I don't >> feel free to take a seat. Yeah. Okay. >> Yeah. Thank you for coming. >> Coming as well. >> I didn't know for a fact, but I had text her >> good morning. Thanks. calls. I got another call. also consent >> whenever. Sorry, I was just ahead. >> Okay. >> Good morning everyone and thank you. Thank you for coming. Uh yes, at the last minute and then early here. So, we're here to uh follow up with the um treatment court uh evaluation and the direction that we were given by the board from the last workshop that we were at. And so, my computer works. Yeah. Yep. Okay. Hang on. Let's try that one. All right. Here we go. So ju this is just a brief recap of the last uh uh workshop that we did and some of the highlights that were from the third party evaluation completed uh about the treatment court. What we found out through that evaluation was that 86 adults were served by our Scott County treatment court uh since it started in 2016 to 2024. So it averages to be about 10 to 11 people a year. um the people that were in this particular uh study, there was a comparison group of folks that were on general probation as uh um to analyze against the average case load size for our high-risisk probation case loads tend to be around 30 to 40 a year. So what we found out was that uh we can serve more people on general high-risisk supervision than we can in our treatment courts. We also found out that in recent years we have been denying over half the people that are referred um to treatment courts. And so we're seeing that higher denial rate. And when comparing those that graduated from treatment court compared to general uh high-risisk probation, especially at the 2-year mark, we're seeing similar results. And so we're finding that the the message that I really hope uh we've conveyed thus far and continue to today is that treatment court is a great program. It has been a wonderful um program for Scott County and they exist across the country for a reason. Um and what we found out is that we're just also doing well on probation and that's also good news for us. The uh philosophy of probation has shifted a lot over the last 20 years. And so when treatment courts were stood up in the late ' 80s and the '9s, probation looked a whole lot different than it does today. Uh it used to be a very uh kind of a tail them nail them and jail them, catch them doing wrong, um lock them up very quickly at times and we have shifted to an approach that does look a lot like treatment courts do today where we're working really hard on the balance of accountability uh with the rehabilitation and really working as a community around uh providing resources to clients just as treatment court does so that people have the best likelihood of success in changing their lives in general. role. So again, I want to reiterate that these are both good programs. I'm happy and proud of the results of both of them and we do know that treatment court is a very expensive program and if we can serve people and in a similar way and have similar results then that's you know that's what we are striving to do. So what happened after the last board meeting or workshop was that we were asked to do these four things. Uh, I was going to go back and I did, to work with our justice partners, not only to share these results, but to have conversations about what could an alternative program here in Scott County look like for a reduced amount of money, but also serving this population. Uh, so that is I'm here today to uh walk through what that looks like in the conversations that we've had uh at different um points along the way. We definitely want to include and that was important that the current participants we have a plan for them. Uh they agreed to this. This is a voluntary program and we certainly didn't want to upset their trajectory being in treatment court. And was there any unintended or fiscal or other kinds of service reduction consequences that at least we could see at this point if we were to shift to an alternative probation program? And so we I met with the various people on these particular dates. So on the 14th of January, I did meet with the treatment court team and we reviewed the evaluation and the results. We then had a smaller meeting with the two judges of treatment court with our court administrator Jennifer Everett, county attorney Ron Hosabar, and chic public defender Lindseay Sai. And then we also met as a justice steering committee on February 6th um to discuss again the results of the um evaluation and what alternative programming might look like. So there was agreement um with the various groups of people um that we would like to transition from our current model Scott County Treatment Court to one probation officer that would continue to do enhanced drug supervision case load that we would through our assessment process usually at the presentence investigation time we would identify those at our highest risk. We have lots of people on probation right for drugs and alcohol and different things. So, we do need to figure out through our assessment who are the highest risk individuals that would need this type of intensive probation supervision. Uh, very similar to how we determine if people are um right for treatment court. And we would like to continue drug testing and providing some mental health services to support this case load um by shifting some of the program costs as well. In addition, although this is not about veterans court um you know in particular, what we do have is one probation officer that is the treat the coordinator for both the treatment court and the veterans court. On the veterans court side, we're working on expanding into the first judicial district. So to support all the counties within the first judicial district and so what we're asking for is to shift the coordinator position from half and half to one full-time FTE for veterans court that you'll see here. I'll go through the fiscal um implications of that, but we get state funding for that position. So that would not that is not being asked for any levy support for that. That would just be to utilize the state money for the state position that would support the first judicial district. So what we're asking um to submit uh for an RBA uh at the next board meeting or whenever uh you would like is that what we see in the first column there is our 2026 budget for treatment court. And so right now we have a total expense of $425,683. And what we're suggesting is that we move that one field probation officer to the sorry that one treatment court probation officer to the field budget. And then we're asking for a small portion of the mental health services and the drug testing and EHM expenses to be moved over as well. So we're asking for the 181,00 to go into the community corrections budget. the as you can see we can off spend offset the program expenses we get more dollars from the state than we're spending in those program expenses so it definitely supports that uh full-time vets court coordinator so we would not be asking for any additional money except to just uh shift that in vets court and then what that would look like is uh the 142,183 that would go back um on to the levy I forgot to mention in the in the transition to the field. The other decision that would need to be made is whether the 152,500 opioid dollars would shift to the field budget. Um they are being used right now in the treatment court budget. If we did shift that over to support the drug case load, then that's what the um the dollars would look like moving over. So that is the ask or the um I guess the analysis that we did. Um, and I will stand for questions or comments. >> Um, Molly, the the transition to field, the moving that money to field, what's what's that going to change in your program? Like is it going towards the current budget? Is it tell us about that transition to field the money going to field? >> I understand the question. So we'd be taking the money that's in the treatment court budget and we would say because that's a case load of people and so we're going to keep the probation officer the case load and the type of supervision that we provide in treatment court and provide that same higher level of like dosage and intensity that we do now um on general probation. And so we're just asking that we keep some of the money, but it won't be as expensive as running the treatment court budget. >> So that was our staff recommendation. Continue to use the opioid dollar. So we're going to shift here anyway and then put that back towards the general fund. I'm surprised to hear that getting similar results in my perception is that these individuals 10 or so here were really surrounded by a team to categorize that I think it was uh surprising uh to find that out. Although that's where I go back to yes, I do not want to say that they are the same. They are not. They're different models. But I will say that we're working on similar things with individuals. We're working on in general probation. We're working on mental health. We're working on substance. We're work. And so even though it's not the like showing up to court all the time, it's certainly other community partners. It could be Damascus Way. could be again any of our community uh CD treatment facilities. Um we're still going to see them at the home. We're still going to see them in the office, right? Cognitive behavioral programming is provided. So we're doing again not the same but very similar. And so to me what is exciting is again they're both doing well. Like treatment court's doing well and probation's doing well. So that to me is um good news and a decision to be made on whether or not we continue doing treatment court or if we can do this and have similar results and serve more people on general probation then great right that's the to me kind of the win-win if you will >> I I think the connect there at least and I've probably heard this a couple times now because of steering and other things is 10 years ago general probation didn't include clude all those things and now it does. So I mean yes 10 years ago it was different results probably >> um when we started and now it's not. My next question though especially with with Chief Pearson here when we when we talk about treatment court we often hear about the the curfew visits the relationships with the law enforcement all that is and again we we assume that contributes to all kinds of good things. how how you consider that or use that with this more intensive case load or how is it maybe it's already being used in a way that we just don't hear about >> you want do you want to and then do we need to >> well I mean we haven't had any formal conversations about what that looks like um you know my hope would be we could someway or I should say probation could some way utilize law enforcement to so we can continue to build to make the connections that we have treat. We're talking about a very small population, you know, so you know, and when you look at this from like a 10,000 foot view, are we are we impacting a whole ton of people? We're not, but the impact that we have had on the small number of people is gigantic, you know, and I could, you know, I could tell stories after stories after stories of the connections that I've made. Um, but I'm one of how many cops that were. Um, so I think there's definitely ways that Molly and I could could brainstorm where where does law enforcement fit into this and do they need to, you know? >> Yeah. Yeah. Ideally, I'd love for that to happen because it it could be actually a even a better a better situation where before that was limited to those folks in treatment court. Maybe there's some criteria or some, you know, some research, some learnings where this certain population of general probation or high-risisk probation would benefit most from that and from that kind of law enforcement partnership and maybe there's some opportunities for that. I just I hope we find people who are smarter in this arena than me find the best population for that and use those resources because I think it it does other things to that partnership. I may misunderstand the process. My perception is that he passed. Some of you said either go to treatment court or you're going to jail. >> Is that true? >> Yes. >> Okay. So, you're saying probation is getting similar results. Well, these people that are going to go to treatment court are going to jail then probation, right? Or no. >> So, now thank you for the clarification. There also has been some laws that have changed especially in the drug um uh charging. So there's not as many people that fall into that category of uh commits to prison or treatment court. So there is a lot more people on treatment court that aren't in that scenario quite frankly that could be on probation there. It wasn't a mandatory again sentence to go to prison. There are a few um and Lindsay Sai and Ron Hosabar when we were talking about that have ways that they can still negotiate that knowing that we have an enhanced drug case load as well. So it doesn't mean that that conversation and that like a plea deal can't be met in the same way that it is now. It just might sound or look a little bit different. Um but so you are correct and there's been shifts along the way and there's still mechanism for that to happen and for a departure to probation in cases especially where people are motivated to want to change their lives. So we won't necessarily see more people going to prison. That was one of my concerns about sunsetting treatment court and it doesn't feel when we looked at the numbers um that that that would necessarily be the case. We also have people that were not referred to treatment court that the county attorneys have negotiated departures to probation anyway that