Adding the rider would cost the county an estimated $182,589 this year, according to staff – to be paid to Blue Cross Blue Shield of Michigan. To cover that cost, each county department will be charged on a per-employee basis. In addition, the county will pay for claims made by employees for this benefit, with the assumption that most if not all claims would be reimbursed by the state.

The board has been discussing this possibility for several months. At its Jan. 22, 2014 meeting, the board received a staff presentation about the possibility of offering such coverage. Colleen Allen, CEO of the Autism Alliance of Michigan, attended that meeting to answer questions and advocate for coverage. The board created a committee to explore the cost to the county for providing employee health insurance coverage for autism. Committee members were Felicia Brabec (D-District 4), Andy LaBarre (D-District 7) and Ronnie Peterson (D-District 6). The committee’s charge was to (1) investigate the cost and sustainability of coverage of autism spectrum disorders; and (2) recommend a policy providing and funding coverage if the state reimbursement fund is exhausted.

The federal Mental Health Parity & Addiction Equity Act of 2008 mandates that any group plan with 50 or more members – like Washtenaw County government – must offer both medical and mental health benefits. Under more recent federal health care reform, there’s been an expansion of benefits, and mental health benefits are considered a mandatory part of basic health care, starting this year. However, autism isn’t included as part of that mental health mandate.

On the state level, in October 2012 a state of Michigan mandate took effect stating that all fully insured plans must provide coverage for the diagnosis and treatment of autism spectrum disorders (ASD). The county is not a fully insured plan, however. Because the county is self-funded, it was exempt from this state mandate.

The costs of treatment are estimated to be about $60,000 a year to cover a child with autism. The state of Michigan has made coverage a priority, and has started setting aside funds to reimburse organizations that provide coverage. In fiscal year 2012-13, $15 million was made available, with an additional $11  million in fiscal 2013-14. Of that, only about $500,000 has been expended on reimbursements. The program is handled by the Michigan Dept. of Insurance and Financial Services.

The state program provides for reimbursement of up to $50,000 per year per child between the ages of 0 to 6, up to $40,000 per year from ages 7-12, and up to $30,000 per year for ages 13-18.

County staff have estimated that offering the coverage would result in up to a 5% increase in medical expenses, or up to $1 million annually. This year, medical expenses are budgeted at about $20 million. The county is expected to be fully reimbursed by the state of Michigan for the amounts that are allowed under the autism program.

The resolution given initial approval on March 19 included two resolved clauses:

NOW THEREFORE BE IT RESOLVED that the Washtenaw County Board of Commissioners authorizes the implementation of the Autism Spectrum Disorder (ADS) rider to existing active and retiree as soon as feasibly possible through Blue Cross/Blue Shield of Michigan, providing mental health and physical health parity.

BE IT FURTHER RESOLVED that Washtenaw County commits to a review of claims paid and/or reimbursed on an annual basis as our individual experience is not yet known. Such review would occur prior to the annual review process with Blue Cross/Blue Shield to determine if such benefit (rider) would be continued in the next year of benefits.

This brief was filed from the boardroom of the county administration building at 220 N. Main St. in Ann Arbor. A more detailed report will follow: [link]

Josie Parker, right, director of the Ann Arbor District Library, talks with AADL board chair Margaret Leary at the board's Dec. 8 special meeting. (Photo by the writer.)

The board had called a special meeting for Thursday to vote on these contracts, which run from Jan. 1, 2012 through June 30, 2015. The agreements are with the Ann Arbor District Library Staff Associates, which represents 30 employees, and the Ann Arbor District Librarians Association, which represents 14 AADL librarians. All but two of these 44 workers are full-time employees with benefits. The library employs a staff of nearly 200 at its five location throughout the district, including about 100 full-time workers.

The previous contracts expired on June 30, 2010. The main difference between the old and new contracts relates to a change in health insurance providers, plans and employee contributions, according to AADL director Josie Parker. She said she appreciated the hard work that both sides of the negotiations had done to reach an agreement.

