Homeless Issues Committee - Regular Meeting

It's 830. We're going to call the Employee Management Insurance Advisory Committee meeting to order now. Linda, can you please start us out by calling roll?

Christy Kowalski? Here. Joshua Cotillier?

Here.

Carrie Meyer?

Here.

Marissa Burak.

Here.

Angela Tabato.

Here.

Misha Dancing Waters.

Here.

Cassandra Riley. Cassandra Riley. Thomas Travis.

Cassandra Riley is here. I could not get unmuted. Thank you.

Travis Thomas here. Tina Knights is excused. Scott Drummond is excused. Brian Tushar here. Patrick Schellenberger here. John Bauman here. Arlen Halvorsen

Here.

Tommy Rylander. Tommy Rylander. Oh, excuse me. He told me he was not going to attend, so excuse. Yogesh Chawla.

Here.

Dean Julian.

Here.

Heidi Fogo.

Here.

Kathy Andrews. Here. Derek Wallace.

Here.

Kate Gravel.

Here.

Jennifer Bingham. Jennifer Bingham. Julie Franzen. Here. Brandon Macbeth.

Here.

David Kniep.

Here.

You have a quorum.

Thank you, Linda. All right, looking at the agenda, the first order of business here is the consideration of minutes for the June meeting that was attached on email for all of you. Do I have a motion to approve those minutes?

Motion to approve. Second.

All right, we had the motion from Heidi, second from Travis. Any discussion? All in favor of approving those limits? Aye. All right, moving on the next item, we have a discussion and possible action item. What was attached to the agenda was the PowerPoint that we saw in June. And then yesterday you may have seen if you were on email that we had some additional slides. I think we'll start by having Nate, are you gonna, I think there were three additional slides you might present right now.

Yeah, so you'll see it on the screen here, and I've got the full presentation from last time, and you can reference that as well. But just this first slide is very similar. We saw before we're listing the officially six, now there's an additional option for changes so that 30-day supply for drugs, 34 at the half percent, modifying the overall co-pays for 0.2%. removing the waived co-pays to $0, co-pays for dependents is a half percent. Then we had two options that impacted co-pays and the dependents kind of globally. So looking at the $10 change for primary care co-pays and then $10 for specialty at 1.4% for option, the $10 co-pay for primary care, 20 for specialty of 1.6%. And then the new option, I'm going to skip over the ER thing for a second, was just looking at what if we went to 15-15, so for PCP and specialists in network, but maintained that $0 charge for children, traditional consideration that came to 1.7%. And then we also had that half percent difference for PCP. So that very last item was the new one. And then also added two more slides, really just some clarifications on a couple of things that we talked about. So we hit on, you know, decrements or estimates, not an exact piece. That's something we can get as a kind of a follow-up to this to be able So we're working with Dean. The one call out we had and had some exchanges, Marissa on this, to make sure we're on the same page, was Dean priced those percentage changes off the HMO plan. And because of it also impact the POS plan, there's the in and out of network benefits. We'd actually see slightly more savings for members on those plans. So instead of it being a... changed to $10, changed to $10.20, and changed to $15, for people on those plans, it might be closer to 1.45, 1.65. So not a huge shift, but did want to call that out. Because part of that is that when you're making changes in network, you also need to kind of maintain that structure out of network. And that wasn't really called out in the previous piece. And so for all of these, we're assuming that we're maintaining the current kind of ratio in to out. So right now it's a $5 copay in-network, $10 out, and that would filter through to these options. So for the $10, $20 out-of-network, still accumulating to that same max out-of-pocket. So the overall risk isn't changing. And then for the 10-20 option, it would be 20-40 out-of-network. also applying to dependents. And then for that 15, 15, $0 for children, it'd be $30 out of network and still maintain that $0 for dependents. Then just kind of as like a market comment, generally what we see for those co-pays is either two times the in-network co-pay or the more common approach, which I think might be probably a bridge too far here. We're making those services apply towards deductible and co-insurance so it wouldn't be a set co-pay. Any questions on that? Does that make sense? I just want to make sure we were all looking at kind of the same.

Yeah, I think when we had started, you know, kind of talking to members about this and the co-pay changes, that's where it started. People started to realize there was some confusion because when we were looking at, you know, $5 to $10, we realized, oh, wait, what about POS? Because they're already at $10. And so I think we You know, thank you for clarifying because that wasn't clear that, you know, we were, especially for the second decrement, that it wasn't just going from like 5 to 20 on the specialists. It was going from 10 to 40 for the POS, as I recall. Thank you for clarifying.

Other things to highlight, just to mention, we hit on this, that the decrements that Dean quoted are specific to 1.1.2027. Part of that is Dean is in the process, is getting ready to transition to the Medica underwriting platform after 1.1.2027. And so some of these are administrative pieces, and certainly Heather and Greg can elaborate on that, but just want to call out that if we don't take advantage of these options, there's no guarantee that they're there next year. As far as the depth of the reductions. And the other thing related to the very final like full plan option that we showed for a high deductible health plan, Dean does reserve the right to modify those rates depending on the amount of HSA funding. We go down that road. We kind of talked about this a little bit, but I wanted to make it explicit there. The basic thing that we don't want to do is suddenly say, all right, well, these rates are way below that free pot of money. We're just going to give all of that to the members. And ultimately the plan ends up with significantly less premium. And then we all be, 50% of the ACA max or more than like $2,000 for a single, we'd be aware of that. We'd hit that threshold and we'd look at tweaks.

So can you just, so the ACA max, it's the ACA max of what? Contributions for an HSA? Yep. And that is, you said $2,000 for a single?

So the max is, is it $4,150? $4,150, Jerry, do you remember?

Yes. I'll pull up again. $4,150. Yes.

4,100. 50, yeah.

Every year, if they increase, it's generally increased by $50.

And so you're saying that if the county did more than 50% of that, so about 2,000 per single, that would be?

Right. And that's not uncommon for carriers to, you know, adjust the rating from that standard.

What's, is there a different rate for family?

So family is two times that. So I just pulled this up. So the 2027 limits for self only is 4,500 and the family contribution is 9,000 as the max. Okay.

Thank you for that caveat.

So that was the updates. I do have the full presentation concern. Last time around, you can certainly walk through any of the assumptions, any of the numbers. It's a lot of numbers, but a lot of good information as well.

I think a lot of us have probably reviewed it a number of times at this point. And so I think I'll turn it over to the group to see if there are

Questions?

Yogesh? Yeah. So one thing I think that would be helpful. So you have basically six options, maybe seven options listed out here. You can't implement all the options at once. So we did ask DOA to like see which options could be sort of implemented at the same time. And they gave us like two, three, like, from the different permutations of those. Did you guys do that as part of your calculation as well?

We did work with them to put together some of those different pieces. We talked about the different ways it could go together. There's a lot of different iterations for it. The ones that stood out were the change to pharmacy and pairing that with the change to ER and then the three different copay changes. Then you can obviously stack on the other pharmacy change to modify those copays. But really the biggest piece is that there's that copay waive for dependent language. That one can't stack on top of the 1.4 and the 1.6. Otherwise, really all of these could be done. Does that make sense?

Yeah, I think it would just be helpful if there was like, a matrix or some display that says, here are all your different options and here are the resulting savings. I have with DOA sent in an email on that. I just think having that in front of us, because we're trying to basically solve a puzzle of trying to get towards a certain number and knowing what permutations you can add to numbers in front of us to get to a piece of that puzzle is helpful.

