NFA News

Nevada public service workers statewide have suffered from a big cut to public employees' health care benefits, made in July 2011. The new Public Employees' Benefits Program (PEBP) plan has such a high deductible that it covers only major medical problems.

Faculty and staff across the Nevada System of Higher Education have complained about it. Campus administrations have expressed sympathy and support for doing something about it, and nearly a year and a half ago the Chancellor appointed a PEBP Benefits Task Force with three charges: seek immediate improvements in customer service from PEBP, research if NSHE could leave PEBP altogether and establish its own self-funded pool, and determine whether, in the meantime, NSHE can offer gap coverage as a supplemental benefit to its employees.

At each of the last three Board of Regents meetings, as well as at various public events in the fall of 2011, individual regents and the board have heard an earful from faculty and staff of UNLV and other NSHE institutions.

At UNLV, the chair of the Administrative Faculty committee (and an active NFA member), Shaun Franklin-Sewell, assisted in developing and implementing a survey to document faculty and staff concerns and especially those who have declined coverage or bypassed prescribed treatments for reasons of cost. This survey was reported to the board in December and will be followed up this spring by an NSHE-wide survey.

At a Jan. 24 meeting of the UNLV Faculty Senate, and again at the Jan. 30 UNLV Town Hall, I (John Farley, president of the UNLV chapter of NFA) asked UNLV President Neal Smatresk a pointed question. We have heard the concerns of the faculty and staff, the Regents have expressed sympathy and a desire to act, and the NSHE Task Force is charged with developing a proposal for gap coverage as a supplemental benefit. So, when can we expect the topic of supplemental coverage to be put to the Board of Regents for action?

The UNLV NFA chapter urges the Board to put this item of gap coverage as a supplement to PEBP for 2012-2013 on its March agenda.

Statistics are valuable tools used by scientists, economists and businessmen, among others. These groups use data to clarify and reveal trends and standings, to make projections, to measure how efficient or how far off the norm a certain parameter is. Thus, a practitioner is able to state pretty accurately whether his or her research interest is near the mean, achieves a certain percentile or is within variance of the top as compared to other similar parameters. When used appropriately, statistical values provide a clearer more concise understanding. That has value.

A problem with statistics, however, is the misuse of them for political purposes. Those bent on political persuasion too often selectively lift statistics out of context in order to serve their argument. This effectively clouds rather than clarifies, and of course, that is the intent of the misuse. That’s the first rub.

The second rub is that statistics tend to sanitize situations. Figures cannot accurately represent situations as felt by the parties they represent. They are bombs released at 30,000 feet that do not accurately portray the situation on the ground.

Therefore, whenever statistics concerning the status of Nevada’s colleges and universities are used, particularly where funding is ranked against other systems around the country, I am reminded that the real story is likely not being represented clearly, or understood accurately.

Statistics aside, here is what is really going on in the Nevada System of Higher Education today:

Virtually every faculty member who has relocated to Nevada in the past 10 years has a home mortgage that is underwater. These junior faculty represent the future of higher education in Nevada. They are caught in a no-win situation of diminished salaries, a bankrupted health care plan and a state government that doesn’t care that they are forced to moonlight in second jobs or use personal savings to get by each month. By comparison, and equally disturbing, senior faculty are calculating to the month when they can escape through retirement. We see recently retired colleagues, many of who gave their entire professional lives to Nevada, being forced to shop through outsourced health plans that are inadequate or disingenuous in their benefits. Our administrators are exhausted and burning out, because they have been forced to assume responsibility for two and three administrative positions that they know they cannot manage adequately. Our institutional presidents are harried by the fact they are cutting worthwhile programs, classes and staff to meet diminishing budgets, and we have a chancellor who is awake at night trying to plan for a downsized NSHE, when in fact he knows he should be enhancing NSHE to meet the demand in the years ahead. Finally we have students who are justifiably frustrated because their career choices, supporting programs and classes are gone, likely never to return. The question for them is whether to stay and attempt to be a contributing member of Nevada’s workforce, or leave the state for good.