The two AADL bargaining units are part of the Michigan Education Association, dating back to the years prior to 1996 when the library was still part of the Ann Arbor public schools system. Paul Morrison, executive director of the Ann Arbor Education Association – the local MEA unit – participated in negotiations and described the outcome as “not great for labor” but reasonable, given the economic circumstances.

The board took two other actions at its meeting on Thursday: (1) a vote to cancel its Dec. 15 meeting, because there are no pressing agenda items; and (2) a vote to call an executive session for its Jan. 16, 2012 meeting, to discuss the written opinion of its legal counsel.

Labor Agreements Finalized

There was little discussion at Thursday’s meeting about the two labor agreements. Board chair Margaret Leary noted that trustees had received copies of the documents for review earlier this week, and had discussed the negotiations extensively in executive sessions over the last year. [.pdf of agreement with Ann Arbor District Library Staff Associates] [.pdf of agreement with Ann Arbor District Librarians Association]

AADL director Josie Parker told the board it was with great pleasure that she was bringing the agreements for a vote, and noted that they would be effective from Jan. 1, 2012 through June 30, 2015. [AADL's fiscal year ends on June 30.]

Barbara Murphy, the board’s treasurer, thanked the staff for their perseverance, observing that it had been a long haul and everyone had worked hard to arrive at an agreement.

Outcome: In separate votes, the board unanimously approved the two labor agreements.

Glen Modell, co-president of the staff associates bargaining unit, and Beth Anderson, the librarians association bargaining committee representative, attended Thursday’s meeting but did not address the board. When queried by The Chronicle after the board adjourned the meeting, Modell indicated that he preferred not to comment on the agreement or the negotiations, other than to say that it was a long process.

In response to an email from The Chronicle, Paul Morrison of the Ann Arbor Education Association left a message on voicemail describing the negotiations as very difficult due to economic constraints of the public sector. The process went through the entire range of steps, including fact-finding and mediation, he said. The outcome is “not great for labor,” Morrison said, but is reasonable considering the circumstances.

The contracts, because of their duration, provide some stability for both employees and the board, he said. Morrison said he hoped to see a brighter future for employees, “but it will be a while.”

The agreements cover a range of issues, including health insurance, a grievance and arbitration procedure, seniority, layoff and recall, vacations, leaves of absence, and performance evaluations, among others. The salary range for librarians in 2011-2012 is set between $41,743 and $59,579. The salary for staff, with six pay grades, ranges from $25,081 to $59,579.

In response to a Chronicle query, Parker elaborated on the agreements. For the new contracts, the bargaining units chose to accept the same health care providers and plans as AADL’s non-union staff, she said. She noted that currently, the health insurance offered to non-union employees falls well below the state-mandated caps that take effect Jan. 1. [On Jan. 1, 2012, public employers will be prohibited from paying more than $5,500 for health benefits annually for a single employee, $11,000 for an employee plus spouse, or $15,000 for family coverage.]

The final agreement was the same as the library’s initial offer, Parker said. Employees have five plan options with three health care providers – Blue Cross Blue Shield, Blue Care Network, and Priority Health – at varying costs. Two of the plans that are the least expensive, offered by Blue Care Network and Priority Health, are based on health incentives. Some of the concerns raised by unions related to these plans, which were considered as intrusive. [These types of insurance plans reward certain health behaviors – not smoking, for example, or following treatment regimes for chronic conditions like asthma or diabetes.]

Parker noted that more than half of AADL’s full-time staff with benefits already choose from these plans and are satisfied. The health incentive plans aren’t mandatory and there are other options, she said, so the library felt the selection was reasonable and fair.

The lack of a renegotiated agreement with AADL’s bargaining units had an impact on the district’s finances in the last fiscal year. The library administration had anticipated reaching an agreement with the unions earlier than it did, and had budgeted for lower employee benefit expenses during fiscal 2010-2011 – $1.5 million, compared to $1.678 million approved for the previous year’s budget.