Yeah, give me just two seconds here.

I should go pull up that document.

I'm back.

All right. So I think I have Travis in the room with a hand and then I have Cassie online with a hand. So that'll be our order next.

Hey Marissa, this is Amy Utzig. I was just notified that the agenda is not out for the public and the public is not able to log in. So you guys are going to have to take a recess until that gets fixed. And if we can't fix it, we're going to have to adjourn the meeting. Okay.

Thank you. We'll take a recess. All right, I'm looking for a motion to recess for 10 minutes to try to resolve whatever the IT issue is.

I'll make that motion that we recess till 9 a.m. Do I have a second?

Second. Second from Kate. All in favor? Aye. All right, 10-minute recess. Please come back at 9. All right. All right, it's 9 a.m. We're calling back to order. Amy, do we have any update from Carlos? Yes.

I do not have any updates from him. I just also went out on my computer and was able to get into Legistar and see the agenda just fine.

It sounds like there's an issue with whatever the computer, Granicus or whatever is the underlying software for Legistar being working intermittent.

I'm just going to ask Carlos if we can continue with the meeting or what we need to do.

Carrie? If I need to step away for 30 minutes, do we have quorum?

Is this still not working?

Yes. Okay. I'm going to do that and I will be back in 30. Thank you.

not sure oh you're not sure if you have quorum i thought i heard you no no we have quorum sorry someone else is asking a question and thought you said yes to it yes good thank you carlos said he's going to check with the board about whether we can continue thank you hold tight okay

Thank you.

All right. Bye.

Carlos is in touch with Amy and they're hoping to get a workaround set up, but they don't have any team. So they're going to let Amy know as soon as they have something.

So I don't know if you want to do another recess or what. All right. Looking for a motion to extend the recess by another 10 minutes. I'll make a motion. Travis moves. Eight seconds. Eight seconds. All right. Please come back at 9.13. Sorry, all in favor? Aye. Please come back at 9.13.

Thank you, everybody, for your patience.

And thank you, I imagine, to the Dane County IT and all the other folks behind the scenes who have been helping get us back in order. 9.13, calling us back from the recess to continue on with our discussion. Um, I think during the recess, Nate emailed something. Some of you may have had a chance to look at, I don't know if you want to chat about that.

Yeah, I can go ahead and share that. Um, It was kind of, I think, follow up to what you would ask as far as a matrix. Yep. So it's not the prettiest document. I'll have a copy here. So this is just an Excel sheet allowing us to play with some of the different options and figure out what the savings in dollars and estimated percent terms would look like. It's not an exhaustive list, but it's a pretty good list of what we can do. The big note here to keep in mind is that option four, that's a typo, sorry. That should be, for whatever reason, that should be three. Sorry. Can that be combined with four or five? Maybe four or five instead of mutually exclusive. Really hard time keeping the rows versus numbering straight this morning. So what we're looking at here are some different combinations of what is possible. And so option one is moving to the 30-day supply for pharmacy, adjusting pharmacy co-pays, removing the $0 copay for dependents and then changing ER copay that nets us in 1.5 million or 1.7%. The next piece here, option two, is those same two pharmacy changes along with the ER change, but rather than simply changing the waived copay for dependents, moving to that $10 PCP, $10 specialty, along with waiving the copay for dependents gets to 2.6. Option three here is the same three options, two pharmacy ER plus going to the 10, 20 copays. Option four is looking at a 30 day supply for the pharmacy, removing the copay for dependents and just the ER. Option five is, is changing the 30-day supply for drugs, moving to a $10 copay for PCP and specialty along ER to 100. Option six is looking at just changing the 30-day supply for drugs along with the ER. Option seven was looking at those same two changes along with the 15-15-0 copay change. So there's different ways we can do this. There are other combinations that could be done. You could just do the two drug changes. It got a little exhaustive to list them all out. So we kind of looked at certain sets, but certainly we can slice and dice these

as desired.

The big thing there is that option three, the waived copay for dependent language is already included in options four and five. So those can't be combined. And then four, five, and seven are mutually exclusive. Because you're changing copays, you can only pick one, pick a lane there.

I think Travis is first in the room, then Cassie online, and then Lee I order.

Thank you chair. I'd like to make a motion to have all 3 decrements of a half percent savings implemented in the plan design the 30 day prescription fill removal copay dependence language and a $100 a year copay and to also have deal a implement a cash in lieu benefit as part of the handbook for 2027 and I get a second I just

We have a motion on the table from Travis. Do we have a second on that motion?

What were the options?

Yes, it did.

Travis, can you repeat your motion?

Motion would be to have all three decrements of a half percent savings. I guess if we're looking at the board here, that would be one, three, and six. That's option four. Yeah, option four. And to also have DOA implement the cash and move benefit as part of the handbook 2027.

So that's Travis's motion on the table. Do I have a second for Travis's motion? Second. Second from Kate. Discussion on the motion?

Yeah. I feel the savings implemented in these decrements, the roughly 1.3 to 1.4 million, coupled with the 600K rate reduction savings and the 1.5 million cash and lose savings based on our survey results, along with the POS shift results in our survey, roughly another 1.5 would be the best plan to get us a $5 million in savings that has been requested Pouring over the results, one thing is clear about our membership, which is they are, while not overwhelmingly popular in any respect, any changes, certainly happier with minor plan design changes, and that's vastly favored over employees paying premiums in the over 70 results I got. from my local, zero people said they're in favor of premiums pay-in. And I think most survey results show this is the most favored path, and it's kind of the best of an undesirable situation that we find ourselves in right now.

Other discussion on the motion? Heidi?

So option four. Change $10 co-pays for PCP and specialty. That's for HMO. No, that's not. So option four is one, three, and six.

Sorry. I should label these slightly differently so we're not talking numbers for everything.

Okay. I misunderstood that. And so my question has been answered. Thank you. Okay. Eric? Eric?

Yeah, so I did Travis reference to survey and I wanted to speak to that a bit more.

I think everyone on the committee received a copy of the summary results. It's about three pages here. But each of the

For those who are listening online and have not seen this, I think it's worth speaking to at least a little bit. So, you know, the six AFSCME affiliated locals, which are represented here today, that's local 65, 705, 728, 95, 1871, 26, 34. We surveyed our members to understand their pride. PB, Jorge Boone. : As we move forward. PB, Jorge Boone. : Prior to the survey we had member information sessions to review these options that were presented the June 10 meeting. PB, Jorge Boone. : As well as the many, many other options and and discussions that we've had I think probably. Over the course of this year, it's been a dozen or so total IAC or RFP IAC subcommittee meetings since the start of the year. So the survey that we sent was sent to about approximately 1400 county employed AFSCME members. We received about 700 responses, so approximately a fairly positive response rate as far as industry standard goes. You know the survey was sent out individually to each local. The results were quite consistent across groups. There was a little bit of a deviation which you can go into, but. So I just hit some of the highlights here. So as Travis mentioned as part of the motion, there is a cash-in-lieu proposal that the AFSCME-affiliated locals presented at the July 9th meeting confer session. So essentially what this does is, as, for example, the state of Wisconsin does, as other employers do, allows employees to, instead of selecting health insurance through the county, it would allow them to get other qualified insurance through a spouse's employer or actually a parent's employer for under age 26. So as part of that survey, we indicated or kind of staged how many employees might be interested in such an option, specifically using a $5,000 cash-in-lieu incentive. Offhand, 32 employees indicated they would pursue that benefit if implemented. Additional 68 employees said they would consider it, like For example, they went to review the specific detailed plans of their spouse. Obviously, insurance changes from year to year, so it's something they'd be looking at at open enrollment. In looking at that, as part of that mean confer proposal, we estimated basically as we've had discussions, there's a cost-benefit analysis of how many people would potentially need to take the benefit in order to realize savings for the county. Um, and, uh, you know, we're essentially estimating that based on, uh, these numbers, um, you know, uh, conservatively, uh, 66, uh, folks, uh, I think is what we put in the doc in the document. There would be close to one and a half million dollars, uh, and potential savings for the county. Um, uh, So let's see. I hope I don't have a time limit. Do I have a time limit, Madam Chair?

