Consensus at Premium on County’s Health Plan

A single mom with a 12-year-old son enrolls in the cheapest medical plan her employer--the county of Ventura--offers, saving herself more than $100 a month.

She is healthy, only needed emergency care twice last year, once when her son broke his toe. Both times, the nurses and doctors at the county facilities were nice and polite, the care fast and hassle-free.

On the other end of the spectrum is a man with a wife and young baby. He picks the county’s more expensive Aetna plan. He doesn’t mind paying more, saying his medical coverage is better with the private insurance company. And he doesn’t want his family sitting in Ventura County Medical Center’s emergency room.

“Why should I have to go to the same doctor as people who can’t afford to go to a doctor?” he said.

What she likes and he mistrusts is the county’s home-grown medical plan, known to county employees as PierreCare, a sometimes fond, sometimes derisive tribute to Pierre Durand, the director of the county’s Health Care Agency.

Technically, it’s just a simple insurance plan, based on the premise that the county can provide inexpensive health care to its own employees using its own medical system, Ventura County Medical Center and its clinics.

But in the politically charged climate that pervades Ventura County’s medical community, nothing is simple. Community Memorial, the nonprofit hospital across the street from Ventura County Medical Center, sees the county’s foray into the insurance field as just another attempt to wrest paying patients out of its beds and into those of its arch rival.

Community Memorial’s campaign against the county hospital has led some government workers to pick the county’s plan out of loyalty to the public hospital. But it’s also made others opt for other medical plans, fearful that they are being used as pawns in a political game to save the county medical center from going out of business.

The county’s medical plan comes with a tempting price tag. At $93.20 every two weeks, it is the cheapest health care option employees have.

But plenty of people have resisted the county plan, from the top ranks of government workers--a member of the Board of Supervisors, the director of public works, the district attorney--to employees who make minimum wage.

Their reasons are diverse.

Some say the county’s medical plan doesn’t offer enough choices, either for doctors or emergency care. A lack of trust in the system’s confidentiality, a concern that their privacy will be violated by their employers, makes others shy away. There are complaints that the cap on prescription medication is too low. Some employees say they feel pressured to join the plan.

And others, half apologetically, share their fears of spending hours in waiting rooms with the county’s poor. One man likened his perception of users of Ventura County Medical Center to people in line at the Department of Motor Vehicles, the kind of people who get in trouble, miss payments and shirk responsibilities.

The administrators of the health plan are all too aware of that stereotype. Frustrated, they point out that one-third of county residents who are employed don’t have health insurance. Those are residents who aren’t indigent, aren’t on welfare, but can’t afford insurance and turn to public health.

But it’s a hard stereotype to overcome. Sitting in his office at the hospital on a recent rainy day, with water steadily dripping out of a gaping hole in the ceiling and into a brimming garbage pail, Dr. Sam Edwards admitted that the hospital he runs lacks commercial appeal.

“Nobody wants to go to the county hospital,” Edwards said. “There is a stigma.”

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When the plan started nearly four years ago, it drew about 900 of the county’s 6,000 full-time employees. According to Edwards, they were the young and the healthy. They didn’t relish the idea of going to the county hospital, but hedging their bets on good health, they figured they wouldn’t have to.

Every time they ripped open their paychecks, they saw what they were saving. The county operates on a cafeteria plan, with each bargaining unit negotiating how much its employees can spend bimonthly on medical, dental and vision plans. The amounts vary from as little as $123.91 for part-time employees to as much as $247 for judges and others.

So if an employee is allotted as much as $190 on a bimonthly basis to spend on health care, and only spent $93, that extra $97 would show up on his or her paycheck.

“That’s considerable cash back,” said Ron Komers, director of personnel for the county, who joined the plan in its first year. “It represents a good value.”

Word spread through the ranks. By 1995, 1,800 county employees were in the plan.

In an effort to keep those workers happy, to make sure its plan was working well, the county asked for comments from the employees. They got plenty of suggestions, ranging from the likes of, please do something about the cafeteria food at the hospital, to don’t make us wait in line so long. And get that nurse to be nicer.

Edwards said the hospital’s atmosphere has improved.

“We’re paying a lot more attention to those things,” he said.

County employees don’t get preferential treatment, he said, but the staff does what it can to ease their way through the system.

This year, the number of county employees in the plan jumped to 2,500. Last week marked the end of the open enrollment period. No numbers are available yet to show how many employees will switch to the county plan for 1997, but in interviews, many said they are contemplating the move.

“I really am torn,” said Kathy Jenks, the head of animal regulation for the county.

Currently enrolled in the Aetna plan, Jenks stuck with it last year because that plan let her go to specialists she already had relationships with and because she lives in Ojai, miles from the county hospital. But she is thinking about changing to the county’s medical plan.

