The Fresno City Council is taking steps to create a new health care plan for city workers and their families. This comes after a breakdown in talks between Community Health Systems, the main health provider in the area, and Blue Shield of California. As a result, over 12,000 subscribers have lost in-network coverage, making health care more expensive for many.
Since February 1, workers have had to seek out-of-network care, leading to much higher costs. Mike Karbassi, the Council President, expressed concern about this situation. “When residents lose in-network care, it can double their costs for regular treatments,” he said. He believes the council’s involvement might encourage both Blue Shield and Community to resume negotiations.
One potential solution is for the City Health and Welfare Trust Board to negotiate directly with Community. The council has set aside $50,000 to support this effort in case of legal challenges.
Councilmember Nelson Esparza is interested in exploring a Kaiser Health Plan as an alternative. He assured that the council is ready to support the board in restoring access to care. In a statement, Blue Shield indicated that negotiations had been ongoing long before the loss of coverage, but disagreements on payment terms caused a stalemate. They stressed their commitment to finding a solution that meets the needs of families in the San Joaquin Valley.
Meanwhile, Aldo De La Torre from Community noted that rising drug and operational costs were affecting their pricing. He mentioned, “Community wants Blue Shield to ensure fair reimbursement rates,” which would stabilize their financial standing.
Sam Frank, from the Fresno City Employees Association, emphasized that the council’s resolution would help protect the board from legal issues while they explore new options. He highlighted that, during previous lags in coverage, it took months to reach new agreements. The next board meeting is set for March 11, and they will discuss new rates and costs.
Additionally, Frank pointed out that Blue Cross had guaranteed reimbursements for out-of-network premiums this year. He suggested a similar promise from insurers would provide much-needed peace of mind for city workers facing unexpected costs.
City Councilmember Annalisa Perea added urgency to the matter, stressing that “when health care becomes a bargaining chip, patients always suffer.” In response, union groups are planning to advocate for new rules requiring insurers and providers to prevent coverage lapses. These rules would help ensure continuity of care for patients, sparing them from having to navigate complex insurance challenges at the worst possible time.
In a related note, a 2022 survey by the Kaiser Family Foundation revealed that 80% of Americans find health care costs burdensome, which further highlights the urgency of resolving this situation for Fresno’s city workers.
These ongoing negotiations are vital, not just for the current city employees, but also for the broader community that relies on accessible health care services.