Okay. All right.

So then we also asked about the POS shift. So 39 employees, you know, this is something that we've continued to see year over year, where employees shift from the POS to that we have. There's an increased employees pay portion of the difference between the POS and the HMO premiums. So We've seen a steady migration of folks leaving the POS to the HMO over the years due to those increases. Based on the rate renewals, we were able to project how much the cost increase would be for this next year, if the handbook language were to stay the same. So basically, you know, probably at minimum, what would the increases be? That's $47 per month for the individual POS plan, and then $111 family for the POS plan. So You know, putting that information out there. We asked, hey, you know, what do you think if you're on the POS, do you think you're going to actually switch? Would you stay on? Ohio Police did stay on. We also asked, hey, why are you on the POS? And the folks were saying, complex medical needs. I have, you know, need to make sure that I'm able to see the providers. was 39 employees who indicated that they plan to switch from the POS to HMO next year. And again, this is approximately a quarter of the entire workforce. So again, conservatively, if we were to say, you know, 80 folks or so switching over from the POS to HMO savings, that would be approximately $1.6 million in savings to the county. Um, so then talking about these, um, uh, we also asked in general wealth priorities about ways to find savings, um, and not just listed to, to insurance, um, but also more generally, um, you know, one of the things we've done this year, um, was to promote the voluntary leave program, um, that has, uh, incurred some savings, um, uh, certainly, uh, you know, not millions of dollars, but it's a tool in the toolbox. That was one of the most preferred or the most preferred options across the board from locals. So then there were on the second and third most preferred options. It was kind of a variation of different things. Continued wage reduction, furlough essentially for another year. potential further department cuts, making some plan design changes. So those were kind of the top next options. And as Travis alluded to, the least popular option across the board was implementing HMO premium contributions. We asked specifically about plan design changes versus premium changes. So employees across groups overwhelmingly supported making minor plan design changes as opposed to current premium structures. And then when asking about these minor design changes before us here. Thanks for bringing that up, Nate. So, you know, we asked about these decrement options, you know, 70 to 90% of employees across the local felt neutral or okay with many of the decrements and no one is terribly excited, right, about making changes. But, you know, one thing that was also fairly consistent was, The 30-day, our exchange from 34 to 30-day was being the least problematic. Second, across all the locals was the co-payment for moving the, or I guess allowing co-payments for dependents. So I think it's also worth noting, you know, how employees see insurance as part of their total compensation package. We included a lot of folks' personal testimony here. For example, our public health nurses, you know, report they took jobs in places like ICUs, hospice, long-term care, they make $15,000 to $30,000 more in insurance. In 720, laborers report jobs in trucking, heavy equipment operations. They could all pay $25,000 to $30,000 more annually. In 2634, social workers, they estimate they could be making $15,000 or more annually in the private sector. And you can see, I won't read some of the quotes here, but I think they're compelling quotes from various members in the surveys. And then... Budget analysts, again, another 20 to 550K potential earnings more in the private sector. So just to summarize here, employees strongly value their healthcare. It's important to recognize what employees have. continue to give up as the cost of living continues to increase, wage increase, the 2025, or sorry, a lack of a wage increase. I wish it would have been nice if we had a wage increase, but we didn't. A 1% wage cut in the 2026 budget and the elimination of hiring reasons You know, employees, as indicated here, are willing to compromise where it makes sense and especially willing to collaborate on creative solutions. One of the things we talked about often is retiree outreach, healthcare education information sessions. I think that was another thing that we learned about. There were certainly folks, not a high number, but there were folks who were on POS who just said, you know, I keep on forgetting to switch every year from POS to HMO. And so I think there's opportunities there for us to find savings in that way. Um, so, um, I, and I think one of the things, and I spoke to this at the main meeting, um, was, uh, we also had open-ended survey responses and some of the quotes were from there, but, um, one of the things that struck me, um, over and over again, employees noting that while a certain change may not impact them, um, or their family at all personally, They were concerned about how such changes might create hardships for their colleagues. I think that's a clear indication that despite challenges that county employees face, the challenges that the county is facing collectively, there's still a collective and conscious effort. and maintain a quality plan that protects both the lowest paid and the least well among us. And so, you know, I'd say our health insurance plan is the ultimate reflection of ourselves as a workforce and of our values. And that's an underlying fact that has to center this committee's recommendation and ultimately the actions implemented by county officials. So if you were paying attention to the math, where, you know, Supervisor Chabla mentioned, we need to essentially find the pieces of a puzzle of $5 million. So we've, I think, projected here $1.5 million in savings from the cash and loop benefit, $1.6 million from the POS to HMO shift, that Travis had indicated. And then finally, there was a renewal reduction rates for the HMO, which results in about $600,000, a little over half a million dollars in savings to the county off of the premium of $5 million. I thank Travis for his motion. I think this is a difficult decision for all of us who are tasked with trying to represent the best interests of our members.

I appreciate Travis

M3 working to create these decrement options, which were certainly much less objectionable to the sorts of changes we were talking about last year. And I'm not a voting member of this committee, but I guess I am speaking in support and encourage my colleagues to support the motion as well.

Thank you, Derek. Brian?

Just because on the fly, Nate changed the options from numbers to letters. For clarity, I would offer a friendly amendment that we change the language from option four to option D. Oh, on the spreadsheet it changed? Yeah, correct. Because this may become part of the record. And then to make it less confusing for anyone down the road, we don't have option four in the language of the amendment and option D listed on that.

Travis, find that agreeable? Seconded. Second. Yes, I'm agreeable to that. Thank you. All right. Other discussion on the motion on the table? Yes.

So if we look at these options here, I've just been trying to do just kind of put together some different options. And I appreciate I read the survey results that were sent in. And it looks like it's pretty clear that adding premiums is the least desirable option. Some of the other more. I would say like some of the different plan changes like high deductible plans and health savings accounts, those look to not be preferred as well. So it looks like when we're looking to attain some health care savings, the options in front of us are kind of the ones that are the most agreeable. They look to be the second rank for most of the locals as I saw it. When I'm looking up here, it looks like there's pretty much a lot of agreement that one and six changing to standard 30 day and six there, the $100. Okay, those seem to be. pretty agreeable to everyone. What I would offer is if we look at three versus seven there, seven was just newly presented to us. It allows for a $0 copay for children, but changes to a $15 in-network copay. That offers quite a bit of savings. And if you look at option G up there with one, six and seven, all it does is it changes three for seven and it offers almost a million dollars more savings. I know we are in this budget year and we have seen with the benefit of surplus, some savings now, what I'm concerned about is if we don't get the surplus that we're looking for, we could be looking at fairly drastic changes. So I think looking at cash in lieu benefits based on the survey, ppo to hmo and going with option g which has just been presented us today that's you know gives us g is the good positive one six and seven that gets us almost a million dollars more and i think it's a reasonable thing to say fifteen dollar co-pays but still preserve Uh, it looks like $0 for children. So that would be my preferred option going forward. And I know there is already a motion on the floor, but, um, I don't want to amend it right now. I'd like to folks to discuss that, but I might offer that amendment at a later time. So I'd ask folks to consider option G. Sure.

