County consultant: keep health plan contributions steady; warns drug costs and rebate trade-offs

Brazos County — At a July 15 Brazos County Commissioners Court budget workshop, USI senior consultant Bobby Anderson told the court that Brazos County’s employee health plan is running favorably but faces rising national trends that could increase costs in coming years. Anderson recommended no change to the county contribution for the FY2026 budget and keeping the $75 wellness discount for employees while suggesting a small reduction in employee-paid dental fees.

Anderson said the marketplace shows growing medical and prescription trends, and that Brazos County should not expect to see the full nation‑level increase in the county’s budget: “We’re not expecting a 10% increase to your budget for Brazos County,” he said, noting the county’s current favorable claims experience.

Why it matters: health plan costs and the county contribution are a recurring line item in the budget that affect both operations and employees’ take‑home pay. Rising specialty drug costs and rebate arrangements can shift dollars between vendor fees, manufacturer rebates and stop‑loss reimbursements, creating trade‑offs for plan sponsors.

Most important facts

- Trend drivers: Anderson said medical trend is increasing (he cited roughly 7.5% projecting into the 2026 plan year) and prescription‑drug trend is “growing around 12% a year,” driven in part by specialty medications. - Plan performance: USI reported Brazos County has run under budget in recent periods. Anderson cited a rolling‑12 scenario where the county’s budgeted cost was about $20.9 million and the net cost was about $18.0 million, leaving a reported surplus of roughly $2.87 million in that view. He also summarized that 2024 ended with a multi‑million dollar favorable result and that year‑to‑date 2025 figures through May showed the plan running well (a net cost/loss‑ratio figure of about 95% through May was reported). - Claims and stop‑loss: Anderson reported large‑claim counts and reimbursements: in 2024 there were 21 claims at 50% of stop‑loss and 11 claims above the individual stop‑loss with reimbursements he said totaled about $4,760,000; in 2025 year‑to‑date he reported 8 claimants at 50% stop‑loss and two reimbursed claims totaling about $1,400,000. - Per‑employee cost: Anderson said Brazos County’s per‑employee‑per‑month (PEPM) cost has increased and showed a 14.9% increase on a PEPM basis in the current data set he presented. - Dental and premiums: The consultants recommended a modest reduction in employee‑paid dental fees after underwriting (USI suggested considering about a 10% reduction from a larger underwriting result), while recommending no change to employer medical contribution and no change to employee medical premiums for FY2026.

Rebates and plan vendor trade‑offs

Commissioners pressed USI on the county’s rebate share under the Texas Association of Counties (TAC) prescription‑drug arrangement. A commissioner asked why Brazos County receives 75% of prescription rebates through TAC instead of 100% and whether the county should move to Blue Cross and Blue Shield to capture more rebates. Anderson and other staff explained that TAC retains 25% of rebates as part of its negotiation/administration and that last year TAC produced a favorable stop‑loss renewal that helped offset costs. Anderson said the difference between receiving 50% and 75% of rebates was roughly $250,000 (as reported during the discussion).

The court asked staff to pursue TAC renewal negotiations in the next few months; Anderson said that USI, TAC and county staff could discuss pursuing improved rebate terms during renewal conversations.

Attributions and quotations

All direct quotations and attributions come from participants who spoke during the insurance presentation. Key quoted lines from the transcript: - “We’re not expecting a 10% increase to your budget for Brazos County.” — Bobby Anderson, senior consultant, USI. - “That can be something as we discuss the TAC renewal in the next few months that USI, ourselves, and TAC can try to negotiate.” — Bobby Anderson (on negotiating rebate terms). - “I think that’s vitally important. No matter who we’re with, we ought to get a 100%.” — Commissioner Brown (questioning rebate split; commissioner asked that the county should pursue full rebates).

What the court was asked to do

USI and county HR recommended no change to the employer medical contribution and no change to employee medical premiums for FY2026; keep the $75 wellness incentive; and apply a slight reduction to employee dental fees (dental is fully employee‑paid). The county staff and USI agreed to pursue TAC renewal discussions and further benchmarking as part of upcoming vendor renewals.

Ongoing items and clarifications

- Projections and trend numbers were presented as estimates based on rolling‑12 data through May 2025; Anderson said June data were not yet available at the time of the workshop. The consultant presented multiple cost and surplus figures using different rolling and year‑end scenarios; those numbers were presented by the consultant and staff during the meeting and are reported here as presented. - Several speakers noted that TAC provided a favorable stop‑loss renewal the prior year that helped offset some cost exposures, which they cited as a non‑monetary benefit of TAC participation.

Speakers

- Bobby Anderson — Senior Consultant, USI (insurance broker/consultant) - Brenda Cost — VP, Strategic Accounts, USI (present on the account) - Jennifer Grama — (county staff present during presentation; involved with benefits/HR) - Rayanna (Rhianna) — (county benefits staff; present during presentation) - Commissioner Brown — Brazos County Commissioner (questioned TAC rebates) - Commissioner Nettles — Brazos County Commissioner (present)

Authorities

- Health Care Reform Act — referenced during an “affordability test” discussion (as stated in the presentation). - Texas Association of Counties (TAC) rebate/stop‑loss arrangements — referenced by staff and commissioners during rebate discussion. - Blue Cross Blue Shield — referenced in commissioner questions about alternative rebate arrangements. - PCORI fee / Patient‑Centered Outcomes Research (referenced by a speaker when discussing small tax/fee obligations).

Actions

- Recommendation: USI and HR recommended no change to the county medical contribution and no change to employee medical premiums for FY2026; keep $75 wellness credit; consider a modest reduction in employee dental contributions. (Outcome: recommendation; no formal vote recorded in the workshop.) - Direction: Staff and USI to open TAC renewal discussions in coming months and assess rebate negotiation options. (Direction from the court; no formal motion recorded.)

Clarifying details

- Employee headcount used in the presentation: reported as about 1,058 full‑time benefit‑eligible employees. - Reported rolling‑12 budget and net cost example: budget ~$20,893,000; net cost ~$18,000,021; surplus ~$2,870,000 (as presented by consultant). - Reported large‑claim reimbursements: 2024 reimbursed ≈ $4,760,000; 2025 year‑to‑date reimbursed ≈ $1,400,000 (as presented). - Projected national health‑care cost trend mentioned by consultant: ~10% (consultant noted Brazos County not expected to reach that level in presented scenarios).

Community relevance and tags

Geographies: Brazos County, Texas Funding sources: employer plan budget, employee contributions, TAC rebate/administration arrangements Impact groups: county employees (benefit‑eligible staff), dependents, county taxpayers

Searchable tags: ["health_insurance","employee_benefits","TAC","USI","stop_loss","prescription_drugs","dental_benefits","Brazos_County"]