Thursday, June 29, 2028

NOTE: To find the most current posts, please scroll down to the two big red arrows.

Saturday, June 24, 2028


Sunday, May 28, 2028

Items of interest in the Archives: The 2013 STRS Board Election

Many people have been very interested in reading about the irregularities of the 2013 STRS board election. There are many posts related to this topic, beginning the first week of April 2013, after the ballots were mailed to retirees from STRS. You can find them by going to the Archives for this blog, over in the right sidebar, and clicking on dates beginning with April 7, 2013. Dennis Leone announced his candidacy for a retired seat in November, 2012. There is a lot of information about him in the Archives, beginning with November 12, 2012 posts. 5/28/13

Saturday, February 28, 2026

STRS board meeting dates

Click here for board meeting dates and other information about STRS board meetings.
For further details, look on the STRS home page, under Member News & Information, Public Meeting Notice:

Friday, February 27, 2026

.....so what REALLY happened in 2003 that touched off a firestorm at STRS that is still smoldering today? Read it here, from the Cleveland Plain Dealer. (Hint: It ain't over yet!)

More here (Akron Beacon Journal, 2003)

Friday, April 11, 2025

Friday, March 10, 2017

To find current, day-to-day posts -- pull your scroll bar down a ways, just below the big red arrows (you can't miss them). Thanks.
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Friday, February 24, 2017

Find your state representative and senator here.

Thursday, September 15, 2016

Note from this blogger.....


In case you weren't aware, I am quite willing to post opposing views on this blog; in fact, I welcome such opportunities. If you disagree with anything you see posted on my blog, please feel free to submit your views and I will gladly post them.
Kathie Bracy
kbb47@aol.com 9/15/10.........................................

Sunday, May 15, 2016

Gettin' a little tired.....


Some communications to Mike Nehf and Tim Myers, dating back as far as 2009, continue to go unanswered. Looks like it will be a long wait, but we haven't forgotten. You can see them here and here.

Friday, April 29, 2016

I know, it's weird.........

Many posts that appear "at the top" for a while are eventually moved down, where they can be found under their original posting dates. Also, if you are confused by the postdating, this is done to keep these posts up there; otherwise, they drift down when new posts are added. It's a "blog thing" which I have no other way to control. KB

Wednesday, February 24, 2016

Handy links: Contacts, information and more (short version)
This is an abbreviated version of the original 'Handy links' post.
 Click here to view a more complete list. (Some of it is old.)
CORE website (Old) Contact information for just about anybody you would want to contact re: pension and HC concerns)
STRS Board.....STRS website
Board calendar
Map/directions to STRS, 275 E. Broad St. Columbus, OH 43215
Rich DeColibus' PowerPoint presentation STRS' PBI Program; Does it work?: click December 21, 2008 (blog Archive) and scroll down to December 23 posts.
Popular links (labels): , , , ,
SPECIAL (must read):

Dennis Leone's INVESTIGATIVE REPORT on STRS: May 16, 2003...Who is Dennis Leone?........(PDF version)...More on Dennis Leone .......(PDF version)
Dennis Leone's STRS Report to ORTA, March 2007
The Plain Dealer article that opened our eyes, June 8, 2003
Historic PBI vote, January 16, 2009

Tuesday, February 23, 2016

CURRENT POSTS BELOW
 

Thursday, October 30, 2014

RH Jones: Time for that 13th check

RH Jones to Bob Stein
October 30, 2014 
Subj: Time for a STRS OH 13th Check for Retired Members
 
Dear Bob Stein, President of the STRS OH Board:

Congratulations on being elected as our STRS OH Board President. I wish you good luck in your new leadership role.

All of us retired teachers have received the happy news that our OH STRS has now reached the 29.5 year funding level that will enable the board members to once again vote to authorize the very fairly calculated “Supplemental 13th Check”. It is my understanding that this vital supplemental check is still on the law books; and, since retired teachers have been especially hit at an alarming level with high medical and costly prescription medications this coming 2015, it is essential for those of us which have been retired over 20-years.  Some did not even get their non-compounding COLA this year and its been 1/4-century since the state has issued an Ad-Hoc increase to keep us even with inflation.

As the “Holiday Season” fast approaches, it is incumbent that this be introduced to the board, voted upon, and passed by the STRS OH Board in the mid-November meeting.  As our Retired Representative and our new board president it will be delightfully appreciated by many of us who have felt that there has been a lack of caring by our STRS OH over the past few years.