“My inclination is, I am going to have to go with the county plan,” Jenks said. “If nothing else, to show my support of what the county is doing and to let Community Memorial know that I don’t appreciate what they’ve been doing in fighting the county.”

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What Jenks is referring to are Community Memorial’s attempts to stymie the county’s efforts to expand the public hospital, including having spent $1.6 million on a campaign last year that swayed voters against construction of a $56-million wing at the medical center.

Community Memorial also lobbied hard, although unsuccessfully, to block the county from receiving a special state license that allows it to run its own HMO, claiming that Ventura County wanted to create its own private health care plan.

Each hospital believes the other is trying to put it out of business. Both concede there probably won’t be room for two hospitals to survive financially. In this hospital war, patients emerge as the bounty. Or at least that is what some of them feel like.

“The spin amongst the county employees is what the county is really trying to do is fund the medical hospital in a different way,” said one former employee.

Randy Feltman, deputy director of the Health Care Agency, says that the number of county employees is far too small to ever make that much difference in the medical center’s fiscal future. The 2,500 employees currently enrolled bring with them an average of one dependent each. That means 5,000 people using the county hospital. But Feltman said that on an average day in the 190-bed hospital, there are only two to three county workers checked in.

“It is a significant number,” Feltman said. “But it just isn’t the basis for the hospital to survive.”

Ventura County Chief Administrative Officer Lin Koester agrees.

“I don’t see this plan as being something we put forward to help the county system,” he said.

But it’s hard to get some county employees to believe that.

“They are trying to generate revenue,” said Sgt. David Williams, the president of the 780-member Ventura County Deputy Sheriff’s Assn. and a vocal critic of some elements of the county plan. “I don’t care what anyone says, that is what they are trying to do.”

In October, Williams went to the Board of Supervisors to register some of his complaints about the health plan. He concedes that there is a reluctance on the part of members of his fairly conservative union to visit the county hospital as patients.

“It’s not discriminatory,” he said. “It’s not the hospital itself. It is who might be sitting in the waiting room next to them. . . . There might be two or three people that they arrested last month in there.”

But sharing a waiting room with undesirables is not among his litany of complaints. He said some employees feel pressured to join the plan to be team players.

“We had employees who were told that their supervisors were watching what plan they were on,” Williams said.

County officials flatly deny that.

“I’m not aware of any individual that has been coerced,” Feltman said. “There have been efforts to kind of win approval of employees, but I don’t know of one instance where anyone has gotten into trouble because they didn’t join.”

Williams’ group also has a beef with the plan’s annual $5,000 cap on prescription drugs. The county plan’s brochure says that excludes chemotherapy treatments. But it mentions nothing about patients with HIV or AIDS, who can spend thousands of dollars every month on medication.

Feltman said that no member of the plan has been denied drugs because of the cap, including AIDS patients. If there were a problem paying for drugs, he said, “initially our reaction would be to go to some of the drug companies and try to get free medicine.”

But Supervisor Frank Schillo agreed with the deputy sheriffs that the cap is problematic.

“I’m going to recommend that it be extended,” he said. “It should be unlimited.”

Schillo also said he would push, early next year, for the establishment of a separate administration to run the county’s health maintenance organization, independent of the Health Care Agency.

“I don’t think that people who are in the hospital business should be running the insurance plan,” he said.

Schillo said the county needs to take more of a business-like approach to the plan and called for an actuarial study of the county’s employees. He said he thinks the health plan is good, but that it is experiencing natural growing pains as it gains new members.

Some improvements have already been made, and others will follow, officials said. In the next few weeks, labor management groups will hold meetings to ask government workers what they want from the health plan.

Many county employees, particularly those with children in college, said they refrained from joining the county’s medical plan because it offers only limited services outside the county. A child enrolled in an East Coast college, for instance, could get emergency care through a network of providers. But if such a student gets the flu or a bad sore throat, he or she would have to try chicken soup in the dorm as a cure, or fly back to Ventura County to see the doctor.

Even employees at the top of the ladder couldn’t get around that limitation. Koester enrolled in the county plan, but held onto a separate insurance policy for his wife and stepson, who live in Pismo Beach, because of it.

Feltman said an agreement signed in recent weeks with another provider gives the Ventura medical plan a shared network in 50 states, improving the plan’s out-of-area services.

Confidentiality has been an issue for some employees, particularly those who work within the medical system. They worry that a few taps on a computer keyboard can call up their whole health history. One nurse said she feels the people she works with are like family. But they are also her employers.

“I don’t want them seeing me in some situations,” she said. “I’d feel embarrassed. And I’m not sure who would say what to who.”

Feltman said employees’ privacy is protected.

“The insurance records are on a completely separate computer system,” Feltman said.

