All right, we'll call this meeting to order. Roll call. Director Gers here. Director Hawker here. Dr. Kelenberg here. Dr. Law here. Dr. Parker here. Director here. Chair Sherman here. Um, let's we'll make a motion here to approve today's agenda. Can I get a second? Second calendar with a second. All those in favor of approving tonight today's agenda this morning's agenda raise your hand and say I I opposed. Um agenda passes. Okay. We are here this morning to talk about insurance renewal approval. Welcome Chris. Go over some of the specifics with us. Right. Well, good morning. Um, thanks for having me. Um, we are here today to talk about um um I guess it's a fairly challenging subject. Um, not one that uh that we're super excited about um given our current situation, but nevertheless um we'll go through um where we're at with our insurance renewal. Um and then um you guys can ask questions. It's the arrows left and right. Let's go ahead and advance it. Right. So based on our current situation, um we projected um through our insurance um consultant $24 million in uh claims and fixed costs. Moving ahead, um premium anticipated premium income is at 20 million 20.5 million. Um so we are finding ourselves uh short $3.5 million in um revenue to support our plan. Um some of the reason for that um are increased claim costs um and also um the changes that we made in insurance um have an impact on that on the plan changes last year as well. So there's a little bit of that involved in this as well. Next slide. Hold on a second. So not everybody was on the board last year. So what happened last year was we had for years and years Stillwater has had two plans that they offered our employees. We've had the what we call the high deductible plan which is our current plan and prior to that we had a was it a zero deductible? Um yeah it was just a co-ay plan. So, which was um exceptionally rare um um and exceptionally expensive and it was really dragging the the the pool down in X expense and the people on the high deductible plan or the higher deductible plan were actually supporting people on the gold plan. So committee a year ago made a decision and the the bargaining units agreed with it to just go to one plan. Well, the impact of that was felt in the short term and we're seeing part of that right now as people who were on the gold plan which they had no deductible had heavy utilization last spring before we transition to the uh just a single plan. And our rates are determined based on a 24-month period. So the usage last spring had a significant impact on our renewal. So that's just a little background for you on that. Yes. Um and also part of that is you know we we did try to help ease the transition um through um the viva contribution. So it didn't always match the deductible and last year it did match the deductible. So that was to help the folks on the gold plans who get adapted to that high deductible. Um, so as we look at our renewal right now, we're we are facing double-digit insurance renewal costs. Um, our claims continue to go up. Um, and um, we are looking at ways to um, help us reduce claims in the future. Um, got a couple of things in the in the plan for next year, but that's not going to help us out with this year. um with this coming year. Um we've been looking for ways to reduce claim costs um for the coming year and we're looking, as it says, for long-term solutions to reduce the claims um and increase premium income um because where we're at is we we don't have enough premium income um versus claims. So really the adjusting the claims is one of the few levers that we actually have to pull. Um so the GLP1s um if you're not familiar with those they are medications that are used uh um initially for type 2 diabetes I think is how they um evolved. Um but they are also used to treat um persistent obesity and weight loss um for folks who are struggling with that. Um so these are just some of the ones and I'm I'm sure you've heard of other ones that and certainly the advertisements on TV are all over the place. Um so these are um just a couple of examples of weight loss drugs that are commonly used in in our group. Um Chris, just a quick question. Um, are those three the only ones that are covered or just examples of one? No, those are just examples. Okay. You know, there are probably there's a list of probably more than a dozen. Yeah. Okay. That are listed as being used for weight loss management. So, we currently cover all of them that are available. Yep. Okay. Thank you. Um, so why we ended up on the on this why we landed here. Um, we've been looking hard at alternative ways. I've been going back through our other benefits. I've looked hard at our LTD. I've looked hard at our um at our life insurance. I've looked at how can we, you know, is there a way that we can shift the cost of one benefit that's not as expensive on an employee individual basis to um to employees and then, you know, be able to divert those funds then into our medical insurance plan to help offset some of those costs. Um we looked at tiered prescriptions. Um, we looked at, um, adding co-pays. We've looked at increasing deductibles. Um, and all of those have small, very small impacts, one or 2% um, of a change versus um, it all. And the other impact of that is if we lower the deductible um and we set premiums based on that then we still have less premium coming in which is where we're going to get stuck. So really the only way to lower our cost is to reduce claims. And this GLP1 is the is a is a group of medications. Um it is for um it it's the fastest growing as we have on the slide here. Um in our slide there too you can see that just one medication increased 134%. Um in the space of a year um so the medication usage is growing exponentially um and they represent a very small group of our