were in that sample as well. So again, there is um a space for that that I don't think we don't foresee having that negative consequence that uh we kind of were wondering about in the beginning. >> Good question. >> Yeah. >> So just to clarif my my simple mind it's like before it was like go to be incarcerated or go to treatment court. out might be go to probation on this with this type of of restrictions high you know high risk case load or go to incarceration think so we're just negotiating a different name there >> similar we decided not to it's not a program like treatment court though so they're going to go through the same process that anybody is placed on probation so they would be arguing for departure based on statute we would then determine in probation who is of the highest risk of all of the folks and put them onto this case lo based on internal assessments. Okay. >> So really it would be um between the state and the defense to make a decision or the judge to make a decision about >> again is this person immunable to probation? Do they have right and then we would doesn't guarantee that they're on this case? So no um because they don't know out of the thousands of cases coming through which are the highest level. So, it's not a program like that per se, but it would be um that we would we still have if they don't end up on this enhanced drug case load. We have a lot of other case loads that are high-risisk supervision that will take care of the rest of them and do very good work. They might have a slightly larger case load and not have necessarily the drug testing money as an example. So, clients pay for that, but it doesn't mean that we're not doing the work that you're seeing actually in this comparison group. Okay? >> We don't have that comp. We don't have that in drug case load now. >> Okay. Thank you. Paul, you said Judge Lennon going to maybe try to come. Do you know where what her comments were or did >> she? Yeah, I was just going to see if she ended up responding. No. Um, when I did have a conversation with her and and this isn't just her. I think it's happened. Um, I do want to honor that the jud the judicial board in the state of Minnesota does have in their strategic plan that they want to stand up treatment courts like all over the state. So, I just feel like I'd be remiss if I didn't say like that piece of it. I also think that there's jurisdictions out there um that are looking at these programs to say have they um what is the word like have they exhausted their time like they were good for a certain period of time but if we're continuing to change how we do work in probation to to rise to that level do we need it or not and you can only answer that if you do a third party evaluation I'm very cautious like don't say because what you see here in Scott County it means it's happening for you that's why these things are so important but it may be something to look at as we decide how I mean again they're expensive programs good programs and you know are they good for your particular jurisdiction that would be obviously up to people to answer it feels like this program that was always the rub right high cost low pool u generally speaking but the times when you saw you know I going to the courtroom for your graduation know court was in session for um treatment court or chief in her former position, you know, at deliberal matters or whatever. Um, you could see the participants like stand a little taller because somebody was kind of coming down to their level, so to speak, and speaking life into them. So, it's like, okay, how do you do that? is that seems to be less less programmatic and more like what drives a person to do that to pour into another person. I mean there's a heart calling for that. So yeah, the program itself is like, okay, it it has some constructs where you it puts some of these things in collision path with one another, but if you don't have the heart for that or you're one cop out of any county that has that heart to do that, that to me was what was the difference there. or you'd see a judge come down from the ivory tower and speak to these folks and like whoa like wow you see something in me and you can you can hear the spine he's still a little taller but so how do we do that is this program because when did we do this workshop where we looked at those um where the numbers were like almost >> the same >> indistinguishable >> yeah they were the same at the two-year mark for sure at the one-year mark they were slightly better for treatment court but very similar again in the single digits. So, I you know, I really I agree with you. I think that the heart is is important and all those sorts of things. Um I believe I believe I hope that my agents have that because that's really why they do this work in the first place. When we do cognitive behavioral groups, for example, we do graduation ceremonies during those and I've taught those in the past and clients have the same kind of responses they do. It's an accomplishment of achieving things and programs whether it's treatment court or again these cognitive behavioral programs that really is rewarding the behavior that hopefully they want for themselves intrinsically and that we're looking for exttrinsically. Uh and I think that we're finding that meaning elsewhere as well. Again, that's why I said I think they're all good programs and we're finding similar results. Um yeah, it's a we're not usually in a situation where we're letting go of something that's good, right? like we found like this is good over here and then as we found probation is as well. So we're actually just trying to find the more cost-effective way to get the same result and that's challenging to let go of something that has been successful too. So >> we heard something this morning statement the what do we keep what do we stop doing? >> Yeah, it's always hard to stop doing something. Excellent thing for me as I look at this is this isn't stopping doing something because it wasn't effective. This is we've taken the lessons learned from there and other things about the touch points we have in our system and said no this is just how we need to operate for this entire population and that's why we're not bad in going away and something that we're also bad at doing something that doesn't maybe not us but government but we've incorporated those lessons and now we're doing that more broadly because it's no longer a pilot it's just how we operate >> and with the subject matter experts that I mean this is a group words like we always talk about if you're coming to do a job I don't know if this is goal that you would do to come job if you're trying to live out your calling yeah this is probably a group to you do that in so I coming but generally speaking around the room believers in making this move >> and it's okay to have because the next question is going to be are those you know, are those that like like I'd like to hear that too because I think it's a good it's a good conversation >> that know what we're giving up, >> right? Again, if I'm that's why I wanted to like u honor the voices that aren't in the room that I did hear. So, as an example, Lindsay Sai would say that they she was worried initially about again would these departures happen like would more people and through that conversation we don't believe that's true. Um again because the county attorney's office does this for other people. So you just present the case and work the case like you would uh normally the judges I already commented that they do have the strategic goal. So it is hard to um see something sunset when you're hearing in the background that we want you know jurisdictions to stand more of these up. I will say that when I met with Judge Weber and Judge Johnson they also looked at all the data and said but I can't argue this like this makes sense. And so like I don't think people are happy like you said it's hard to see something sunset but I would also say I mean Sam is still going to be Sam and doing the work with these folks like that doesn't change. We can still go back to court to a judge and ask for the things that we ask for in court. I can still go to law enforcement. We do now if we have a home visitor we need some help. Law enforcement has is great in general probation. Um, yes, we can explore unique other, you know, pathways to make that even stronger, but I would say that we we do some of that, maybe not formally like in treatment court, but they those those partnerships still exist. And so, um, I just want to keep doing probation work really well so that we continue these results. >> I had this question in my mind is wondering what the judges would say that we're in the ground floor. They were here vote that they would say. >> Well, I think that's what you were getting at. Judge Lennon did say like maybe they've run their course. Maybe this is maybe probation is caught up essentially to this work. >> Was one of >> Judge Wilton? Is that the other one? Well, any are we at a spot where it feels like um sure the state is saying whoever state want to stand up more of these we've sort of gone down that road and this feels like a better option better because my whole thing like big believer in you can get better outcomes with power of hope and transformation and all kinds of things talking about this now. But with the power of hope and transformation, we can get better collectively. We get better outcomes and and lower cost doing government business. Like it feels like maybe that's where we're at, which is a great place to be, which is what I think where we're trying to hope to be, right, with all the things we want to do as as a governing body in this cute little adorable Scott County. I think that's exactly what we're trying to say, right? You've asked us to run programs. We have run this program. It has shown some success. I think it has modified the way probation, some of these specialy courts operate. We have changed that operation. And we feel that these folks over here can get the same results, if not better, over time as running that type of a program, still saving millions of dollars. And so we wouldn't be here recommending it if we thought we should still be running treatment court because the board didn't say close down treatment court. We did the evaluation which you've asked us to do. You're going to see what three more of these come before you this summer on programs that >> that's great. >> So it's what you've asked us to do. Run programs, measure the outcomes, look at the data, and then make recommendations on. Great place to be. One more and again I you have to fill me in um veterans court. Why is it different? >> I don't know. Um we haven't done a third party evaluation first of all. So I think that's the unknown. We will need to do that at some point. We recently uh it may come back the same and it may be different and I don't know. we'd have to dig into like if there is a difference what that is and what makes that different than treatment court. Um so right now because we've uh more recently combined with the first judicial court we need to give it some time um to work you know to be a program for a while just like we did with treatment court and then work again that evaluation in and have similar discussions and uh depending on what we see as a result. >> When did we officially start a little year and a half ago? >> Yeah, that's what I would want to say. >> Well, we started the format where that we're at right now >> as a true court right >> well for the joint I mean we had >> like our best courts back to what 2020 >> yes with the federal grant and then yes about a year and a half with >> yes >> I just asked to understand better I'm not >> a good question >> recommendation no I think that's that's all of these programs it's important to do that evaluation we're just not ready yet, which was my hesitation. >> So, are you looking for the commissioners to stay a >> Well, just support for it. That would be our recommendation for process how we sunset it begin to some of the supports. We don't even know exactly those dollars put enough in there to it. It could even a little less could be >> is this um RBA or the U resolution for April 21st you're planning on consent or doing a short presentation >> whatever you >> I think a short presentation >> that's my bet too. I mean, it doesn't have to be the whole thing, but it just it just makes it fun. >> And the other thing I'm hearing you say is to work with law enforcement to see if there are some opportunities just probation practices, work. >> Yeah, I think we have a very good relationship as it stands. Um, and I think it would just be kind of fun to come up with some new ideas on how to kind of implement us in this process, thisation process. And it may work and it may not. Maybe we're stepping outside of our lane. You know, probation is probation. Law enforcement is law enforcement. I fully recognize that. But I think these connections are really important um and valuable for the officers that are willing to make the connections. So if there's a way to partner on on something or come up with fun creative idea, I think that ongoing conversation certainly continue. >> I agree. Absolutely. >> I do think there's a lot of that find a >> good way to do it. I mean again for much broader community and partnership. >> All right. Thank you very much. >> Thank you. >> Thank you. I'm >> well. >> Of course, I'm fine not being See, I have some documents. >> Oh, >> guys at the same time. Oh, man. They say signing your name over and over builds confidence and stressful situations. I'm going to make you very confident. >> Yeah, this is dispatch supervised everywhere to sign and then I have three copies. This is not a break but don't break. So what do we >> Nothing. >> You're signing stuff. >> I I can do more than one thing. >> Okay. >> You want to wait for Commissioner Brennan or go ahead and move forward? >> No, we'll wait. version. Someone else No, thank you. All right. >> All right. >> So, here to present on the scale feasibility study results. This was presented to the uh scale services committee a few weeks ago. Um, as part of this and the reason you're seeing at this time, we also have our health insurance renewal information. I just want to note like that is really intended for justformational and contextual purposes for this. We have the data but we haven't gone and had a formal recommendation from the employee insurance committee yet. Um and so that's still to come. So this is just moreformational purposes for them as well. So we have seen this graph before um pools trust coalitions on based on the Arthur J. Gallagher company um shows that it typically beats the medical trend overall for being in um these sorts of pools. Now, >> this triggers my thought. I'm still wanting to see the comparison. >> So, we have some of that counties. Yeah. >> Not in a graph, but in a percentage for each. >> We have that in this presentation. >> Not all the counties, but a smattering of that. >> So, the idea here is that the place where these consortiums really have the saving is that poolled claims layer here. we see where there's less insured stop-loss, there's administrative saving, professional services savings, and then our claims costs are more fixed and that variability is handled by the pool overall um within the insurance pool. So, the feasibility study results and I'm showing a little bit more detail than we have in the past because we've started to see these slides. Um, so wanted to show some apples to apples, but we have medical claims history data, prescription drug history data from all the members of the pool overall. And the total pool would experience about a 12% increase um, and their health insurance rates, but that's different based on each entity and what they would see. Our standalone calculation for Scott County without being in the pool based on this projection is this bottom number of an 8.6% 6% increase for health insurance. I will note the slides you're going to see here in a little bit when we do our renewal shows an 8.3% increase. That difference is due to some of the assumptions they made in the pool for some of the fees that you see down at the bottom. So, they don't haven't gone out to market and said, "What are the fees for this for this entire pool?" We do know exactly what our fees would be for these renewals. So, that's where you're going to see a little bit different number. Um, so it's saying we would be at 8.6% 6% and that being in the pool would be down to an 8% based on the makeup of the pool. So when we look at that for all participants, so this is all the ones that have been included in the study over here on the left. Scott County I've highlighted in yellow. Um our increase would be 8% so 6% below projected. But overall they would say in general the pool would be 6% lower than they would be without being part of the pool. And again, each entity has its own different variation based on what their specific claims data information is and their current rates. So you can see Carver has a pretty significant variance um within here. Uh Shakipy has a pretty significant one. Elco market does. Um so some of these smaller cities I will say the smaller cities data isn't as solid because they don't have the specific claims data. So that is an assumption based on their population data that they've brought in there. So I I I distracted. >> Say again what this variance means. >> The variance is what the difference between the expected increase in our claims. So if you see Scott County were highlighted here at 8%. From being in the pool with all of these participants, if we were not in the pool, their projections would have us at 8.6%. And we asked them to run a number of different analysis on this. So the next one includes everyone excluding Scott. You can see that the variance actually goes further 7.8%. What that kind of anecdotally tells me is that we're a drag on the pool a little bit. So we're benefiting more from this um because of our claimants and our claims history. >> Funny how Jordan's been such a big proponent and it looks like this isn't gonna help them very much. Interesting. And again, it's not about the one-year picture as much as the long-term trend is Carver Dakota. >> I think Carver is very interested in this >> number from what I I mean very interested in being able to pull the trigger at the time. >> I don't know about their feasibility on pulling the trigger. Um in conversations with their some of their ER folks, they have been looking at going self-insured. they actually like the idea of a pool as opposed to going self-insured because it's not just them on their own. It is a group making the decisions. Um they felt that was a better middle ground as opposed to going from fully insured to just self-insured within there. So um but specifically with their percentage change, they're I think even more interested than they were before, but this was something that they were >> definitely interested in um before we even had the feasibility results. So the next one includes Scott County but doesn't include Carver or Dakota. So we would actually under this scenario see a little bit of an increase in our rates um for the 2027 year um really those large employers again why the cities are interested helps to pull that down because there's more people to spread out that risk and those claims overall. And then we have excluding Dakota County. So Dakota County again is probably a little bit of a negative influence on this. You see that we would have a 1.5% negative variance. So less of an increase. The overall pool would be a negative 7.7%. Again, if we think of the trend and the spread risk, >> right? I know. >> And then we ran with the five cities that had said we are very interested in this. um they would still see a substantial increase a little bit higher than they're projected but a lot of these cities when you look at the number of employees that are part of this are very very small so you don't have specific claims data for them. Um the other piece that they would have to do that's different than being part of a pool like us is because they do not have a large enough population to have or number of employees to have the claims history data they would need. They would actually probably have to they could still form a pool. would have to go fully insured for a couple of years in order to get that claims data before they can transition to being self-insured uh through the pool. So, the next piece is the history. So, we p had a 10-year history. So, we have Dakota, Carver, Washington, Scott. As we were trying to pull this and we were a little bit late to the game, so apologies, Commissioner. A lot of people were on spring break. Um, and so it took a little bit to get that information. You can see Dakota, who is self-insured as well, has averaged about 6.6%. Carver County, you can see the wide variability that they've had their rates going up 11.5% downg%. Down 15%, up 12%, but their his average over that time period is about 5.4%. Washington County has been about 6.1% and ours has been 5.2%. um didn't get 2015 data for all of these. Washington had 2015 data and then we have our 2015 data. If we had included ours, our actual increase would be closer to 6% on average because in 2015 we had a 20% increase in our health insurance rates. Um so again depending on the time frame you pick the year it impacts that and then we normalize this data as well. Um, so again, doing that starting at 100 and applying the percentage increase over that 10-year period, um, you can see we actually have not had the same kind of trajectory of increases there for quite a few of these years um, the last few years. And we've seen that in our 11 and 13%. We've kind of crept up as some of the others kind of had a little bit of a spike down um, with Dakota and Scott being the two that are uh, self-insured here. Can >> you go back? Yeah, I was just curious and see the last five. >> Yeah, the last five years went way different for us in the first part of this grant. >> We had a stable period there for a little bit. And we'll get into this a little bit with our health insurance renewal. One of the biggest drivers for us is not just our straight claims data that the pool is paying. It is our stop-loss coverage. And that's where that pool has that pulled kind of insurance claim that allows for a bigger stop-loss coverage within there >> bigger stops. >> So it's going to So when you have this pooling, yeah, >> you have a bigger stop loss then because you have a larger pool and the pool can handle a lot more of those large claimments. We're even looking at that as part of our renewal of where do we need to be and what's that bad? But that pool then is handling more of those high-cost claimments as a group um as opposed to us being a smaller number. So again, we have eight that's a large number of claimments that are high cost for us. That's not as big when you're in a pool with say a Carver Dakota County. Um but the pool's handling it and our rigs are more stable as opposed to it being handled. So is somebody able to analyze on ours what ours experience would have been if we would have had a stop loss that was say it's 250 is it >> 225 >> 225 >> it was say 400 >> and we'll get to that as the next part of the presentation we have some >> any other questions on this one. So again, the impact. We've talked about this quite a bit, so I won't delay on it too much. And then there's the timeline. Um, we probably need to be having a final decision of where we're going to go in early May, um, on what this will look like for us. Right now, our plan for finalizing the JPA and the bylaws is we're moving forward without feedback from the Department of Commerce on this. So, um, talked to or got in contact with our attorney on this and she's like, "I'm not hearing anything back from the Department of Commerce. The previous contacts I have are no longer there. No one's made in the shop. My recommendation would be move forward with it." So, with that being said, we Pratt was going to carry some uh bill with the language. Didn't need to. Well, >> there was other pieces, but the attorney from the Senate and the revisor said we didn't need that if we had it in the JPA language. That's the part I would like to see how we firm up as the JPA language over that pool language. But when you get to the DOC rules, >> right? So because we don't want to get bamboo by rule making and so >> but the other part they are part >> there is still a bill >> right does seem to me along the way that uh changes of information you know that uh I is that you feel that too? >> Well, so from Gallagher, I don't feel like we've had a lot of change in information. So, we went into this. >> Well, there's been changing people, but what we're talking about with the legal side is there's been two insurance pools set up in the state of Minnesota under the statute that we're doing. And Darcy Heightsman has set them both up. And so we've been working with her and we've reached out because a little bit of silence there of like who else does this and she is the person that does this. And so she came in and said this is the rule. This is the issue we need to get around. That's what helped us to draft the statute. She helped us draft that language and that's what we heard back from the Senate and the reviser. You don't need this statutory change. And so again, when there's only two though, how much has been pushed on this? So Gallagher I think the discipline was maybe at the scale meeting because they did advise us the small cities they would have that which they clearly did. They didn't even show that example and then it was that the cities before could pool even if you were under a thousand employees but they would have to go fully insured pool and then go out after a couple years. I don't think that was clear at all in December or January, whenever that meeting was to the city. So that was a change I thought by Gallagher in the recent meeting we saw than I think what people expected at that. >> I think that some of the detail they showed was different than what we had asked for. >> Some you're you're right. That was a little >> The two pools that are in Minnesota, what's what's how old are they? >> I don't have a lot of We reached out to them. Are they glad they did it? Is it >> one is a pool under this that is for it's like a farming cooperative >> underneath it and I don't know what the other one is that's organized under the statute. I don't know if >> I hear mixed reviews. I just so I I I didn't talk to them with them. But yeah, I hear mixed reviews on the results of pools. And a lot of it comes down to what I think we've seen in other collaboratives where people want to make calls and ultimately the pool makes the call and people are upset because they have strong feelings on whatever the issue was that they wanted to. And then Darcy did make the comment early on that it depends. She has one pool that works really well and one that doesn't comes back to the governance body and their commitment to having meetings and talking about insurance and pooling where for one that I think was the farm cooperative one doesn't work as well because they just don't meet enough and they aren't engaged enough in the topic to make it go. So one question you know we've had early on was giving up >> and so then we talked about voting if we go to Carver Dakota that's going to completely uh >> change that control issue the first uh so you know the control issue becomes even