It boggles the mind to realize the power that NEA should have as the biggest union of women in the country. At the same time it is politically unwise to speak too adamantly about gender needs because some men might feel that favoritism is being shown. But the more surprising thing is that women themselves would rather downplay anything that suggests feminism. So the article in TEACH, the TEA's house organ, should not surprise the reader when it talks of insurance without ever mentioning differences between men and women. The source of the article was NEA's advocacy section. Both NEA and TEA apparently agree on the need to "tone down" the insurance conflict. However, it needs the spice of man-woman lifestyles to really make the point clear.
The basic concept of insurance is to take a large group of people, some needy, some not needy, charge them all the same price and then the needy people are protected and the not so needy have confidence that they will also be taken care of if their life situation changes. Insurance companies can make money if there is some way to decrease the number of needy individuals and/or increase the number of "unneedy" individuals. The beauty of our insurance trust, over the years, is that with the mix of teachers we have, any money to be made actually comes back to the teachers in the form of lower insurance costs in the pay stub. Young and healthy teachers implicitly know this when they join the trust, believing that by the time they are older the premiums they paid over the years will have been worth the cost.
Along come the Republicans with the idea of splitting the insurance trust. If the trust is split between the healthy and the needy, then the costs can be charged differently to the two groups. Guess what! The needy group will have to pay so much that it becomes cost prohibitive. The healthy group which saved so much money in the beginning will now be joined by the needy group, but the benefit is so much less that the needy people are still paying out-of-pocket tremendously larger amounts of money even though they nominally have insurance.
Who are these two groups? Predominantly men are the healthy teachers and women are more likely to be the needy group. Don't believe it? Look around at the young teachers. Men and women start out equally in the health situations, but women have to get involved with the health care system because of reproductive care. Even the most healthy women need to go to the physicians more often than men. Then, because children are more often on the mother's coverage than the father's, there are more costs for women attributable to family situations. In teachers over the age of 50, the gender differences are less. Men have increasing health care problems as they age. But a great many men could teach for twenty-five years before they move to the "needy" pool.
What do these pools look like? The pool for women would look like what we have now. In the beginning the cost would be no more than what we have now. The pool for men would resemble what is known as "catastrophic" coverage. That is, a high deductible of two or three thousand dollars per year. If men do not use the health care system, they don't need to worry however large the deductible is. Then, for these men, if a true emergency occurs, they would not be thrown into bankruptcy; everything over $3,000 would be covered. The reward for men to change would be a greatly reduced premium. The incentive for the school system would be that the 75 percent of the premium the system pays would also be cut drastically.
What kind of women would join the men's pool? Primarily, it would be young and healthy women. They could go some years before being hit with the big payouts. But a woman with a $3,000 deductible will be paying a lot of money--thousands of dollars--every year, and she will wish she had something that paid for everything over $250 like we have now. With a split pool, the costs for the regular insurance--with fewer teachers, older teachers, and female teachers--will be much higher: so high that women will decide they have to stay with the $3,000 deductible even if they feel like medical costs are robbing them.
The TEA-NEA writer is adamant about resisting the splitting of the pool. If more teachers will read and understand the issue, it will be good. By throwing the male-female angle into the mix it may cause people to take what might otherwise be a tedious insurance article more seriously.
This issue has not been proposed to the Insurance Trust in Nashville. In other parts of the country it torments the local associations. We learn from sad experience, most every bad thing that happens in education elsewhere must be fought locally by the MNEA.
How does this Republican plot work? The TEA (probably wisely) avoids mention of the partisan struggle, but explains the plan as part of the something-for-every-insurance-company Medicare changes of 2003.
HDHP/HSA is the legal enticement produced by the national government. You cannot have the HSA, which is part of the tax law without also having your employer provide the HDHP. It is like a self-insurance plan for an individual, but with a tax deduction. An individual can contribute up to $2,600 per year, and if they have family coverage they can contribute up to $5,200 per year. That reduces the tax obligation. Now, after four or so years, a single teacher could have $10,000 socked away. He or she can stop contributing at any time. So with about $10,000 in the bank and an insurance policy that will cover anything over $3,000, he or she is good for a three year emergency. Sounds pretty good for a healthy male.
A woman, trying to put away enough for the family policy, plus having to pay all medical bills for herself and her children up to $3,000 per year will soon find that she is falling short. She will come a lot closer to spending the full $3,000 every year than a man will.
The school system is an even bigger winner, because they don't put anything in the HSA, nor do they help the individual pay the deductible. So they save money on premiums with no corresponding increase anywhere.