DRAFT

The idea of extending health and dental benefits to an adult household member of an employee, rather than merely extending such benefits to an employee's domestic partner, is a relatively new concept. Some public employers have done this, such as the City of Rochester and the City of Atlanta. Some private employers have also taken this approach, such as Household Insurance, Bank of America, and Merrill Lynch.

After religious forces in Columbus created a firestorm when the City Council first proposed domestic partner benefits for city workers, the Mayor and the City Council President decided to jointly convene a Task Force on Household Benefits. The idea was that there would be less political opposition if a broader approach was used -- one that did not focus solely on domestic partners and which did not assume a sexual relationship between the beneficiary and the employee.

After one year of study, the Household Benefits Committee has released the draft of its report for public review. AASP is making the full draft report available on our website.

I believe that the recommendation of the Committee is flawed and should be revised.

The Committee has recommended that a different level of funding be applied to benefits for an adult household member than for a spouse.

If this recommendation is adopted by the City Council and Mayor, then an employee would have to pay considerably more for a household participant than for a spouse. Coverage for an employee and spouse would cost an employee about $36.50 per month, while coverage for an employee and adult household member would cost an employee $161.50 per month. As a result, a married employee with spousal coverage would take home about $1,500 more per year in income than an unmarried employee with coverage for an unmarried adult household member.

This recommendation has the effect of reinforcing and perpetuating martial status discrimination in employee compensation. It also fails to respect family diversity by giving financial preferences to some households over others.

Section I: Executive Summary……………………………………………… 3

Section II: Introduction………………………………………………………. 4

Section III: Employee Opinion Research…………………………………….. 6

Section IV: Public In-Put Meeting Findings………………………………... 12

Section VI: Design Specifications and Cost Options………………………. 20

Section VII: Recommendations………………………………………………. 30

Section VIII: Conclusions……………………………………………………… 32

On May 6, 2002 Mayor Michael Coleman and President of City Council Matt Habash appointed an eight member Joint Committee on Household Benefits with the charge to thoroughly review information pertaining to seven specific questions on the subject of extended household healthcare benefits and make a recommendation to the Mayor and City Council on the provision of these benefits to City of Columbus employees.

The Joint Committee’s study on this subject included grounding itself in an understanding of the issues surrounding access to health care for the uninsured locally, statewide and nationally. The committee reviewed research done by City Council Staff on extended household benefits plans offered by public and private institutions across the United States. The committee contracted with the highly regarded Mercer Human Resources Consulting group to provide assistance in the development of benefit design and cost parameters for an extended household benefit. The committee contracted with CJI Research Corporation to conduct focus groups with City employees to determine their interest in and reaction to the offering of such a benefit. The committee developed a hypothetical extended household benefit framework and then held two public input meetings, attended by approximately 105 citizens who gave input that helped to shape the model design and ultimately the Committee’s recommendation.

The full committee divided into two subcommittees to continue its work. One subcommittee focused on synthesizing all of the research and input meetings for the benefit of the full committee and made a recommendation for final public input on the design. The other subcommittee focused on refinement of a plan design and associated costs and a recommendation for the full committee to consider.

The recommendation to the Mayor and President of City Council is framed within the context of the city budget challenges and as such makes no statement as to the timing of the implementation of this recommendation. The committee recommends that the City of Columbus extend medical and prescription drug benefits to household members of city employees on the following basis: Optional coverage would be available to up to two additional adults who live in the city employee’s household, who are not employed by the city employee, and who are not otherwise eligible for city benefits or other employer or government sponsored group insurance including Medicare. Optional coverage would be available to all children who live in the employee’s household, who are under age 19 (or age 23 if a full time student), and who are not otherwise eligible for city benefits or other employer or government sponsored group insurance. Employees electing such optional coverage would pay 50% of the full cost of the premium for household coverage. The 50% recommended contribution is in comparison to projected 10% employee contribution levels for present coverage that will be implemented over the next few years.

In addition to the recommendation the committee notes two issues worth further exploration by the City. The issue of the availability of health insurance for part-time employees should be examined. The committee also believes that the City should consider plan designs that allow employees to choose from among the panoply of benefits those that they really need including this extended household benefit. The first issue goes to access, the second to effective cost containment.

On May 6, 2002 Mayor Michael B. Coleman and City Council President Matt Habash appointed an eight member Joint Committee on Household Benefits to study the issue of access to health care for dependent and interdependent members of households of city employees. Members of the committee are: Chair Philip H. Cass, PhD, CEO, Columbus Medical Association and Foundation; Mark Huddy, Director of the Department of Social Concerns for the Roman Catholic Diocese of Columbus; Susan E. White, Vice President of Research and Development for Cleverly and Associates; Bishop Timothy J. Clarke, First Church of God; Donna James, Executive Vice President and Chief Administrative Officer for Nationwide Insurance; Bessie King Jackson, advocate with Central Ohio Area Agency on Aging and AARP; Councilmember Michael Mentel; Councilmember Charleta Tavares.

The Committee was asked by the Mayor and the President of City Council to research and report recommendations to the city on how access to health care can be improved for dependent and interdependent members of city employees households. Specifically the committee was asked to address the following questions:

· Will offering a household benefit plan be valuable to city employees, and how would a household benefit plan increase access to health care?

· What other public and private entities have household health care policies, and what has been their experience with such a policy?

· Who should be considered as a dependent or interdependent person eligible for coverage?

· Should the coverage be as inclusive as that offered to full-time employees or should it be more restrictive?

· How could it be monitored to assure the plan provides access to health care only to city employees’ household members who have no other access to health insurance?

The committee first met on May 17, 2002 to consider a work plan strategy and to review orientation materials. This meeting was followed by a meeting in which all committee members became familiar with access to health care issues in our community and nationally. An orientation to household benefits plans in other communities and businesses was also provided. The committee agreed to enlist the services of Mercer Human Resources Consulting to assist the group in the areas of plan design and costing. The group also agreed to contract with CJI Research Corporation to conduct interviews and focus groups with city employees who would potentially benefit from an extended household benefit as well as with city employees that would not immediately benefit. This research was done to attempt to answer the question of how city employees would view such a benefit.

The committee met almost weekly to gather information and to learn about the necessary questions that need to be answered in order to design a plan. A framework of design parameters was developed (definitions of eligibility, coverage levels, employee contribution levels and cost estimates) and the possible options and questions were outlined. Using this framework, two public input meetings were held with over 100 citizens in attendance. Using a facilitated process attendees were asked to discuss and give feedback to the committee on the very questions that the committee would need to make recommendations on. Attendees also had an opportunity to comment on the work of the committee and the overall concept of a household benefit. Written and oral testimony was given and recorded.

