Kane County committee hears options to rein in rising health‑plan costs; no vote without quorum

KANE COUNTY

Kane County officials spent more than an hour on March 24 outlining choices for the county's $20'$25 million annual self‑insured health plan and asking the board's executive committee whether to pursue market bids or pursue benefit changes to contain rising costs. The committee did not take any votes because there was no quorum.

Jamie, a county benefits presenter, told the group that health insurance costs have risen faster since the COVID pandemic and that the county's plan is largely driven by its own claims experience. "Health insurance costs are going up. They go up every year. They have gone up steeper since COVID than they did before," Jamie said, and noted stop‑loss coverage is set at $205,000 per claim.

Why it matters: County staff said the county's 2025 medical spend to date is $22,923,000 and that, maintaining the current plan design, roughly $4.5 million more could be needed in the next budget cycle, an approximate 18% increase over two years. Staff also said the county expects to draw about $2'$2.5 million from reserves this year because rates were held flat for 2025.

Staff outlined three primary options and their tradeoffs. One is to stay with the current carrier and adjust plan design — for example, tightening the pharmacy formulary or removing voluntary weight‑loss drugs from the pharmacy benefit, or increasing deductibles and copays — measures that would reduce benefits for employees but lower county costs. A second is to solicit competitive bids from other carriers, an effort staff and the broker said can produce multi‑million‑dollar differences but risks disrupting employees' existing provider relationships. A third is to leave the plan as is and absorb the cost.

Cliff, a long‑serving staff member involved in benefits management, described the county's move years ago out of a larger consortium into self‑management and defended the county's stewardship of reserves and broker relationships. "We made the choice about 6 years ago to pull from that grouping and self‑manage ourselves," he said, adding that staff have adjusted reserves since then.

Board members pressed staff on practical effects and legal limits. Several asked whether changing carriers or benefits would conflict with union contracts that require a "substantially similar" plan. Mr. Shephard, the State's Attorney, and staff said the phrase has not been precisely defined in past negotiations and that any material change could require attorney review and bargaining. "That is something that should be clarified during the discussion," staff said.

Operational questions dominated the Q&A. Members asked whether continuity‑of‑care protections could preserve access for patients mid‑treatment; staff said continuity plans enable temporary overlapping care but do not permanently keep an employee on an out‑of‑network provider. Members also discussed plan types: more employees are on HMO plans than PPOs, an HSA high‑deductible option exists as a plan design available from any carrier, and carriers differ in how they handle utilization limits such as physical therapy or specialty medications.

The county's broker, Brian, said that because the county is self‑insured most of the costs are claim driven (provider payments and pharmacy costs) rather than administrative premiums, and that carriers' negotiated provider rates or pharmacy rebate arrangements explain much of the variance in bids. He estimated a formal shopping/RFP process for an account this size would take about 45—60 days.

Contentious levers: Several board members singled out GLP‑1 weight‑loss drugs as a fast‑growing pharmacy cost driver. Jamie said the county spent over $500,000 on weight‑loss drugs in 2024 and expected 2025 spending to approach $750,000, and staff described a plan change that would preserve diabetes treatments while removing elective weight‑loss medications from the formulary and offering a separate county‑funded weight‑loss program as an alternative.

Next steps: Staff asked for direction to the Executive Committee in April. Members agreed two possible resolutions should be prepared: one to authorize marketing the plan (an RFP/shop) and one to pursue plan‑design changes while remaining with the current carrier. Multiple members said they would prefer plan‑design changes to avoid disrupting members' access to doctors; others urged that at least one outside quote be requested to understand the potential savings. Because the committee lacked a quorum this evening, no binding vote or formal resolution was adopted.

The committee adjourned after asking staff to prepare clear options and cost estimates, including the budget number or reserve assumptions that the Executive Committee should use when weighing whether to shop carriers or change plan design.