Statistics that are deployed to mask this state of affairs serve no meaningful purpose, nor do they reflect the reality in our classrooms, on our campuses and in our System office.

It took a generation to create a fine system of higher education in Nevada and two bienniums to degrade it by a third. Without a viable and adequately funded system of higher education, a diversified economy is absolutely not going to happen in our state. No statistics are needed to support these two facts.

At almost the same time that University of Nevada, Las Vegas, faculty and staff were asking, repeatedly, at today's town hall meeting in Las Vegas if the Board of Regents would be taking up the prospect of a supplemental benefit for Nevada System for Higher Education faculty and staff to offset the woefully inadequate coverage offered under the current Public Employees' Benefits Program, the executive director of PEBP was telling an interim legislative committee in Carson City that it has accrued a breathtaking $43 million reserve.

This is deeply distressing news, particularly in light of the impact that the shift to a choice of either high-deductible catastrophic-only coverage or high-premium HMO coverage has had on NSHE faculty and staff. A survey of UNLV faculty and staff conducted in November found the changes have led to a marked increase in UNLV staff either declining coverage outright, delaying care or skipping needed medications (especially among those making less than $50,000 per year, which is over half the campus workforce).

What is particularly galling about the news of the surplus is that the PEBP staff's own report to the Board prepared for the most recent Board meeting in January, attributed over half of the reserve ($23.5 million) to "[d]ecreased self-funded claims expenses" (p. 109) – this despite repeated claims made by the Board and staff in 2010, when they proposed converting the PPO to a high-deductible/ catastrophic-only model of "participant over-utilization." Equally galling is that most of the rest of the reserve is attributed to a claim of $20.5 million in "[h]igher beginning cash" at the start of the plan year, last July 1. (Another $5.3 million of the surplus is attributed to "[i]ncreases to HMO premiums.")

This means that the overcharging of participants clearly pre-dates the beginning of the new plan design, since PEBP was already running a hefty reserve in fiscal year 2011, precisely at the time the claims of "participant over-utilization" were being repeatedly raised at Board meetings.

PEBP is now sitting on a reserve that has accrued almost $1,200 per insured state worker in the last six months – a time during which treatments have been skipped and a record number of employees have dropped off the plan. (This also puts the state in jeopardy of running afoul of new federal requirements, to take effect in 2014, that all individuals must be insured.) Keep in mind that the employer contribution for each employee will actually increase in fiscal year 2013, so that the supposed good news of stable premiums for participants that the PEBP board will consider at its March meeting means PEBP would still be increasing its revenue next year while continuing to offer sub-standard health coverage.

Finally, as for the PEBP staff's assertion at the hearing that the reduction in benefits paid is a consequence of "sheer luck" and that insurance claims in the latter part of the current plan year will reduce reserves, this raises a puzzling question: Who performs the actuarial work there? After all, PEBP and PEBP alone has the full data on its participants' past utilization experience, and PEBP and PEBP alone designed the current plan. If their economic models in fact projected that claims would be lower in the first six months of plan year 2012, then why did they not project this hefty surplus? And if they are in fact running significantly ahead of their own expectations for cash on hand, then why in the world does a nonprofit, self-insured plan not adjust the rates accordingly and give not only participants but also the state a break on premiums for next year?

Or, of course, go back to offering decent medical coverage that we public service workers have been paying for, but clearly not receiving.

President Obama in his State of the Union tonight "put colleges and universities on notice" about rising tuition, proposing to cap federal financial aid eligibility for students at institutions which increase tuition.

While this sort of cost control measure clearly has populist appeal, keep in mind that the same approach to capping Medicare reimbursement rates, which is part of federal budget law, is annually circumvented through the so-called "doc fix" precisely because medical providers are in a position to decline Medicare patients if the reimbursement rates are below the cost of providing care.  

The President is right to call for greater access to affordable, quality public higher education. But it would appear from the President's rhetoric tonight that he does not believe the actual cost of providing education at many institutions is rising, only the price charged students. If there are institutions where that is the case, his approach seems sound and salutory.