At its next meeting the committee of the whole made the decision to split into two subcommittees. A Benefits subcommittee made up of Mark Huddy, Susan White, Donna James and Councilman Mentel worked to further refine the definitions and costs of possible plan scenarios for the larger group to consider. A second subcommittee made up of Phil Cass, Bishop Clarke, Councilwoman Tavares and Bessie King Jackson reviewed all of the information from the public input meetings and the CJI research and synthesized this information for the rest of the committee’s consideration. This subcommittee also recommended that the full committee consider a final public input process once draft recommendations were developed and before the final report was submitted to the Mayor and Council President.

Each subcommittee met on several occasions following the formation of the subcommittees. The Process subcommittee reviewed the CJI employee research results and the input of the public meetings and wrote and reviewed a draft report on these findings. The Benefits subcommittee reviewed the Mercer Consulting work, asked for some further refinements and then met to formulate a recommendation for the full committee to consider.

It was decided at this point to delay moving onto next steps in light of the City’s budget concerns. After it became clear that city revenues were not going to improve in the near term, the decision was made to go forth and finish the work of the committee. On May 15, 2003 the full committee met in to review the work to date, hear and decide upon the recommendations from the Benefits subcommittee and set the direction to finalize the report. By consensus the full committee accepted the recommendation from the Benefit Subcommittee and then decided that Mark Huddy and Phil Cass would write a draft report to be edited by Susan White and Bessie King Jackson. The full committee also decided that it would meet again on June 4, 2003 to review the draft report. Once reviewed the draft report was made available to the public for thirty days review and for written comments. Once feedback is received from the public the committee will meet again to consider that feedback and issue a final report to the Mayor and to the President of City Council.

The recommendations made in this report are made in the context of the access to health care problem within the larger community. Uninsured dependent and interdependent household members of City employees experience being uninsured in the same context as all others do in the community who are without health insurance. Approximately 130,000 Franklin County residents do not have health insurance, yet 72% are employed and 17% are children. Fifty-six percent of those without health insurance have been without insurance for more than three years and 30% are below the poverty line.

For those without insurance the health care system poses many barriers to care. Often cultural barriers stand in the way of care and uninsured people often don’t receive the same level of care or outcomes as those who are insured. Accessing care in a timely and consistent manner is also a problem. “Waiting out” medical situations is common for people without insurance with many getting sicker as a result. Care is usually fragmented with decreased continuity and increased cost. Accessing specialists is often difficult, cumbersome and confusing to providers and alienating to patients. People without insurance frequently resort to utilizing the hospitals’ emergency rooms for their primary care which is inefficient, provides for poor continuity of care for patients, clogs the emergency rooms resulting in ambulance diversions and other system side effects which hampers the hospitals ability to effectively treat true emergencies. People without insurance tend to “probe the perimeter” of the health care system trying to find an access point. As a result they often schedule multiple appointments and keep the more immediate opportunity, creating high no-show rates for others.

People without health insurance also don’t have insurance for their medications. As a result people often go without their medications or go through long and confusing processes to get their medications. The result is that often people without prescription insurance get sicker. The health of people without medical and prescription insurance is often compromised including the dependent and interdependent members of City employees’ households.

One of the questions that the Joint Committee on Household Benefits was asked to address was “Will offering a household benefit plan be valuable to city employees.” In an effort to answer this question in an unbiased manor the, CJI Research Corporation, was contracted with to conduct individual interviews with city employees who might stand to benefit from a household benefit and to conduct focus groups with city employees who at the present time would not benefit from such an opportunity. The research that was done was qualitative in nature and designed to help us understand the issues in depth from the City employee’s perspective. The research was not designed to support or oppose the policy.

Research was conducted in two phases with current city employees. Participants in the research came from five different city departments. The first phase consisted of two focus groups that included a total of sixteen employees who would not directly benefit from a new household health care benefit plan. The second phase consisted of ten interviews with persons who might be eligible for dependent and interdependent coverage if such benefits were to be provided.

The purpose of this kind of qualitative study is to obtain readings of the range of opinions that one might expect to find in the larger population of all City employees, and to understand some of the subtleties of the attitudes and household situations of City employees. It is important to understand that these respondents are not intended to constitute a representative or random sample of all City employees from which we can derive numeric support or opposition to the proposed policy.

The following summary from both the focus groups and from the individual interviews is included here as it was reported to the committee from the researcher. Also included is the researcher’s assessment of points of agreement and disagreement.

Those who would be unlikely to benefit from a household benefits plan

The findings from the focus groups conducted among employees who would not be covered can be summarized this way:

· The focus groups included both supporters and opponents of a household benefit. More supported the benefit than opposed it.

· Although most participants supported offering a household benefit, they differentiated among various groups of potential beneficiaries. Participants felt that it would be desirable to extend coverage to certain categories of persons whose situations evoked sympathy and whose situations were, in their opinion involuntary such as parents of an adult child with severe disability. But they were divided on the issue of extension of benefits to unmarried persons whether of the same or different sexes.

· Their opposition diminished dramatically if covered persons had to pay a premium for that coverage. This can be interpreted to mean that respondents perceive the extension of a household benefit without a premium as driving up their own insurance costs and thus forcing them to in effect subsidize behaviors of which they disapprove, and / or subsidize coverage from which they cannot benefit. Thus, they feel much better about accepting a household coverage package if it includes charges for the newly covered household.

· The focus groups demonstrated what is perhaps obvious, that the issue for many opponents is not offering a household benefit per se but the types of dependency situations to be covered. Participants were asked whether they approved or disapproved of covering certain types of relationships under a household policy. These ranged from a grandparent with responsibility for a grandchild, but no custody of that child, to a heterosexual unmarried couple to a same-sex couple. If household benefits per se were the issue, then all of these would be disapproved. However, only two participants consistently rejected coverage for any of these groups, thus consistently opposing a household benefit.

· The willingness of some participants to approve of covering certain types of relationships depended on several things. For a small number of participants, the issue was stated as a moral one: neither an unmarried heterosexual couple nor a same-sex couple could ever be legitimate and thus should not be included in any policy with which the City of Columbus would be a sponsor. However, this line of argument was not the norm in the focus groups. Most participants were reluctant to make the latter moral argument, but rather spoke in terms of the other kinds of concerns. For example, one participant emphasized that the question was whether there were other coverage options such as Medicaid or Healthy Choice. If so, she said, the employee should use those options (as she was doing in her household to care for a nephew) and the City should not intervene. For others the issue was whether there was an alternative approach to obtaining coverage under the existing healthcare policy. For example, an unmarried heterosexual couple could marry, or a grandparent might seek custody. Two other participants argued in a similar vein that the question was whether the relationship was clearly defined in a legal sense (e.g. marriage or custody), a legal definition they associated with protection against fraudulent claims of a relationship where none really existed. It is noteworthy, however, that under all of these scenarios that defended present arrangements as adequate, a same-sex couple would have no options. For some of the participants, this exclusion was acceptable; a fact that suggests that underlying the concern with legal definitions or legal alternatives there was a moral issue at play. However, for others in the focus groups the exclusions was unacceptable either because they believe that everyone needs healthcare, or because they feel that household relationships are not for them to judge.