Most humbly requested,

Bob Jones, a retired STRS OH teacher

Thursday, May 29, 2014

Cleveland teachers, YOU are getting screwed BIG TIME!

From John Curry, May 29, 2014

Remember when Michelle (with a motive) Rhee was wined and dined by Kasich a while ago? I do! Now...look what has happened to your jobs! They are being taken by those Rhee "five week wonders!" An even sadder note is that some of you will still run right out and vote Republican the next time you enter the voting booth. There's really no cure for stupidity, is there? Some times (actually, many times) teachers are their own worst enemies! John
Cleveland Schools To Fire Quality Teachers; Union President Speaks Out
By On May 29, 2014
The Cleveland School District is in the news this week as they are working to remove teachers who have received good evaluations while simultaneously expanding their contract with Teach For America. This contract expansion will replace these experienced and qualified teachers with untested, under-trained TFA corps members (who each come with a “finders fee” paid out to Teach For America which will total $400,000 in additional spending).
At the Cleveland School District Board of Education meeting this past Tuesday, hundreds of teachers gathered to protest these changes that caught these successful teachers off-guard.  One of the key speakers to offer public comments to the Board that night was Cleveland Teachers Union President, David Quolke.  At our request, President Quolke shared his remarks with us so that we could share an accurate story of what is taking place in Cleveland:
I am David Quolke and I am the President of the Cleveland Teachers Union. There are many issues that I could talk to you about today. Many issues that I – and my members – think should be brought to your attention. However, today, I need to talk about Non-Reappointments.
The first week in May, 70 of my members received notice that they were being recommended for non-reappointment. Now that number could be off because these were the numbers that I was given by the media after they spoke with CEO Gordon or someone from the District. When talking to the media – I explained that many of my members were blindsided when they received this news and that the CTU was blindsided also. You see, I have many cases of members who had good evaluations – developing and skilled all year long, who were taking on leadership roles in their schools, who have increased student achievement, who have a composite evaluation with developing and skilled ratings. So, yes, when these teachers were suddenly told in May that they were going to be recommended for non-reappointment they were indeed blindsided.
Before you say to me – David, you know that state law does not require poor evaluations in order to non-reappoint a limited contract teacher. I know. I know. However, when the media came to the CEO regarding the teachers that were being recommended for non-reappointment – here are some of the quotes directly from CEO Gordon:
“We have a few people that either can’t or won’t. These are the people that our principals say are not meeting the expectations for our kids.”
“At some point if you are not getting the job done, we shouldn’t continue to pay you to do it.”
“It’s new for us to evaluate this thoroughly. It’s part of the Cleveland Plan to make sure that we have the right people in front of kids.”
So I ask you –
Is it a part of the Cleveland Plan to non-reappoint teachers with Skilled evaluations?
Is it a part of the Cleveland Plan to non-reappoint teachers with Skilled evaluations who have made a year’s worth of growth with their students in just 5 months?
Is it a part of the Cleveland Plan to non-reappoint teachers that were hired in October, November, December and are Developing (where a new teacher should be) or a combination of Developing and Skilled?
Is it a part of the Cleveland Plan to non-reappoint teachers that are Developing or a combination of Developing and Skilled who are taking on leadership roles, such as AR Champion or in servicing staff on SLOs (at the request of the principal) or who are accepting students from the local universities to observe their classes?
Is it a part of the Cleveland Plan to non-reappoint teachers that start in September, score Developing and Skilled on evaluations, and take over 100 hours in voluntary professional development?
Is it a part of the Cleveland Plan to non-reappoint teachers that are described like this by an administrator “His relationship with scholars and teachers resulted in one of the most successful classrooms in the district. I placed some scholars in his classroom knowing that it would be their last chance for success within CMSD.
I hope that none of this is a part of the Cleveland Plan. If it is – this should serve as a dangerous warning to all people enrolled in local teacher preparation programs – Come work in Cleveland where we ignore teacher Development and get rid of you simply because we can.
I know what you are thinking and what some people are already saying. The teachers union protects bad teachers. David Quolke wants bad teachers teaching kids no matter what the cost. I know that these words are already echoing in city hall, at 1111, and throughout the community. Let me be very clear – THAT IS NOT TRUE. It is a lie. I am furious about these non-reappointments. The officers of the CTU have worked around the clock in hearings for members over the last two weeks. There are good teachers that are doing the things that I want my daughter’s teachers to do. There are good teachers doing the things and the good work that our development and evaluation system ask for. There are good teachers doing what is needed to increase student learning and student achievement. They do not deserve to be recommended to this Board for non-reappointment.
So obviously a logical question would be – why are these people being recommended for non-reappointment? I have no answer for you. I can only speculate, but it is certainly a question that must be asked and answered by the people who engineered this massive non-reappointment of good and qualified teachers.
I think some people will look at tonight’s Board agenda and see that one of the items is a resolution to approve $400,000 to hire Teach For America teachers. Are these non-reappointments to make room for Teach for America? I will not bash Teach for America. They are our colleagues and once hired work shoulder to shoulder with us trying their very best to educate our students. But the irony of non-reappointing new teachers in order to replace them with Teach for America is that TFA does what the district should be doing – provide mentors and support. That is the actual Developing of a teacher that CMSD has completely abandoned.
Great way to recruit and develop a talented work force.
Sounds more to me like the beatings will continue until the morale improves. Not a good strategy for real reform.
Evangelize!