But as is abundantly clear  from the recently published 2011 College Board report on Trends in College Pricing especially the section on "Institutional Revenues -- Public Appropriations", the most significant driver for increases in student tuition at public colleges and universities, not just since 2007 but going back to at least 1998, is declining public support, while the cost of delivering education has risen below the rate of inflation. (Since 2004, the report shows, 4-year public colleges and universities have seem a reduction nationally of about 5% in state and local support, while the national average for increases in student fees over that same period is only 4%).

 

Thus, the increases in student tuition are not a reason, as the President proposed, for reducing the amount of "public taxpayer dollars" invested in higher education -- but the result of already reduced public investment. 

The case of Nevada is telling. According to the same College Board report, as reported in the SF Chronicle and elsewhere, NSHE institutions charged as of 2010-2011 the lowest tuition in the country in their categories, with University of Nevada, Reno, identified as the least expensive public 4-year university in the nation (for in-state fees). The cost of a 4-year degree at UNR, with UNLV only marginally higher, is only a fraction -- as little as 1/10th of some private institutions that were singled out for praise for cutting tuition and about 1/4th of the amounts charged by the University of California system.

The significant increases in-state fees imposed at UNLV, UNR and other NSHE campuses  over the past four years have been entirely in response to the over $200 million in state support cut from higher education in Nevada in that period.

 

So while the President's proposal to cap financial aid in response to tuition increases may have merit, keep in mind that it will apply primarily to those colleges and universities whose high costs result in their students becoming eligible for federal aid, either in Pell Grants or subsidized loans. Nevada's in-state students qualify in much lower numbers than students in other states for Pell Grants and incur significantly less indebtedness due primarily to our low in-state tuition (even after the sharp increases of the past few years). So that this proposed cap would not actually apply to most Nevada students, because students at Nevada's public colleges and universities generally qualify in lesser numbers and for lesser amounts of federal aid due to our comparatively low in-state fees.

 

The more direct way to keep college affordable is, as he put it in the prior line of his speech, for states to restore the massive amount cut from public higher education allocations in the past few years. 

 

Another would be to revive an idea that only four years ago was supported by most Democratic candidates for President and a majority of 2008 primary voters, making community colleges and public colleges cost-free for all qualified students. Long before he became a national laughingstock for his personal failures, John Edwards proposed a policy of "College for Everyone" that would have given every qualified student aid for full in-state tuition through a combination of direct aid, work-study and direct loans repaid based upon a proportion of future income. While that proposal did nothing to address costs, it did not need to -- because the cost of delivering education is not what is making college unaffordable, especially in Nevada. Declining public support for our colleges and universities is.

(As for the case made by Richard Vetter that colleges and universities spend far too much on non-educational expenses (a case he will make this morning on KNPR), he may or may not be right depending on whether students consider those expenses necessary for their college experience. But either way, as Professor Vetter has acknowleged, those costs are borne on most campuses -- and certainly at UNLV this is true -- by student fees and are funded neither by instructional fees (commonly referred to as "in-state tuition") or by state general fund appropriations. Effectively, students make -- individually and collectively through their student government -- market decisions to pay for those services, and while students could reduce their cost by not paying those fees, those fees have nothing to do with the cost of delivering education and therefore do not reflect any sort of inflation. They simply reflect rising student expectations for services, just as most of us expect more health care services than our parents or their parents did.)

Another way the state of Nevada could cut in-state fees is to reduce state subsidy for out-of-state students who attend NSHE institutions on exchange scholarships, which allow students from California and other neighboring states to enroll for 150% of in-state fees, less than half of regular non-resident tuition. Currently there are more than 1800 such students enrolled at UNR (about 1/8th of their undergraduate student body) and another few hundred at UNLV (about 2% of UNLV's student body). The current discussion concerning a new funding formula for higher education in Nevada is a good occasion to address this problem.

So yes college is getting more and more expensive in Nevada, and that is something the President and our state government ought to stop and reverse. But blaming colleges and universities that have done more with less for years is neither economically sound nor going to solve the problem.

 

The Nevada Faculty Alliance is pleased and honored to announce that our integrated print and electronic communications program has been recognized by the AAUP Assembly of State Conferences.