· Although the focus groups consisted of persons who are at this time not in a position to benefit from household coverage, several of the participants felt that there was a probability that either an elderly parent or a child (grandchild, niece/nephew), or in one case a sibling, would become dependent on them within then next ten years. Thus it may be that there will be some fluidity in the population of city employees desiring household coverage.

· It is important to note that although objections to household coverage were clearly voiced in the focus groups, that in a paper vote (taken both before and after discussion) a substantial majority of participants (11 to 5 if no premium were charged; 13 to 3 if a premium were charged) approved the concept of a household benefits approach. This strongly suggests that some people, though they voiced some misgivings, would accept the policy change.

Those who might benefit

The findings from the individual interviews with employees who might be covered by a household benefit plan can be summarized as follows:

· There are diverse needs. This was not only an issue of same-sex coverage. Those interviewed in this phase included not only same-sex partners, but also grandparents with responsibility for, but not custody of, grandchildren, and “sandwich generation parents” whose own surviving parent is elderly and is, or may soon become, dependent. Also included was a mother whose adult son has mental retardation and is dependent upon her, but who will soon be too old for coverage under her healthcare policy.

· Motivation. Only two of those interested in household coverage were motivated by a lack of any insurance coverage at all for the dependent. More often they were motivated by a desire to enjoy similar assurance of financial stability during an illness in the household, and similar flexibility in decision making about health needs enjoyed by other households.

· For the most part, the dependent in the household already has some type of coverage, though he or she may be underinsured (e.g. Medicare lacks prescription coverage; many plans are less generous than that of the City), thus creating a tension in the household due to the discrepancy that would be unacceptable in a nuclear family. Most of those interviewed who desire coverage are in the same position that members of nuclear families are in: simply desiring to protect against the contingency of the costs of future ill health rather than having an immediate need for major medical coverage.

· Concern was raised in the focus groups of persons unlikely to be claiming a household benefit that adding household benefits would result in some fraudulent claims of relationships where none existed – i.e., that people would move in together to obtain coverage. However, those interested in the benefit dismissed such thoughts as without foundation, since, as one put it, “I don’t know anyone who would make their decisions about whom to live with based on insurance coverage.”

· Those in a position to benefit from a household benefit argue that they need the same kind of insurance against financial disaster resulting from ill health that their peers enjoy.

· Providing healthcare insurance, they argued, is one way in which the City assures a more stable workforce (and insures itself against destabilization of its employee base). It would serve, they say, as insurance for the City that employees covered by household benefits, like those now covered by family benefits, would not be lost to household financial disasters caused by health problems. Therefore, it is in the interest of the City to insure all employee households.

· They also argue that it is in the interest of the city to provide this type of coverage because it would aid in recruitment and retention.

· Willingness to pay. Those interviewed who would like to have this benefit are willing to pay significant additional premium to obtain it.

· Among the people we interviewed, most household dependents already had coverage of some kind. Thus the social costs to the city’s institutions of not providing such coverage did not often include community costs such as non-covered emergency room visits or other health care costs. Thus, providing the benefit would perhaps save little of that type of cost in the short-term, at least among the participants in the study.

· In the opinions of those desiring household coverage, the social costs of their lack of coverage include stress and distraction, and their long-term inability (current or potential) to save for essential needs of education, housing and retirement.

· But, to the participants in this stage of the research, just as important as all of these arguments, was the sense that their relationships, whether with grandchildren, elders, or same-sex partners were as legitimate as those of others with more demographically frequent kinds of household structure, and should be so recognized.

Points of Agreement and Disagreement

The key points of disagreement are well known. They tend to revolve around the question of the perceived legitimacy of the dependency relationships in question rather than around the question of the wisdom of the concept of extending benefits to others through a household benefit mechanism. However, this is not to say that the nature of the relationships is the only issue, for there are other concerns such as the cost to the city, the perceived potential for fraud, and other concerns as well.

· To supporters, the question is one of reducing qualification for coverage to a simple and objective matter of residency. To many opponents, the question revolves around the cultural legitimacy, as they define it, of the relationship to be covered. This is why the premium would be important to a compromise position – payment of a premium reduces the sense that they would be subsidizing relationships of which they do not approve.

· While the key point of disagreement is about the latter question, it is not expressed only in those terms. It is also expressed in terms of concern for cost to employees, cost to the city budget, for the level of actuarial risk (and thus insurance costs), and in terms of the possibility of fraud.

· Disapproval on moral grounds was not the only reason for opposition to a household benefit. Two opponents argued consistently that no household benefit should be paid at all. Others argued that adequate choices already exist for unmarried heterosexual couples (who could marry) and for non-custodial grandparents (who could seek custody). Thus to them, the one relationship for which dependent coverage would be unavailable would be a same-sex couple relationship – and opponents with this viewpoint saw no problem with that exclusion.

In spite of the disagreements, there may be agreement on a sufficient number of points for a compromise to be reached. The key points of agreement among the supporters and opponents of a household benefit are these:

· There is agreement that health care coverage is important for all. The disagreement is about whether the city should provide it to all members of employee households. This question revolves around two points: sponsorship and cost. To some opponents, any use of the City of Columbus as a sponsor of such a benefit is morally inappropriate. But to more of the people in the focus groups at least, the question was more one of who pays the bill. If the largest portion of the cost is borne by the employee receiving the benefit, then the fact that the City provides the channel of availability seems to become unimportant.

· There is agreement between those that would not benefit directly from household coverage, and those that would be potential users of the benefit, that a premium for household coverage would be appropriate.

· There is agreement that certain classes of dependents who represent culturally sympathetic images should be covered. While this was not unanimous among the respondents, it was close to unanimous. Thus there appears to be implicit agreement that coverage could be legitimately extended beyond the limits of present nuclear family coverage to cover others in a household. To some but not all of those in the focus groups who were slightly but not adamantly opposed to covering unmarried people or same-sex couples, it would be worth compromising on the latter issue to obtain the potential of coverage for family elders and for groups such as grandchildren and persons with disabilities not otherwise insured.

