By Ben Joravsky
With his five-year-old son recovering from a spinal-cord injury, the last thing Juan Carlos Ocon needs is to shop for a new doctor, especially since he's happy with the care his current doctors have given his family during their traumatic two-month ordeal. But that's exactly what he and his wife must do as a result of a breakdown in negotiations between the Board of Education and Rush Prudential HMO that's left thousands of teachers less than two months to sign up with a new health plan and find new doctors. "We're feeling scared and vulnerable," says Ocon, who teaches English at Sullivan High School. "It's not a good thing to mess with people's lives like this."
It's certainly not what Ocon would have predicted when he went to work for the board four years ago. Insurance is traditionally based on the assumption of pooled risk--the larger the pool, the more comprehensive and cheaper the service. "You can't get much larger than a tax-supported institution of 40,000 employees," says Sandy Pardys, who also teaches English at Sullivan. "We've always had good health care."
Pardys pays $34.95 in monthly premiums to get comprehensive coverage (after a nominal fee for office or hospital visits) and subsidized pharmaceuticals for herself, her husband, and their two daughters. Best of all, the plan has enabled her family to stay with the same doctors for almost 18 years. "The doctor that delivered my children is still my gynecologist," she says. "The family practitioner we went to when my oldest daughter was born is still our family doctor."
Over the years those doctors became part of the Anchor Medical Group, an HMO that was eventually bought by Rush Prudential. Pardys didn't keep track of the ins and outs of health care or of the large corporations that continually swallowed smaller practices. But then, she was happy with her doctors. "They cared about us, they knew us," she says. "I can remember when my doctor saw some curious symptoms and said, 'Didn't you tell me your brother was a diabetic? Maybe we should get you tested.' I had no major symptoms, but he became suspicious of diabetes long before other doctors would have because he remembered something I had said years ago. Sure enough, my diabetes was diagnosed and treated before any damage. I'd never dream of changing doctors."
But on October 9 she abruptly learned that she had no choice. That's when she received a form letter from Anchor's medical director. "We've just learned that the Chicago Board of Education has decided to stop offering Rush Prudential as a healthcare benefit plan choice as of this coming January 1," the letter began. "Many of us in Anchor have worked with many of you for over twenty years. We have long valued this relationship. We are truly sorry that we will lose you as a patient and will do what we can to help you with this change."
That worried Pardys. "This is not a good point in my life to have to search for a new doctor," she says. "I'm in the middle of treatment for a chronic illness, I'm 48, things are beginning to change."
She soon learned that other teachers, including Ocon, faced even more dire predicaments. "Two months ago we got in a car accident," says Ocon. "We were hit head-on. My wife was hospitalized for a week with back pains and bruises, but my son got the bulk of it. He fractured a bone in the back of his neck. He had to have immediate surgery, and he's wearing a halo, which he'll have to wear until the middle of January. The bone was fractured so bad that part of it was touching the spinal cord. Because of that, his whole left side was getting weaker. His left hand hung loosely at his side. He lost all function in his left leg.
"You have to understand what he's gone through. My son weighs only 28 pounds. The halo's 7 pounds. It causes incredible problems for him. After the surgery he had to have a lot of therapy, both physical and occupational. My son's in a wheelchair--he can't do anything on his own. My wife stays home with him. But we have a second child who's one and a half years old, and she can't do everything. Now we have to change doctors? That's devastating. Our doctors have been so incredibly helpful. We're on a first-name basis. We trust them. They know us. How can they make us give them up?"
Ocon and Pardys say the reaction from the board's central office to their concerns has been cold indifference. "I called the board after I got the letter from Rush to see if there was any recourse," says Pardys. "I was sent to someone in Risk and Benefits, and I talked to a man who said, 'It's a done deal, and you'll just have to pick one of two remaining health plans.' So I called my union field rep, who gave me this whole line about Rush's rates going up 35 percent and how [CEO Paul] Vallas and [board president Gery] Chico had struggled so hard to save the deal. I said, 'Well, it's pretty bad that I didn't learn about this from my employer or my union.' He said Rush had derailed negotiations by having their doctors contact their patients. I didn't buy that. It seems like my union cares less about protecting our interests than protecting Vallas's image."
On October 13 Vallas sent a letter to employees, explaining that the board had dropped coverage with Rush and United Healthcare because they were asking for budget-busting multimillion-dollar increases in premiums. "We have been in negotiations with our three current HMOs since June and were faced with cost increases as high as 40 percent over our current two-year, $150 million HMO costs," Vallas wrote. "We negotiated in good faith and made every effort to continue the current HMOs; however, to retain all three HMO options, either benefits would have had to be reduced or payroll deductions increased. Only Humana agreed to the [Chicago Public Schools'] final offer of a 15 percent increase over the next two years--or the equivalent of a $17.4 million increase--which was 40 percent less than the best and final offers of either Rush or United."
On October 22 Tom Reece, president of the Chicago Teachers Union, sent a letter informing the rank and file that there was nothing the union could do. "Your contract guarantees coverage," he wrote. "It does not guarantee the coverage will be with a specific insurance company. We want the board to negotiate what it pays. We don't want insurance companies eating up the money that is used to finance our contract."
In general, union leaders call the big insurance companies greedy predators that are trying to exploit the health-care anxieties of teachers to wring more money from the board. "I should have known something was up when I got a call from [a Rush lobbyist] back in September," says Jackie Gallagher, a union spokesperson. "He said, 'Jackie, we have to talk. We're in the losing column, and we have to raise premiums.' I figured he was trying to get us to call the board on their behalf and use the union as a wedge against the board during negotiations."
Gallagher speculates that Rush's letter to its patients, which apparently surprised the board too, was part of the same strategy. "I think this is a cynical attempt to whip up a grassroots campaign to get the teachers to pressure the board into accepting their premium hike," she says. "I wouldn't be surprised if Rush comes back to the board with another offer. It's disgraceful. They're playing with people's lives. It only underscores why we need comprehensive national health care."
A Rush spokesman accused Vallas of "pandering" in his letter to employees and promised to call back with more information, but he hasn't called.
In the meantime, the central office continues to assure employees that, as Vallas wrote in his letter, their coverage "will continue, without any changes, through December 31," that they won't "experience any cost increase or reduction in benefits," and that "trained benefits representatives are also available in the CPS Employees Benefits Department."
But Ocon and Pardys say they've been given conflicting information in their calls to the central office. "They said open enrollment would begin in November and that they were sending out information booklets," says Pardys. "But here it is late October, and we still haven't received the booklets. The booklet I'm looking at is last year's. I felt a little better when I recognized the name of a pediatrician in it. But when I called her number--or the number the booklet gave for her--I got a message telling me to call another number. When I called that number I learned that the doctor had closed her practice in 1998."
Pardys has also discovered that the remaining HMO plans (Humana and a special board plan), recommended in Vallas's letter, offer less service than her old Rush plan. "Vallas said there would be no reduction in service, but that's not true," she says. "There are annual and lifetime maximums, which aren't in the HMO. My family better not run up more than $1 million in coverage or we're in trouble. In any event, it seems to me that a system of over 40,000 employees would have more than two options in health care."
Ocon says he can't get the answers he needs from the central office. "Whenever I call I get bounced around to different secretaries who tell me they have no answers now, but questions will be answered during open enrollment," he says. "That does me no good. My son will be in that halo past January. I need answers now."
Art accompanying story in printed newspaper (not available in this archive): photo/Dan Machnik.