Brown County approves 2026 insurance plan, discontinues county gap coverage and opens path to direct primary care

Brown County commissioners voted to approve the county's 2026 employee insurance package and to discontinue the county'paid gap coverage fund. The motion passed by voice vote and was recorded as "3 to nothing." Commissioner discussion and a lengthy advisory presentation from Austin framed the decision as the first step in a multi-year plan to control premiums and improve employee access to care.

The commission's action follows Austin's presentation, in which he recommended continuing the county's self-funded approach and using the projected savings from ending the gap policy to buy time while the county explores alternatives such as a flexible spending account (FSA) and a direct primary care model with local providers. Austin said the move would create roughly $90,000 in budget breathing room based on 2025 usage and urged a phased, 3-to-5-year strategy to capture long-term savings.

"You are having one of the top five most important conversations you can have for the county's tax future benefit in this meeting," Austin told the commission during his presentation, urging an early start on provider negotiations and employee enrollment planning.

Staff and commissioners discussed implementation details during the meeting. The packet presented to the commission lists 2026 insurance rates and shows the county's existing gap arrangement: individual participants paid the first portion of a deductible (the county reimbursed the remainder up to a cap), and roughly 23 employees had participated in the gap plan during 2025. Commissioners and staff cited an approximate total cost for the county's gap coverage in 2025 of about $89,000.

The commission also asked staff to increase employee outreach about existing pretax options: the county already has an FSA framework through a vendor used for employee benefits, and staff were instructed to ensure employees are notified during open enrollment that FSAs are available. Austin recommended initiating conversations with local providers (he mentioned Amberwell Health and other regional systems) and said collaboration with neighboring Nemaha County could make the pool more attractive to direct-primary-care practices.

The transcript contains two schedule references: staff noted 2026 insurance typically begins Jan. 1 and open enrollment is imminent, and the final motion recorded the discontinuation of the county'paid gap policy as "effective November 2026." The commission directed staff to reconcile implementation timing and to begin open-enrollment and FSA outreach immediately.

Next steps recorded in the meeting: staff will publicize FSA enrollment options for employees during open enrollment, the commission tasked Austin and Commissioner Richard to begin provider outreach and schedule follow-ups in the first quarter of 2026, and the board set a work session to continue insurance planning.

Outcome: Motion to approve 2026 insurance package and discontinue county gap policy carried (voice vote; "3 to nothing").