more so a question we're So the language we've been using for kind of had a couple of different options. I more think one that's more sustainable in the future is the way to go. But it basically says based on the number of participants you have in the pool, nobody can have more than 40% share in that pool and it's distributed by that share. So if it was the small cities and then us and a Carver, say we probably have a pretty equal voting share in the pool between us and Carver and it would probably be more than 50% combined. But the cities would still have one vote. If it was a KOD, yeah, that constantly change um where that control would be. The only thing though with these numbers, I mean, pools need numbers, right? Numbers drive these pools, right? You got a car, right? Yes. Um potentially both short long term. One or both of those, that's when we start to see some real savings. And so that's what I like that if we could get Carver, which it feels like that's a compelling number. Um, if I'm them, which I'm not. Yep. Scarbor. Um, and then you put the code in there because what was that? 2,000 bodies. >> Yeah, that's a substantial. >> Carver was like for some reason a little under us. I'm not sure how they were using those numbers, but employees. But regardless, having those two pools of folks in this I yeah the weighted voting which is the government's thing I brought up way back when yeah we might not have the same weight or whatever but the savings ultimately what we're after. Well, the savings is important, but I think Lori hit on to it is that people are engaged, want to be engaged with insurance, understand it what it provides and how important it is to families and the organization, right? So, it's great if Dakota has a couple votes, but people that engage in it, they need to care and want to participate. We have to have those meetings the way we historically have. I think that's a really important part as I've tried to listen to all of this that you have engaged people that want to be there and then that's why then ultimately they have to make those decisions just like joint powers right or that pool and how it's going to operate understanding in the background the form organization as well and how that is going to operate within it. So, I don't know, Commissioner Bear, that I would count on Dakota. I think Carver is a much more likely based on what I think they heard and what where they are in their things. Dakota could be a long longer term partner. I don't know that, but I would not count on them to come in in 2027. Um, I think Harbor has been planning and looking at this carefully and then passed away. Do they want to be in a more merged pool or do they want to be in I think the other thing we need to remember in this process is it's important to look at all the history and to think about that that control and what we're doing. But I think we're we're we're our heads are in the sand if we think health insurance is going to look in any way like it looks now in 10 years. >> So we should not be making a decision about what health insurance has looked like in the next 10 years. It may even be in the next five years. There's systems imploding. There will not be the same options in health insurance that there were 10 years ago. They're within a couple years those are going to be gone. So I I think it's important to think of that history and the control and operating. In some ways, I'm sitting here going, I'd love it to be a pool because we say the pool decides. Sorry, this is, you know, um you're making a decision for a much bigger group and not having to try to go down a rabbit hole for one union negotiation or something like that. Like there there is some differences there. But I think we have to remember health insurance as we know it is almost done. >> It has to change. >> Well, it's almost done. Yeah, >> but that's where again I'll pull out Lory's. You need the people that you want partners that you know are going to engage in this because >> it can very quickly all of a sudden be how did we end up at this decision without people that are truly trying to understand and know what the issues are within this and debate it and have the conversations like because it's so important to employees and the impacts of them. And so that's where even with the Dakota end, I think Dakota would be a good partner in this for the long term, but it wouldn't just be something that we want anybody to join because then it's just about cost for them and not about making sure that we're having a good benefit for the employees and doing a good job of understanding the pieces of it. >> Sure. But but this current pool, there's a lot of likemindedness there, >> right? It's not like we have a for-profit business, a government, you know, co-op or Well, that's what they say the benefit of is you have to have likeminded businesses and those same type of things. >> And I mean, when you look at Carver, the thing I and I don't know, maybe I'm wrong, but it sure looks like Carver gets a negative on their bid and then it spikes like in their second or third year, then gets a reduction in the next bid and then it's it kind of seemed to reflect that a little bit. So, I think they are interested, right? And that would help stabilize, which is one of the things you see different when I look at it between ours and Dakotas. It seemed more stable. >> And that's actually one of the comments we heard from some of the cities is like it wasn't all about the price. Although that was important. It was that stability for planning. It's not this huge jump, this huge decline, and all of a sudden you're trying to build a budget and people are trying to build their finances on am I going to be up 15% next year? Am I going to be down 17%? budget, but being able to budget having that ability is huge. But that trend line that Gallagher showed us and saw it again. All of those lines were below assuming that trend line is as accurate as it can be, which I'm guessing it is. Knowing healthcare on this trajectory is nothing nuts about this. The macro side of this it has to change. Has to change. But between now and then having even just a carver, no makes makes a big difference. >> So having massive change doesn't inform me whether the pool is a good idea or not. It's uncertainty. That's it. Doesn't direct us one direction. I mean, our pool has had a great track record. I mean, our self insurance that we have had has had a great track record comparatively. Um, we do better than that with massive change. I don't know. I think it's two pieces. One, it's going to help spread out the risk, right? That's always the piece of having the larger risk pool is that that risk if we have a hard large number of claimments one year it doesn't necessarily mean like a Dakota a Carver or the cities would have large claimments. So it spreads out that risk a little bit more and so the trend is going to decline some from where it currently is but whether it's with us or we're still going to have those same risks of the changing market. You know, this reminds me a little bit, it's going to sound crazy of jail practices and change like one thing with the judges. If they have a much more hardcore, we're going to put in prison. It changes the jail population. So, change a couple pieces of things and it affects the outcome. So, okay. I'm wondering cities typically hire young people and then they turn over and they keep hiring young people or do they stay savages turn over crazy still is the county more stable and we have higher claims because of longer potential employees older employees >> I don't know you know the practices of pool members it's Go to >> I agree. Jeff had a comment that I'd also look do we know any data on comparisons for cities tenure of employee versus counties? >> Not ready to hand. Uh certainly something all for resources but that was not something we prepared for. >> Yeah, I raised my hand a while ago and I accumulated a few thanks that I just wanted to rattle off uh for the group. Uh the first I I should uh uh speak on the record. uh commissioner working you mentioned the benefit of the pool would be that the pool decides that would not be entirely correct right you would still have an employee insurance committee certain aspects we have collective bargaining agreements that reference that in employee insurance committee so there would still be an operation for that and a touch point with the union which is a positive thing um and that that is also something a needle that needs to be thread as we discussed with them because again as we have been informed by outside council and I will inform you as well um this is an issue that would be a mandatory subject of bargaining. If the disgruntled union were to follow an unfair labor practice or grievances, they could enjoin things, slow things down. Um there's also the other an aspect under the statute. If this is deemed to be a dissolution of something, the largest uh collective bargaining group, ID, ASME, has a vote um in whether or not an insurance self-insured fund is dissolved. Um so again other things the other thing that I would say and I do this to the annoyance of my friends and family constantly right but you know things can be argued from two sides right the larger the entity and the more dispersed decision-m is the less nimble it is in a changing environment I've spent the majority of my career it's almost 5050 between public sector and healthcare uh health insurance the HR director for a health insurance company for three years um that is important and the ability to change and make changes the plan design etc. which perhaps becomes more difficult if decision-m is is dispersed. The last thing that I will say again from my experience as an HR director insurance company with 500,000 members we were hellbent for several years back in the in the teens uh 2012 to 2014 to grow the size from 500,000 members to a million members. Uh several consultants told us the projections would uh eliminate my health my public sector uh uh health city health hospitals corporations $200 million yearly and we were in the red that would correct that. It would fix everything. All we had to do is expand the pool. We couldn't expand the pool. We could only find sick people who made things less like you have to grow the right way. You have to grow with the right populations. You can add 2,000 members, but if there is a rash of something or other, that ceases to be beneficial. This is it. These are just all things to be aware of. And I just heard three commissioners mention the changing nature of healthcare and the need to be live and nimble. I think that one needs to kind of look at that that fact from the opposite angle. It's just again it can be um we could we could gain stability and size at the loss of nimleness and ability to adjust to a changing market. Those are my three points. I'm sorry. I collected them over a while. I talked too long. So, >> you made it really clear what we should do. >> He's an attorney. That's what they do. They go, you can do this or you can do >> I seek only to give you tools to make decisions. I don't try I try not to make primitive decisions. >> All right. So, that's the update on the feasibility study that we'll have to come to some recommendation on in May. If I'm understand >> the next staff recommendation about for internet is that >> I think that would work session. We would come back with a recommendation based on I think we still have questions data and then this is your health insurance renewal. So this feeds into it as well. >> No. So don't plan on work on those numbers that you just had up there. won't be here for cities. >> How come some such a big range,000 per >> put that thing up there? >> He wants to go back to the total cost what the actual premium is and you and I had done some research on that. We all >> do they offer different things? >> Yes, >> it depends what you and all those different >> all of there you go. So like Dakota, if you take that number, >> yeah, >> 44761, the current premium divide by two, we're at 22,000. Uh, El Market is that same 25727. So that goes back, if you remember our last presentation on this where we looked at some of the different counties and what their costs were for insurance. It's a I mean, we were kind of in the middle. There are some lower and some higher, but it all has to do with those plan designs that we talk about, right? >> Which you still have some control over that was 135. >> They're not interested. >> They should. >> Yeah, they have a good deal going. Well, they it all depends how you look at it >> because if they're set up if they're on a high deductible plan with a 5,000 individual, 10,000 family and they don't contribute anything into that HSA, their rates could be significantly lower per person, >> which could lead to turnover. >> It also could lead to nobody's taking family coverage and so they're just on single employees and some of those things as well. So this is the type of conversation like that worries me because this is a long game and Gallagher has but long game six to 10 years and if if organizations that are trying to get in to save money which we want to but with the health care market changing so much like they're talking about gene therapies we've got GLP1s like things are really driving cost we're going going to see volatility no matter what we do. Um, and I just worry again, you have to want to do the long game insurance pool for the savings and the lower trend line more importantly than anything else. And I just agree because there there's going to be volatility as we go into this. And there's some conversations that because we've been self-insured for a while, we know how to say no to some things that fully insured haven't had to. they've