18 MONTEREY COUNTY WEEKLY june 20-26, 2024 www.montereycountynow.com son at the time deflected it back onto SVH: “It’s disappointing that Salinas Valley Health would threaten to terminate its contract with us unless we agree to significantly increase local health care costs for our members, employers and families in Monterey County,” the spokesperson said. “The increases being sought by Salinas Valley Health are unsustainable and will lead to significant cost increases and result in higher premiums, deductibles and copays for local health care consumers.” The standoff was high stakes. About 11,000 Anthem Blue Cross patients had visited SVH or affiliated Salinas Valley Health Clinics the year prior. County Supervisor Luis Alejo, writing on behalf of the Monterey County Board of Supervisors, wrote to Anthem: “Where are the increased premium dollars going if not to the health systems providing care to those paying the premiums?” At the time, Covered California—the state’s health care exchange established by the Affordable Care Act, which allows people to purchase subsidized insurance plans—reported that Anthem’s premiums were rising by 11 percent. Eventually, four months later, Anthem and SVH reached an agreement. Anthem patients would remain in-network, just as the open enrollment period for 2024 was set to begin. And then early in 2024, SVH would find itself in highly public negotiations with another insurance provider. MCSIG stands for Municipalities, Colleges, Schools Insurance Group, which started in 1982 as a joint powers authority, composed of various government entities that pooled into a collective insurance group. Today, it insures 11,070 subscribers (and their family members) employed by 28 member agencies. The list includes local school districts such as Monterey Peninsula Unified, Carmel Unified, Salinas City Elementary and Salinas High School Unified, as well as the City of Seaside and some more far-flung members, like the El Dorado County Office of Education (in the Lake Tahoe area). It costs about $15,912 to insure one employee/patient per year. Each employee has different options for plan configuration through their employer, but the cost, determined by an actuary, is immovable. The most popular plans, unsurprisingly, are the cheapest for the insured, in which they pay a lower premium. The rule of thumb is that higher premiums pay for better coverage, and the same goes here. Until March 1, 2024, members of MCSIG’s lowest-premium plan—the PPO Select, also the most popular plan—had insurance cards that conveyed a strong message in all-capital letters: “NO MONTEREY COUNTY HOSPITALS ARE COVERED UNDER THIS PLAN.” The actual business of insurance and claims is managed by Blue Shield, but MCSIG leadership negotiates the plans. And MCSIG members have been a regular presence at OHCA meetings in Sacramento, and an increasingly vocal presence locally when it comes to health care expenses. They’ve been unable to reach agreements with Natividad and CHOMP, but as of March 1, SVH began accepting PPO patients insured through MCSIG. (Patients with different plan configurations were covered at local hospitals prior to the agreement.) Organizers and SVH administrators trumpeted the agreement as a breakthrough. “Salinas Valley Health recognized that many teachers and other educators in our area were falling through the cracks of unaffordable commercial health insurance plans and low cost government healthcare programs,” SVH CEO Allen Radner said in a statement. “The situation was unacceptable. We listened to concerns and diligently worked with MCSIG to provide educators with local, quality care at no additional cost to them.” Steve McDougall is a longtime teachers union rep, now serving as president of the California Federation of Teachers early childhood through grade 12 Division Council of Locals. He also serves on the MCSIG board, and spearheaded the effort to get PPOinsured patients in-network at a local hospital. “Our members win. They have an in-network hospital,” McDougall said at the time. “Good on [SVH] for working with us on this. Maybe we can get similar things done with other hospitals.” McDougall is first and foremost an old-school union organizer, but he’s gotten a crash course in health care and now that is a major focus. He is now ready to advocate for MCSIG members to boycott two of Monterey County’s three major medical systems. “If I had things my way, we would steer all our business to SVH, and starve Natividad and CHOMP until they do something akin to what SVH has done,” he says. (In a nod to the challenging landscape for educators, Montage announced in March it was donating $5 million to create the Montage Health Fund for Teachers at the Community Foundation for Monterey County, with the funds intended to go to teachers as cash that might be used to offset medical costs. McDougall, along with other teachers, received a $1,000 check at the end of the 2023-24 school year but says he won’t cash it: “I call that a prop. It was to make the folks rattling cages with Montage look like fools.”) Union members have regularly spoken up at OHCA meetings. For Hector Azpilcueta of Unite Here Local 19, representing hospitality workers in the region (like Gonzalez who is struggling with medical debt), the creation of the OHCA board was “the Hospital system: CHOMP Natividad Salinas Valley Health State average: gross patient revenue $2.6 billion $1.4 billion $2.8 billion % from Medicare 57.9% 23.2% 44.4% 17.7% % from Medi-Cal 15.4% 55.0% 29.8% 17.2% % combined government payer 73.3% 78.2% 74.2% 34.9% The Problematic Payer Mix Local patients are disproportionately reliant on government-provided health insurance, rather than commercial insurance. Here’s how it breaks down. The chart below covers the period of July 1, 2022June 30, 2023 for Natividad and Salinas Valley Health; for Community Hospital of the Monterey Peninsula, it covers calendar year 2022. Source: California Department of Health Care Access and Information Daniel Dreifuss The Natividad Board of Directors (shown on June 14) governs the public hospital, owned and operated by the County of Monterey. Board members are appointed by the Monterey County Board of Supervisors. In January 2015, the hospital became a Level II trauma center after a competitive process versus SVH.