Auditing employee health insurance rolls to make sure everyone receiving benefits as a dependent is entitled to them is exactly the kind of thing Baltimore needs to do if it is to have any chance of controlling the cost of government, cutting taxes and making city living more attractive. The fact that the effort has caught some employees so completely off guard — some reportedly had no idea this was going on until they sought to fill prescriptions for children or spouses and found themselves without coverage — shows just how lax management has been up to this point and how far the city has to go before it is running a truly efficient operation.
The Baltimore City government provides health insurance coverage for tens of thousands of its employees and retirees and their dependents. An outside consulting firm that examined Baltimore's finances reported in February that the city faced a $750 million structural deficit during the next decade, and that employee benefits were a major driver of the problem. Among many other suggestions for improved management, the consultant deemed it "critical to develop a health care program that is more affordable for the city" and estimated, based on the experience of other large employers, that a dependent eligibility audit — then already under way — could save the city about 3 percent of its health care expenditures a year.
The vast majority of city employees with dependents responded to the audit and were able to provide documentation proving the dependents' eligibility. More than 22,000 dependents were deemed legitimate, but 2,181 were dropped, about 1,600 of them because they did not respond to requests for documentation at all. The city expects to save $6.5 million a year as a result.
Now some city union officials and at least one member of the City Council are calling the process unfair, onerous and even inhumane. They complain that some workers were not notified of the need to justify their dependents or that they were unable to find the necessary documents — like marriage licenses or birth certificates — to prove eligibility.
If the city made an error in rejecting any of the dependents, it should correct it. And if anyone is forced to go without health insurance coverage for a time because their parents or spouses failed to respond adequately to the audit, that is unfortunate. But at some point the workers themselves need to accept responsibility.
The city sent five separate letters to each worker starting in January, plus an email, and departments held informational sessions. The city also worked with employee unions to provide outreach. Some workers are complaining that they never got the letters because the city did not have the right address for them. One might argue that it's your responsibility to make sure your employer has your correct home address. But even so, are we to believe that these employees didn't hear about this at work either? Did they miss the information sessions, the email or the chatter around the water cooler? The city pushed back the deadline three times. Just how far does it have to bend over backward?
Dependent audits are an increasingly common tool in the private and public sectors to control rising health care costs, and requiring documents like birth certificates and marriage licenses is standard operating procedure. It's smart management practice, and if other local governments in Maryland aren't doing it already, they should.
Mayor Stephanie Rawlings-Blake said on Friday that she is willing to work with those who made a good-faith effort to comply and has provided a city hot line and human resources staff to help determine whether the city was at fault. But she expressed little sympathy for those who did not respond to the audit at all, saying she didn't want to send the message that workers could "pay attention to this if you want to and if you don't, don't worry about it, they'll fix it in the end."
That may sound a little harsh, but she's not wrong on the substance. Anyone who was kicked off the rolls can reapply for coverage that starts on Jan. 1, and options exist for maintaining coverage until then, though it may be expensive. What the mayor is doing is injecting a bit of management rigor into an organization that has needed it for a long time. It may come as a shock to the system, but it's just one example of the kinds of things Baltimore needs to do if it intends to reduce the size and cost of its government.