had an insurance company say, "No, we're not going to cover X, Y, or Z." And we need to have our partners as we go into the pool be as willing as we would be to say no and the reasons why for the health of the and the good of the pool. So, it's some of those things that are the nuanced challenges as we look at this and try to help make recommendation towards what's the best to do. But along along those same lines, I think was sitting in the little conference room at the time were um a year or two or three or four ago ones were the big big deal. Um and so I've always used that example in this conversation of okay the pool one pool shallow end deep end kitty pool I probably the wrong but different still wet different differences so in this pool that we're talking about I've always heard these service delivery and things like this that oh well this city could have x in the pool. This city could have Y in the pool. >> That place could have elemental P. That's still in the pool. >> That's in terms of some of the plan designs. >> Well, but I wanted but I always use GLP1 or formulary or things like that as a as a opt in or opt out or because whatever the next new thing is, right? Because now those down, but there's always going to be something. This is one where I don't want to say I'm speaking out of turn, but the details of it I don't have as much of a grasp on. So if you're talking about like a side plan for GLP1s, that would be like this separal kind of addendum to it that they would have to do and I don't know if the cost feasibility is there to ever do something like that. It's an option and Darcy kind of spoke to that. You can do a lot of these side kind of insurance things but it still has to be under the opaces. may not be covered by the pool and it may not be cost like it may become cost primitive to do those sorts of things. Well, that was the big question is not um if we've said no to GLP1 just because it was the example of the day given day and um if we were like no we're not doing that would in this pool in this environment would we because we're no more than 40% or whatever the language is going to say potentially be outvoted by multiple cities in another county% >> I actually even if we even if we have our own plan and there's been talk about these other plans and individuality. I'm actually more concerned the other way honestly with this group that they're going to do everything to save a buck and not do things that we're going in our experience. This is something we should be covering for our employees. This is something that we hear from the employee insurance committee that it's a benefit that we can work in this way or that is the way I'd be more concerned on that. I'm gonna use expression hurting cats and I the RTF gota tell like hurting cats and I like nimble I like having control I don't like hurting cats I like the yes or no to something the only and I understand because it's been a little bit hurting cats every once in a while here. This has a mechanism to say well it doesn't matter if you don't here's how much your premium is increasing and if you want to have a discussion understanding of it you need to make it to the meetings and you need to understand where it's coming from where RTF just kind of always gets to say no you have to have these premiums you have to pay or else you're not going to have insurance for your employees and for all >> these So, so this will have a structural mechanism to avoid this relations are relations, right? Um, humans are humans, people come this JPA still JPA without necessarily having uh legislated language that eventually will have that kind of mechanism to avoid that very issue. If they join, they are bound by the rates established by the pool and they can say we're not paying period and we kick them out of the pool and they're still obligated to pay for their claims under the agreement. It's a contractual relationship and they're I mean this is the worst case scenario, but we'd be in a lawsuit saying no, you have to pay up. >> Okay, so that covers that piece. I'm still going to come back. kind of like look at you with with using the GLP1 again example and all of the customizable plans that each entity could have really isn't case they can have them but I don't know the exact specifics of the mechanisms that they use to get them is what I'm saying so when we're having our plan and we go through this and looking to people that can help me out if I misspeak on this like there is a list that our um health partners equivalent would give us of these are the things that we are changing in our health insurance policies for fully insured plans and these are the ones that Scott County has the option of you can join this or you cannot join us this year it's usually what five six a year that we look at under those >> now that's is that just formulary for >> just it's not just formulary but this is where do you want want to cover weight loss medication or no? And we get the information that nobody's covering this. And for the most part, that has guided us unless we have a specific case of nope, this is something we've discussed in the past or we have a lot of people utilizing or something like that. Um the GLP1s kind of came as a surprise because we didn't realize we were covering it the first time uh when we were looking at it. We knew we were covering weight loss medication. In the middle of our plan year, it got approved as a weight loss medication. So we were automatically covering it, but that was from like September to December 31st that all the health insurance providers were covering it. So a few months and then they terminated it. Well, we had just started our plan year and we're getting this renewal information and going, "Okay, that's where it became a bigger discussion because we're going to cover people for most of a year under this drug and then tell them no, we're getting rid of it." But that would be one that the insurance pool would make the call on on that and they have to be responsible to the pool, the health of the pool overall in their decision similar to how we were trying to be responsible to the business of the organization and going we can't afford this. It was so new that we couldn't get cost estimates for it. So, we were doing our own cost projections. They were scary. I remember those, too. >> All right. Any other questions on that? Comments? >> Keep going, you guys. Right. So, this is our 2026 health insurance rule. As I said before, this is moreformational. Invite discussion and questions and what you'd like to see for the next recommendation that'll come from the employee insurance committee. Again, showing a little bit more detail because you all have started to see a lot more detail in the last couple of years, especially around stop loss and what some of that means. Um, one thing that's going to be different in here that we haven't seen before is that you're going to see 12 month renewal and five month renewal here. So, one of the things we're very very seriously considering is adding a health uh savings account plan, high deductible and HSA plan. Um, when we do that though, we'd like to move our insurance from a 81 renewal to a one uh plan year. So, we' be on a calendar plan year, more typical. That's what that fivemon renewal is. We have to do a renewal within 12 months of every plan year. So, we have to do a short-term renewal and then we'd have another renewal there. This is the piece that we haven't sat down with the employee insurance committee and said this is what the recommendation is going to be. That should happen here in April, I think. >> Yeah, we have to do that. >> Um, so that's where this kind of piece at sees and you'll see it in there like why does it say five month and what it's coming back and forth with. Has the eight always been a thing? Like I mean it's been that way since I've been here but >> it's always like a wait did I burn it up? Do I >> I don't even know what year happened. It was before 1997. There's always been plan decision made in the past. >> That'll be good to clear that up. I mean, for all kinds of reasons. >> It will. >> So, this is looking at our claims. So, I'm showing two pieces of claims. So, this is our 24th through 25 claims year. Um, and if you look at that bottom right column, that is our loss ratio. We want that number to be below 100. And that means that on our actual claims that we're paying out, we are spending less than we had planned for. So for the last entire plan year, we were at 92.2% of our expected claim. So that's good. We want to be less. And then if we look at the next year, what is going on? This shows our information through so far this year. So you believe it's through uh January, so you don't see February through July. And again, we're showing a trend of it being at 93%. And so when Gallagher is putting together these numbers, they actually have weights to this is how much we've seen in this year. And then this is how much weight is given to last year in order to do our claims projection going forward. It keeps I'm so sorry. I don't know why this keeps skipping back. >> You can share mine. But one of the big drivers for us is our stop-loss coverage. So this is again going back a claims year. Um you can see the gross claim amount of 3.4 almost $5 million from seven claimants within there for our last plan year which are amount over the $225,000 individual stop-loss. That's the amount that each individual the plan has to pay for up to $225,000. And then we have our reinsurance was uh $1.88 million. Our premium that we paid was only $1.16 million. So the insurance carrier is losing on us and so we saw a significant increase to our stop-loss coverage. You look at this year so far, it's not to that level yet, but we're also at the part of the plan year that we're covering most of the costs. The later in the plan year, the insurance ends up covering more and more of the cost because you start accumulating more and more expense. So on their projections, they are going to be a loser again on our stop-loss claims. >> Danny, last year, do we know after March how many had already exceeded? Was it about three just like this year? I'd have to go back and look >> about the same. So, you would expect kind of that same range. >> Yeah, they are. They already have them in the pipeline. You might have them. >> Okay. >> I don't have the ones that are close on my data. That's one. >> We're going to be >> If you have an older employee that's on Medicare, what how does that affect? >> I would have to get the details on if they're on Medicare but they're still taking our insurance coverage. It depends on which insurance is getting hit first and how much they're covering up to. >> Medicare is first for us and secondary if they >> so if something wasn't covered with Medicare then it would come to ours. >> This shows our reserves within our health insurance fund. Um, so we have just a little bit over $10 million in reserves. Um, and that equates to about 7.8 months of coverage. That varies throughout the course of the year. We've always tried to kind of target that six months of coverage. Um, maybe be a little bit above. Um, these last couple of years have helped out with the claims being low, but that's where we're seeing these stop-loss increases from us always being quote unquote the winner um, on the coverage. So as we look at our health insurance renewal so healthy as we're >> yes in general we're healthy as a pool but we do have the high cost claimments that are expensive. So this shows a fiveyear history of our stop loss and if you look in that first year our premiums paid were $886,000 and the stop-loss reimbursement we got was $490,000. So the county fiscally, not in terms of because we didn't have as many high-c cost claimments, which is a good thing. We lost, right? The insurance company made money on us that year. But then you start looking at these next couple of years and we paid $815,000 in stop-loss and they paid out 1.14 million. Then we paid $900,000 in stop- loss and they paid out 1.23 million. Then we played $1.2 million in stop loss almost and they paid out 1.88 million. So, they have been a loser in the last few years um and have been increasing our stop-loss coverage because of that. And that is a major major driver of our health insurance increases right now. >> And their look back window is three years. So, now we have three bad years. >> Yeah. We don't have a year to offset. So, we're gonna go up. >> So, we used to have not that I ever participated, but employee wellness big. Yeah. through wellness and then also through our health insurance provider and this is one that I don't know as much detail. We do things like um disease management and stuff where our health insurance providers actually reaching out to make sure people are on their medication if there's something coming up making sure they're getting to their doctor and some of those things so that we don't have people that are sick not doing anything and then having to come back and it cost us more as opposed to the disease management side of things. >> You'll see people down in our workout room if you walk through there as part of it. We offer day will be coming up. I'm assuming next month we do things in October. We now have our little winter weather thing where you see people down there doing a few things act. So we're trying to promote those types of activities and and people we you'll see wellness posts come out about things you can >> pick. Yep. Nice court. Yeah, it works well. So okay some I don't know what the health club reimbursement is you know people they go x amount of times they get or something what is that and why have we never done >> we've debated it multiple times at the insurance committee but it's a cost to to do