And I appreciate your comments and I think we're all, you know, kind of, uh, rolling the same direction here. And I think I would, you know, one counter to that is that when we're thinking about the health insurance, part of what we're thinking about is kind of going forward, how are we making ourselves more competitive? And one of the things that came out of the RFP subcommittee that some of you are on as well, is that there are some nuances to our plan design that have historically made us less competitive because we have these little administrative things that are onerous to vendors. One of those is the 30-day or 34-day supply for the prescriptions. The other one is the co-pays for kids. And so that would be my concern with some of the later ones that was offered today with removing the copays for kids is that that is one piece that, um, is what we've heard from M3 and from Dean historically, it has been somewhat problematic. And so I think that when we're thinking about trying to move ourselves forward and be more competitive for the 2028 contract, that is part of why I think, you know, that is somewhat more appealing. Um, I think the other concern we have had is that the 1515 the, none of the information, we didn't have the information of the POS. And so when we surveyed members about some of these decrements, we didn't understand that it might be tripling or quadrupling their copays. And so if I'm looking at the $15 copay right now, somebody can correct me if I'm wrong, but right now the copay for POS would be $10. And under that, it'd be going to 30. So it'd be tripling their copay. And so that is significant, especially, you know, we've heard from folks with the survey about, I think what jumped out to me the most were mental health appointments. You know, when they're going to a mental health provider right now, if they're paying $5 or $10, they feel like, you know, they can, you know, go see that provider fairly regularly. If that triples or quadruples, that, you know, becomes much more effective. of a hardship. I understand the max out of pockets aren't changing with these, but it still is an out-of-pocket cost that I think, you know, we don't want our 911 communicators or the social workers dealing with CPS to have any barriers to getting treatment. We've had, you know, kind of enough concerns there. So just a few thoughts. Other discussion on the motion?

I just want to about making us more competitive. And speaking on behalf of 895 members, us being more competitive in the RFP process is a large concern. And those two things will definitely impact us in a positive way. if we keep them, as you explained, and change the RFP to the 30 days and the kids go pay.

The other update that I just wanted to flag for people is the retirees. We've talked quite a bit about retirees in the past in this group, and we are continuing to move forward with outreach to them because we, I think as a group, have recognized that the retirees participating in our plan, while the county is not paying their premium or any portion of their premium, simply by having them as part of the group and raise our overall rates. And so we see an opportunity for a win-win there. to present the retirees with information about other options available to them, such as Medicare supplements. This is primarily targeting the retirees that are 65 plus, um, and what their options are. Um, so we've been working with the folks at M3 and we're continuing to, to work with them on trying to put together some info sessions for the retirees that'll be hopefully, um, offered to them. We were talking about September, September, we're avoiding October. So that'll be offered. We're also hoping that, you know, we've historically talked in this group about the cash in lieu option, and there's been some concern about who's going to take that. Are we going to lose, you know, some of our healthy young members? I think the hope is that when we look at kind of the number of people interested in cash in lieu, and then we also look on the other end of the spectrum at the number of retirees that are over 65. They're pretty close, if not more retirees. So I think we're hoping if we kind of pursue both of those things simultaneously, we'll even out, so to speak. Other discussion on the motion? Yes.

So Marissa, as Derek mentioned, there's a number of folks that I guess don't realize that they could switch or didn't didn't switch from POS to HMO. So is there a concerted effort to reach those individuals when renewal time comes? And if not, can there be? And then that is another leg of the stool that might realize savings, as you mentioned.

Yes, I think, no, that's, thank you for that, because, you know, we did put that as an option on the survey, and we're like, no, but it's, you know, did have people really, and then a couple of people really said, yes, I just forget, and we're like, wow, that's kind of an incredible thing to forget every year, but it happens, you know, I think many of us get, you know, you keep the same homeowner's insurance, you keep a lot of things just out of habit.

One survey result where they said, I did not realize that HMO had no premium at all, and I probably will be switching because I

So there we go. There's one more. Yes, I think this is a conversation we've also been having. Some of you may remember before COVID, there was one of our former IEC members and county employees, Shannon Meyer, And I did what we call the Health Insurance Roadshow with Heather. We went around to all these workplaces. This was before Zoom was super popular and we did a lot of education in person. I think now the county does have a new tool they've been using called NeoGov. I'm just brainstorming here. I don't know if there's a way that, you know, NeoGov is a kind of an online training tool that has been used to assign training, you know, on like sexual harassment or other ethics things, you know, for employees countywide, could we do something on health insurance? You know, that, you know, that about, you know, things like POS and the price, using your health insurance wisely, how to read an EOB. It's incredible how many questions come up that people just, you know, the healthcare literacy is not there. And if we can help people with that across the board, you know, I think that we would be happy to partner with the county and with Dean and folks on how to get information out to have people using their benefits wisely. Thank you.

So just to follow up on that then, how many folks are under POS? I don't remember the number from...

It's about 14, no, it's 16% of all active employees right now.

And is there... an ability for some entity, an EG person or DOA or someone to directly communicate with those folks, send something to them or provide them information instead of just log into NeoGov and take this training that maybe or maybe won't happen.

Well, the NeoGov trainings have been mandatory. And so there's been a lot of follow-up on that. you're missing it or you're getting late in the year to do them. So I think that's an option. I think, you know, kind of targeting people individually about their healthcare choices is probably a slope we don't want to slide down, but I think in terms of general information and we, I think have historically been able to do some good outreach and

So to that side there, as I understand it, the county automatically renews people in the plan that they have selected and they're currently in?

Correct. So everybody gets an email at annual enrollment time saying, if you're not making any changes, you don't need to do anything.

So we call that a passive enrollment, where folks just, if you don't do anything, it just continues. It wouldn't require an active enrollment. and make people make an election, now the risk there is people don't do it because they're used to not. And then they don't have insurance coverage and go into that. But if you're really trying to make people think about the money spent on the POS side, that could be an option that does create some extra work for employee relations and folks there to track people down and send reminders. But if you really want to make sure people are thinking about that election,

I don't think that most of the people on POS don't know that they're on POS. I think that's probably just a very small percentage of people because it does cost quite a bit of money to be on the service. So, you know, I'm surprised that there were at least three on the service. That's crazy to me, but yes.

Yep.

If those are the numbers, though, I think going to an active is basically a solution looking for a problem.

All right. Supervisor Chow, this hand up.