Some employees who live outside Ventura find the plan inconvenient. Take Supervisor Maggie Kildee, who lives in Camarillo and doesn’t belong to the plan. “You get to where you kind of want a clinic or a hospital close by,” she said.

Kildee is also attached to her doctor of 30 years. That’s a common feeling among county employees. Tax Collector Hal Pittman, a cancer survivor, said his rapport with his doctor is worth more to him than the dollars he could save changing to the county plan.

In response, the county has added more doctors to its list of primary care providers, offering employees 110 doctors with private practices to choose from and another 70 who work in the county’s clinics. And added services are making employees such as David Panaro who have been with Aetna think twice during open enrollment.

“I’m going to take another look at it, definitely,” Panaro said.

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If employees continue to migrate in droves to the county’s medical plan, some worry that the private provider, Aetna, will pull out of its county contract in the future. With the county plan drawing those who are relatively healthy, that leaves older, sicker, and therefore more expensive, clients for Aetna.

“Maybe in 1998 they [Aetna] will say we decline to bid on this particular plan because it is no longer profitable for us,” said Barry Hammitt, director of Service Employees International Union Local 998, which represents 4,024 of the county’s employees. “That’s a distinct probability.”

With the growing popularity of the county plan, Williams worries about his Aetna premiums going up. He also questions whether the county plan’s premiums will stay so low.

“I think nobody can predict the premium,” Feltman said. “There is no plan here to raise premiums any more than is absolutely necessary.”

Saying the county health plan has already fractured workers’ negotiating power, Williams said his group is considering finding another health care provider.

Sources on the labor management committee say the county recently brought up a proposal to eliminate the Aetna HMO as an option, leaving only the more expensive Aetna point-of-service plan, or the county HMO as choices. The committee rejected that idea. But it isn’t dead.

“We’ll see what happens down the line,” Feltman said. “It is a possibility.”

Supervisor Susan Lacey said the board is a long way from making the county’s medical plan the only choice for employees.

“I don’t think we will ever have that as a sole option,” Lacey said.

(BEGIN TEXT OF INFOBOX / INFOGRAPHIC)

Officials Comment on Coverage Many of Ventura County’s top officials are divided on the question of whether to take the county’s health care plan or stay with private insurance. Here are some of their views: *

Name: Michael D. Bradbury

Position: District attorney

Plan member: No

Comments: “My wife has a real good policy as a schoolteacher.”

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Name: Bruce Bradley

Position: Elections chief

Plan member: Yes

Comments: “I’ve been very satisfied with the service.”

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Name: Richard Dean

Position: County clerk

Plan member: No

Comments: Not willing to give up rapport with family doctors, “it’s traumatic to change.”

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Name: Pierre Durand

Position: Health care administrator

Plan member: Yes

Comments: Blanches at the nickname PierreCare.

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Name: Sam Edwards

Position: Hospital chief

Plan member: Yes

Comments: Says his health is great, but he is happy to be in the plan.

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Name: John K. Flynn

Position: Supervisor

Plan member: Yes

Comments: His staff says he is enthusiastic about the plan.

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Name: Art Goulet

Position: Public works director

Plan member: No

Comments: Inconvenient because he lives in Camarillo.

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Name: Glen Gray

Position: Assessor

Plan member: No

Comments: “I wanted to be able to go to whatever doctor I wanted.”

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Name: James Isom

Position: Head of social services

Plan member: No

Comments: Son lives out of the county, too inconvenient.

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Name: Kathy Jenks

Position: Head of animal regulation

Plan member: No

Comments: Needed specialists the plan didn’t offer. Is thinking of switching.

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Name: Maggie Kildee

Position: Supervisor

Plan member: No

Comments: Hospital and clinics are too far from her Camarillo home.

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Name: Lin Koester

Position: Chief administrator

Plan member: Yes

Comments: Kept another insurance policy to cover his out-of-town family members, will switch them to the county plan soon.

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Name: Ron Komers

Position: Personnel director

Plan member: Yes

Comments: “Only good things to report about it.”

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Name: Susan K. Lacey

Position: Supervisor

Plan member: Yes

Comments: Hasn’t used much, but very satisfied.

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Name: Thomas Mahan

Position: Auditor

Plan member: No

Comments: “I live in Ojai and they don’t have that area covered.”

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Name: Judy Mikels

Position: Supervisor

Plan member: Yes

Comments: Often speaks highly of it publicly.

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Name: Hal Pittman

Position: Tax collector

Plan member: No

Comments: Has ongoing relationships with specialists outside plan that he wants to stay with.

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Name: Frank Schillo

Position: Supervisor

Plan member: Yes

Comments: “I haven’t been sick much, but we have an outstanding clinic in Thousand Oaks.”