of our overall um insured population. So this was this is one lever that we can pull to help reduce the claims so that we don't have to increase the premium as much. So overall the population 3,000 people are covered. Um well there's 9 Yeah. Yeah. You're right. Individuals belly buttons as people are covered. So out of those 3,000 people 90 are counting for this cost. Yes. Sarah. Uh just a couple questions just for clarification. Is there a PBM invol? I mean is there does the district have a PBM? Yeah, we do get um in we do get um rebates on insurance and there is a there is a PBM in the middle of that. Okay. So is there I'm just thinking in terms of like um utilization management um resources like um I I guess I don't part of my question is do we know why people are using these drugs? Do we know it's solely for weight loss or is it for other types of things? Because what I've seen other plans do is implement um case management programs that say you can use these drugs but only for um with the assistance of a PBM to help manage those costs because it's kind of a universal issue that these drugs are really expensive. Well, I think Blue Cross has um um Aaron has shared with us that Blue Cross is implementing a plan for some some much more in-depth screening. Um and so I think Blue Cross is going to manage that um much more closely. Okay. Um I don't know that they're going to do it through a PBM, but I can find out. Sorry. And I should be clear. Yeah. For uh PBM is a pharmacy benefits manager. Sorry. And they're usually um uh with respect to a plan's prescription drugs, they're sort of the the management arm of of that side of the health insurance plan. Sorry. Any other questions about that? Okay. So, moving on. I'm sorry. Just I saw I was asked that question, but uh just can you repeat what your response was to director's um question on on PBM's? Yeah, I mean what I what what I understand is um from Aaron is that Blue Cross is implementing um a much more in-depth screening process. Um so they're going to be reviewing those um and so so that we can um do a little bit more cost containment um because what has happened and this is obviously from Aaron Aerin's research and what he's shared with us is that um often times folks are given have been given in the past like a full year prescription for the medication and then they're given like maybe three months at a time when they're first trying it and it doesn't go very well. either it doesn't work for them or they don't like the side effects or whatever and then they stop taking it when we've already it's already been paid for. Um so making sure that we're only giving um like a 30-day prescription out at a time and then that we're closely managing and monitoring um you know who is eligible for those medications. Do we have any um estimates on what that cost savings might look like with those additional safeguards implemented? Just also can you explain who you're explain? Oh yes. Um Aaron Casper is our um insurance consultant. Um so we switched consultants u from one digital to NIS last year and so he is our um insurance consultant and he guides all of our um insurance committee meetings to um help us figure out you know what is the next step um what's going on in the market and you know where we're at with our plan both financially and plan-wise gives us information about plan designs um plan design changes he's the one who helped us with you know figuring out is the deductible or is the deductible um something that's going to have an impact or not. And Aaron is intimately familiar with school districts. He's the chair of the Eaton Prairie School Board. So he works with school districts throughout the state. And we know what they're doing. I mean other districts. I mean Yeah. So just anecdotally, um I know, you know, there was um an email string that went out that said, you know, what are you doing? Um there were about 11 school districts that responded and half of them it was a it was a it was a as near as a 50-50 split as it could be. Um six in favor of keeping five in favor of only uh keeping for weight loss or sorry for diabetes treatment. And so that's the proposal here is to keep them just specifically for diabetes not for weight loss. Um yeah I mean it is for we're not going to be eliminating medications for type two diabetes. Um, when we look at the the GLP1 spend, it's it's over a million. It's around 1.2. Um, but $700,000 of that is is for treatment of of those illnesses. Um, it's really just that that one category of half a million. Parker, hey, thanks a lot for this. Uh, two questions. One, can you describe who the insurance committee is? uh because it looks like uh the insurance committee is recommending the continuing coverage for this. Yeah. And then and then second, is there any have we in the past or is there um uh is there examples of specific medications or treatment options being excluded? Can you just talk me a bit about the insurance committee first and then talk about the Absolutely. Um the insurance committee is made up of representatives of all the bargaining units. Um so they've been around for a long time. Many of the people that are on the committee have been on the committee for years and years and years and years and they've watched um all the changes over the years. Um um in addition, there is someone uh on the committee who's representing retirees. Um so there's a wide range of folks on the committee. Um, and as far as um as far as I know and based on the conversations that we've had at the table with the insurance committee, I do not believe that the district has ever excluded um any any treatments or medications from the insurance plan in the past. Got it. And then the question for us is are are you making recommendation for us that's on the summary or are we making a determination or is this information only? Um we are asking you to make a determination and that is between a a and b like the 18% and the 13% or yes continue. Sure. Um so you can see on the screen the impact of the premiums. Currently the premiums are um 813 for single and 2319 for family. Um the 18% increase um you can see those totals reflected there. 