On Thursday, October 22, the board meeting of the Teacher Retirement System of Texas will be devoted almost entirely to a “town hall” conversation on health-care coverage plans for active and retired school employees, the costs of these plans, how the plans will be paid for in the future, and by whom. The discussion will start shortly after the board meeting convenes at 8:30 a.m. Central and will run until 4 p.m. Texas AFT will be there to advocate significant and ongoing increases in state funding to make these health plans sustainable and affordable for school employees and retirees.
We encourage you to take part directly by way of the TRS live Webcast of the whole event, including two Q&A sessions allowing those attending in person and tuning in online to submit written questions to speakers. The morning session of the town hall will feature panels talking about the health-care market in which school districts and TRS must operate their health plans, as well as about strategies for cost containment. The afternoon session will cover TRS-Care, TRS-ActiveCare, and health plans run by school districts not participating in ActiveCare. Texas AFT will be represented on a panel of association spokespersons discussing their members’ health-care needs and solutions to current funding problems. At the end of both the morning and afternoon sessions, audience questions will be taken up.
To see the live Webcast of the town hall on Thursday,go to the Texas AFT Web site and send our health-care petition to legislators for increased state funding for school employees’ health care—because ultimately it is the legislature, not TRS, that has the power to fix this problem.
Whether you follow the conversation online or in person at the TRS building in Austin, remember you can submit questions to any of the speakers at Thursday’s town hall. Here are some questions you might want them to answer:
- It is my understanding that the employee share of the cost of employee-only coverage under TRS-ActiveCare 2 was 29 percent in fiscal 2003 and has since then more than doubled to 63 percent in fiscal 2016, the current school year. (This assumes a school district contributes its required minimum share of $150 a month on top of the $75 from the state.) Over that same period, how much has the total monthly premium gone up for that employee-only coverage under TRS-ActiveCare 2, and how much in dollar terms is that 63-percent share costing the employee today?
- We areall too familiar with increasing premiums for TRS-ActiveCare plans, but benefits have been cut back as well. Can you tell us how those cuts have increased the costs to plan participants?
- Isn’t it true that TRS last year predicted a “death spiral” due to rising premiums for TRS-ActiveCare 2, much like what happened to TRS-ActiveCare 3, because healthier employees will migrate to a less expensive plan and leave only those with the most serious medical conditions in the higher-cost plan? Isn’t it also true that only the legislature, not TRS, can solve this problem, given the fact that state funding has been capped at $75 per employee per month since fiscal 2003?
- How does the employer share (state plus minimum required district contribution) for active school employees and for retirees compare to the state’s contribution under the ERS HealthSelect plan, which covers many higher-education employees and state-agency workers? Please provide the monthly and annual dollar amounts the state provides for ERS HealthSelect, for TRS-Care, and for TRS-ActiveCare 2.
- In percentage terms, what share of TRS-Care costs does the state pay? What share do retirees themselves bear? What share is paid by active school employees? By school districts? How much of the ongoing shortfall in TRS-Care funding for fiscal 2018 and beyond could be covered if the state increased its percentage share of TRS-Care costs to the 55-percent level allowed by current state law?
- How much if any saving could be achieved for TRS-Care and TRS-ActiveCare by increasing participation in wellness programs?
- What are some cost-reduction measures that would not compromise the quality of health care?
- We often hear that paying more for health care for active school employees and retirees would cost the state a bundle, but what about the value the state gets in return? Aren’t health-care benefits a significant part of the compensation package needed to attract and retain highly qualified teachers and support personnel? And doesn’t the state’s spending for school employees’ and retirees’ health care boost the state’s economy? Why aren’t we hearing more about those pluses of increased state health-care spending?
- Some school trustees and administrators have contended that school districts should be free to leave TRS-ActiveCare to take advantage of lower rates that might be offered for equivalent health-care coverage by commercial insurers or through individual district self-insurance. How likely is it that any given district could, on its own, achieve a cost saving outside of ActiveCare for more than one or two years? If districts were allowed to leave ActiveCare, how would that be likely to affect rates and coverage for employees in districts that remain in ActiveCare? What would the effect be if districts were allowed to leave and re-enter ActiveCare participation whenever they chose to do so?
- The rates and benefits for TRS-ActiveCare plans are the same throughout the state. Rates and benefits for employee health-care plans in school districts not participating in ActiveCare differ significantly from one district to another. At one time TRS prepared data enabling us to compare these various plans, but TRS hasn’t published such comparability studies in several years. As employees, how can we make reasonable comparisons among these plans?
- TRS-ActiveCare Select plans provide coverage through so-called “accountable care organizations” (ACOs)—which feature a narrow network of providers associated with a single health-care system. A similar scheme was among options studied for TRS-Care. At least one ActiveCare Select ACO—Seton in Austin—does not provide the full range of covered health-care services. Seton’s refusal to provide covered reproductive health care would be an issue for any group of employees but is a particularly serious concern given that women of child-bearing age form a significantly large portion of our ranks. Why did TRS and Aetna select Seton given this problem? What concrete steps have TRS and Aetna taken to ensure that all participating employees and dependents have reasonable access to the full range of covered health services?
- I’d like to be able to use my health-care benefits as effectively as possible, but it’s very difficult and time-consuming to get even a little bit of information about coverage, cost, and quality among providers. Is TRS, its vendors, or the state doing anything to address this problem?