· Finally, there is general recognition that insurance coverage is an important tool for recruitment and retention of employees.

Two public in-put meetings were held, the first on June 25, 2002 from 6:00-9:00 PM and the second on June 28, 2002 from 12:00-2:00 PM at the Columbus Health Department. Approximately 75 people attended the June 25 session and approximately 30 people attended the June 28 session. A facilitated process (Storyboard Process) was used followed by an open meeting format in which anyone wishing to address the committee and also those in attendance had the opportunity to say anything they wished about household benefits as well as the meeting process. The facilitated process included an overview of information about the uninsured in Franklin County. This was done to provide a context for the remainder of the work that was done in small groups. People then were broken up into small groups of approximately 15 people per group. Trained facilitators from the Columbus Medical Association and Foundation facilitated these small groups.

The facilitated process began with people answering the question “At this time what are your thoughts, feelings and reactions to the notion of a household benefit?” Each person wrote their response to this question on an index card and shared their response with the group. The cards were then collected. The facilitator then asked a series of questions concerning the concept of a household benefit. They were:

· Should the plan design for the extended household benefit be the same as the current employee benefit or should the extended household benefit provide less of a benefit?

· The City currently spends approximately $63 million for the City Health benefit. The options discussed this evening could increase these costs from $0-0% to $3.5 millioin-5.4%. Is there a dollar figure that the committee should not exceed in its recommendations?

There was group discussion and then this information was recorded on index cards and displayed on storyboards for all to see. Once all questions were asked and responded to a final question was asked in which people were asked to write down on an index card anything that they wanted to make sure the committee considered in their deliberations. These were then collected.

The following is a summary of the feedback given to each question. The entire text of the remarks made on note cards is attached as Addendum B.

Knowing only what you know now about the concept of an “extended household benefit” at this time, what are your thoughts, feelings and reactions to this concept?

Reactions to the concept of a household benefit ran a spectrum from people who adamantly opposed the concept to those who needed more information before deciding to those who ardently support the concept.

Those who oppose the concept of a household benefit often cited religious and moral concerns. Within this group there were those who quoted scripture as the basis for their opposition (Mathew 23, Deuteronomy 28:1-3) to those who had a more generalized moral discomfort with the concept. Central to those who opposed the concept from these perspective was the belief that “household benefits” has the effect of redefining the family by including non-blood relatives in the benefit and in particular unmarried adults. There were a number of people who supported a resolution by the Baptist Pastors conference (included as Addendum C) in which support for extending household benefits to children and other relatives was supported but not to unmarried and unrelated adults.

Some who support the concept of a household benefit also cited religion and morality. The basis for this support came from a belief that health care is an individual human right and that human rights are inherently moral conditions and also that there is no religious basis for discrimination about who should get health care and who should not.

There were a number of participants who voiced support for the benefit based on a belief that present reality has already provided a more expansive definition of family that is inclusive of more traditional views but also includes unmarried heterosexual and homosexual couples and their offspring.

Others wanted to make sure that the household benefit concept was separated from a religious and moral view and supported the concept based on either a human rights perspective or a pragmatic view that the growing uninsured is a community problem and that this is one way to help solve this problem. In general participants with this perspective did not distinguish blood relatives from other household members and tended to support the concept in an inclusive way.

Still others saw the issue from a more economic and/or taxpayer perspective. A number of participants cited the City’s financial situation and concluded that regardless of the merits or lack of merits the City simply can’t afford this benefit at this time. There were some people who believe that tax money should not be used to support a household benefit.

A few people offered some alternatives such as “Cafeteria Benefits Plans” that would provide a dollar figure for benefits that then would be up to the City employee to use as he or she sees fit and could include purchasing benefits for whoever the City employee chose to cover. Some felt that differentiating who the beneficiary is and excluding unmarried adults might get part of the job done and avoid the moral controversy.

As will be seen in the summaries of each of the facilitated questions many of the perspectives voiced in this first question play out in the responses to the other questions with some exceptions.

Should an extended household benefit include the same benefits as the present City employee package (i.e., medical, prescription, dental and vision) or should it be more limited?

Interestingly, most participants supported the idea that if an extended household benefit were to be offered it should not be discriminatory and should have the same benefits as the City employee receives. Comments about not setting up a two- tiered system or second class status were numerous. Recognizing potential cost issues, some participants offered recommendations such as including all four benefits but charging an increased premium to the employee for dental and vision or if dental and vision were the “deal breakers” or perhaps not offering dental and vision benefits at all.

The concept of a “cafeteria approach” to benefits was again raised in response to this question. The idea would be to give the employee a set dollar amount and let the employee decide which benefit they would want to purchase. This was discussed by a couple of the participants.

There remained some who believed that the question was irrelevant because the entire concept of an extended household benefit was inappropriate.

If an extended household benefit were to be offered, who should be considered eligible for the benefit?

Participants in the small groups included people that supported Definition A and those that supported Definition B. For those who supported one of the existing definitions more supported Definition A than B.

Without question answers to this question shows the differentiation of support for and against the concept of an extended household benefit. Almost all of the statements summarized in the answers to Question 1 were repeated in response to this question. Issues of being a more inclusive community, health care as a right, redefining the family, favoring the Columbus Baptist Ministers resolution, as well as economic and tax payer arguments were all repeated.

Some participants recognized that using the household as the “door” to health care benefits as opposed to a definition of family was a new paradigm that avoided redefining the family and yet extended coverage to more people.

A number of participants suggested that if a household benefit is offered it would need to be regulated so that it isn’t abused. Things like establishing length of stay criteria, verification of eligibility and not including those who are eligible for other insurance should be part of the recommendations.

It was in response to this question that several participants identified the part-time employee as someone who needed coverage and that the proposed definitions did not include them.

On this question a number of participants felt that there was not sufficient information to allow for meaningful feedback. For those who did offer an opinion they ranged from employees should not have to expect to pay any kind of higher premium for an extended benefit to some who believed that an employee should pay for the full benefit with no City money used to subsidize any portion of the benefit. There were some who felt that 50% was appropriate and others suggested that employees bear 60% of the cost and the City 40%. A couple of people suggested that the premium be based on who was being covered with the requirement being to pay 100% if the people being covered are unrelated.

Again the cafeteria concept emerged which would allow the employee to purchase what he or she wanted and pay accordingly. There were also those that felt that the question was irrelevant because an extended benefit should not be offered in the first place.

Should an extended household benefit plan design be the same as the current employee benefit or should the extended household benefit provide less of a benefit (i.e., different coverage levels, co-pays, out-of-pockets limits, etc.)?