Wednesday, May 21, 2014

If your hospital tells you they want 'cash up front', tell 'em to 'take a hike!'


From John Curry, May 20, 2014 
Please pay first, more hospitals say
Columbus Dispatch, May 18, 2014
An OhioHealth registrar called Kelley Finan to pre-register her for her scheduled outpatient arthroscopic knee surgery and verify her insurance policy.
Then the woman told Finan that she owed $1,365.16 out of pocket for the procedure.
“How would you like to pay for that today?” Finan recalled the woman asking. “We take credit cards or debit cards.”
Finan, 54, of Grandview Heights, said she refused to pay upfront, and the OhioHealth representative backed off.
“She never indicated her demand for payment was a ‘suggestion’ until I called her out on it,” Finan said.
Increasingly, local hospitals are requesting not only co-pays upfront but also deductibles and co-insurance, which is the patient’s share of the cost of a covered health-care service beyond the deductible.
Officials with all local hospitals that request payment of deductibles and co-insurance before a scheduled surgery or other health care said they don’t deny patients care if they refuse to pay upfront.
“We’re not holding patients hostage,” said Keith Coleman, Mount Carmel Health System’s chief financial officer.
On July 1, Ohio State University’s Wexner Medical Center will begin requesting — but not requiring — that deductibles be paid upfront at all of its locations where health-care services are scheduled in advance. The practice has been used sporadically for two years by Wexner Medical Center, which has not yet begun requesting co-insurance payments upfront.
Some other service providers, such as the travel industry, expect payment upfront, so it’s not unprecedented for the health-care industry to do the same, said Debra Lowe, the hospital’s administrative director of revenue cycle.
“If your car needs replaced and you owe your $500 deductible (in an insurance claim), it’s very clear that you need to pay that for services to be rendered,” Lowe said.
Hospitals are taking such steps to head off the possibility of bad debt as consumers see their deductibles balloon for employer-sponsored and individually purchased health coverage. Among workers who are enrolled in health benefits through their jobs, 15 percent had a deductible of at least $2,000 last year, up from 3 percent in 2007, according to a survey by the Kaiser Family Foundation and Health Research & Educational Trust.
In the fiscal year that ended June 30, Wexner Medical Center collected $3.6 million from patients upfront, primarily in co-pays and deductibles. That total is expected to hit $4 million in the current fiscal year, which ends next month.
Local hospital systems recorded a combined $357 million in bad debt in their most recent fiscal years, up 14 percent from a year earlier.
Larger deductibles appear to be more common with the advent of policies available through the federal government’s new health-insurance exchanges, or marketplaces, Lowe said. She said Ohio State already has seen at least three patients whose policies purchased through Ohio’s federal exchange have deductibles of at least $10,000.
More hospitals are testing and adopting the approach, said Elisabeth Russell, the founder and president of the patient-advocacy consultancy Patient Navigator. “It’s harder to collect money from someone after they’ve walked out the door.”
With far more of patients’ own money at stake, it’s important that they understand how much is owed, Russell said. But she said patients also can lose leverage in their dealings with hospitals and other health-care providers if they pay deductibles and co-pays upfront.
“I think they should, if possible, avoid paying upfront (in case) things get messed up — as they usually do — in hospital bills,” Russell said.
At Wexner Medical Center, patients’ deductible payments are underestimated to reduce the chance that a patient will be overcharged.
“The last thing we want to do is overcollect and then have to refund your money,” Lowe said.
OhioHealth began collecting co-pays upfront from patients in 2008, and deductibles and co-insurance in the past two years, said Jane Berkebile, system vice president of revenue-cycle management.
In its most recent fiscal year, which ended in June, OhioHealth collected $19 million from patients at the point of service, including co-pays, deductibles and co-insurance, Berkebile said. The amount is increasing “as that portion that’s due from the patient has grown.” 
Mount Carmel, meanwhile, collects about $500,000 to $1 million upfront each month from patients, said Karen Geisler, patient-financial-services consultant. She said Mount Carmel has requested upfront payment from patients, including deductibles and co-insurance, for about eight years. 
Nationwide Children’s Hospital said it does not ask families of patients to pay their deductibles before services are provided.
“If we did move to collecting deductibles prior to service, we have financial counselors that would work with the family on other options,” the hospital said in a prepared statement.
@BenSutherly