The ASC granted the NFA its "Print and Electronic Communications Award" for 2011, in recognition of our "outstanding tabloid-style newsletter" and our "highly professional" electronic update and website.

During 2011, not only did the NFA create a new website with a new news blog as well as a Twitter feed and active Facebook page, and introduce a weekly electronic newsletter, but it also streamlined the editorial and production process of The Alliance print newspaper and integrated its editorial content onto the website and newsletter while also updating the design and layout of the print version. In 2012, the NFA is working to further enhance the value of these important assets for members.

We are gratified by this national recognition of our hard work.

Members of the Committee to Study the Funding of Higher Education, got a last-minute surprise at their Jan. 11 meeting, held at the Grant Sawyer State Office Building in Las Vegas. Nevada Senator Steven Horsford, chair of the committee, added Nevada System of Higher Education Chancellor Dan Klaich to the agenda so that Klaich could present NSHE’s proposal for a new way to fund public higher education in the state.

Nevertheless, everyone present and attending via videoconference from Carson City and Elko came prepared, and they seemed to agree on one thing: Equity must be part of whatever new formula is adopted.

Senator John Lee, whose bill established the committee, opened the meeting with a lengthy statement expressing concerns that the current formula redistributes student fee dollars in a way that “turns students into taxpayers,” as he said. Lee also drew on the last committee’s 2005 findings as a way of underlining concerns of historic inequities of more than $20 million each for the College of Southern Nevada and UNLV.

Following Lee’s statement, Horsford said he believed the intent of the legislation and the committee was, “to evaluate the best formulas that ensure equitable allocation and distribution of those sources, based on the mission of each of our institutions throughout the system.”

As Klaich walked the committee through NSHE’s proposal, he said: “I want to be very clear that I want to be mindful that this is not a taxation committee. It’s not my point here today to talk about the adequacy or inadequacy of funding for higher education. That’s a discussion for another day, and certainly I have strong opinions on that. But after we price our product, it’s up to us to fairly and adequately allocate those funds amongst the institutions based on the work that they do.”

Klaich touched on the shortcomings of the current model, which has been in use since the 1980s, saying it is difficult to understand (undermining its credibility) and discourages differentiation and entrepreneurial behavior. He added, “This issue of geo-politics is inextricably wound in, and you (Senator Horsford) stated it correctly – whether ‘real or perceived.’ It doesn’t matter whether it’s real or perceived; it’s there.”

Klaich proposed that the committee set aside Nevada’s current formula and start over, rather than tinkering with a broken model. The NSHE plan he presented was meant to provide a conceptual framework for a new model. Klaich explained that it would need to be developed through further study of the cost factors in Nevada (likely to be studied by an independent consultant) and of funding formulas used in other states, such as Texas, which also have multi-tiered systems of higher education.
 
The proposed framework has three main elements: 1. base funding, calculated using a weighted student credit hour matrix, in which each student credit hour completed would be weighted according to the cost of the discipline (with disciplines sorted into clusters of roughly common cost) and on academic level; 2. add-ons, or enhancements, for research missions (at universities) and for economies of scale at other institutions; and 3. a performance pool of funds available to each institution that achieves certain performance benchmarks, particularly the number of graduates or certificates awarded.

Members of the committee spent considerable time asking Klaich questions about the new approach, which was summarized in just over three pages. Assemblywoman Debbie Smith expressed concern about the many technical components of the proposal that would need to be fleshed out, pointing as an example to vagueness about distribution of performance pool funds. No questions were posed on the financial impact of shifting from the allocation of state funds based on enrollment to allocation based on completion of credits, and there was no discussion of a timeframe for transitioning from the current formula to the new one.
 
Klaich said following the meeting that he was pleased with the reaction of the committee, which agreed to integrate NSHE’s new model into the request for proposals from independent consultants that will go out in the coming weeks.

“As I tried to emphasize to the committee, this was a proposal that needed a lot of detail work and independent vetting,” Klaich said. “I think the questions from the committee highlighted many of the areas that we will have to study. I thought for such short notice, the committee was extremely well-prepared.”

