are popular. We teach some basic principles:
• No paperwork
• Choice of provider
• Affordable and fair payroll deductions for insurance
• Low or no out-of-pocket costs
• No high co-pays or deductibles
• Changes must be negotiated and any increased costs to workers to be reimbursed by the employer.
• Any “self-administration” or time spent handling insurance problems to be done during work time.
These days employers want to foist off on workers the administration of their insurance. Where we used to go to the front office to get help from human resources, now we are given a phone number (“call 1-800-UR-SCREWD”). Locals should not let members or union officials be forced to take care of insurance issues on their own time.
Contract language must protect against insurance changes during the life of the agreement. No year goes by when the company does not claim the carrier is “mandating” changes to the plan (increased co-pays, ending coverage for certain procedures). This is b.s., because a company can have any insurance it wants, as long as it pays for it.
Language such as “the new carrier or plan must provide comparable coverage and network” leaves the employer an opening as big as a house. Language that says the new plan must provide “identical” or “equal” coverage gives greater protection.
Best yet is to have the insurance plan and coverage levels written directly into the contract, with no language concerning how it could be changed. Then the plan holds for the life of the agreement.
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A system with co-pays for this and deductibles for that means we must know the membership and everyone’s particular situation. The variation among plans means that if the local does not have up-to-date information on members’ needs, it could potentially put some in serious financial trouble.
In many UE locals the membership is thoroughly surveyed: Who are their doctors? What types of prescription drugs are members and families using?
Our experience is that most folks are OK with giving out this information, to help keep insurance affordable, as long as the company isn’t in on it.
The idea is not to pry into members’ health conditions but to be able to gauge the effect of changes in coverage. Especially in shops with older workers, even seemingly small increases to prescription or other co-pays could mean hundreds and maybe thousands of dollars in additional expense.
Surveys have also enabled us to better figure out the annual cost difference to members from one plan to another, what members are paying now in premiums, co-pays, and deductibles vs. what the proposed plan would mean.
Getting the employer to refund up-front deductibles can sometimes make a high-deductible plan cost less to a member over the course of a year than the premium deductions and increasing co-pays of an HMO. But we shouldn’t make any switch without solid information on the effect on each member.
Another issue is how we pay for health insurance. Traditionally we have deducted from our paychecks a certain percentage of the premium or, in some cases, the employer pays for the single plan and we are responsible for the difference that a family plan costs. People with families bear a disproportionate share of the cost.
Many UE locals have been setting caps on how much comes out of workers’ paychecks, or flattening out the paycheck-deduction difference between single, two-person, and family plans. Basing our paycheck deductions on premium rates leaves us hostage to industry profits and market forces over which we exercise little control. Paying a percentage of income for health care is less risky and more equitable.
The University of Vermont, for example, where UE represents custodial and maintenance workers, bases the premium on a wage rate range. Employees who make least pay the lowest percentage of the insurance premium and those who make more pay higher percentages.
PUT UP OR SHUT UP
A final note on a tactic some UE locals have been using to “make trouble.” We present the employer with a letter to sign: “We, Name of employer, support the only viable solution to the continuing crisis in health care—a single-payer public health insurance program for all name of state residents and the passage of legislation supporting the same.”
Not surprisingly, 99 percent of the time the employer refuses to sign. That’s “socialism,” they say—despite its reduction in cost to the employer by nearly two-thirds. As we report to the membership the company’s crocodile tears over its insurance costs, we let members know the company has no interest in supporting a real solution to the nation’s health care woes and we, therefore, have little sympathy for its premium plight.
We need to use our negotiations to force employers to face this question. And we need to educate members on the unsustainability of our present private health insurance system and the need to secure a universal, single-payer system of health care for everyone.
Peter Knowlton is Northeast Region vice president for the UE. For a sample survey and single-payer letter for employers (as well as a PowerPoint presentation on health care costs and union strategies), go to uenortheast.org/ and click “UE documents.”