that and like like some other types of coverage we've chosen not to supplement a small subset who like to go to a club um across the whole membership so it's been an insurance committee discussion and we have determined not to do it as a >> my recollection is also it doesn't pay for itself typically we don't see a significant change in health quality from doing something like that >> I think many places have stopped doing it because they didn't see >> you were correct many places have stopped doing it many many plants have stopped offering it what they offer is stripped down now in the last two rounds of bargaining to unions the human service supervisors and ASME have specifically brought up or attempted to bargain some kind of wellness credit directly with us. Like if we if somebody shows me that they went to the gym x amount of times, I'll give them back money. I'll never agree to that. Um that new language, but in those conversations, they have opined that something that I I don't know if it was one of the something that was discussed at the EIC, but like orange theory fitness and you get that much back. That's unacceptable. They would like a bigger, more robust rewards plan and it doesn't exist. It's not something that's in the market that we could give them. So, it's a product that is falling that is disappearing from the market. I think in part because it what you have is not giving you a robust benefit necessarily. It's become the sort of sideshow which is a shame because you know when I was a director for a health insurance company we gave everybody Fitbits and there was walk-in and it felt like we were making people healthier but it has not survived the market. And I'll tell you, if you go downstairs, there's nice equipment down there and the people that use it really like it. >> What we're doing doing here directly, I think, is a far better way again to try to engage employees, get people voluntarily to come to a building, collaborate, see people, etc. Far better than a program run by a third party to give back rebates that doesn't appreciably reduce our costs or or increase outcomes. But that's just why. >> And also Les is a great pickle ball coach. >> Can enter. >> Yes. Surgery. >> Knock on wood. All right. >> So, this number right here for our 12 month renewal, that 853,000 right above that red box and 50% is the increase for our stop loss that we have quoted for our 12 year 12-month renewal right now. So, this part of it I'm trying to show apples to apples what we typically would see. the five-month renewal gets a whole lot wonkier um and isn't as good on the apples to apples comparison. >> And this is at the two and a >> Yeah, at 225. >> Yeah. >> And then this one just real brief to remind you this is our aggregate stop-loss marketing. Do not look at that 591,000. That is what we have to get to before aggregate stop loss kicked in. we're only seeing a $2,200 increase in the aggregate stop loss. Um, but I show this to keep in mind that as we because I said I have asked the question, what if we went to $700,000 or whatever, like going crazy with our individual stop-loss, you see that flipped around on your aggregate stop-loss then, right? So, you're not taking as much on the individual, you're taking more on the aggregate. And so, because of where we're at, so that'll shift. It probably wouldn't be a loser for us if we increase that stop loss, but going to 500 to 600,000 does not mean that that aggregate is going to stay low. It's going to start making up for itself on that side of it. We did look at stop-loss. So, this is not quotes going forward, but this is to show what we would have had historically if we had had a higher stop-loss rate. So if we had just gone up to $250,000 in specific stop-loss in 2425, we would have had $111,000 in savings, 77,000 the year before, 188 172 $178,000 in savings from the premiums versus what we would have had to claim. So you can see the premium savings over here in this uh left column next to the year, the additional exposure that we would have had to pay for out of this and the cost and savings. So number of claimments that would have been within that band one each year really and the number of claimments that would still be over. Um our premium still would have gone up each year because there would have been probably losers. We probably would have been losers in the financial side but that's what the savings estimate would be. Next one down below goes to $275,000 specific stop-loss. Again see savings in the more recent years we'd be picking up more of it but in the past years we would have had more savings on that. And then again going up to a $300,000 specific stop loss, we would see $700,000 in savings, but we would have been picking up $451,000 of cost. I do want to continue going down this path though because I do think there are some savings there. We have a healthy fund balance. Um, we need to play with that and have more debate and discussion on it. But we have been asking for we need specific stop-loss increases. >> How many months are we at right now? >> 7. I just showed it. Six is our target. >> Six is our target. Now, some of that may be what do we do for these five months? Because if we don't want to do two increases, do an increase and another increase, we'd have to use some fund balance. That's the piece we haven't talked enough about, though. >> So, why do we you five or six is our goal? >> Six. >> Six. And then in this pool, we're saying three. Why us six now and saying all partners three. >> So we have always been higher. Gallagher says that we don't need you know three months is enough for premiums to come in um and cover the payments as more premiums are coming in because of the delay in billing. We like the flexibility of being able to say hey we are ready to take either a little bit more risk in this year and not be as high as Gallagher's saying. And this is to some extent art night s science. If you look at um Health Partners renewal projection for us, they were at something like 7.6% and Gallagher was at 9.94% for what their our expected claims were for next year. And we're kind of sitting in the middle of that at that 8.3% where it's at. We have gone lower than Gallagher before in the past. We're saying no, we have enough fund balance. you're inflating the trend more than we think it needs to with health partners saying this and we have enough fund balance to take a little bit more risk of that without taking a huge risk and we've done that in years before >> we've done that consistent >> lower than they said and we've stayed that six months despite them saying go lower that's just been what our committee and style has been and it's worked for us >> and it's worked for us because we got a scare one year so having it at six months was a good So based on what you know right now, you just if we didn't change it, what would you change instead? >> I would be looking at going up to $300,000. I mean, that's my gut on this. I asked for this information on my own outside of the group. I had to miss our last meeting. So Bory and Jeff and Janelle haven't had a chance to weigh on it. So, this is just Danny speaking, not the wisdom of the group, which there's a lot more wisdom in that group than you get from me, those individuals, a lot more history on it. But, um, we've done it in the past. When I first got here, we increased our stop loss by 75,000, 100,000 um, and it helped us for and we overpaid for a few years and then it's been helping us again. We're seeing those stop-loss increases go up and up and up. We take on more risk and handle those smaller claimments. Um, but when we get those million-dollar claimments, the pool is still or the uh reinsurance is still covering it. >> Will you ever go crazy and go to 400 or 500? >> That's the piece that I've never had a good enough handle on. What is that going to do to our aggregate average? Because >> you looked at all those claims that there's got to be equation. >> There is, but the aggregate stop loss is the piece that I don't know how to do the equation on. So the aggregate is looking at a pool, okay, if we go up to 500,000 and we have 10 claimants in there, our aggregate is going to go through the roof in there. But if we only have one or two claimments, it's going to be that individual that's hit. >> Yeah. So that's what we're asking for more because I always think you lose when you buy insurance somehow or another, right? >> Yes. the big X factor and Lori alluded to it earlier, these gene therapies that are out there where if we have six people on that gene therapy and those are a million dollars a pop. That's $6 million hit to our plan. If we have a really high stop loss and these gene therapies are starting to come in, we're going to see that turned around our aggregate going, you're blowing through your aggregate coverage every year. You have to take on more of this risk. Yeah, that you do lose on insurance and it's designed that way >> because you need it to handle the big spikes in those years that you would otherwise lose on. >> Members Gallagher said they want the stop loss providers want 85%. >> I thought it was 70%. >> Thought it was 85. Anyway, they want a much lower number than to us as the other part of that equation. So this is just looking at the number of claimments we had in there. So if you look back to 2122, we had five claimments that uh were over that stop loss a couple by not a ton of money. 22 to 23, we had four. 23 to 24 though. And this is when Lory's talking about that three-year look back. We had a lot of people. And this is where we increase that stop loss. We're taking it several times versus these couple of years here. we're not going to hit as many times because it's just one person hitting within that band, not as many people. >> So if we moved it to 400,000 that 23 to 24, we would have only had four people five people collect, right? >> If for 23 24 we would have had one. >> Wait, >> oh 400,000. Sorry. >> 400. Yeah. So we moved it to 400. If you add all those up, so you'd have 200 300,000, how much less would our premium go to and then the difference between those other ones? >> I don't know the amount for 400,000. I'm guessing our stop loss premium would go down by another couple hundred,000 going up that high, but it's that risk. Then >> go almost down by half. >> I don't know. The other piece of that though is our aggregate stop loss is going to go up because we have the number of claimants that now are hitting our pool that we might be above that 20% increase on it. This is the break even analysis that Gallagher is helping us with. >> So you're going to Yeah, they're going to give us quotes for these numbers that we're looking at. um they are probably I'd say more risk averse than I think I am and Commissioner Wolf over there is probably more in line with the rest of our ER team that is a little less risk averse um based on where we at and that's where we find that mesh and really have the insurance committee but >> so do you think 300 represents the best >> well if you look at Gallagher they're just going up by $25,000 increments I think I would like I would at least like to see numbers at four and 500,000 like Commissioner Wolf's saying to say what is this I don't think we should go there that is too big of a bite for us to do in just one jump >> I think 300,000 we do want to hit that looks like >> the reason I want to go that high though is not to actually go there I want to see what it does to our aggregate so that when you talk about this math that we can kind of do on our own can see where that middle point And that may just be more of my nerdy exercise in trying to figure out the math behind the stuff than actual value. So >> we replace the retirees on our insurance be great if we could do that. I mean that was the goal right to that place. >> Yeah. >> Thank you. >> Well I mean that was the goal. I wasn't there for the discussion. So, were you there or sorry? >> No, I got No. >> Okay. >> They don't even want me there. >> That's just if if those seats are remaining, it just be good to have somebody in them. If they're those seats are gone, that's great. >> So, just gone and uh >> Jenny's gone. >> Yeah. Who else is gone? Three. Oh, there were two. >> And do we need them back or >> I think that was always the intention >> or something to represent those >> just for bringing maybe the newer retirees that were >> want those two guys back. I'm just asking I because they're going to wonder was a term thing and thing. >> So no and that's what I explained was that we're looking at getting insurance. >> I'm just wondering >> well we talk about retiring insurance at the insurance committee. Um so we do have the right retire plan because under statute if you retire from county you can stay on the plan. So, we we have that >> what am I trying to say? The um the supplemental plan, a supplemental plan or we have people who still qualify to have us pay for insurance based how long they were here, >> right, >> previous years. So, we still have that group too that's interested in. >> So, you want somebody on that plan and then you want somebody who's more a cobra or supplement person, >> right? Well, both them of them represented one was Medicare enrolled and on one of the advantage plans or supplemental plans and then the other was um you know both being 100% county contribution to the plans. Um the other was um Medicare rule but still on our open access based plan. So we do have a good amount of money still on which is our active Yes, we will actively look to replace them. I I think there was some debate in previous insurance committees about sometimes they dominate the conversation and current employees felt like we want more say in what we're paying for and what we're working for. So that