As the formula is being hammered out, Klaich stressed, he wants teaching faculty to know that it will be based on what he considers their primary mission, teaching. “We will value it fairly across the system, and we will be highly supportive of the model that funds performance, excellence, assessment and rigor,” he said.

His next step will be to begin executing the committee’s request that NSHE fill in some detail in the model and provide examples of implementation. Klaich said he welcomes the NFA’s input as the process unfolds.

This next step will undoubtedly be the subject of discussion at the special meeting of the NSHE Board of Regents scheduled for Friday Jan. 20 at DRI in Las Vegas.

On behalf of the NFA state board, this statement is to clarify some of the confusion created by AAUP president Cary Nelson's email sent Tuesday.

As of last Wednesday morning (January 11), the state board confirmed, unequivocally, that the NFA remains the Nevada affiliate of the AAUP and its members remain AAUP members.

The NFA is indeed engaged, as you know, in discussions about restructuring our affiliation with the AAUP to ensure NFA members get the services they need and deserve -- rather than having more than half our dues used to subsidize AAUP activities in other states.  This negotiation was begun with the national officers and staff in the fall of 2010 and is currently being pursued with the AAUP's governing board, its National Council. NFA has indeed, as we have reported to members repeated, withheld dues to AAUP until the situation is resolved, primarily because the invoices received from AAUP placed all our members in the highest income band and assessed dues on all our members at collective bargaining rates. But there has been no action by either party taken to end the NFA affiliation with the AAUP or to expel NFA members from the AAUP, and there has been no diminution in services from the AAUP to our members.

Let us offer a few additional points of clarification :

Any comments, concerns or questions may be addressed to the NFA state board directly at info@nevadafacultyalliance.org. Additional updates will be emailed to members directly and posted on http://nevadafacultyalliance.org/News.

UNLV HR Benefits manager attended the Dec 15 PEBP Board meeting on behalf of the NSHE Task Force on health coverage and filed this report:

The Public Employees Benefits Program (PEBP) met on Thursday, December 15 for their regular board meeting. NSHE and Nevada Faculty Alliance representatives made public comment regarding the difficulties experienced by employees related to the Consumer Driven Health Plan (CDHP) as well as comments on the proposed plan changes.  These included:

• That the majority of our employees would prefer PEBP contributions to Health Savings Accounts (HSA) and Health Reimbursement Arrangements (HRA) be made at the beginning of the plan year rather than semi-annually;
• Support was expressed for the PEBP Staff recommendation that no limits are set for roll over amounts within the HRA;
• Major concerns regarding the high cost of prescriptions and the need for a richer prescription benefit plan were shared; and
• Support for a middle tier plan with more predictable out of pocket costs, but with a reasonable premium, was emphasized.

PEBP Board members acknowledged the financial difficulties that employees are experiencing with the new plan, especially with the cost of prescription.  They echoed our concerns that employees may be deferring taking medications and have asked the prescription plan provider to evaluate if this is a prevalent issue in the plan.  

Discussion regarding the middle tier plan occurred, but the majority of the PEBP Board Members did not support such a plan. The board cited concerns with adverse selection. Additionally, concerns about future volatility of premium costs in the PEBP Self-funded plan were expressed. This volatility would be due to the anticipated, smaller population base in the CDHP should a third tier plan be added. Board members, however, did express support for the possibility of using plan savings (if there's any as a result of changing to the Consumer Driven Health Plan) to increase the seed money that goes into employees' HSA.

In addition to the discussions summarized above, the Board approved the following plan changes:

• Seed money going into employees' HSA and HRA account will continue to be deposited once a year, at the beginning of the plan year. The amount of the seed money remains the same at $700 per employee and $200 per covered dependent to a total maximum of $1300.  Individuals who are hired mid-year will continue to receive a prorated amount.

·  Currently, the cost of preventive dental care is charged to a participant's annual maximum benefit ($1000), which reduces the amount you can use for other dental benefits. For the FY13 plan year, the Board excluded preventative dental cleanings and exams from the maximum. By excluding these benefits, you will be able to use the full $1000 maximum benefit for other dental services (ie. fillings, crowns, root canals, etc). No action was proposed or taken with respect to the number of preventive dental cleanings, as such they will continue to be available four times each plan year.