Again there was a range of opinions on this question. Some participants suggested that the extended household benefit should be differentiated from the individual and family benefit, with the extended benefit having higher co-pays and higher deductible levels. Others felt that the plans should be the same and to do otherwise sets up a two-tiered system. As with each of the questions there were some participants who felt the question not relevant because the whole issue of an extended household benefit was inappropriate because of a belief that it redefines the family. Still others felt that the cost of the plan should drive the decision making on this issue especially because of this potentially being a tax payer supported benefit. Several participants felt that there was insufficient information to give an informed opinion.

The City currently spends approximately $63 million for the City health benefit. The options being discussed could increase these costs anywhere from $0 or 0% to $3.5 million or 5.4%. Is there a dollar figure that the committee should not exceed in its recommendations?

In general participants felt that this question was very difficult to answer given the information that was provided and that coming up with a number would almost be impossible. This was best characterized by one participants comment that “there is no recommendation that the group feels could be made on the limited data and information and the complex nature of providing health insurance.” Some participants answered this question by providing broad parameters like “costs should not be too out of line with the rest of the City budget or what are the budget trade offs, don’t do anything to hurt bond rating or financial stability.” Several people suggested that when it came down to final costs the committee may need to prioritize who would get coverage and the children and older adults probably should be covered first. A number of participants shared the opinion that if there is an extended household benefit there should be no cost to the City and that the employee should bear the entire cost. Support for this position for some was based on the argument that the City’s finances are already stretched and for others that “in principle” beneficiaries should bear these costs. There were some participants who felt that the upper limit of $3.5 million stated in the question was not unreasonable. In one way or another, those participants who commented on this generally believed that the costs should not be prohibitive and should be as low as possible.

In concluding the facilitated part of the input session please share any individual comments about an extended household benefit plan you would like to make to the committee by writing your comments on the index card provided to you.

· Adopt the Columbus Baptist Pastors Conference recommendations for eligibility guidelines.

· It was suggested that each employee be given a specific dollar amount to spend on health care. If the number were based on the number residing members of your household, thus letting the employee decide whom to provide health care.

· The Committee needs to go back to the drawing board and come up with a plan that does not have the controversy of this plan.

· I believe the context of the uninsured population related to benefits provides a disingenuous representation of the targeted population to be served.

· All employees should get, in addition to personal medical insurance, a fixed dollar amount (possibly age-adjusted). An employee benefits consultant should design a cafeteria plan for this dollar amount, based on employee needs, actuarial soundness and administer-ability. The plan would include household benefits, expanded personal medical or long term care benefits, etc., so that parents/single/married/etc., would all be able to help themselves. The ultimate total medical cost should be set so that the health benefits provided by the city are as great as possible while not risking the privatization of city services. Example: In the 60^th percentile.

· I feel the household benefits are extremely important for our community. I believe it will be cheaper in the long run and will tell employees that they are valued as healthy human beings. (Those stressors we have at home do come to work with us – health care is a need, not a want. Maybe it is not really the City’s responsibility to change how coverage is dispersed, but whose is it?

· I support household benefits for the entire household. Anything less is discrimination. I am willing to help pay for it and believe it is more important then the consultants brought in such as the Hay Study or The Ohio State University’s personnel survey.

· The expansion of City benefits is a small but important component in the overall community goal to expand health care coverage to the uninsured. It is also an important element in ensuring a quality city workforce and the future quality of city services.

· For the following reasons, I am against the City of Columbus providing Domestic Partner health insurance: Undercuts family values as it relates to the institution of marriage. With 126,000 other Franklin County residents without insurance and the vast majority of them taxpayers as other residents, they would be subsidizing city families. This point among others would create a strong division with the community. Due to fiscal problems of the City financing, this program would retract from other services and/or raise taxes. City admin as reported in the press seem to favor the “special” interest groups pushing for these benefits by helping them to better organize their efforts. Should action be taken to repeal any action taken by the City approving the Domestic Partner Plan, it would further polarize the community. Finally, I think the administration’s timing of this action is most inappropriate. Thank you.

· I really feel strongly that Option A is a redefinition of marriage and should not be passed by Council.

· Religious groups are trying to make this a moral issue – their participation has nothing to do with health care

· Any decision on household benefits must include insurance for blood or adoption relation only.

· I support the eligibility plan presented at the meeting by the Pastor’s Conference and believe that a plan that is not consistent with it should not be recommended.

· I believe this benefit is a positive step for the city. It enables the city to stay on a level field when it comes to recruiting and hiring qualified applicants (vs. private companies). It allows the city to not only talk about their commitment to diversity but also to show it in action.

· Health care is an important issue, as is the definition of family and household. The city appears to be trying to redefine family and attempting to extend benefits to individuals whom citizens may not feel are entitled. This issue should be presented with clarity to the taxpayers for vote.

· More education regarding present plans – how are the present cost decided? The expected/projected increases are based on what figure?

· Please contact me before moving forward with any benefit plan which has the effect of endorsing, promoting, recognizing or legitimizing live-in heterosexual or homosexual cohabiting relationships. It is very important that city government not contribute to the redefinition of family or marriage in an effort to extend insurance coverage. Please comply with the principles expressed in the Baptist Pastor’s Conference resolution in drafting any plan for extended health coverage to city employees.

· I would like the Mayor, City Council and the Committee to adopt the Columbus Baptist Pastor’s Conference statement regarding the persons to be covered by the extended health care benefits

· What is the cost to the city, if any, for uninsured people to use the emergency room versus the increased cost of providing household benefits ($3.5 million)?

· Maybe the Committee should use survey numbers from city employees with numbers of potential benefactors to plan changes vs. cost-effectiveness (to taxpayers, hospitals, etc.).

· Please consider and endorse the Columbus Baptist Pastor’s Conference resolution as the only eligibility option that preserves and strengthens the family structure in Columbus. I applaud the efforts to extend coverage based on this eligibility.

· Cost issues: Please check with other cities that have similar benefits to see their actual (not projected) costs. 5.4% sounds higher than I would expect. Can we recover any savings from hospital ER’s? $3.5 million/750,000 people is about $5/person. I spend far more than that on ADAMH. I’ll gladly spend another $5.

· Cover current eligibility only. Pursue another “context” or “contexts” for discussion of health care provision to the uninsured, i.e., faith-based initiatives, churches, synagogues, etc., non-profit organizations, etc. I need to know who is on the Committee.

· The household benefits definition must include health insurance for domestic partners available at a cost similar to married couples currently.

· Prescription drug benefit for seniors (Medicare eligible)? Medicare currently does not cover this.