Yeah. You know, I think going to RFP, when we go to RFP, we can set the parameters of the RFP. It doesn't have to be constrained by this. This is looking at a short-term cost savings to make up for a $7 million increase. million dollar increase over the last few years and i think really impressing upon people like what the cost of the pos for a family is i think it's 45 000 a year in premiums somewhere in that neighborhood so when we look at these options here um they were they're gone now cost i think i think when we're yes these are some of the costs there i think when we're looking at this The amendment that's in front of us is a very, it's not a very aggressive approach. And the thing that I really worry about is we are going to potentially hit a cliff. We are seeing slowdowns, spending, we're seeing lots of pressure on our economy. And if we get to a point where we're just nibbling at this and like, I'm all for doing Furloughs, because that way people can get some time off that's unpaid, but they're getting a benefit out of it. They don't have to work and they're not getting that money, so they're getting some time back. It's a one-time solution and those are one-year solutions. And I think if we look at some of these other options, they're pretty modest in terms of what they are for co-pays. When we looked at just the surveys I think that M3 did on the community at large, and even like if we look at other public employee options and for example, MTI or City of Madison, these would still be lower than what some of those other employee groups are paying. So I'm all for doing this collaborative process, but I think if we look here at 1.3 million of all the options in front of us, it's basically the second lowest amount of savings. So I would just implore people, if we could come to a consensus to get that number a little higher, isn't the right option. There's a number of other options in front of us. And I think looking at what some of those other ones are. And part of the thing is when we talked about premium, adding some very modest contribution to a premium, but making that progressive, the thinking behind that was if you have that, The folks who can afford to pay would be the ones that are paying the folks who got a 9% cost of living adjustment. If you're a high earner, that's a lot of money. If you're making $150,000 and you get a 9% cost of living adjustment versus if you're making $50,000, you get a 9% cost of living adjustment. Those are very different real numbers. So when you approach those higher salary levels, making those premium contributions. So if somebody does have to go to a lot of mental health appointments, it's not just the users of the systems that are paying, it's all the providers. participants that are paying. And if those options are not a minimal, that's what we saw according to the survey, getting us a little bit closer to something more towards the middle here, maybe not the highest option, but the second lowest option in terms of savings. It just makes it really hard when we're looking to do budgeting. So I would just ask the folks in this room to consider a recommendation that is more than 1.3 million. Because if we do that, I'm just saying it right now, if we don't get those surpluses coming in to pay down those budget deficits, we're going to be in big trouble. And when that time comes, We're going to have to maybe make changes we don't want to make. So I think as proactive as we can be, and in this room we can collaborate on that, I'd just like to see us get a little bit higher. Maybe not the highest number, but one of those options somewhere more in the middle.

So when we're talking about the surpluses, I think at the beginning of the year, or maybe in the first quarter we received some information, or maybe... other committees you're on has received some information about kind of those projected surpluses, you know, with the voluntary leave, the hiring freeze. Have you received kind of information from quarter two, kind of on how those projections are looking for the year?

Yeah, we received one number that was, look, the optics and the politics of how these structural deficits in Provided I don't like that. I don't feel it gives us an accurate picture of what's going on and we're working off the best numbers we have in front of us. We had many presentations from our controller and the explanations that were given were very plausible and understandable. And I understand they got later projections coming in. The way they were presented, I think, had a political lens to it, which I didn't like. But as we're looking at the numbers that are in front of us now, and we've asked for more updates on that, it presents the situation we're in as such. And if you look at the surplus charts that we were provided and how volatile that surplus is every year, 9 million to 50 million. And then it's a hard thing to rely on that surplus to get us through year-to-year budgeting. And that's what we're trying to get away from.

No, I understand that. And I think part of the, and I think we're also probably, you know, I think again, we're kind of throwing the same direction, but we probably have, you know, we're representing different groups and with different backgrounds, you know, so I can just say from the employee's point of view, working under a hiring freeze is hard. I'll use myself as an example. I work at the ADRC. We're down at least 10% of our staff. We still have the same number of phone calls coming in, the same number of home visits to go do. We are slammed. And so I think it's very hard when we're asking people to provide the same level of service to the county residents. We're open the same number of hours. We still have the same timelines on how to do process applications and do home visits and get people services. We are asking people to do more. or less. Um, and so then shaving off for health insurance, you know, yes, it's a benefit, but I think as we've seen in the survey, it's not just a benefit, it is part of their wage structure. And so when we're kind of eroding wages, um, not giving raises and then also, uh, coming after healthcare, it is a double whammy. And I'm very concerned, um, longterm, how we are going to remain competitive. You know, we had, I think Derek's survey alone was 39 pages of comments. I mean, it was a tremendous amount of information from people on their thoughts and feelings on this. You know, and many of the comments were about kind of what keeps people at the county being the health insurance is a huge part of their decision to stay and how other counties surrounding us are becoming more and more competitive places to look for work as people continue to be concerned about this. So you know there's a lot to consider I think that I appreciate Travis you making the motion to get this on the table and give us something to consider and you're putting together some math for us to to see how it does add up because I think being creative is exactly what we need here.

I would also like to add two things. One, you know, the employees of this county have been doing their job dutifully this year, 1% less coming in than they did the year before. I think it goes without saying that it certainly hasn't gotten 1% cheaper to live or thrive in this county or in this country for that matter. And to the charge of this committee was to find 5 million dollars and we did. And I think this is the least intrusive way of doing it to a collection of employees that have frankly had to do more with less so far this year so.

I'm just going to say, I think that the point about looking at copay changes and some of those other options is really well taken. And the thing I wanted just to mention is we're still accumulating to the same maximum out-of-pockets as we are today. So that $250, $500 in-network, $500,000 out-of-network, that is flat. I think that if you're talking about the health insurance benefits and the biggest levers that folks have to pull generally are deductible, co-insurance, and maximum out-of-pocket. And for us to be able to be talking about millions of dollars in savings and, you know, honestly, full percent savings for changing copays is a really good opportunity. I know when we looked at that with our underwriters, they were estimating a much smaller savings on the plan from a pure actuarial standpoint. So just to the point of looking forward, I wanted to call that out that I think it's still, you're still going to be maintaining an amazing benefit plan. asking folks to pay a little more when they when they use the use the doctor from from five to ten or something like that you're looking at um the setup on the screen so number four number five with the ten dollar pcb specialist co-pays in network two times out or the 10 20 those are both still really good options and beating the market

Right. And then I think Supervisor Chow, you had your hand up.

Yeah. I just want to do a little bit more analysis of what's in front of us. So what we see is $1.3 million in concrete savings. Do we have the amendment written here that breaks down what the other savings costs are? Is it in?

Are you asking what Derek has just said?

Well, the amendment said... 1.3 million we would get from here. And then was the cash in lieu of the other 3.7 million.

No, Travis, would you like Travis to repeat us? So Travis's motion was option. What are we at? D D D and then recommend the cash in lieu. Derek then did math that was based on the survey that got us to 5 million cash in lieu and a

service shift.

And so last year, I'm sure you recall, PNF did a, you know, had a projected POS shift as part of the budget. And so that was what Derek is referencing as part of, I think that was 1.5, 1.6 million.

Yeah, I'm happy to speak to that throughout your

ask a question to staff if DOA, Chuck Hicklin, Shelby are on the line. Can you do an analysis of the motion in front of us? And give us your analysis that's going to get us to fight.

Can you hear me? Okay.

Yep.

