www.montereycountyweekly.com march 7-13, 2024 MONTEREY COUNTY WEEKLY 15 I keep my health insurance card in my wallet, but I admit I’ve never spent much time reading the fine print on the back, mostly a list of phone numbers related to claims. The insurance cards of some 2,500 local people who are insured through MCSIG, plus their family members, have a similar back-of-card list, followed by the following proclamation in all caps: “NO MONTEREY COUNTY HOSPITALS ARE COVERED UNDER THIS PLAN.” It’s a wild carveout, leading to horror stories of people seeking care in Santa Cruz, Santa Clara and elsewhere. As of March 1, that carveout is no longer in effect, thanks to a new agreement with Salinas Valley Health, which now accepts patients enrolled in this low-cost plan. MCSIG stands for Municipalities, Colleges, Schools Insurance Group, and started in 1982 as a joint powers authority, composed of various government entities that pooled into a collective insurance group. (The current insurance provider is Blue Shield—that little card with the now-outdated proclamation on the back bears the Blue Shield logo, which handles claims, but the coverage itself is negotiated by MCSIG leadership, not Blue Shield.) Today, MCSIG has 27 member agencies, including school districts like Monterey Peninsula Unified, Carmel Unified and Pacific Grove Unified, as well as the City of Seaside. Employees of those agencies can choose to enroll themselves and their families in a plan. Most payors choose the PPO Select plan—the lowest-cost to the employee. Each employer has its own contribution arrangement. Employees of Salinas Union High School District, for example, pay no monthly contribution for themselves for the most popular PPO Select plan, or $530.21 for a family. The next most popular plan includes better coverage— including at local hospitals—and costs $544.61/month for an individual, or $2,396.21 for a family. The big takeaway from those numbers is something we already knew: Health insurance is expensive. And most people choose the lowest-cost option available and hope they will stay healthy instead of paying a ton for health insurance up front. Local health providers, meanwhile, have the task of negotiating rates with various insurers, like MCSIG, Anthem or Blue Shield. They don’t get the opportunity to negotiate with government insurance providers Medicare or Medicaid, which reimburse at a standardized rate that pays less than the actual cost of care. With a large population insured by Medicare and Medicaid, that leaves local hospitals especially reliant on reimbursements from commercial insurance companies—the rates that they can bill MCSIG, Anthem and Blue Shield. Salinas Valley Health and Anthem hit an impasse last year, finally negotiating a deal to keep at least 11,000 Anthem-insured patients in-network, a sign of how fragile these insurer-provider agreements are. Negotiations with commercial insurers like MCSIG are a little different than those with a big faceless insurance company like Anthem because MCSIG has good, old-fashioned union organizing on its side. Teachers union leaders Steve McDougall and Kati Bassler are both on the MCSIG board. They deal with all sorts of issues among members, but increasingly the top line is health insurance. Bassler realized in 2019 after getting mammograms for a decade at SVH’s Nancy Ausonio Breast Care Center that suddenly, it was out-of-network. “I went marching over to MCSIG and said, ‘What’s going on here?’” she recalls. It was the beginning of an education in health insurance. MCSIG members stacked SVH board meetings, and MCSIG eventually negotiated a special agreement to cover mammograms— members would get a voucher to bring to the breast care center indicating it should bill MCSIG directly, rather than handing over their usual Blue Shield cards. Perhaps the mammogram arrangement set the stage for successful negotiations regarding the PPO Select Plan. “Our members win. They have an in-network hospital,” McDougall says. “Good on [SVH] for working with us on this. Maybe we can get similar things done with other hospitals.” Already, union leaders have met with Montage administrators. SVH may just be the first domino to fall. Sara Rubin is the Weekly’s editor. Reach her at sara@mcweekly.com. Healthy Agreement A health insurance agreement with Salinas Valley Health is a milestone. By Sara Rubin Court Drama…Squid did a double-take while reviewing the agenda for a Feb. 28 meeting of the Monterey Peninsula College Board of Trustees, after seeing there was a closed-session discussion about “the threat of litigation by a Trustee against the District.” Such items are purposely vague for legal reasons, but after checking Monterey County Superior Court records, Squid had a hunch who the trustee might be. It turns out Trustee Debbie Anthony sued MPC in small claims court last June for $3,000, claiming the college owed her for attorney costs to defend herself “against a false claim of breach of confidentiality by [the MPC board].” A judge denied her claim on Aug. 29. Squid’s colleague contacted Anthony to ask if she was filing a new suit. Anthony says she is not and was surprised to see it on the agenda. Her version of events is that she was asked to leave the closed session meeting, and refused. “How can they discuss something that you never discussed with me?” she says. She told them they would have to call the police to escort her out. The board canceled the conversation. It’s not the first time Anthony has been at the center of controversy, and Squid expects it will not be the last. If it ever does wind up in court, Squid will be there for the fireworks. Connect the Dots…Earlier reporting by the Weekly brought to light the big bucks that it is costing Pacific Grove to address controversies surrounding P.G. Councilmember Luke Coletti and his treatment of employees. In September, the paper estimated it was at least $534,000 since January 2022, totaling only the costs of an investigator and other attorneys surrounding a complaint filed by former city manager Ben Harvey (three of his allegations were sustained) and Harvey’s severance package last July. With at least three other complaints filed by current and former employees in the last couple of years, the cost total is a lot more, but it’s difficult to pry any information about billing from City Attorney Brian Pierik. A Pacific Grove City Council budget hearing on Feb. 28 may hold a clue. It was reported that day that the 2023-2024 mid-year estimate for the cost of attorney services is $1,144,480—that’s more than double the 2022-2023 total of $538,146. Of the $1.144 million, a little over $510,000 is estimated for services provided by Pierik’s firm. The remaining $634,000 is for outside attorneys, whose tasks certainly include handling all of those investigations. Pacific Grove Mayor Bill Peake suggested the jump could be partly due to an accounting change. Maybe. Squid is still waiting for the receipts. the local spin SQUID FRY THE MISSION OF MONTEREY COUNTY WEEKLY IS TO INSPIRE INDEPENDENT THINKING AND CONSCIOUS ACTION, ETC. “I said, ‘What’s going on here?”’ Send Squid a tip: squid@mcweekly.com
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