· Is voter approval needed, because section 152 of the IRC will result in a tax burden should the voters approve an increase in tax revenue.

· What is the current employer/employee ratio in the premium? 70/30, 80/20, 60/40?

· Disagree with the concept of household benefits. The Committee’s jurisdiction was too narrow. The Committee should not have been directed to only review household benefits plans. This greatly narrows the scope of possible options. There should have been direct community input on whether the scope of options would be limited to household benefits. This limitation predetermined the outcome of the Committee’s recommendations.

· Until Section 152 of the IRC is changed, this benefit ought to be shelved because it places a tax burden on the working poor.

· Will the Committee bow to the vocal protestations of the right wing religious organizations, or will it do what is best for the citizens of Columbus and recommend extension of benefits?

· Under the current plan, how are “eligible stepchildren” defined? Must the employee be a residential or custodial parent?

· Proposed “other” definition of eligibility: Any beneficiary named on the employee’s life insurance policy and living in the same household is eligible. (Copy the language used by President Bush in the Mychal Judge bill he signed 6/24)

Section V: Research from other Cities and Businesses

City Council Staff conducted a comprehensive review aimed at identifying extended health care options in both the public and private sectors at the national, state and local level. Staff also gathered information and additional sources from benefits consultants experienced with extended health care options. This information was made available to the Committee.

From this research the staff narrowed the search to only those cities and companies that extend benefits to employee household members. This list included the cities of Atlanta, Georgia and Rochester, New York and to the University of California system and Nationwide Insurance. The committee reviewed all of the information and then focused our attention on the four organizations just identified.

At the time this research was conducted twenty-one out of the top 50 cities (ranked by population) offered domestic partner benefits and only one city (Atlanta) offered a household benefit. The City of Rochester also offers a household benefit but does not rank in the top fifty cities by population.

Atlanta with a population of 416,474 passed legislation extending benefits to dependents of city employees and domestic partners in 1993. Because of various legal actions it took the city six years before it succeeded in extending the benefits enacted in 1993. Under the cities household benefit plan a city employee may choose to cover a dependent life partner of either sex or dependent household members, including elderly parents, grandchildren and adult children. To receive the domestic partner benefit, the city employee pays 25% of the benefit premium, with the remaining 75% is assumed by the city. Premiums for dependent household members are covered entirely by the city employee. Cost to the city for the extended household/domestic partner benefits were $323,627 annually. The cost has remained stable over time and currently accounts for 0.99% of the entire employee health plan expense.

Rochester, New York has a population of 219,773 and extended household benefits to employee dependants in 1994. Extension of these benefits to household dependants falls under the city’s domestic partnership benefits program. The program allows an unmarried employee to select, a mutually dependant domestic partner of either sex or an unmarried household dependent, which includes parents or other family members. The legislation creating the domestic partners benefits program was coupled with another ordinance updating the city’s 1983 anti-discrimination policy. Currently, 4.6% or 120 city employees take advantage of the extended household benefits program. Costs to the city remain low and represents 3.29% of the city’s total annual healthcare budget of $13,978,500. No legal action was taken against the legislation.

The University of California system offered an extended household benefit to its employees in the late 1990’s. The University system insures approximately 1,130 individuals under the household plan. Benefits coverage extends to a legal spouse, an adult dependent relative or a same-sex domestic partner. Costs of the extended household benefits program benefits to the university system remains low and accounts for approximately o.23% of the total cost of the entire health care plan of $442,000,000. To receive such benefits for a family member the university employee must complete an affidavit of dependency.

In doing research on the private sector it was found that of the top 50 companies listed by revenues, 21 offered domestic partner benefits. Bank of America Corp. offers an extended household benefit as does our own Nationwide Insurance here in Columbus. Of the top 14 companies in the Greater Columbus area, all offer a domestic partner benefit.

Nationwide Insurance began offering health coverage to household members in the late 1990’s. Nationwide’s household member benefit coverage extends to the following: a dependent household member or a child (natural, adopted or employee having legal custody. Employees that enroll household members in the health care plan must contribute to the annual premium. In 2000, participating employees contributed $204,967 or 33% of the overall cost. In the same year, Nationwide’s premium contribution was $409,656 or 67%. Overall the cost of the plan to the company has not exceeded projections. To receive such benefits for a household member, company employees must complete an enrollment form and dependency affidavit.

Section VI: Design Specifications and Cost Options

In early June 2002, the Joint Committee on Household Benefits made the decision to contract with Mercer Human Resource Consulting to assist the committee in its work to fulfill its given charge. In its effort to assist the committee Mercer Human Resource Consulting provided the following services:

· Facilitated discussions on the establishment of broad objectives for proposed changes.

· Projected plan costs under various definitions of eligibility and benefit options.

In the first meetings with Mercer Consulting the Joint Committee spent its time learning about household benefits. Mercer educated the committee on: common reasons to expand eligibility benefits, policy and compliance issues, IRS rules, approaches and criteria for defining eligibility, other eligibility decisions that need to be made, determining a scope of benefits and various rules that need to be considered.

Once the committee was sufficiently grounded in the options and issues concerning extended household benefits it began the task with Mercer of defining some possible benefit scenarios. Mercer was asked to evaluate the cost impact of two definitions of Household Member, the impact of employee contribution levels on those costs, and the feasibility of offering a modified plan for Household Members.

Current: Spouse, employee’s natural or adopted children up to age 19, 23 if full time student, children for who the employee is subject to QMCSO, other children for whom employee is legal guardian.

Definition A: Related or unrelated adults over age 18 who: live in the employee’s household, are not otherwise eligible for City Benefits, either depend on the employee for support or have agreed with the employee to be mutually responsible for each other’s common welfare. Related or unrelated children who live in the employees household are under age 19, 23 if full time student, are not otherwise eligible for City Benefits.

Definition B: Same as Definition A except that the adults would not be eligible for Medicare.

Currently City employees make payroll deduction for medical and prescription drug coverage based on two possible coverage levels:

Since it was likely that employees will be asked to contribute to the cost of coverage for Household Members, it was necessary to add two additional coverage levels:

For purposes of illustrating possible costs three contribution levels were estimated:

· Base: Employee pays the same incremental cost for the Household Member as for

The following are the projected costs for various eligibility and contribution scenarios. The estimates are for the projected city benefit costs for 2003 (less premiums paid by employee contributions) as well as FICA taxes that the City must pay on the fair market value of the Household Member’s coverage when it is taxable to the employee. Costs are shown in total and as a percentage of the projected total benefit cost of $65 million.

scenario and final costs are contingent upon enrollment and participants demographics

For the purposes of illustration for the Public Input Meetings the committee chose to use the Definition A: Base scenario at its maximum of $3,536,000 for reactions from participants in those meetings.. It was the committee’s belief that showing the most costly scenario was, in effect, the worst- case financial scenario and also the most expansive definition. Getting public feedback on this scenario would allow the committee to then use this input to refine a scenario that would lead to a recommendation.