The next meeting of the PEBP Board is scheduled for January 19, 2012.  Information regarding composite rates for the plan year 2013 (beginning July 1, 2012) will be presented at that meeting. The PEBP Board are scheduled to make a final decision regarding rates at the March meeting.

David Holland, assistant professor of history at the University of Nevada, Las Vegas, has won the 2011 Nevada Professor of the Year award in the U.S. Professors of the Year Program, sponsored by the Council for Advancement and Support of Education and the Carnegie Foundation for the Advancement of Teaching.

The award recognizes excellence in undergraduate academic instruction. Holland and his wife were invited to a celebratory reception in Washington, D.C., where they also met with U.S. Senator Harry Reid of Nevada.
 
“I was pleased to welcome Dr. Holland and his wife, Jeanne, to my office to congratulate him on this impressive achievement,” Reid said.  “I have always remembered and carried with me the lessons my favorite professors and teachers taught me as a student.  Students at UNLV are fortunate to have such a wonderful history professor in Dr. Holland.”
 
Holland currently teaches U.S. history and religion courses. Before joining UNLV in 2005, he was a lecturer at Stanford, where he earned his Ph.D.

In response to the very high concerns voiced by faculty and staff across the Nevada System of Higher Education, NFA remains actively involved in the System's efforts to restore adequate health coverage as quickly as possible. In this story, we report on two, related developments: 1. the work of the NSHE Task Force on Health Coverage seeking alternatives to current PEBP coverage through a short-term supplemental benefit for NSHE employees (possibly as early as next year) and considering a longer-term alternative outside of the Public Employees’ Benefits Program (which raises some legal and financial challenges to achieve), and 2. this Thursday's PEBP board meeting, where an alternative to current coverage will be considered for next year.

NSHE Task Force update: Legal and Financial issues related to seeking improved coverage

At last week's Board of Regents meeting, the NSHE Task Force on Health Coverage presented an update on its work, which included the following:

• data from research (with the help of an external consultant) on current costs, coverage and insurance utilization of NSHE employees within PEBP
• discussions with the PEBP board of improvements that we hope to see in both customer service and coverage
• an exploration of longer-term alternatives to current coverage for NSHE employees through a self-funded insurance program outside of PEBP

The report did not discuss another aspect of the task force's charge and earlier report, the exploration of an NSHE-funded supplemental benefit for faculty and staff for next fiscal year, as a stopgap measure. The board discussion showed a great deal of concern among regents about the current state of affairs and longer-term solutions, but no formal action was taken.

In light of this discussion, and the high priority that faculty and staff place on this issue, it is worth explaining some of the legal and financial issues involved in this discussion.

First, neither the board of regents, the chancellor nor the campus presidents have the authority to seek insurance for their employees outside of PEPB. That would require approval of the PEBP board and/or legislative action. That approval is not assured and would require a careful effort by the System as a whole to educate the legislature and the governor, and to convince them that this would lead not only to better coverage for us but be cost-effective for the entire state.

Under current PEBP board policy, any group of employees that leaves the program must demonstrate that the withdrawal of those participants would not have a negative financial impact on the overall program of greater than 5 percent. If PEBP determines that the withdrawal would have an adverse impact of greater than 5 percent, the group withdrawing is responsible to cover all costs of its departure on the remaining participants.

One question the NSHE consultant will study is whether the withdrawl of NSHE participants as a group would have a negative financial impact on PEBP of greater than 5 percent of its total program budget. If that were the case, then we would need legislative action to change that rule before we could pursue alternative insurance. (It would also mean, of course, that NSHE participants had paid significantly more over the recent past than we have received in benefits. If that is the case, it would mean that the reserve funds held by PEBP came disproportionately from NSHE participants – and this would be an argument for letting NSHE withdraw without having to pay for the cost to remaining PEBP participants.)