Okay. I'm not I cannot do that analysis right now while this meeting is underway. One of the things that needs to be considered, and I'm not sure whether the data that Eric presented, the projected savings, would be, you know, we have quite a few people right now who are not participating in health insurance. And depending on how the cash in lieu is structured, All of the, you know, so those people's insurance cost is not part of our budget. And if you're going to pay people who don't participate in the insurance, and you include paying all of those people the cash because they currently aren't participating, that number would be in the neighborhood of $750,000 cost that would offset any savings before anybody, you know, you can recognize any savings from new people leaving. And that was based on the proposal of $5,000 for non participant. So I don't know that that was included. And, you know, I don't know what people's analysis is relative or, you know, personally about whether they would participate, but I would challenge an assumption that many people would find coverage. You know, the cash in lieu would need to be pretty generous in order to make it economically attractive for someone to give up. a plan with a, you know, $10 copay and no premium contribution. But so I'm, you know, suggesting that people say now that they know what that would be. I don't know. It's speculative in the sense that people make a different decision. We have locked ourselves into a payment benefit of the people who are currently not participating on the speculation that some people will move on. If they don't make that decision or not as many people actually make that decision, that savings could diminish.

So I can be nice. We have done that analysis. We essentially looked at comparatively to UW, to the states, they offer a $2,000 incentive. We knew based on our conversations here, we were going to have to offer a much higher incentive because of the way that our plan design is structured and seeing how you know, what incentive would it take? That was certainly one of the presentations that we had with M3 that was insightful and that, you know, using the benchmark data of, you know, other insurers insurance plans throughout the region, we were able to look at, you know, $5,000 is, you know, potentially where you're hitting those out of max amounts in many places where that balance could be achieved. To Controller Hicklin's point, yes, we accounted for that. Obviously, there are folks who are not taking insurance currently. By our math, it would be based on the data that we've received from employee relations. There'd be currently 93 employees who are not enrolled in the county's health insurance. Um, so, um, you know, some of those, that's a, probably a conservative estimate because, uh, there are gonna be folks who are married to each other, accounting employees who are married to each other who wouldn't be eligible for this benefit. So it's probably less than that, but let's assume 93. So yes, if we're paying 93 employees $5,000 each who aren't already on a plan, that's a $465,000 expense now. So then where is the break even point, right? You have to take $33,000 for the HMO benefit, HMO family. That's the most popular plan that folks are on right now. Minus the $5,000 incentive, that's about $28,000. So you take $28,000, multiply that. Once you get 16 employees who've opted out, that's going to essentially... gets you to that break-even point. So if you take another 50 beyond that, so that's where essentially you get to that 1.5 million. And so we had in our survey, 40 folks basically say, yeah, I would do this. And that's just a quarter of the workforce. We had many other folks who would say, yeah, I definitely consider I look at it. you know, an open enrollment and see what the benefits are. So I think, honestly, that's probably a conservative estimate based on the savings that we would potentially receive from that. Now, the other component is, or let me speak to the other one beyond the decrements here. So the 1.6 million we have from the POS to the HMO savings. So again, we had about 40 people say, hey, you know, based on these rates, I'm probably going to be moving to HMO. Again, that's a quarter of the workforce. So, you know, conservatively, we can say, you know, 80 folks are going to be switching from that. And that would be still less than switched last year. estimate. And so the savings would be $1.6 million based on that. And then finally, the rate renewal from decrease, instead of the 12.9 for the max out-of-pocket, it was 11.9. And there's about $600,000 from those savings. And so when you add up that $1.5 million for the cash in lieu, the $1.6 million for the POS to HMO savings, the $1.3 million in decrements, and the $0.6 million in the renewal savings, that's the $5 million. Now, I do want to also speak to, you know, as was alluded to, there are 39 pages in the survey. In my local specifically, I did not read all the individual comments from every individual, but reading through my local, I had employees saying, I can't afford anything more. I am going to a food pantry. I am barely making rent. I am being priced out of my home. My costs are continuing to increase. And I can't afford anything more. And I think we need to be cognizant of that. I think we, to your point, Supervisor Chabla, yes, the surplus certainly has been a very big factor regarding our county finances, an unpredictable one. I think that speaks to the fact of why we should not be making dramatic changes beyond what we need to and take this on a year by year basis. so that we can do the least harm to employees as we continue to manage our way through these difficult budget years. And it's going to have to be on a year-by-year basis. We've done our homework. We've gotten to that $5 million and asking for this committee's support and for the county board's support and the county executive's support to advance these decisions.

My interest is, we want is to be able to see all these things on paper since we're only seeing and hearing these things today. So we can kind of like what was done here, but the four options that you, they get to the four, the 5 million. So we can see those side by side. The other is, Travis, can you explain, is the cash and lube, does that have to go with the motion? I'm trying to, or can these be separate items that we vote on instead of voting on two different things at the same time?

Well, the Cash in lieu being included was part of the structure to get to the $5 million savings that was requested. The cash in lieu is part of that. to request the DOA for that to be in the handbook in 27.

Would we be able to vote separately on each of these things and still get to that $5 million, though? Instead of joining them together?

Well, the motion itself that we're discussing right now is just the lump of all of these things together. So I don't really know if that would be possible because that would be another vote. I mean, this would be this is a package deal, this motion. So I'm not really sure if we took that out, we wouldn't really be getting to 5 million, which is what this is, the intent of this motion is.

I hear you. I'm I hear about getting to the 5 million. I'm just trying to understand how can we get there? Does everything have to be together, or at least these two together, or can we vote on the separate? Let's look at that 5 million. My interest is rather be separate. So we take each one, but I hear what the motion is. I'm just asking the question, do they have to be? And can we still get to the 5 million? I don't know. Do we have an answer? Can we still get the 5 million if they were separate?

Yeah, I have no idea because there would be no guarantee that they would pass separately. So then the answer would be no, it would still be shorter than 5 million. Thank you.

Other discussion on the motion?

Heidi? Could you bring up the slide, please, that talks about the total cost per person for both HMO and POS? Yes. Thank you. So employees are definitely doing more with significantly less. And when we look at these plan costs for 895 nurses in particular, the amount of money that we can make in private sector is definitely made up in this very particular benefit, right? So many of us can go into private sector and make anywhere from 32, several of our nurses because of their degrees could make upwards of 80 to 100,000 more, right? And if we go after this very, very aggressively, we really take a hit on this benefit, folks are going to, you know, look elsewhere, right? Because we're not getting pay increases, you know, we're doing less with more. There was an additional over a million dollar hit to public health. In the county as a whole, We depend on each other to keep our residents in this county getting the services that they need, right? So public health, we certainly depend upon many other departments, right? We depend upon CPS, Adult Protective Services, EDRC, airport, roads, you know, we're all together on this. you know, our Dane County ways that we, you know, take care of each other. And I want to raise the concern and the awareness of what's gonna happen if this benefit is aggressively pursued. And the proposal that's on the table gets us to the $5 million. And it does so in a way that it's not dramatically impacting every single one of our members. And we have a subcommittee that's looking at changes for the future. My concern is that if we don't take this in a slower step-by-step process, the impact to the county is going to be extraordinarily detrimental. I came here with a giant pay cut. This made up for it. And we stay at public health and in the county because we believe in our work. We believe in what we do. I'd hate to see negative consequences.