959 for single, 2737 for family versus a 13% increase of 918 and then 2621. Are those is that monthly or those are monthly. Yes. Um, as we um talked about this in committee, to your point, Parker, yes, the committee has recommended that we continue to cover the the uh GLP ones at the 18% increase. Um, so as we discussed the um concerns uh with the insurance community, um overall it was felt that we might need more input. Um so we did prepare a survey um to bring that to the larger population of our insured um employees. Um so we got 66% of our employees um responded. So again this is the insured group. So we didn't go out to every last employee to ask the question just those who are currently um on our insurance plans. Um 44% of the respondents have family coverage. 56% of respondents are at least somewhat familiar with um GLP medications for weight loss. Um 69% of respondents indicated their preference to discontinue coverage in order to um contain premium costs. Okay. A quick question just on the timeline there. Um did the insurance committee get the result survey and weigh that into that decision or did they make that decision before the results came? So they had initially made the decision before that but then we brought the um survey results to the committee yesterday morning. So they had a chance to review that um and the um just the temperature in the room indicated that uh they would stick with their with their recommendation and continue to cover. Did they articulate a rationale for um I think the rationale are just you know they didn't feel like singling out a specific medication. Um we did receive a lot of feedback um from folks who um have very um poignant stories to tell about their experience with these medications. Um I think all of that weighs heavily um as I'm sure it it does on all of you. Um, so making the decision um is is just a really tough one. You know, we're talking about people. Um, so they they did not appear to waver on their recommendation. Just one one question just so I'm clear at the 18 or or 13% increase that makes up the difference that that makes up the difference in the three three and a half million. Yeah. So, okay. So, I mean, we're Yes, we're just a little bit over even. So, we're we're going to get a little bit into the fund balance to help grow that. Um, and we're going to, you know, not be in the hole. Um, so this is survey information. So you can see how many folks we have a total of 94 folks enroll in our insurance um employees enrolled um which is different than employees covered um or sorry than people covered um 593 um employees responded to the survey um so of the teacher group you know about 65 uh% of them responded to the survey um I think the highest we had for percentage participation was the um coordinator supervisor specialist group. Um we also had very high percentage among um the uh nutrition services group. Um about 60% of the paras responded. Um so that just gives you a sense of you know who all was looking at the survey and who who waited. Um so this is the this is the final question on the survey. It was just five questions. Um and so the result is, you know, pretty much a 7030 split in favor of not continuing to cover the GLP1 for weight loss. Um this slide shows you um kind of the breakdown by group. Um so you can see how many folks um in each one of those bargaining units um voted which way. So the red is to discontinue, the blue is to continue those coverages. Um so we're obviously aware that this is um a a sensitive uh topic. Um it affects you know people in a very personal way. Um the survey results came from a wide variety. Um and I think it was pretty well represented. It's unusual to get such a high percentage of folks to respond to a survey. Um, and you know, we did end up with most folks voting to discontinue coverage. Um, and as we have in our in our we've already discussed, um, the insurance committee does recommend moving forward with continuing coverage. All right. Um, so now for discussion and we'll start with Sarah. Sorry. I think um one question I have is with the switch to a high deductible health plan, it seems like naturally um members are going to be absorbing more of the cost with this arrangement. Do we I guess my question is do we know what these costs are going to look like for next year's renewal now that we have people paying more upfront for drugs that previously I think were probably covered by the plan. Um at this point I don't think we're we're looking you know quite that far ahead. I think we need to figure out where we're at this year before we can look at what next year what the following year is going to look like. Part of the reason for the increase is our consultant believes usage for those drugs is going to continue to increase and that's why we're looking at an 18 versus a 13. Dr. Can you shed some light on what is the uh school district's kind of exposure with this? So you're sharing like the premiums for the participants. What does that look like in terms of the shared responsibility from the district within those scenarios? That's a great question. Um, we can talk history here a little bit and then we can talk with the reality of our our parking unit agreements are. So past practice for the district for a number of years has been to maintain an 85% contribution before negotiations even begin or are completed. So for example, we've got different units right now that are going to start. We have one unit that's currently