Following the public in-put meetings, the Benefits subcommittee met on numerous occasions and considered what it had heard. With this in-put in mind, the subcommittee asked Mercer to do some further work. Mercer was asked to calculate cost estimates based on four expansions of eligibility for coverage under City of Columbus benefit plans and the impact of several employee contribution levels. Mercers concluding research is included here in its entirety. It is this research that is the basis for the recommendations that follow:

Eligibility

Definitions:

Cost estimates are based on four expansions of eligibility for coverage under City of Columbus benefit plans. Definitions A, B, C and D are defined as follows:

Note that the difference between Definitions A/B and Definitions C/D is that Definitions C/D contain a “coverage of last resort” provision, excluding those Household Members who are eligible for other group insurance, including Medicare and Medicaid.

Coverage’s B and D are variations of A and C, respectively, where an employee may cover more than one adult Household Member. Note, however, that all definitions differ from the more typical practice of limiting employees to one adult, including the spouse (e.g. the employee may cover Household Member or a spouse, but not both).

Potential Enrollees:

In preparing cost estimates, we have considered three different types of Household Members who might be enrolled:

Non-Medicare Eligible Adults: This could include domestic partners, roommates, and resident parents under age 65, other adult family members such as siblings, or children whose age exceeds the current limit for eligibility.

Medicare-Eligible Adults: This could include parents over 65, grandparents, domestic partners over 65, other elderly relatives or boarders.

Children: This could include grandchildren, nieces or nephews, or children of a domestic partner.

Employee Contributions

Coverage Levels:

Currently, City employees make payroll deductions for medical and prescription drug coverage based on two possible coverage levels:

Since it is likely that employees will be asked to contribute to the cost of coverage for Household Members, it will be necessary to add at least two additional coverage levels, as follows:

In addition, if the City decides to offer a separate plan for Medicare-eligible Household Members (“Medicare Member”), it may be necessary to add additional coverage levels, as follows, where “NM Household Member” refers to a non-Medicare-eligible Household Member.

The number of coverage levels could further increase if the City decides to charge on a per covered person basis.

Sample Contributions

For illustrative purposes only, the following chart illustrates how employee contributions might look for one current group of employees (AFSCME) in 2003 under a Definition A. Please note that the current contribution levels and plan costs do vary for the various union groups covered under The City’s health care plans, so AFSCME was chosen as the representative group since it covers the largest number of City employees:

· “Base”: Employee pays the same (current) incremental cost for Household Member as

· “25% Subsidy”: Employee pays 25% of Household Member’s full cost

· “50% Subsidy”: Employee pays 50% of Household Member’s full cost

· “100% Subsidy”: Employee pays 50% of Household Member’s full cost

Note that the employee contributions are based on a full cost (or funding rate) that includes paid claims as well as the reserve for claims incurred but not reported at the end of the year. This is consistent with COBRA rates. The illustrations are based on current level of contributions for one current employee group, and are for medical and prescription drug coverage only.

The chart below shows sample contributions under Definition A using the following assumptions:

· There is no distinction between Medicare-eligible and non-Medicare eligible Household Members

Alternative Plan Designs

All of the costs projections are based on the assumption that Household Members would be enrolled in the same plans as employees currently have. Another option would be to offer a less rich option in order to reduce costs.

The chart below reflects, for illustrative purposes, the type of plan design changes that would be required in order to reduce the plan value by 10% (the 90% Plan scenario). The plan value difference means that on an actuarial basis, the plan is expected to reimburse 10% less.

However, it is important to note that adverse selection (the enrollment of poorer risks) can more than offset differences in plan value. The plan design is based on typical averages rather than claims experience specific to the City.

Cost Estimates

The chart below shows projected 2003 costs for various eligibility and contribution scenarios. The estimates are for the City’s 2003 benefit costs for medical and prescription drug coverage (i.e. premiums less employee contributions) as well as FICA taxes that the City must pay on the fair market value (assumed to be the full cost, as defined above) of the Household Member’s coverage when it is taxable to the employee. Costs are shown in total and as a percentage of the projected total benefit cost of $51.5 million.

Note that the costs under the 100% subsidy scenario are expected to be zero. However, the City would still bear the risk of claims fluctuation and adverse selection if contributions did not cover the full cost.

Other Coverage’s:

If dental and vision coverage were to be offered to Household Members on the same basis as medical coverage (e.g. Household Members get the same plan as City employees and employees pay the same percentage of Household Member dental and vision costs as for medical), the above costs would increase by about 8%.

Cost Assumptions

Total Projected 2003 Costs:

Projected costs for medical and prescription drug benefits are developed using the City’s actual claims experience through September 2002. Costs are projected for expected inflation and then adjusted for administrative savings and plan design savings. A total projected cost for medical and prescription drug benefits is $51.5 million.

Household Member Unit Cost:

The projected total cost for medical and prescription drug benefits for a Household Member is based on:

· The projected per employee cost in 2003 of approximately $6,475 (this includes employees as well as family members)

· The portion of that cost attributable to current dependents under the program

· The expectation that Medicare will be primary for Medicare eligible participants and that Medicare will pay 60% of their overall medical costs

· The assumption that about 10% of employees who enroll an adult Household Members would enroll a second Household Member if the City does not limit employees to one

Enrollee	Annual Unit Cost
Non-Medicare Eligible Adult	$3,087
Medicare Eligible Adult	$1,920
Child or *children*	$2,365

Note that these projected costs do not include a reserve for claims incurred but not reported at the end of the year. Based on other discussions with the City, we expect the current reserve to be able to accommodate these additional participants. These projected costs also do not include the payroll taxes that the City must pay when this benefit is taxable to employees.

The above costs do not reflect the impact of potential adverse selection, which occurs when the people who ultimately enroll in the plan have higher costs than average. Selection is primarily influenced by the level of employee contributions, both in terms of the burden on the employee as well as the relative cost of other available health insurance, such as a Medigap Plan.

Selection factors are the expected increases in cost when employee contributions increase.

Enrollment Assumptions:

For each type of Household Member, there is a range of expected enrollment. These ranges represent the numbers of Household Members (based on 7,954 employees) who are expected to enroll. While the ranges may seem wide, the overall percentages remain small. In addition, it may take several years for enrollment to reach these levels; enrollment in the first years is typically somewhat lower.