that was some of it but again we committed to re to have them represented because they are part of our >> yeah we we we also wanted some folks who might be a little bit closer in time to employment um having been on a board like that a long time what sometimes happens uh right it becomes a lot about the history of what's happened over the last 15 years and not necessarily what's happening in the market right now that is not a comment on first right >> I totally support that in all our groups I Right. >> All right. What else? >> So this is showing like I said that fivemon renewal. So this shows about a 4.2% increase is what Gallagher's recommendation is. So you see expected claims trend. Gallagher is at the 9.9% health partners at 7.6%. This is where Scott County threads the needle and figures out what we are comfortable with. Um, >> this is the comparison renewal though that I wanted to show. So, this is that 8.3% down at the bottom. Again, the reason this shows different than the trend that we saw for the feasibility study is because one, it's 1127. The other is because it's using the same claims data. all of these fees that we have actually locked in information on that for the pool they're doing an estimation of these are what the claims are going to be. So that'd be the difference in why you're seeing that. Um because this I was sitting in the presentation to scale going back and forth and trying to understand why these numbers were different. Um so that's the reason why but the big thing is what is it going to be for employers or employees? Um, but one thing to be considering, I'm kind of one thing to take away and plant in your brain about considerations for the next conversation. So, this one shows our base year for current plan estimated base plan renewal at a 4.2% increase. Again, we need to figure out where we're going to land in recommendations for this. But a decision that will be coming up if we go down the path of having an HSA and a high deductible qualified health plan is what that impact is going to be and what are the levels we want to set it at. So this shows a couple of different scenarios. Um we need to work up different scenarios for decision making on this. It shows a 34 uh individual 6800 family plan um and what the impact would be of that. >> So will you go back and explain again what is our insurance? >> Yep. So we have a traditional health insurance plan. It has an out-of- pocket deductible. It has co-pays but that deductible is pretty low within there. What an HSA is, it's a health savings account, which actually isn't really the plan. The plan is a qualified highdeductible health insurance plan. And so that means when you have a health insurance plan that meets certain qualifications and has a high enough deductible that you are eligible to use a health savings account to set money aside to pay for uh those years when you have higher out-ofpocket costs than you do in a typical year. When you switch to those, typically the premiums are a decent amount lower what they than what they were on a traditional plan. But the idea is that you reinvest some of those savings, especially for an individual into that health savings account. The other incentives with that is those health savings accounts are portable. So they don't it's not a Scott County one like some of the other things. They can't move around anywhere. Um they also if you can invest up to the cap of those but they can be used in retirement as a retirement vehicle as well within there. >> So different than our health savings account now which is only when you retire or leave the organization. >> This is for HCSP or this is a different >> Yep. >> program right. This goes anywhere. But yeah, >> it's your personal savings account to spend towards their cost. >> And you you still get your um checkups, right? Covered just like you would on your normal account. Your preventive care is still covered. >> Care is covered, but but everything else out of your pocket until you hit your deductible max depending on the plan type. So that's where there's a it feels like more of a hit to people because they're paying because they're blind to their premiums that just come out of their paycheck, but every time they go to the doctors, they're having to pay that bill until they hit that. >> So the the $3,400 is a deductible for a single person is 6,800 or a family or something or Right. And then the other one is 5,000 and 10,000 which is comparable to what the other counties. >> Yeah. So we have some other counties. Not a lot of I've seen places that have that five and 10. They almost always have that 34 and 6,800 for people to go into. That's a pretty big jump in how much you're pulling out of pocket to go to 5,000 or the family $10,000. And if we we're going to continue to offer the base insurance, the traditional insurance, is there any impact to people on that plan if we have an HSA? >> There is no impact, >> which is interesting because that was a question and answered three, four years ago. knowing things change and that small little conference room of like we offer that >> all the healthy people go on that and it'll make >> because it's a great investment vehicle so you're healthy. The way you have to think about it is when we're getting our evaluation done on this they're looking at all the risk in the plan overall right this is what you should expect to pay out. This is what you should expect to have contributions for. When you look at our actual current plan deductible 7,500 and500 but then they're right above for the current plan and that 346800 to an individual that is a significant jump in money. When you look at the insurance claims we're paying out for those higher cost claimments and things that is not that significant of additional amount that we're actually paying out. So the plan is not looking worse because when you're looking at our high-c cost claimments and our claims experience that is a pretty minuscule impact on the overall plan and they're still looking at that based on how much cost this person had knowing that person could jump back to a regular traditional plan if they had a bad year. Right? So that's not going to shift what it is are in plans are going to increase in step with each other. If we're at a 6% in here all the plans are going to increase by 6%. The difference is in that employee for that day-to-day employee who doesn't have a lot of health care costs is going to be taking on a lot more of those day-to-day expenses with the assumed benefit of being able to actually get some savings and invest those dollars and have it be portable with them versus all that money is just going into the health insurance pool and I never get to touch it if I leave the organization. >> So to clarify, you wouldn't offer both of these at the same time. Uh you could be I don't know that we have gone through the scenarios. Um other places have a couple of different tiers for it. >> So what about the dynamic of of sick people would stay in >> the traditional then they're going to pay a higher premium for that but they'd still have it available. For us though, as the employer with the health the insurance pool, when you look at it into totality, the difference between us paying or them paying $7,500 or $3,400, that few,000 difference is not a major decision-making point for us in terms of the health of the health insurance pool overall. >> So, how does that work then? So the premium for a family on let's say the 3468 is $2,900 in total. So the county pays $2,200 instead of uh 2400. Is am I reading that right? >> Yep. And actually this number hasn't been inflated for the increase. >> Yeah. >> And then the employee place 734 versus 813. Then how do they build up their account or whatever that is? How does that work? So there are several different mechanisms. One, um, a lot of people will take the savings or what I used to do is take the savings between that and put that into that HSA. Um, frequently there is an employer contribution. So if you run through the savings and kind of apply this overall, there's a dollar amount and annual savings for each employee that's on these from where they had been before. There's usually some share of that savings because the employer, if you look at a single employee, we get 90% of the savings. For the others, we get 75% of the savings for each employee or family that is on that HSA. There's usually some level of sharing of that. And that is usually a direct um placement within their HSA to help them build it up so they do have coverage because we in general these plans are less expensive to the plan overall to our health insurance pool. And so it is an incentive for us to get more people onto that because it is less costly to the organization overall to have people on those plans. >> So whatever that projected shared savings which we don't know yet taking it you would share that between the county and the employees. >> We had some well we haven't come with a proposal yet. >> That would be a mandatory subject of >> Yes. >> Right. So we could say we're going to do this for you and they say that's not enough. >> Okay. And so for a young family to get up to $6,800, right? I mean, you have one broken arm, you're there pretty quickly or something, right? Um, it takes How long would you estimate it would take Barb to save $6,800 under a family to have it in her savings account? >> I haven't done that math yet. >> Okay. >> If we don't know that yet. I were someone going to that though and this is dependent on every single employee and what their circumstances. You try and get up to that amount really fast in the first year or so and then you have a smaller contribution that builds up, right? Because you want to be able to have that one year of coverage because the fallback is always, okay, we had a really bad year. Was it a one-time bad year of a broken arm? Or was it we have a now a condition that we are treating for the rest of this individual's life that we need to go on a traditional health insurance plan for >> or have a lower deductible plan because we want that lower premium and less out of pocket. >> So, we haven't done the calcet on knowing how long it take a family to get to. That's that's part of your analysis yet to bring back. >> Yeah, it depends on our contribution. >> Well, it's it's funny. I mean, if they if we did nothing, the savings is there in that chart. It's on the far right. So if I was in the family, I'd take that $80 a month, put it away. That's going to take me We're just having them selfund what? Four years. And that's up to them. You might not do it. >> Right. Right. >> Most people don't. So that's where so that's how we initially talked about some of this at the insurance committee and that is collectively our largest unions question is how much are we going to send them to go into this plan she answered it from Gallagher answered it saying well typically there's a lot of employers who just have you use your own savings like the HSA is your money you're not putting it into insurance that every year is just gone like you're now building a savings plan that's your money that you can take and people can build a lot of money in those savings plans. So, it's a really big choice point if we're going to as an employer share in that savings that 7525 or just have them take their 25 which is savings for them and they get to put that $80 away and that's money they don't have to spend anymore. >> And it does come down to a strategic question. How much do you want to incent? Um what is our you know because again we realize the savings for every person but different things are differently situated. That's something which we have not fully talked through but it is a part of this decision is are we attempting to drive people are we attempting to see what the natural forces where where that outs. The other thing I I want to I want to just throw out there was mentioned I am not a believer that this is a bait and switch. I know a little bit about insurance. It's got the third time I mentioned it in this meeting. Um the employee insurance committee is very much concerned it is a bait and switch. Any of you elected officials may get questions that this is the direction we go and I think we have very good answers. They're right. This is not uh this is not just being driven by finances. This is something that want we have plenty of folks who are single, who are young for whom this is objectively beneficial. Um and there may be an outcry for it. But I want to be really clear. While we may not in this room agree that it's a bait and switch, that is a commonly held belief and we should all be prepared to speak to that or be questioned about it. I want you all to be be prepped for that. I've already gotten that a few times, Laura. I'm sure you have. It's >> it was and it was brought up at insurance committee, but she explained it. It's a paradigm shift. >> Insurance is changing greatly and HSAs are very, very common. It's more uncommon for us to not have that at this point in time. And we're the only metro county I believe does. >> Well, and there's a lot of private businesses where that's your only options. You don't have the traditional. >> So that is also then that's the other side of the worry. As he said, we have both ends of the spectrum. The other side of the worry is when there's that um um um >> no the selection the alternative the >> adverse selection. >> Adverse. Thank you. when you have that adverse selection at some point in time does it get that 98% of your people HSAs and then you have your 2%. So again it's not adverse selection in that because they're all pulled together the cost will always be pulled together. Your claims are your claims and then they figure out the pricing structure based on the two plan