Thursday, May 15, 2014

STRS Board Meeting May 15, 2014

Issues at the Statehouse:
As I reported in April, the Ohio House of Representatives passed Amended Substitute House Bill 483.  The House modified it just days prior to its passage. The amendment places a moratorium on the mitigating rate applied to alternative retirement plans and requires a study to be conducted relative to the mitigating rate. The moratorium would cease to be in effect as of July 1, 2015. The mitigating rate is a portion of the employer contribution that stays with the system when a member of the faculty at a public college or university chooses an alternative retirement plan (ARP) instead of a plan administered by STRS OH. The current rate is 4.5%. For every person covered by an ARP, STRS OH receives 4.5% of the 14% employer contribution to mitigate the negative impact that participation in an ARP has on STRS Ohio's Defined Benefit Plan. The faculty member's account receives the remaining 9.5% of the employer contribution. STRS Ohio's Executive Director, Mike Nehf is anticipating testifying before the Senate Finance Committee to express concerns with keeping the mitigating rate below the 5.5% recommended by the Board's actuary and to advocate that the study to be conducted on the mitigating rate be done by an actuarial firm.
On May 8th, the executive directors from STRS OH and the Ohio Public Employees Retirement System reviewed with the Ohio Retirement Study Council (OPERS) the systems' plans to discontinue the Irrevocable Waiver Program for health care. This program allowed benefit recipients of one system to enroll in another Ohio retirement system's health plan as a spouse by agreeing to irrevocably waive coverage in the system that pays their pension benefit. Because of changes in the Ohio retirement systems' programs that significantly reduce or eliminate spousal subsidies for health care coverage, the systems want to allow these individuals to enroll for coverage in the system that pays their benefit. The STRS Board voted in April to take this action and will allow these individuals to enroll in an STRS OH plan during the 2014 and 2015 open enrollment periods.
Paul Snyder, STRS Ohio's Deputy Executive Director for Finance, presented the system's proposed budget to the Council as required. This budget reflects a 1.08% increase over the current fiscal year's budget.
Issues from the STRS Meeting of May 15th, 2014
John Morrow, Chief Financial Officer of the Investment Department, reported a positive return of +13.0 for the fiscal year. Eight out of the past ten months have consistently produced high returns. The total fund is $72.9 billion dollars. April returns were good as employment improved. An early preview of May's returns were described as just so so. He reported that the Opportunistic/ Diversified theme has been expanded to include banking insurance and asset management. He gave a preview of a Domestic Equities initiative for 2015 that would have a) a Small Cap Value portfolio beginning in July of 2014 and b) a Concentrated Value portfolio also beginning in July of 2014 with a total of a $20 to $30 million investment. He promised to report more on these investments next month.
Callan Associates, Inc. also reported on STRS Investment Department's Performance Review. For the one-year period ending March 31st, 2014, the STRS Fund's domestic equity composite modestly trailed its benchmarks. The Total Real Estate exceeded its benchmark, but ranked below its peer median. International Equity and Fixed Income exceeded their benchmarks.
The Member Benefits Department (Pension Benefits) proposed a change to survivor benefits in which if a beneficiary dies, STRS would pay qualified children monthly survivor benefits to age 22 regardless of school attendance (recognizing other school and training options available today). This would provide a predictable, reliable stream of income to the surviving family. It would financially support children post-high school through studies & training to help them establish careers. Student benefits were added to survivor benefits Aug. 27th, 1970. This statute was written when college was a traditional four-year ( or two-year) course of study. Online and self-paced degree and training programs are now viable options for pursuing careers. Family incomes are disrupted when students don't meet the two-thirds of full-time basis outlined in the statute; yet, they may be in school or training. The formulas for this survivor benefit are two fold: a) dependent-based benefit in which the amount of the benefit depends on the number of qualified survivors in the family and fluctuates as children go off and back on survivor benefits and b) service-based benefit in which the amount of the benefit depends on years of service credit and the total benefit amount is constant and redistributes to remaining family members. OPERS retirement board approved pursuing payment up to age 22 at their Apr. 2014 meeting. SERS is paying up to age 19 due to recent pension reform changes. The STRS Board voted today to approve a change to the statute to pay all children monthly survivor benefits up to age 22.
The Member Benefits Department (Health Care) Greg Nickell reviewed the premiums and health care changes for 2015 that were recommended at last month's STRS meeting. He asked for Board action on those changes (which I sent in detail in last month's report) for 2015 ONLY. The Board voted to approve the changes effective January 2015. The health care changes proposed for 2016 will be reviewed and voted on at next month's STRS meeting.
The next STRS Board Meeting will be held on June 18th, 19th and 20th.

