Questions Continue Over New Health Plans

Criticism and confusion continues with the Quinn administration's proposed health plans for state employees and retirees in the next fiscal year.

The proposal would remove Urbana-based Health Alliance from the mix, raising difficulties for patients who use doctors at Carle, Springfield Clinic and McDonough District Hospital in Macomb. Those hospitals and clinics have exclusive HMO contracts with Health Alliance (a Carle subsidiary).

Instead, HMO coverage for state employees would only be offered by Blue Cross/Blue Shield of Illinois which has no primary care physicians under HMO contracts in the Champaign County area. A spokesman for BCBS says they do not have HMO providers in every county.

But a spokesman for the Illinois Department of Healthcare and Family Services says there are other options in their proposals --- namely the open access plans offered by HealthLink and PersonalCare. Mike Claffey says those plans offer medical coverage at different levels. He says Tier 1, the least expensive, works like an HMO. Claffey says it's his understanding that Champaign-based Christie Clinic is part of the provider network at Tier 1 levels in the open access plans, while Urbana-based Carle is available at the more expensive Tier 2 and Tier 3.

State Representative Chapin Rose says the proposed health plan lineup goes before a legislative advisory panel in Springfield on Monday. And Rose says he thinks the Commission on Government Forecasting and Accountability is predisposed to approve the proposal. The east central Illinois Republican says the commission needs more accurate numbers on the new health plans --- numbers he says won't be available until after Health Alliance files its formal protest.

"Filing their protest is what gives them the cost document they need to officially disprove these cost issues," Rose said. "If the (commission) votes on Monday, they will be voting without the actual real numbers to prove or disprove what's going on."

Meanwhile, an organizer with Champaign County Health Care Consumers is urging state employees not to panic. Anne Gargano Ahmed says if the state's decision is approved, it should give Carle the incentive to negotiate with Blue Cross Blue Shield for HMO coverage.