types. But again over time what other companies have seen is that people really like HSAs and maybe in 10 to 12 years you have a issue because so many people want HSA. That's more the natural selection of how these things >> and the concern you get from employee groups not just here in Scott County but other places that I've been where we've had these discussions right is uh your union leadership tends to be in a certain they've been around Yes. They've been they've been at your your employer for a little while. They have a family. Maybe they got into public sector service because of benefits. They've got a spouse who does something else with their life. You have oftent times people with outsized voices and that decision-making process who are biased toward the existing PO plan and are more susceptible to the argument that hey 97% of the people are going to go into in this and then in five years your premiums are going to be through the roof. Again, I I echo Danny's point. I think that that is sort of an overblown fear, but it's a fear that we should be prepared to speak to because it does exist and it's going to be over represented most likely by decision makers in those groups just by the nature of demographics. Right? This is an HSA and a high deductible is not a plan for me. I have two young children who have health issues. That's just not it's not for me and I am a decision maker. I'm going to bring that bias. And so that's something we want to be prepared for. not a reason not to move, but just to be prepared to speak to these concerns. Um, >> the other thing I'd say when we talked about this a little bit at our last time, we talked about the feasibility study. If you want to talk about savings to health insurance right now of what we have available, it's increasing the risk pool or it's doing plan design changes. This is one of those plan design changes that we can control that offers a benefit to employees that reduces some of our costs. It's not going to reduce our health trend line, right? It's still going to be going up. We're going to have those same claimants, but the cost we're putting in is going to go down the more people that are on an HSA. We're not going down a path of eliminating traditional or anything like that, but this is a less costly plan for us as an employer for the average employee. >> I just want to say one thing about if I so beer or anything, I apologize. Right. This is not a surprise, right? We bargained at the table with all the unions. We adjusted insurance language in two different ways with all the unions to allow us the opportunity to add new plan types without bargaining and only have to engage the union that we're going to remove something which is frankly what we'd have to do anyway under the labor law 179A. So again I don't mention that to talk about contracts. I mention that to say that this is something that is on the union's radar. Employees are well aware of this um that this is a direction. So if I made too much concern, I was only trying to prep you for push back, not discouraging. >> I just want to revisit the whole idea of the HSA will not diminish the traditional whatever we're going to call our current plan, our traditional plan, nor will it raise the cost because you have to look at the whole pool of claims. >> Go ahead. I >> you have to look at the whole pool of claims, right? All of our claimments are coming from the same pool. All of that payment. The only difference is how much is coming out of pocket from the employee. That lower amount. We have a little bit lower premiums coming in, but they're taking on more of the cost. And that's what it's geared for. That gap that they're now taking on. It's basically, I think we use the term, it's like their own individual stop-loss coverage, right? They're taking on more of that initial risk so that on those bad years, the county can take on the risk. But if you look at the difference between a $7,500 deductible and a $3,400 or $750 deductible and a $3,400 deductible, that is a very small amount for the size of our insurance pool of additional risk that we are taking on from having those people on the individual plan. You'll see we're not talking about the $10,000 claims in here. We're talking about the million-doll claims. So that is why it doesn't have a significant risk on the pool. They're still basically pricing our pool with all of that risk there. >> Well, and understand things change, but again going back that question was three or four years ago with that tiny little before we had this um I would say it was more like six, seven years ago. Three, four years ago we were talking about this and said we can't do this now, but we need to start planning for when we can do the agent. >> Well, I mean it's it's a great option. Well, >> it is a great option. Well, it's a great option to have. >> It is. It's a good option. >> It is. My reluctance is just it's like, holy cow, where have we come with health insurance the last 10 years? >> And so that's where whenever like when you I smiled the question because that is what we've been told that they will look at that actuaries will look at all of our claims and we will get rates based on all of it together. I don't know until we see what happens with claims and we just don't know. So I I never want to sit here and say it's go down because I have no idea what is going to happen. >> We would have to we would have to make a shift in how we do it when we see an increase to our health insurance. It's not like we go this plan gets this much, this plan gets this much. We apply the increase across the insurance claims or the insurance options and increase them all. So we would have to make an active choice to say nope the individuals that are doing this because that's where all of our high cost cameras are we're giving them a 15%. And I don't envision us doing that. That would have to be an active choice not a structural problem with the the plan. >> So that's a dumb question. Since we have six months, is there enough in that six month pool to create a deductible pool where we could raise the deductible of our insurance? If you had four 5,000 bucks, you'd pay four million bucks for the whole >> to add it to the >> be able to give funds >> so that they would have the funds deductible pool. The funds would be sitting there. >> So that is a method that places do in order when they're trying to get people to go on to an HSA plan, eligible plan. So what they will do is they'll say okay if you move to this plan in the next year or the next two years we'll fully fund a lot of times it's just for I'm consulting the outside expert that I had when I was doing this Thursday night of my wife um who has been part of this they might do it for a year or two to fully fund it right there but those are your two years to get in. They don't do it as much except for the regular contributions to the HSA for employees. So it's a shift to try and urge people on to it. So, I've done some back of the napkin calculations that I'm not ready to share here of what some of these options look like. I told you I wasn't ready to share. Honestly, >> I don't know. >> But she said you might. >> What calculations are those? looking at based on number of people on each of these plans, what would be the savings and what would the be the cost on some of the >> I was even wondering could you raise your regular insurance deductible up if you had a pool to help people um would there be a savings there out of the box >> we would have to pay the deductible then out of the insurance >> the pool that's what I was wondering is there enough to create a pool there that could raise it what we've got all paid >> raise like generate net rates. >> I think they've talked about it more is like we decide what we're going to invest in single and family and then whatever the county is going to invest you give it >> to the fully insured how it needs to pay out and then you give it to potentially the HSA with that there but you want to be careful because again over time you want to have a savings so you don't want to overstep where you're now stuck with more than what it's going to cost us more over time. >> I was thinking the same thing you said. It's like an individual stop loss thing which to me then I would go but I'm not really insured up to certain level I'm completely on my own. And so a person that thinks that way would they take less well care of themselves? I mean, would they be less likely to go to the doctor and what their studies show that that's for for the overall health that's bad? I mean, in other words, it could be bad for the organization back. >> I have not had any of that data shown to me that people are less likely to use it. So, preventative care is still covered under this at no cost to the employee. those preventative services. It's those things that are, hey, you need to go get this looked at or get that looked at, which I haven't seen data, and I don't know if you've heard anything on that, that people choose then not to because they are on the high deductible health insurance. >> I don't have broad data on that point. I've seen some niche things from like the decade ago, but it's a very good question. It's a good question because that is an anecdotal argument that you get, right? we we're going to do this. The young the singles who are healthy aren't going to go to the doctor, which is a little bit crap because preventative care is covered, checkups are covered, and that's the most important thing. But right then, you're going to have greater number of people sick for long-term illnesses and it's going to cost any money. I've heard that for 20 years. I've never seen it really happen. But again, it is a common sense anecdote that you hear, right? If people are on their own to take care of themselves, they won't go to the doctor as much. They'll get sicker. They'll be absent more. We'll have to pay more overtime or hire more people. Again, I have not necessarily seen that in numbers. And so when an ask me or someone comes at me with that, I I have to ask them to show me those numbers, right, to prove that to me. And if they cannot, right, it is it is an anecdotal story which has some resonance with me, but it's not data that I make a decision. Um, I'll do some research as well because I don't know what else is out there. But I I've seen things like this on specific insurance plans, HIV special needs program, etc. where we had to deal with grandma. I'm not making an argument on that. I'm asking question. I think it's a very good question too and it's we're a thing that people focus on >> and I think that is a belief among some of our insurance members because we have talked >> but it is >> and then we did um it's been several years now but they did we did ask them how much do people make in these banks and it was lower than we would have expected the HSAs like we expected some of these organizations that have had them for years we thought they be 20 to 30,000 but it averaged around eight. And again, it's because you're using it. So again, it's not that it's bad. We just as a insurance committee thought there'd be more money in those. >> I think it also depends on where you're at, right? So if you're part of a plan that only has HSAs, you might have your younger years of employment where you're building it up and putting money aside and then you have those years where you're dealing with health issues and that sort of thing. And then maybe as you're near the end of your career, you don't have kids on there and that sort of thing and you're continuing to put the savings in based on where your income is or you do have health insurance costs and you're spending it out all the time. So what what >> it doesn't take much though. My husband has this and we utilize this and so does I mean you can have one like MRI for your kid that screwed up their ankle and it's like 1,500 bucks and so My my son just started a medication that cost $7,000 every month. >> So my wife's HSA is going to be up there. So >> okay. So we're going to have more announce back more information on >> and this one we do have to make decisions on because our plan renewal is 81. So, rightision and then there's quite a bit of work just between now and >> one one if we're going to make all of these changes within a new system that we just finished changes. >> So, what what's the deadline Lori for that decision? >> Tech. We typically have the decision from the board second meeting in May. The very latest would be the first meeting in June because we got to have time. >> I think we can be right about it. >> You're coming with a recommendation. Yes, we didn't really even hear your recommendation yet. We're looking at now. >> So, that's what I'm saying is when will you bring back what this would look like? What the cost? >> We just have to pick the date in May and it's kind of do we want to have do you want the slow water torture of two health insurance presentations or one at each? >> So, we have to talk to the insurance. >> Yes. >> Two week next week. Next week. So the first week in May, we should have a work session on it and then May 12th said we have to have a second, right? And then >> one work session, >> one work session. So we come back the first week of May and then have some action the second week of May. >> All right, that works. >> Yep. >> Thank you. >> All right, you can be done listening to me. Thank you. >> All right. Anything for Commissioner Round Robin this uh board meeting? Mir, >> Mr. Brennan. >> Okay. >> So, one thing I was thinking >> and I just want you to think about it for the I was proposing that the Ron Robin beer computers. Now, I know that's not Jico strongly. No. Let me just want to throw another me. I think it's good to have a little bit of prefing. >> Yes.