Thank you, Heidi. Thank you and looking around this room. I realize that I don't like this object, but I realize I'm one of the few people, a couple of us still here that have been around a long time. And we have taken pay cuts many people in order to maintain our benefit plan and I think what we believe as unions is that we want to see everyone doing better, that we all do better when we all do better. And so while I appreciate the request to look at some kind of more long-term, bigger savings, I want to say that I appreciate the time, the energy, the effort, the creative attention to detail the thinking outside the box that has really occurred here in the last year that hasn't really taken place in the past. And I think we are remiss if we try to take on more right now and not continue to have these very critical dialogues. I think, you know, from, I think sometimes people want to just get those big numbers and we ignore the the things that we could do on a small-term basis that make a difference over the course of time. And I think us having these robust discussions and holding each other accountable and asking questions with curiosity and trying to learn i think we need to continue to do that and so i agree um that we do need to be looking at this from a year-to-year basis and right now i think we have done what has been asked by the county executive to come up with five million dollars um about and again that's coming from the backs of the employees that is not coming from the community that people live in this is coming from you know on the backs of our employees and those those um who work here. And so I do believe that we need to focus on this year by year and not get too far ahead of ourselves and look forward to continued discussions. Okay.

Julie, and then Supervisor Chawa, and then Nate.

So I want to speak to the point of service and the cost of point of service. So I work in 895. So with nurses who should understand their health care, I've spoken to several people over the last couple of weeks who did not know that if there was not a provider that Dean offers, that they could get a prior authorization to go out and network. I think that's a big thing for a lot of our employees because the folks who are saying that they're going to point of service are saying, hey, I have providers where Dean doesn't have an equivalent. And if the staff maybe had a care manager or somebody explain what point of service and HMO means between having like, if you have HMO, it's not that if you have a rare type of cancer, you don't get to see a doctor, you're going to die. Because that's the feeling that I've gotten from some employees is like, Dean is going to let us die. I think there needs to be some communication about what that looks like for point of service members versus HMO members. that it's not that folks can't get care if Dean doesn't have a provider. And I'm wondering how that can be communicated.

But that's not always true, right? Because the members I talk to and the folks that I know that bring their concerns to me, point of service, have indeed switched to point of service because they cannot get prior authorizations from Dean for their family members' very serious medical problems. There's two sides to it, and education is key. That is something that our IAC subcommittee has discussed. I just feel that it's important that we have both sides presented on that. I do agree with Jubilee and with our subcommittee, education is key.

Supervisor Chawa. I'm going to pass. All right, Nate, and then I've got two more committee members online with comments. Cassie and then Misha.

I just wanted to mention, and we've hit on it a couple times, but the year-to-year approach makes sense. I think that's the world we live in. It's really hard to budget super far in the future. I do want to call out that we do have kind of a unique between number four and number five. So the half percent for removing the 0.0 co-pay dependence, and then the 1.4% for the $10 co-pay for PCP and specialty while also removing that. It's an $800,000 swing on there. And that's just not something I would expect to be available at that same extent next year. I went and pulled up my notes. Our underwriters would have for that plan design change. So I think it's important to think year to year, but also we have a unique opportunity to try and save some money. Because to your point, the health insurance costs are unsustainable across the board, and it makes sense to hold the line, but just wanted to highlight that, that this might be the year to do that, to avoid having to make changes to the deductible, the max out-of-pocket, and the things that really, the first dollar, last dollar costs that impact

And sorry, if I could add just one thing to that, you know, we talked extensively with Dean and, you know, for them giving these, these decrements, you know, very much wanting to partner with the county to try and help, you know, the least impactful way, if you will, to kind of get to a continuing the journey with them and that, but also with these decrements and, you know, given that one time it was, you know, we do things like this with clients a lot and, you know, these decrements are outstanding compared to that. And I'm just saying from the reduction, I'm not, you know, from impact to that.

No, I appreciate that. And I think the challenge for many of the employee groups is having kind of done member outreach with people, having done surveys with hundreds of people, the information about the POS portion was not understood at that time. And so we didn't communicate kind of accurate information. And so when people are kind of voting and helping rank preferences, they didn't have accurate information. Um, and so I get it. Um, but I think that makes it very hard for an employee group then to go back and, um, you know, say, oh, you, you know, voted for this, but people didn't weren't given the full picture, if that makes sense. So I'm going to move to Cassie and then Misha, please open the Derek.

Um,

Hi there. I was just going to say on behalf of 705, we have a lot of members that are working below their education because the benefit package is so good with the county. We've had a number of people come in as CNAs or janitors or dietary servers that have transferred to other jobs that require a four-year degree. What's nice is it's kind of a stepping stone into a better educational opportunity to come in as a laborer. The downside is we have some of the lowest wage caps across the board. And with seeing option one and six seeming to be popular with all locals because it's included in every option, our concern is that the $100 ER co-pay is over half a day's pay after taxes. in the event of emergency. So we were just wondering if we could have that removed and still come to a million dollar savings, if we could see an option that included, that discluded the a hundred dollar ER copay.

So Cassie, thank you for the comments and we're, you know, Thank you for the comments. I think the motion on the table includes that right now. I think the other factor, I'm not sure if you were at the last IEC meeting, the other relevant piece with the ER co-pay that I've been telling members as well is that the max out of pocket isn't changing.

They're aware of that. It's just as these day-to-day things come up, like if you have two kids and one gets injured at the beginning of the month when they go back to sports in September and another one gets injured, you might not have that extra $200 that month. That's what they're saying. It's not that they don't understand that the maximum would not change. It's just that as day-to-day things arise, the less money you make, the harder it is to manage an emergency. That's all we were saying.

That's fair. I think that's what Derek has also said has come out in his survey as well.

And like, we're also kind of agreeing with what Heidi had brought up with the public health nurses. It would be a huge detriment to our residents at Badger Prairie if we all sought out private sector jobs, either as laborers, caregivers, et cetera, or within our other education, because we serve a very unique clientele at Badger Prairie. It's a different type of job than other healthcare settings, just like public health has very delicate clients we do too. So we just want to acknowledge too that as we're serving as public servants, we need to make good choices with our municipal funds. And it would be a huge detriment to have to retrain people because they're losing this healthcare benefit. Thank you.

Thank you, Cassie. Misha? Thank you.

I wanted to respond to the comments about understanding the point of service plan and assuring people that they that doesn't mean they'd be unable to get care. And then I couldn't tell who was speaking right before Cassie. So I kind of wanted to thank them and also reaffirm that personally, as one of those family point of service people, I I have reasons due to multiple disabilities and complex diseases that there literally is nothing for me at Dean. I cannot get help. In fact, I haven't even been able to find a primary doctor there for two years. So that makes it hard to think about, you know, how would I even go about trying to do referrals? So the referral process with Dean could also become like a part-time job. and people that are already working with chronic illness or a sick family member don't have the energy or the time to work and babysit the insurance company. There's other reasons. I saw some in the survey as well. Some people live out of the service area or their children do. Some people just have long-term providers that know them well and are a good provider for them and they don't want to leave that. So I fully believe we have people that know what they're getting in the point of service. And we've pared it down greatly just from what we've been talking about today and the numbers. So I think we're at probably more of a core group, except for maybe a couple that are saying they forget to unenroll. But I think the people that have point of service are very aware of the medical system, the barriers, the issues. and have chosen that very conscious. That's it. Thank you.

Supervisor Chawla.

Yeah, I'd like to offer a motion. And if I get a second, I can speak to it. The motion that I'm going to offer is to go with option E. If I get a second, I'll speak to it. We have a motion on the- It's an amendment. I just want to offer an amendment to the motion that's on the table to- to change from 1, 3 and 6 to 1, 4 and 6.

I think we have to dispose of this.