Friday, April 25, 2014

STRS Board Meeting April 24, 2014


Issues at the Statehouse:
At the March 20th STRS meeting, Segal Company recommended that STRS increase the mitigating rate for ARP from 4.5% to 5.5%. The first order of business at today's STRS meeting was scheduled to be a discussion of mitigating rates which the Chair, Dale Price promptly canceled. The reason was that the Ohio House of Representatives has taken up a study of the ARP mitigating rates, and it has now become part of the Amended Substitute House Bill 483. However STRS had wanted a 1% increase in the rate but before the STRS Board took action on this increase, the amendment to place a moratorium on the ARP rate of 4.5% was introduced in the House Finance and Appropriations Committee to express concerns with the amendment, namely:
1) The STRS Board as fiduciaries had a recent recommendation of their consulting actuary (Segal Co.) to increase the mitigating rate to 5.5% and:
2) the study being called for should be conducted by an actuarial firm and the systems for which the mitigating rate is an issue should be consulted (the systems were STRS, OPERS, and SERS). STRS Ohio worked with Rep. Dan Ramos (D_Lorain) to change the language.
Removal of the amendment altogether was ultimately offered as part of a package of amendments and failed along party lines. The bill as amended with the moratorium has moved through the House and will be taken up by the Senate when they return from spring break toward the end of April. The Senate has not yet established a timeline for acting on Am. Sub. H.B. 483 but passage by sometime in May has been mentioned.
The ORSC (Ohio Retirement Study Council) met April 10th and STRS Ohio's 30-year funding plan was presented by Executive Director Mike Nehf with an update to STRS Ohio's 30 year funding plan. He informed the Council that the Retirement Board approved a change that will direct the 1% of employer contributions currently being allocated to the Health Care Fund to the pension fund instead. That, coupled with the smoothing of the projected return on assets this year, is expected to reduce the system's funding period to 32 years. There were no comments or questions from the Council members.
Issues from the STRS Meeting of April 24th, 2014:
John Morrow, CFO of STRS Investment Department, reported a good month for March investments with a +12.4% estimated return for the fund. Alternative Investments led all indices. The market value of the fund is now back to $72 billion dollars. It seems as if everything is rosy in our investments and is on the right track. He reported that the new Fed Chair's (Janet Yellen) comments that the first short term interest rate increase could be "something on the order of around six months" caused an uproar but low interest rates will continue for a long time. He said that domestic equities shrugged off unrest between Russia and Ukraine with the S&P 500 closing March up .8% for the month. The S&P 500 has gained 18.4% on a total return basis for fiscal year 2014. International markets moved slightly higher in March and finished the month with a return of .3% for the STRS Ohio Blended Benchmark.
Greg Nickell, STRS Health Care, reported the first changes for the Health Care programs for January of 2015: 
a) Medical Mutual Plus and Basic plans will have an increase of deductible and coinsurance for both In-Network and Out-of Network plans as well as two in-network primary care visits at $20. each in the Basic Plan. 
b) The Aetna Plan will have a reduction of In-Network copay for primary care physician, specialist physician, deductible, out-of pocket limit but the same 4% coinsurance percentage. Aetna will have an increase in Out-of-Network copays for the above physicians, deductibles, out-of-pocket limit, and coinsurance percentage 6%.
