Benefits Column

Travels to Coal Country

A recent visit to West Virginia uncovers some lessons about the perspectives of the silent majority on employee benefits.

Monday, December 12, 2016
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I've spent 98 percent of my lifetime in homes on either the East Coast or West Coast of the United States. I briefly contemplated accepting a job in Chicago -- a city I love -- but could not reconcile to myself that living near Lake Michigan was the equivalent of easy access to the ocean.

I rarely considered that where I resided impacted my perspective on employee benefits and practices. That is, until I experienced an "a-ha!" moment over the Thanksgiving holiday when I traveled to spend time with a friend who lives and works in White Sulfur Springs, W.Va.

You may recognize the name of this town for two reasons: It's been the home of the historic Greenbrier hotel since 1778, and it was the epicenter of a 1,000-year flood that hit on June 23. In addition to 23 lost lives, more than 1,200 homes were destroyed by the flood.

As I spent time meeting and speaking with the residents over a four-day period, I recognized I was talking with members of what's been categorized by some in the media -- especially during the last election -- as the "silent majority." We spoke little about politics. Instead, we talked a great deal about the things that contributed to a life well-lived.

Like most employees, one overarching theme draped over all the conversations: providing for your family. The factors that drove this life goal were having an income, maintaining a home and caring for their family's health.

The differences between the West Virginians with whom I spent time and others I've helped throughout the country were sometimes stark.

My friend is the Greenbrier's medical director for employee and community health. She's been spending a lot of time doing pre-employment screenings for people who were displaced from coal-mining jobs and were returning to work in the shale industry. I involuntarily winced when I thought of the risks associated with this type of employment. It did not go unnoticed.

The West Virginians I encountered are proud people who often refuse to take anything they consider to be a handout. This includes unemployment compensation, state- and federal-assistance programs and funds raised to help the people of Greenbrier County after the June flood. They will undertake any type of work -- no matter the risks -- if it is honorable employment. In West Virginia, hard work is always honorable.

This pride in self-sustenance extended to their homes. Clusters of homesteads, particularly those located in "hollers," were wiped out in the recent flood. Many people lived in these homes for 30 to 50 years. The only helping hand they seemed to willingly take was from the Greenbrier Hotel, which owner Jim Justice (who is also West Virginia's governor-elect) opened to 300 of the neediest families. In West Virginia, your community is an essential part of your life and the Greenbrier has long been part of White Sulfur Springs.

Pride, self-sustenance, home and community carried into our conversations about healthcare. And here is where I found some lessons about the perspectives of the silent majority on employee benefits.

While West Virginia overwhelming voted for the Republican presidential candidate on Election Day, the major driving force for their support was the hope for a resurgence of coal-mining jobs. Many of the people who spoke with me about the election said it was a one-issue ballot for them.

In fact, West Virginians were largely appreciative of healthcare reform -- despite the need to amend the Affordable Care Act. As most employees report, healthcare and medical insurance is, by far, their most important benefit. They see health insurance as part of the way they provide for their families. But West Virginians report running into new challenges as health insurance offered by their employers and the public exchanges changed during open enrollment:

·         Employees trusted the health-plan directories when they selected their medical insurance during annual enrollment. They are now finding that some or all of their physicians and hospitals are no longer in the network.

·         Many or all of the health-plan options moved to local and/or narrow networks. West Virginians report this is challenging for them because those close to the border states of Virginia, Ohio, Pennsylvania and Maryland -- as well as the non-border state of North Carolina -- often seek care outside West Virginia for more complicated medical conditions.

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·         Several Blue Cross Blue Shield plans in West Virginia are restricting the "Blue Card" to emergency care only in other states. The Blue Card is how many West Virginians formerly paid for healthcare outside the state.

·         There are no "centers of excellence" outside the state available to policy holders.

·         Employees who were already being treated by physicians and healthcare facilities outside the state have been given 30 to 90 days to transfer their care to in-state physicians and hospitals -- even when there isn't equivalent care available in West Virginia.

·         Insurance premiums are much higher in West Virginia than neighboring states such as Virginia. (Note: This fact is most likely related to West Virginia being ranked second highest nationally in the prevalence of adults with fair-to-poor general health.)

When it comes to employee benefits, especially healthcare and medical insurance, West Virginian workers want access to the best care for themselves and their families. Silent majority or not, they represent the hopes and desires of employees across the nation.

Carol Harnett is a widely respected consultant, speaker, writer and trendspotter in the fields of employee benefits, health and productivity management, health and performance innovation, and value-based health. Follow her on Twitter via @carolharnett and on her video blog, The Work.Love.Play.Daily.


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