I think we need to dispose of this with this motion first.

I don't hear a second. Oh, let's get a second.

Christy will second.

I will speak to the motion. And I think we're pretty much, I think we're in agreement on one and six. It's just what that middle thing looks like. And to see if we can get a recommendation out of this committee. The reason why I want to go in number four is it's a standard $10 copays are more standard than $15 copays. We're told by our consultant that that option might not be on the table next time, and I feel like it offers, or the modest trade-offs it offers, it offers a lot of savings. We're trying to solve a $7 million problem here, and those are $7 million of costs that the county is going to have to pay, and that's either reducing services, that is... eliminating jobs, reducing programs. We're trying to solve a $7 million problem right here. And I think that will really help us get there. And I feel like it's a reasonable compromise to come out of this advisory commission. So I'm going to offer that the amendment is to go with options one, four, and six.

Eric?

Yeah, I'll speak in opposition to the motion. I certainly appreciate the sentiment. I appreciate the call out that, as it often says, that, you know, this may not be something that's available next year. You know, I think, too, versus, as Marcia indicated, There was not a lot of strong support in regards to changing co-pays. That would have been one of the things that I've consistently said here too in this space in regards to making sure that folks are able, for example, our 911 communicators dealing with some of the most traumatic that a human being can ever potentially deal with, making sure that they have access to appropriate mental health care. Once you start increasing those co-pays, it starts creating more of a potential barrier to accessing those services. And I think that was reflected throughout our survey results as one of the least desirable options. And, you know, I think those with the new information about how the POS folks would be even further impacted by these changes, it would, you know, honestly just make such a difference. motion or decision even more untenable for employees. I am speaking in opposition to the amendment.

I think I would echo what Derek has said because I think right now in the world we're living in, transparency is really important. The fact that we were not able to accurately share with employees the impact of this potential option because we didn't understand the POS impact. People didn't have the full picture of this. And so I would be very concerned about that. Brian and then Supervisor Erickson.

I would just add that part of what I fear and I know members that I have spoken to is that at the beginning of this year, we were facing a very, very large deficit that was driving a lot of this to begin with. And it wasn't too long after that that that number was cut in half. So what I'm afraid of is that we make a large course correction in fear of what could happen. And if that doesn't happen then we have loaded all this on to the backs of the employees. When we may not need to. So that's I would speak in opposition to this amendment as well.

Supervisor Erickson.

Thank you. I've asked that you support Supervisor Chavla's amendment for the reasons stated and what things look like going in the future.

Travis. I speak in opposition of this. Yeah, I think Brian really hit it right there. It is an unnecessary course correction given that the floating deficits that... Tony faces, but yet we were asked to make the exact same sacrifice, although I would ask where is 7 million. This is a you said 7 million twice. This is 5 million. I believe we were asked to get $5 million in savings.

My recollection as well.

Do you want me to answer the question. So I can, let me look some things up here.

I mean, I think the projected cost of health insurance potentially for this upcoming year was projected to be around $7 million. I think the ask for from this committee was to be the $5 million.

Okay. Thank you. Okay. I can answer that. I sent a memo, a personnel and finance committee sent a memo when they were asking for me to confer. exact thing that we wrote or I wrote. Our goal is to retain the robust benefits as much as possible while balancing the reality that the county's health insurance expenditures have increased by $25 million since 2021 and an estimated $7.5 million increase in 2026 alone. Whereas the countywide budget for health insurance is $77.7 million. So those were the numbers that I was referencing. Yeah. MOI sent to DOA when we asked them to look, Personnel and Finance asked them to look into a number of changes.

So I just want to remind everybody too that, you know, so we've been asked for $5 million in the memo from the county executive earlier in the summer, spring. Time is flying. I'm not sure where we are. But you know, Travis's motion, Derek has kind of done the math for us gets us to 5 million. So if we, you know, the motion, the amend the proposed amendment on the table would actually get us above 5 million with the other features of Derek's. And so I think it would be very, you know, we'd be hard pressed to be asking employees for more than what was originally asked.

Any I'm in opposition of the amendment as well. The points that have already been presented by folks in opposition are my feelings as well and transparency is really key in making sure that every member understands exactly what's happening.

So I can call for a vote. All right. So I think we can call for a vote on the amendment. Linda, we're requesting a roll call vote on the amendment.

Before the vote, can we please restate what the amendment is? Please, I kind of got lost with everything else happening.

Thank you. Where do you state your amendment?

Yeah, the amendment was to change 1, 4, and 6, or 1, 3, and 6 to 1, 4, and 6.

So that was the 30-day supply for RX, the increasing co-pays to $10 per and the HMO and the $20 on POS and the $100 ER copay. So I think we need to deal with this amendment first, and then we can move back to Travis's.

If it fails. In the cash in lieu is the original amendment, not the original motion, not the amendment, correct?

No, the amendment only changed the options. The cash in lieu would still be part of that, if I'm understanding, Supervisor Chalmers.

Yeah, if the amendment was to pass, then we'd vote on the main motion. That would be the process. Thank you.

All right, voting starts. Christy Koblowski?

For option E one, four and six. Yes.

Joshua Cotillier.

Yes.

Carrie Meyer. Yes. Marissa Burak.

No.

Angela Tabato. No. Karen White- Misha dancing waters. Karen White- Now, Karen White- Cassandra Riley. No. Karen White- Travis Thomas. No. Karen White- Brian to share.

No.

Karen White- Patrick Shellenberger Karen White- No. Karen White- John Bowman.

Yes.

Arlen Halvorsen?

Yes.

Yogesh Chawla?

Yes.

Dean Julian?

No.

Heidi Fogo?

No.

Kate Gravel in place of Taina Knights? No. Okay. Six yes, nine no's.

The motion fails. So we are now going to vote on the original motion. Roll call again, please. Revis, do you want to restate the motion so people understand?

Yes. Motion to have all 3 decrements of a half percent savings implemented in the plan design. So that would be which option is that D? Yep. Option D. And also have DOA implement the cash and move benefit as part of the handbook for 2027.

All right. So that is, so that recommendation is Travis's motion. That's on the table. Linda, can we do a roll call please?

Christy Kolbowski? No. Joshua Cotillier?

No.

Carrie Meyer?

Yes.

Marissa Burek?

Yes.

Angela to bottle yes. Misha dancing waters.

Yes.

Cassandra Riley yes. Travis Thomas yes. Brian to share.

Yes.

Patrick Schellenberger yes. John Bauman?

Yes.

Arlen Halverson?

Yes.

Yogesh Chawla?

No.

Dean Julian?

Yes.

Heidi Fogo?

Yes.

Kate Gravel? Yes. 13 yeses and 3 noes.

Thank you so. The motion passes I will. That recommendation passed on. Right. And back to our agenda. reports to committee we have none. Future meeting dates we have September 3rd and December 2nd regular meetings taking place here at every invite soon. Linda do we have anyone registered for public comment on items away.

Madam chair if I might if I may I believe that September 9th is the date that's what it says on the end of that sorry.

All right.

Thank you.

Thank you. And then December 2, which I think is an adjusted date slightly earlier due to holidays. So just pay attention to that. Thank you, Kate. Linda, do we have anyone registered for public comment?

Let me just double check my list. Thank you.

no okay thank you any other business i just um have a request that the um updated sheet that you provided us thank you all right nate's going to send that can i get a motion to adjourn