The Express Scripts plan will increase the covered brand name deductible to $200. from $150 as well as implementing a specialty drug tier with a 10% coinsurance and maximum per prescription fill limit of $500. Other health care program changes effective January of 2015 will be:
a) Continue the Health Care Assistance programs at $0 premium with an increase to the emergency room copayment to $150 from $50 and increase the covered brand-name drug copayment to $20 from $15 at retail, and to $40 from $30 for home delivery.
b) Continue Medicare Part B premium reimbursement at 2014 levels for plan years 2015 & 2016.
c) Limit Medicare Part B reimbursement to benefit recipients enrolled in an STRS Ohio Medicare plan.
d) Discontinue subsidies and Medicare Part B premium reimbursement for individuals who become survivors on or after Jan. 1, 2015.
e) Continue the current Delta Dental and Vision Service Plan programs for the next two year period 2015 and 2016.
f) Apply the same 2.2% subsidy multiplier used for the Aetna and Medical Mutual plans to the regional plans based solely upon the costs of the regional plans not to exceed the base plan subsidy.
Health care plan program changes effective January of 2016 will be:
a) Discontinue the Medical Mutual Plus Plan. The Medical Mutual Basic Plan will have an In-Network deductible of $2,500 and out-of- pocket of $4,000.
b) Aetna Plan will have the same In-Network reductions as in 2015 except the deductible will be $150 and will also have Skilled Nursing/Home Health Care of 2%. Out-of-Network will be the same as 2015 except that specialist physicians will be $55. and out-of-pocket will be $2,000, coinsurance will be 8%, and Skilled Nursing/ Home Health Care will be 4%.
c) Express Scripts will change the maximum allowable amount to the 2016 standard Medicare Part D limit
d) Discontinue AultCare, Health Span, and Paramount plans. Now I do not recall any motions or voting on this first peek at proposed changes in our health care program so maybe this first look at HC programs will be subject to change in the future.
A report from the Finance Department followed with explanations from Paul Snyder, the new head of STRS Finance, on the proposed budgets for 2014 and 2015. The components of the budgets are operating expenditures, capital expenditures, and state of Ohio requirements. The budget process involves the departments of Member Benefits, Finance, Investments, and Executive. All of these departments develop individual budgets. The budgets are then presented to the Executive Director and the senior staff. The budget timeline requires a review by the ORSC before adoption by the STRS Retirement Board. Apr. 24--Board Presentation (occurred today)  Apr. 25 -- Budget sent to the ORSC May 8th -- Anticipated presentation to ORSC  June 19th -- Adoption of budget by the Board. The operating budget overview proposed today involved many increases in everything from salaries and wages to repairs and maintenance to supplies and materials to travel/vehicles. Building improvements, computer software, equipment for information processing & maintenance totaled $1,597,500. State of OH requirements amounted to $300,000 for the ORSC with $60,000 for Attorney General reimbursement, and Treasurer check processing fees of $5,000.
A discussion of STRS Ohio Funding followed led by Paul Snyder in which key funding policy components were suggested and by the time they got to the end of the presentation, the Board members had more questions than answers, and they decided to take their time in determining what their funding policy would be. They agreed that this was a very important policy and must be developed after much consideration and discussion. So it will be taken up at a later Board meeting.
The next STRS Board Meeting will be held on May 14th, 15th, and 16th.

