Retired Public Employees Council v. Health Care Authority

919 P.2d 625, 82 Wash. App. 773, 1996 Wash. App. LEXIS 274
CourtCourt of Appeals of Washington
DecidedJuly 26, 1996
DocketNo. 18480-0-II
StatusPublished
Cited by3 cases

This text of 919 P.2d 625 (Retired Public Employees Council v. Health Care Authority) is published on Counsel Stack Legal Research, covering Court of Appeals of Washington primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Retired Public Employees Council v. Health Care Authority, 919 P.2d 625, 82 Wash. App. 773, 1996 Wash. App. LEXIS 274 (Wash. Ct. App. 1996).

Opinion

Armstrong, J.

The Retired Public Employees Council of Washington (Council) filed a class action lawsuit, on behalf of retired state employees over 65, challenging the State’s method of calculating health insurance premiums. The Council alleged that the State improperly set the premiums of retired state employees over 65 based on the claims experience of only active employees over 65, rather than of all active employees, in violation of RCW 41.05.080. Because the plain language of the statute requires that [775]*775the premiums of retired state employees be determined from the claims experience of all active employees, we reverse the trial court’s summary judgment for the State.

FACTS

The Council is a non-profit labor organization comprised of retired state and local employees. It filed a class action lawsuit on behalf of retired state employees over the age of 65 who participate in the State’s Uniform Medical Plan (Uniform Plan) for health insurance. The Washington State Health Care Authority (HCA) is the state agency that administers state employees’ health insurance benefits.

In the 1970s, state employees paid their own medical insurance premiums. Employees could participate in their health insurance plan after retirement. The law, however, required that retired employees be charged the same premium as active employees. Former RCW 41.05.080 (Laws of 1973, ch. 147, § 7).

In 1977, the State began underwriting the insurance premiums of its active employees. Because state employees were no longer being charged premiums, the Legislature amended the law to provide that the rate for retired employees "be developed from the same experience pool as active employees.” Former RCW 41.05.080 (Laws of 1977, 1st Ex. Sess., ch. 136, § 6).

In 1988, the State began to self-insure the Uniform Plan, a traditional fee-for-service health plan. The present dispute concerns the process the HCA developed and used to set premiums for retired employees over 65 from 1988 to 1994.1

The HCA first determined the projected total cost of the [776]*776Uniform. Plan for the upcoming fiscal year, based on the previous year’s claims from all Uniform Plan subscribers, administrative costs, and any additional expenses because of benefit changes. The HCA allocated the total cost of the Uniform Plan to four employee groups based on each group’s medical costs: active employees under 65, active employees over 65, retired employees under 65, and retired employees over 65. The HCA reported these medical costs as relative cost factors. The HCA then established premiums by allocating the Uniform Plan’s total cost to the subscribers in proportion to the relative cost factors.

Because the State has paid the premiums of almost all active employees since 1988, the monthly premiums for active employees were calculated primarily for purposes of the budget. The relative cost factor for retired employees, however, established the base for calculating the premiums charged retired employees under the statute.

The HCA assigned active employees under 65 a relative cost factor of 100 percent. People over 65 have, in general, higher medical costs than those under 65; the HCA calculated the relative cost factor for active employees over 65 to be 229 percent. Retired employees over 65 received the same 229 percent relative cost factor.

After the full amount of the premium to be charged retired employees was calculated, it was "actuarially reduced” by the value of Medicare coverage.2 The parties agree that Medicare pays, on average, 70.5 percent of Medicare-eligible retirees’ claims covered under the Uniform Plan. The Uniform Plan pays the remaining 29.5 percent of the claims. Accordingly, the Uniform Plan premium charged retired employees over 65 was reduced by 70.5 percent.

[777]*777A few active employees, however, pay their own health insurance premiums. The HCA charged a single premium rate to these self-paying, active employees, regardless of their age. Furthermore, the State provides insurance coverage to other governmental entities; the HCA charged these various political subdivisions a single premium rate that did not reflect an employee’s age.3

Although the State charged retired employees over 65 the same premium rates as active employees over 65, retired employees actually have higher health care costs. This resulted in a subsidy to retired employees of approximately $8.7 million.

The Council maintains that RCW 41.05.080 required that premiums for retired employees over 65 be determined from an experience pool composed of all active employees, rather than just active employees over 65. According to the Council, a single monthly premium should have been determined for all active employees. Retired employees over 65 would have paid this same amount, minus the 70.5 percent reduction for Medicare reimburse[778]*778ment.4 Under this formula, the State would have provided a subsidy of approximately $14.7 million to retired employees.

Both parties moved for summary judgment. The trial court granted summary judgment for the HCA, finding that use of the over-65 active employee age group to set premiums of retired employees over 65 was authorized by the statute.

DISCUSSION

A. Statutory construction

In construing a statute, the court’s paramount duty is to ascertain and give expression to the intent of the Legislature. Service Employees Int’l Union, Local 6 v. Superintendent of Pub. Instruction, 104 Wn.2d 344, 348, 705 P.2d 776 (1985). The interpretation of a statute is a question of law. Waste Management of Seattle, Inc. v. Utilities and Transp. Common, 123 Wn.2d 621, 627, 869 P.2d 1034 (1994). Accordingly, the court engages in a de novo review of the trial court’s determination. Waste Management, 123 Wn.2d at 627. The court interprets a statute according to the plain and ordinary meaning of its language. Flanigan v. Department of Labor & Indus., 123 Wn.2d 418, 426, 869 P.2d 14 (1994).

If a statute is unambiguous, the court will determine [779]*779the Legislature’s intent from the language of the statute alone. Waste Management, 123 Wn.2d at 629. If a statute is susceptible to more than one meaning, it is ambiguous and consideration of the legislative history is appropriate. Timberline Air Service, Inc. v. Bell Helicopter-Textron, Inc., 125 Wn.2d 305, 312, 884 P.2d 920 (1994).

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Bluebook (online)
919 P.2d 625, 82 Wash. App. 773, 1996 Wash. App. LEXIS 274, Counsel Stack Legal Research, https://law.counselstack.com/opinion/retired-public-employees-council-v-health-care-authority-washctapp-1996.