Sep 13, 2013 - By Eric Blom, Staff WriterRising health care costs took a big bite out of Fremont County's general fund in the last budget cycle, and the figure has climbed year after year. Commissioners are trying to get ahead of the problem by discussing now how to address it in the future.
At its meeting Tuesday, the county board decided to have a full-day retreat on the matter where it would decide its priority in regard to health insurance and how best to pursue it. It also reviewed a list of ideas to lower costs with other county elected officials.
"Obviously the concern is for controlling costs," commissioner Stephanie Kessler said. "(The goal of the list was) to think outside of the box and do some investigation for opportunities to start early in this process."
In the current fiscal year's budget, the $6 million county employee health benefit plan accounts for roughly 25 percent of the general fund's $24.2 million in spending. The cost of health benefits was up 15 percent from $5.2 million the year before.
The general fund pays for most county departments but not large capital projects such as roads and bridges.
Commissioner Keja Whiteman thought the county board had to decide a basic question before it could evaluate specific options on the list.
"One question that would help me move forward would be to know what the top priority is," she said. "Is the top priority saving money or maintaining benefits?"
Before deciding to hold a retreat to answer that question, some commissioners offered their thoughts.
Budgeting for the health benefit plan should start with a dollar amount the county board thinks it can afford, and deciding the level of coverage based on that, commissioner Travis Becker said.
"You set a number, $4 million or $5 million, and you work around that," he said.
Commission chairman Doug Thompson was leery of starting with a level of benefits and trying to maintain it every year.
"I think the idea of we pick a plan and this is going to be our health benefit plan, and we're going to provide that every year to our employees no matter what--we would paint ourselves in a corner," he said.
The current health benefit plan is much like a typical insurance plan for employees: They pay a premium every month and pay copays when they receive medical services.
Health care providers then send a claim to the county.
For the county, though, it is much different. It is mostly self ensured, meaning every month it pays a set amount for each employee, depending on their level of benefits, into an account.
The county then pays claims out of that account.
It has a private insurance property to guard against catastrophic claims.
The rising cost to the county stems from higher costs of
providing health care to employees on the health benefit plan.
"It's claims that are driving this, it's not administration or anything else," deputy county treasurer and executive health committee member Jim Massman said at a March commission meeting.
Claims climbed about 21 percent in 2009, 16 percent in 2010, 12 percent in 2011 and 19 percent in 2012. They are projected to end this fiscal year 11 percent lower than last, then climb 8 percent again next fiscal year.
Two other structures were put forth at the Sept. 10 meeting.
One option was to pool the county's health benefit plan with that of other government entities to create a multiple employer welfare arrangement.
Dianna Madvig of COBECON, Fremont County's insurance consultant, said such a structure would end up costing the county money because they involve a high risk. Wyoming has no laws to protect groups that create multiple employer welfare arrangement, she said, so insurance companies working with them have to charge high fees and require strictly binding contracts for participants.
As a result, Fremont County would pay a high cost to be in the arrangement and would have difficulty leaving it.
"The only one who gets money out of it is us," Madvig said.
Thompson liked the idea of "medical savings accounts." He thought it would give employees an incentive to consume medical services economically.
Under the plan, if employees spent little on medical expenses in a year, they would receive a portion of those savings themselves.
"If they have a way of benefiting from not having poor health consumer practices, if there was a way of doing that," he said. "(If)R00;we can cut down claims costs I would assume we could cut down insurance costs."
Fremont County Attorney Michael Bennett had reservations about such a plan.
"My concern is under our current system of health care, is average Joe Q. Citizen in the position to be a better consumer, a wise consumer when we start dealing with doctors and hospitals?" he asked. "They always want to run a battery of tests, and I don't know what those tests are and if they're necessary"
The commissioners and other officials discussed many ideas, but they made no decisions about them. They decided the next step would be to have a retreat in October where the county board would first set its priorities regarding health insurance. Then, it would meet with other elected officials to decide the best way to pursue those objectives.
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