Wednesday, April 16, 2014

STRSers, don't be afraid to appeal!

From John Curry, April 16, 2014
Patients Often Win If They Appeal A Denied Health Claim 
By Pauline Bartolone, Capital Public Radio 
Apr 14, 2014 
This KHN story was produced in collaboration with NPR
SACRAMENTO, Calif. -- Federal rules ensure that none of the millions of people who signed up for Obamacare can be denied insurance -- but there is no guarantee that all health services will be covered. 
To help make sure a patient's claims aren't improperly denied, the Affordable Care Act creates national standards allowing appeals to the insurer and, if necessary, to a third-party reviewer.
For Tony Simek, a software engineer in El Mirage, Ariz., appealing was the only way he was able to get additional treatment for sleep apnea. Though mild for many people, the condition had become life-threatening for Simek, who couldn’t get enough sleep.
"I had actually gotten to a place where I had fallen asleep while driving a vehicle," Simek says. "That's something that would normally have never ever happened to me."
Simek's doctor recommended he go to a lab to undergo another sleep study test to see if his night-time breathing machine needed adjustment. But his insurance company denied the test.
"I was rather surprised," Simek says, “so I reached out to my doctor to find out why. My doctor had been told [by the insurance company] that it was 'not medically necessary' in their judgment of my health condition."
Simek spent hours on the phone with the health plan, trying to get approval for the test. The insurance company responded with four denial letters. Simek has job-based health insurance through a California employer, so he filed an appeal with the California Department of Insurance.
"I have never had a problem with health insurance prior to this," Simek says.
Capital Public Radio in Sacramento analyzed multiyear data from California and found that about half the time a patient appeals a denied health claim to the state's regulators, the patient wins.
A 2011 GAO report sampling data from a handful of states before the health law took effect found that patients were successful 39 to 59 percent of the time when they appealed directly to the insurer. When appealing to a third party (such as the state insurance commissioner), patients also were often successful in getting the service in question – winning as many as 54 percent of such decisions in Maryland, for example.
"It's often very worthwhile for a consumer to appeal," says Cheryl Fish-Parcham, who directs the private insurance program at Families USA, a nonprofit that supports the health law. "It's a really important protection for people."
Until a few years ago, Fish-Parcham says, the rules regarding such appeals varied by state and employer.
"Insurers often get it wrong the first time," she says. "So if you've been denied a health care service, it might be because the plan didn't understand why that service was needed and why it fit their guidelines." Many consumers, she adds, are not exercising their appeal rights as much as they should.
Administrative errors are the source of many denials, says Peter Kongstvedt, a senior health policy faculty member at George Mason University.
"It can be an error on the health plan side," he says. "Maybe they put somebody in the system wrong and they don't know that [he or she is] eligible yet. Or a data entry error occurs, and the computer says, 'Oh, we don't pay for this service on that diagnosis,' — that type of thing." 
Other denials, like Simek's sleep test, are based on judgments of medical necessity. Insurers may consider a treatment experimental. Kongstvedt, a former executive in the managed health care industry, says such decisions require human discernment. 
"The computer doesn't — usually doesn't — make that decision," he says. "It simply flags it and then it gets reviewed — first by a nurse reviewer who then presents it, usually, to a medical director." 
Insurers say medical studies support their decisions.
"The more evidence that's available about the appropriateness and effectiveness of a particular drug or treatment or technology — that's what drives what's covered," says Robert Zirkelbach, spokesman for America's Health Insurance Plans, an insurance industry trade group.
Zirkelbach says only about 3 percent of claims are denied. And, he adds, insurers support the strengthening of the appeals process under the Affordable Care Act.
"Health plans are committed to getting it right," he says.
Appealing a denial was the right thing for Tony Simek. Ultimately, a California regulator overruled his insurer, and Simek got the test.
"I have been sleeping well ever since," he says. 
This story is part of a reporting partnership that includes Capital Public Radio, NPR and Kaiser Health News.

Saturday, March 22, 2014

Many who read this will be public servants actively working or retirees....

From John Curry, March 22, 2014
........and these are the people who need to know what ALEC has done and is doing re. their public pensions....and it isn't for your benefit! 
John 
"These pieces of legislation are uniformly disastrous for retirees and anyone who hopes to retire one day. They include initiatives to wipe out public pensions systems in favor of private 401(k) plans, regardless of how well the public pension is doing. Policies like this not only scapegoat and attack public services, public workers and collective bargaining but expose workers to higher fees, which go straight into the pockets of Wall Street bankers." 
ALEC: The New-and-Improved Political Corruption 
March 21, 2014
The American Legislative Exchange Council (ALEC) has been described as a "shadowy group" of companies and politicians working behind closed doors to rewrite our laws, frequently to bolster corporate profits at any cost. Over the last 41 years, ALEC has worked tirelessly to tear down many of the programs and protections Americans, particularly seniors, have come to rely on, and only recently have many of their objectives come to light. 
ALEC doesn't just exist in the backrooms of Washington, D.C.; they're also in the backyards of every community in every state, pursuing their agenda at the state and local level. When these representatives and corporations sit down at the table to craft "model" legislation, middle-class Americans don't win. 
These pieces of legislation are uniformly disastrous for retirees and anyone who hopes to retire one day. They include initiatives to wipe out public pensions systems in favor of private 401(k) plans, regardless of how well the public pension is doing. Policies like this not only scapegoat and attack public services, public workers and collective bargaining but expose workers to higher fees, which go straight into the pockets of Wall Street bankers. 
ALEC hasn't been content to stop with public pensions either; they continue to push for privatization of Medicare and Social Security, which would effectively end these programs as we know them. This push to hand over our most crucial earned benefits to the very same individuals who helped to engineer the financial crisis of 2007 is unacceptable. 
ALEC isn't invincible. The efforts of individuals across every state to shine light on ALEC's actions have produced clear results. Dozens of lawmakers have withdrawn their ALEC membership within the last few years. ALEC legislation has met with tough fights state by state, and it's just beginning. Protecting corporations' bottom lines at taxpayer expense has gone too far. It's time to expose ALEC. 
Learn about "Stand Up to Alec" here. Spread the word on social media here.

