HARTFORD, Conn. – Instead of imposing higher co-pays and rolling back health insurance coverage for state employees, Connecticut officials want their workers to get a colonoscopy to help cut costs.
They also want them to get a mammogram and an annual physical, and to take their diabetes medication.
"If we keep people healthier, costs will go down, workers will pay less and the employer will pay less," said Dan Livingston, the labor attorney who helped to negotiate a tentative concession and labor savings agreement with Gov. Dannel P. Malloy's administration on behalf of 45,000 unionized state employees.
The deal, which still needs to be ratified by rank-and-file members, calls for the creation of the Health Enhancement Program, a version of a so-called value-based health and dental benefits plan that tries to encourage workers to take better care of themselves and ultimately help avoid costly medical problems down the road.
Many businesses have already embraced incentivized health care programs, such as paying workers to stop smoking or providing maintenance drugs for chronic conditions free of charge. And a growing number of states, counties and municipalities have passed laws mandating wellness programs for public employees.
"There's a kind of economy of scale. When your program is large enough, having this kind of program seems to work better and more economically," said Richard Cauchi, health program director for the National Conference of State Legislatures. He said employers like a state tend to have a large number of career employees, making it easier to predict, project and estimate savings, which tend to accumulate in later years.
As of last July, at least 16 states had created wellness incentive programs for their public employees, according to the NCSL. The list includes Alabama, Arkansas, Delaware, Kansas, Minnesota, Mississippi, Missouri, Montana, New Hampshire, North Dakota, Ohio, Oklahoma, South Dakota, Virginia, Washington and West Virginia.
Most offer positive reinforcement as a way to encourage healthy lifestyles. In Arkansas, public employees who complete a health risk assessment, which gauges smoking, alcohol consumption, seatbelt usage, body mass index and weekly physical activity, receive a $10 monthly discount on their health insurance premium. Those found to be low-risk receive an additional $10 discount.
Alabama, however, in 2008 gave its 37,527 employees a year to start getting fit. If they don't, they have to pay $25 a month for insurance that is otherwise free.
Robert Krzys, an attorney and health care expert for a coalition of Connecticut state employee unions, said the proposed Health Enhancement Program was a concept first suggested by the unions. Krzys, who sits on a health care cost-containment committee, said it's a way to make the state employee population healthier while holding the line on health care spending. Connecticut now spends about $1.3 billion a year on health care for 250,000 active and retired workers and their dependents.
Recent figures show that 12 percent of state employees use an existing program that provides workers with disease counseling, such as education about controlling their diabetes.
"It doesn't really do us any good if they're not using it," Krzys said.
When he pitches the Health Enhancement Program to union members, he mentions that a 57-year-old worker didn't feel well last year, was told to get a colonoscopy and discovered he had stage four-cancer. The man's treatment cost the state $1.3 million and he died shortly afterward. Under this plan, he would have gotten his first colonoscopy at age 50.
The plan is voluntary. Those state workers and retirees who decide to participate, including their dependents, must agree to have physicals — annually for those 50 years and older — age-related screenings such as mammograms and cholesterol tests, and cervical and colorectal cancer screenings.
The two insurance companies that administer the state's insurance program will inform the state Comptroller if employees are getting their proper screenings and filling their prescriptions. If they're deemed to be noncompliant, they are dropped from the program and allowed to participate in the regular insurance program for state employees, but will pay $100 more a month and a $350 annual deductible, Krzys said.
Some state employees already see the initiative as big brother watching to see if people quit smoking or a way to eventually ration their health care. Others have posted concerns on union message boards suggesting there's a political motive behind the plan, which is being promoted by union leaders who support universal health care.
Godfrey Ferguson, a child support officer who is active in his union, said he likes the concept because he thinks it will help him remain healthy. But he said some of his colleagues are skeptical of it.
"The criticism we are hearing is more of a philosophical basis, 'they can't tell me what to do or I don't take medication, they want to put me on medication,'" Ferguson said.
Despite concerns voiced by state employees, Krzys insists employees will not be penalized if they don't stop smoking or don't lower their blood pressure. Those who are deemed to be noncompliant will have an opportunity to appeal to a special committee.
The Democratic Malloy administration is counting on the Health Enhancement Program to be a money saver.
The tentative agreement assumes $77.5 million in the first year of the two-year $40.1 billion budget. Besides savings from healthier workers, that estimate, provided by consultants, includes the $100 additional monthly payments made by people who opt out. About half of the approximately 50,000 state employees are assumed will participate.
Mark Ojakian, Malloy's lead labor negotiator, said the $77.5 million represents only about 40 percent of the potential anticipated savings once the program is fully up and running.
Ojakian knows state employees are wary. But he's optimistic they will come around.
"People don't understand it yet. And I think the more that people understand it, the more that they feel that it's not what it's being represented to be," he said. "It's not big brother, quite honestly."
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