However, health care costs were higher for the fiscal 2010-2011 year than budgeted, requiring that the board authorize the transfer of $60,000 from the salaries and benefits line item into the employee benefits line item at the end of the fiscal year. The board took that action, along with other year-end budget adjustments, at its June 20, 2011 meeting.

Employee benefits for 2011-2012 are budgeted at $1.51 million out of an overall $12.034 million budget.

In response to a question from The Chronicle, Parker indicated that labor issues have no connection to the recent decision to explore the future of the downtown library building on South Fifth Avenue. [See Chronicle coverage: "Library to Restart Downtown Facility Review"]

Parker said she appreciated the hard work of all involved on both sides of the negotiations. The agreements were signed by Parker, board chair Margaret Leary, AADL associate directors Ken Nieman and Eli Neiburger, and human resources manager DeAnn Doll. The Ann Arbor District Librarians Association agreement was signed by co-presidents Lucy Roehrig and Betsy Baier, Ann Arbor Education Association executive director Paul Morrison, and bargaining committee representative Beth Anderson. The Ann Arbor District Library Staff Associates agreement was signed by co-presidents Graham Lewis and Glen Modell, bargaining committee representative Robin Madigan, and Morrison of the AAEA.

Present: Nancy Kaplan, Margaret Leary, Barbara Murphy, Jan Barney Newman, Prue Rosenthal, Ed Surovell. Also AADL director Josie Parker.

Absent: Rebecca Head

Next meeting: Monday, Jan. 16, 2012 at 7 p.m. in the library’s fourth floor meeting room, 343 S. Fifth Ave. [confirm date]

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The goal is to develop a plan to provide better health care for the county’s low-income residents, the uninsured and people on Medicaid – prior to changes that will be mandated by the federal Patient Protection and Affordable Care Act.

The Washtenaw Health Initiative (WHI) is a collaboration led by retired Saint Joseph Mercy Health System chief executive officer Bob Laverty, former county administrator Bob Guenzel, and retired University of Michigan treasurer Norm Herbert. The effort is jointly sponsored by the UM Health System and Saint Joseph Mercy Health System, and faciliated by Marianne Udow-Phillips, director of the Center for Healthcare Research & Transformation – a joint venture of UM and Blue Cross Blue Shield of Michigan. Several other groups, including Washtenaw United Way and the county public health department, are also involved.

Organizers say they hope this initiative will become a model for other communities nationwide that are facing similar issues.

Details of exactly what kind of services will be provided, what funding and other resources will be tapped, and how a coverage plan will be implemented haven’t yet been determined. Initial steps that could occur as early as this year include reaching out to enroll about 6,000 county residents who are eligible for Medicaid but not currently signed up for that coverage. Another project that could be implemented this year entails coordinating local dental clinics to offer sliding scale fees for low-income residents.

More information is available on the initiative’s website. [.pdf of WHI press release] [.pdf of Washtenaw County health care overview]

As a primary care physician, I believe strongly that we need meaningful healthcare reform. In practicing for over 25 years, I have witnessed how impossible it is to get healthcare without insurance. And in the last 10 years I have seen an increasing number of my patients lose their insurance.

It saddens me that I can’t provide adequate care for them. It also has been alarming to me to see how easy it is to lose healthcare coverage, especially in these difficult economic times. It will only get worse without substantial reform. If nothing is done to reform healthcare, the nonprofit Commonwealth Fund predicts that over one-fifth of the nation’s gross domestic product (GDP) will be spent on healthcare by the year 2020. And it won’t mean that more Americans are covered: that year, the number of uninsured is expected to rise to 61 million.

People who are complacent about the problems of the uninsured may be ignoring how vulnerable we all are when there is no promise of universal coverage. Some people lose coverage when they are laid off, some when their small company decides they can no longer afford covering healthcare benefits for their employees. I have patients who are retired but too young to qualify for Medicare who are told that their former employer has dropped healthcare coverage from their retirement benefits.