Thursday, March 20, 2014

STRS Board Meeting March 20, 2014

Issues from the STRS Meeting of Mar. 20th, 2014 

The new head of the STRS Investment Department, John Morrow reported positive returns of +11.6% estimated for February. All indices were positive and the total fund value was $72.8 billion dollars. The early report for the month of March was volatile especially last week caused by negativity to the Russia/ Ukraine situation. This week shows improvement since the sanctions by the U.S. turned out to be placed on Russian individuals only.
Following the Investment Department report, Mike Nehf, Executive Director of STRS presented a review of previous Board discussions of STRS Ohio funding. He mentioned that at the Board Retreat in January a lengthy discussion was held on the 30-year amortization of the pension unfunded liability and possible solutions were considered. At the February STRS Board meeting, he reviewed further funding discussions that occurred and shared a letter of support from the Health Pension Advocates (HPA) which indicated their approval of the health care funding change (directing the future l% employer contribution from the Health Care Fund to the pension fund beginning July 1st, 2014).
This health care plan was approved by the STRS Board and instructed Mr. Nehf to present the plan to the Ohio Retirement Study Council (ORSC). There was agreement to continue to hold discussions with stakeholders and to study the impact of the health care funding change and to also explore a possible mitigating rate change to the Defined Contribution program.  At the March 7th STRS Ohio meeting, background was provided on the history of heath care funding as well as the history of the Defined Contribution program mitigating rate. The staff was directed to include these matters on the March 20th Board meeting. So today, it was shared that by directing future 1% employer contributions from the Health Care Fund to the pension fund beginning July 1, 2014 would reduce the unfunded liability of the pension fund by 4 years from 40.1 years to 36.1 years. It would also reduce the Health Care Fund's solvency to 20 years.
Another point mentioned regarding the Health Care Fund was that it was always an optional benefit whereas the Pension Fund benefited all STRS members. Today the Board approved unanimously to discontinue the current allocation to the Health Care Fund of 1% of the employer contribution beginning July 1st, 2014. Board member, Craig Brooks, added that in the future, the 1% will be considered to be replaced to the Health Care Fund.
The Board's actuarial consultant, the Segal Company recommended increasing the mitigating rate from 4.5% to 5.5% for the Defined Contribution program effective July 1st, 2014 which would mitigate the negative financial impact on the Defined Benefit Plan.  This has to do with the Defined Benefit plan and the Defined Contribution plan offered to universities which are known as the Alternative Retirement Plans (ARP). The legislature recognized the need for a portion of the employer contribution to be used to mitigate the negative impact of future faculty no longer participating in STRS (the mitigation rate is based on the 1997 benefit design). When the motion for these changes to the Defined Contribution program was about to be voted on today,  Board member, Mark Hill moved to postpone the proposed motion on mitigating rates to the April STRS Board meeting. The vote to postpone the vote was passed by 6 members voting for the postponement and 3 members voting not to postpone (Price, Stein, & Hayden). The reason cited by Mr. Hill was to give time for the HPA (the Health Pension Advocates) to further discuss the motion with the UAAL (the universities' union).  The head of the UAAL attended the March 7th STRS meeting and spoke of their disapproval of changing the mitigating rates. Craig Brooks also requested that the STRS staff conduct a study capping the COLA and to have it available by the April STRS Board meeting.
Nick Treneff, the STRS Communication Department, announced that no election would be held this March since there were no petitions received for the two contributing member positions of the STRS Board. Thus, Dale Price and Mark Hill were re-elected to their present positions on the Board.
Sandy Knoesel, Member Benefits Department, and Greg Nickell, Health Care Dept. shared that recent complaints regarding Express Scripts have been addressed with the assignment of 10 to 15 more staff to help reduce the amount of work necessary for an appeal whether by phone or by online. Doctors will now be able to go online to complete an appeal. There were questions regarding the Aetna Medicare Advantage plan and whether the current plan would be affected by Obamacare. Mr. Nickell said that the plan has not been affected since it is still the most successful health care plan.
The next STRS Board meeting will be April 23rd, 24th and 25th.
Larry KehresMount Union Collge
Division III
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