At the November PEBP board meeting, NSHE leadership (namely, then vice-chancellor Bart Patterson, and now Renee Yackira, director of government relations for NSHE) testified to the PEBP board to express our concerns. They urged PEBP to consider, as early as next year, a "middle tier" of coverage between the current high-premium, fee-for-service HMO and the much-derided high deductible "consumer-driven" plan that replaced the old PPO.

However, such a "middle tier" may not be financially feasible for PEBP to offer, because the costs to the program have increased at a rate of roughly 10 percent per year for each of the past several years. These rising costs are the main issue in the question of whether NSHE – and the state – could get better coverage for the same money than PEBP currently offers. The question of whether PEBP reimburses health care providers at higher rates than other insurance plans has been posed going back to the 2009 legislature, but has not been fully answered. (The PEBP board and staff have stated publicly that rising costs are due to over-utilization of service by participants and that the "consumer-driven" high-deductible plan will curb that over-utilization and cut costs. Critics of PEBP's coverage have maintained that the roughly 10-percent annual increase in the cost of the program has been passed along almost entirely to state public service workers, rather than reducing the rates it pays providers. This claim is hard to verify, however, because reimbursement rates to providers are considered proprietary information and are not publicly available to participants.)

There is then the separate issue of supplemental benefits within NSHE. The task force was charged to consider this possibility and recommended consideration in its report of last January and has continued to discuss this in meetings this fall. This issue was not explicitly presented in the task force's report to the board on Dec. 2, but several regents did ask about whether immediate action would be possible.

A supplemental benefit for NSHE employees would not require legislative approval or, based on what the task force has researched, PEBP approval. It would, however, require NSHE to spend its own money on supplemental benefits. The issue then becomes whether 1. NSHE wants to spend between $5 million and $15 million of its aggregate $1.2 billion budget on a supplement to bring health coverage for faculty and staff up to a minimally acceptable standard, and 2. there would be negative political consequences for the System for doing so that might outweigh the negative consequences for its staff of not doing so.

PEBP board update: Middle tier of coverage to be considered this Thursday

This Thursday, December 15, the Public Employees Benefit Program governing board, composed of gubernatorial appointees, will hold its regular monthly meeting (for agenda, backup information and links to view or listen to the meeting, click here). As part of this meeting, the PEBP board will consider adopting a "middle tier" of coverage option for next year. Such a "middle tier" would be more comprehensive than both the new (and much-maligned) "consumer-driven" plan – which offers choice of doctors but limited coverage until a high deductible has been met – and the health maintenance organization – which charges lower fees for each service, but charges higher premiums and offers limited choices. The proposed "middle tier" would restore deductibles to near-2009-2010 levels ($500 per year for individuals and $1,000 per year for families) and fixed-cost co-payments for office visits ($15 for a primary care visit, $25 for a specialist, $45 for urgent care). It also would restore low, set-priced fees for generic drugs ($4 for 30 days supply) and reduce co-insurance costs to 10 percent for many services. On the other hand, participants in this plan would not be eligible to contribute to a Health Savings Account, so they would receive no "seed money" to offset costs incurred during the year. Moreover, the premiums are likely to be much higher – and will not be known until February 2012.

As a different alternative for creating a "middle tier," PEBP will also consider offering three plan choices: two CDH plans and an HMO plan. Under this scenario, participants could choose the HMO or one of two CDH plans with differing deductible, coinsurance, maximum out-of-pocket and HSA seed money amounts. One option would offer a lower deductible option ($1,200 per individual, $2,400 per family) that would also have a lower out-of-pocket maximum ($3,000 and $6,000) and a lower co-insurance (20 percent), but would offer only $400 (individual) or up to $700 (family) in seed money to the Health Savings Account. The other, higher-deductible option  would require individuals to pay $3,000 ($6,000 for families) before receiving coverage, and insureds could incur higher out-of-pocket maximums ($4,500 for individuals, $6,000 for families) and would pay a higher co-insurace rate (25 percent). However, participants would receive a higher amount of seed money ($1,100 per individual, up to $2,000 per family) and, presumably, pay a lower monthly premium.

In all cases, premium rates will not be determined until February so it is very hard to know how costly each option might be for an individual or family.