These assumptions are based on the experience of other employers who have expanded eligibility for benefits. For example, private employers who expand benefits to domestic partners typically have enrollment increases of about 1%. For those few who have further expanded eligibility to include extended family members, enrollment can double. In addition, government employers generally have somewhat higher enrollment rates for these types of programs.

However, the City is contemplating a definition of eligibility that is broader than any known plan. Therefore, since the experience of other employers is not available, proxies were developed using US Census data about the makeup of households.

To estimate the impact of the “coverage of last resort” provision, we reviewed the eligibility criteria for the Medicaid, CHIPS and Healthy Start programs. While we do not have household income data for Columbus employees, we do expect that some of the household members eligible under Definitions A and B would be eligible for these programs and have reduced the enrollment assumptions accordingly for Definitions C and D.

It is also assumed that employee contributions will have an impact on enrollment, as shown below.

Finally, one other factor that could have an impact on enrollment is the administrative procedures for verification of eligibility.

Section VII: Recommendation

The Finance Subcommittee of the City of Columbus Joint Committee on Household Benefits was established to formulate eligibility criteria for extended medical and prescription drug coverage of household members of city employees. The Subcommittee was also charged with the responsibility of establishing a recommended employee contribution rate and benefit design for this coverage that would provide greater access to medical care for individuals who were not eligible for any other private or governmental health insurance.

Factored into the Subcommittee’s work was due consideration of the city’s current financial position. In completing the assigned task and in making its recommendation, the Subcommittee became acutely aware of the financial position in which the City of Columbus finds itself. The current City of Columbus budget does not contemplate additional expenditures for the optional coverage proposed by the Subcommittee’s recommendation. The Subcommittee in making the recommendation does not speak to the timing of its implementation.

The Subcommittee chose a plan design for extended coverage that does not challenge the preferred status of the traditional family in public policy. The Subcommittee focused its efforts on offering greater access to health services for those persons who live with city employees and who are not currently covered by private or governmental health insurance plans. It has not attempted to enter into the question of examining or legitimizing any particular form of relationship.

The Subcommittee’s recommendation is a response to a limited part of the community access question because it deals only with city employee benefits. Ultimately, the only effective solution to ensure access to health services is large-scale health care reform beyond the City’s power to adopt or legislate. Until the fundamental right to basic health services is recognized for all people who live in this nation, a patchwork quilt of private, legislative and administrative policies with all the overlapping seams and loose threads showing, will be the reality of best efforts to address the access question.

The Subcommittee has reviewed considerable data from other cities, private employers, and from a private consultant – Mercer Human Resource Consulting – hired for this purpose. While a number of cities had extended some form of coverage beyond the single and family categories, generally this coverage was restricted to domestic partners. The Subcommittee’s focus was much broader, intended to promote greater access to health services by a wide range of individuals who live under the same roof as a city employee. Thus, the role of the consultant became very important in assessing enrollment and cost figures for optional coverage of household members.

While there are no comparable plans that we have found, we believe that the data provided to us by Mercer is the most reliable data available. We have relied upon that data.

The Subcommittee considered various eligibility criteria and centered on criteria that extended last resort coverage for up to two adults and all children living in the employee’s household. It also examined various employee contribution levels for such coverage ranging from current base levels for family coverage and progressing upward to 25%, 50% and 100%. We believe that the 50% contribution level offers the best balance between achieving access on the one hand and sharing responsibility with the City employee on the other. While employee contribution levels in excess of 50% may at first blush seem attractive, the Subcommittee does not recommend them. We believe that the potential for adverse selection, that is, of only insuring those most prone to use the coverage due to serious illness, would limit any significant cost savings to the City.

Data from our consultant for the eligibility criteria chosen by the Subcommittee at the 50% contribution level indicate that enrollment of between 190-286 adults and 84-125 children would be expected. These assumptions are based on the experience of other employers who have expanded eligibility for benefit coverage. In addition, Mercer developed proxies by using U.S. Census data about the make up of households and reduced enrollment levels to account for individuals who would be covered under Medicare, CHIPS, and Healthy Start programs.

Using the enrollment assumptions outlined above, projected cost data was generated. The City of Columbus benefit costs for the extension of this medical and prescription drug coverage include premiums less employee contributions plus FICA taxes that the City must pay on the fair market value of the taxable portion of household members coverage. Mercer has estimated that the cost to the City would be in a range between $415,000 and $622,000 or between 0.81% and 1.21% of its projected total benefit costs. The enrollment and cost data is mature and reflects a fully ramped up program.

Recommendation:

The City of Columbus Joint Committee on Household Benefits, after reviewing considerable data and various options, makes the following recommendation:

That the City of Columbus extend medical and prescription drug benefits to household members of city employees on the following basis: Optional coverage would be available to up to 2 additional adults who live in the city employee’s household, who are not employed by the city employee, and who are not otherwise eligible for city benefits or other employer or government sponsored group insurance including Medicare. Optional coverage would be available to all children who live in the employee’s household, who are under age 19 (or age 23 if a full time student), and who are not otherwise eligible for city benefits or other employer or government sponsored group insurance. Employees electing such optional coverage would pay 50% of the full cost (a funding rate that is based upon paid claims and the reserve for claims incurred but not reported at the end of the year) of the premium for household coverage.

The full Committee in making this recommendation would also note that input from the within the Committee and from the public meetings suggests two areas beyond the purview of the Committee’s work that are worthy of thoughtful and deliberate consideration by the City of Columbus. The issue of the availability of insurance coverage for part-time employees should be examined. In addition, the City should consider plan designs that allow all employees to choose from among the panoply of benefits those that they really need. The first issue goes to access, the second to effective cost containment.

Section VIII: Conclusions

As can be seen in this report, the Joint Committee on Household Benefits conducted a process that was both thorough in addressing its charge and inclusive in seeking broad input from many interested parties. The committee’s work concentrated its considerable efforts on answering the first five questions posed to it and acknowledges that further work will need to be done on the evaluation and monitoring questions. The issue of access to health care is one of the top two or three issues facing this country, this state and this community. The recommendations set forth in this report are quite modest in the context of the larger access issues and modest in the context of the alternatives that were explored. Many legitimate options were evaluated and are available for further exploration, however, the committee believes that the option recommended best meets the charge given to the committee. The committee also hopes that the City will further explore the issues raised in the closing observations section of this report.

The committee wishes to thank Mayor Michael Coleman and City Council President Matt Habash for the opportunity to serve the City in our capacity as Joint Committee Members and is encouraged by their efforts to find ways of helping more citizens gain access to health care.