Still others, who have some insurance, find that they can’t afford the steeply rising premiums so they opt for a plan that only covers catastrophic illness; then they must pay for all clinic visits and preventive care out of pocket. Screening tests like colonoscopies are very expensive, so of course they choose not to do it. I have patients who struck out in their own promising new business only to be devastated by an illness or depleted of capital because of exorbitant premiums.

Perhaps most poignant for me as a mother of a 20-year-old is the plight of young adults who are trying to establish their careers, achieve financial independence, perhaps start a family. Many of them have beginning job positions that do not include healthcare coverage. If they get ill, they may never get ahead of their debt.

The scenario just gets sadder when you consider what happens when an uninsured person gets ill. I have a young patient who has osteomyelitis, a bone infection. Without insurance, she cannot afford the medicine she must take to keep it in check. Medicaid will be her only option for coverage – but she must spend all of her savings and become “medically indigent” in order to qualify. Plus she can’t have a job of any significance because she would then make too much money to continue getting Medicaid. She must choose to remain poor so that she can get healthcare – in what universe does this make sense?

Not long ago surveys showed that a majority of Americans agreed that we need healthcare reform. Now we hear of people’s fear of reform. What happened? Distortions and lies have successfully confused people and confounded the debate. Please don’t believe the manufactured lies. I’m a doctor – I can tell you they are untrue. There won’t be death panels, or socialized medicine, or federal funding of abortion. Medicare won’t be dissolved and there won’t be discrimination in healthcare determined by the government. If you want to know what the proposed bills really contain I encourage you to check out the facts and comparisons provided by The Kaiser Family Foundation website. Keep in mind that the American Nurses Association and even the conservative American Medical Association have endorsed President Obama’s reform agenda.

I cannot imagine anything more unethical than spreading lies in order to instill fear, then to use that fear to further one’s own avaricious goals – and in the process worsen access to healthcare for millions of Americans. This is what many insurance companies are doing. Their lobbyists in Washington provide congressmen with money as well as lies, they encourage disruption of town hall debates on reform, and, through phony “grassroots” groups they fund commercials and websites that spout dishonest propaganda. Then they pay for it all with the money we pay them in insurance premiums! What remarkable irony! The only thing more despicable is to be a congressman who has vowed to represent his constituents, who intentionally misleads, manipulates and frightens them to serve his own greed for power. It doesn’t get lower than that.

Cost projections by Commonwealth Fund have shown that the best way to start curbing health expenditures is to have a public option. Remember, dollars paid as a premium to Medicare are spent on healthcare. There is no money going toward profits, executives salaries, lobbyists, advertising, or routine auditing; therefore bureaucracy and overhead for Medicare are much less than for private insurers.

It is clear to me that the outcome we should be most afraid of is that which will occur if we do nothing. Then we will certainly have 1) rising percentage of our income paid for healthcare, 2) rising numbers of uninsured, 3) more small businesses failing, 4) decreasing ability of American industry to compete in the global market, and 5) rising inequity in income in the U.S.  as executive salaries (from the insurance and pharmaceutical industries, for example!) keep sky-rocketing while individual and small business income suffers. Don’t fear the ridiculous myths of death panels or baby killing. Be worried about what is happening now.

How do you counter lies with the truth when there is no respect given to the truth by the anti-reform gangs? I think there are many other voices, from both parties and outside the realm of politics, that can speak more responsibly and ethically. Let’s make the lies and the liars irrelevant. In the spirit of Ted Kennedy’s legacy of standing up for one’s principles yet choosing to work together, let’s open our minds and hearts and find solutions to this problem.

About the writer: Dr. Amy F. Saunders is a primary care physician practicing medicine at a clinic in Ann Arbor, caring for a large patient population. She received her MD degree from Ohio State University, did a fellowship in general internal medicine at Duke University Medical Center and received a masters degree in public health from the University of North Carolina.