Portage County committee warned of 27.9% health-plan premium gap as reserves fall

Portage County Human Resources Committee members reviewed initial projections for the county’s self-funded health plan and were told Friday that closing the 2026 funding gap could require a 27.9% increase in total premiums to break even.

The projection presented to the committee estimated total 2026 plan costs at about $10,913,000 and showed that the plan ran a roughly $2.5 million shortfall in 2024, leaving reserves at about $3.8 million at year-end 2024 (roughly 32% of overall expense). Committee members and consultants said that leaves less than ideal cushion—with targets typically set at three to six months of expenses—and limited room to absorb another large year of adverse claims.

Committee members said the slide deck showing recent claims experience indicates medical claims drove the spike in 2023–24, with prescription costs relatively steady. Consultants advised the group that the most recent 12 months were not re-weighted to dominate the projections because that period contained the worst experience; the committee’s presenters said they plan to revisit experience-weighting in future projections as claims patterns evolve.

Committee members and outside consultants discussed several options to reduce future plan cost growth: maintaining the county’s current ordinance that phases down the county premium contribution (the ordinance would move the county contribution to 80% for the PPO and 90% for the high-deductible plan on Jan. 1, 2026 unless changed), exploring a ‘‘plus-one’’ employee tier between employee-only and family coverage, narrow-network strategies, targeted incentives for employees to use lower-cost providers, and integrated programs (for example, supplier weight-management or multisite musculoskeletal management programs). Staff said they are continuing conversations with the county’s vendors, including plan consultants and Anthem, and that some proposals (such as incentive overlays and targeted networks) require further vetting for long‑term cost and operational implications.

Presenters also noted the timing constraints for budget-setting: the committee must provide rates and contribution guidance in the next meeting cycle so departments can plan for the June budget calendar. No formal rate change was proposed at Friday’s meeting; staff said a follow-up meeting will include updated exhibits showing how different employee/county cost-share mixes would affect department budgets.

The committee was given a reserves update showing the 2025 budget as currently drafted would use approximately $2.0 million of reserves, leaving roughly $1.7 million (about one month of expenses) if projections hold. Members described that as a precarious position if adverse claim experience recurs.

Next steps identified by the committee included staff working with consultants to prepare revised exhibits showing alternate premium/contribution scenarios, more detail on potential program costs and expected savings, and a recommendation for the committee’s next meeting. No formal vote or change to premiums or contributions occurred at the session.