in the middle of negotiations. Um but we have a number that are going to start after July 1st. That's an ML unit. So, so historically the district has just increased our contribution to maintain an 8515 relationship. So, you know, you know, you're aware of the big bigger budget concern that we have. Um, and so we cannot with these consistent doubledigit increases, we cannot maintain an 8515 relationship like we have had. So we have suggested to the committee that we are looking at a district increase for contribution and this would have to be done through anou of 6 and 12% towards the 13 or towards the 18 and that the employees would have to pick up the rest. So those thoseus have not been agreed to. Um the uh um one thing we're waiting for is the board to establish what the uh um you know what the renewal rate is for next year. And that's kind of why we're um having a special meeting this morning so we can start to get moving forward with the with the renewal and start talking to the units about okay here's what the our proposedou is for our contribution. Um, if we didn't have an overview, then technically the district would not increase any of our contribution until after the negotiations were complete. That's that's what it works. That's how it works in most of all the other districts. So I don't ask a question or so just a um so normal p uh process most districts is that anou does not go into place so the increases are temporarily covered by the by the employee by the employee okay and then there was be like a retro in the uh in the but that's not has been still that's not the best practice here not still correct Um, kind of going back to my other question about the um the drugs that are um covered in this plan that we cover all of them for weight loss. Is there a way to limit the um like pull out if there's a particular drug or a couple drugs that are the most expensive to kind of amend the plan to make it a little bit more cost effective for the district? Um or is it an autographing kind of thing? Um we did go back to Blue Cross with that. Um and um it is an all or nothing. That was the answer that we received from the insurance company. So they won't um pick and choose particular medications out of this classification um and eliminate or not cover those. Dr. Funk, Chris, this was asked the insurance committee yesterday and we didn't have an answer at the time. I don't know if we're able to find it. So people who currently are have prescriptions for the obesity management drug are they what happens to them post July 1 if the board were to say okay we're going to go off the yeah we're going to go off the plan I did get an answer to that um later in the day. So um the question was asked you know that and then would we be able to grandfather in those who already are using those medications and um the answer to that was um that would more or less defeat the point of the reduction. Um so the answer to that would be no the the prescriptions would end as of July 1st with the new plan. Um and um grandfathering. Yeah, it it the whole point of the of eliminating them is to save the money and it's the folks who are already on them that are that we're spending the money on. So yeah, we would not be able to grandfather them into the plan. And did we get an answer to the other part of the question is what happens to them? like today they spend $10 because it's a co-ay and tomorrow they're going to spend $1,000 a month or what is what is do we know what those numbers are? I don't know what the exact co-pays are. I mean, I've heard that yes, those some of those medications are north of $1,000 a month, but yes, they would they would have to start paying out of pocket for those. Do we have an idea of I don't know the medicine behind it, the impacts of going off of it. If it's cost prohibitive for them to stop to pay for it moving forward if we're not covering it, what are the effects of not using the drug anymore? Yeah, I I wouldn't be able to comment on that. I that is well outside of my my field um to I I have no idea what the side effects would be of stopping those medications. Um I have firsthand personal experience from friends who have stopped um but that I can't extrapolate that out to you a wider population and that the effects haven't been bad but you know again that's just people I know. Um, is the are the are they currently under a co-pay right now? Because I we're on a high the district's on a high deductible health plan right now, right? Yep. So, are the drugs themselves on like a is the form are they subject to? They couldn't be, I guess, for a high deductible health plan. So, people must be paying out of pocket at least up to their deductible. I mean, that's not always true. Um, you can have a you can have a co-ay on if it's not HS. I'm sorry. Yeah. So, um I believe these folks are paying a copay. Okay. So, then right now the formulary is subject to or these GLP ones are subject to a co-ay even though the plan is a high deductible. Do we know what the co-pays are? Is it just that the co-pay would go away? Um that I you know what I'm sorry I don't need that. I was just I just I was thinking they'd be paying out of pocket for them. It sounds like they are still subject to a Okay. Yeah. I mean I can certainly get back to you on that. Yeah. if you want to find it. Thanks. I'm not sure you're going to be able to answer this one either. Okay. Um, but is there an opportunity to know like we have generics coming out like in the near future that will substantially lower costs? Um, I guess I'm thinking about this in terms of we've got all the name brands. They're going to hike up their prices at the beginning until generics hit and then then the market kind of corrects a little bit. Do you have any idea if those genetics are coming soon? Like um I think you know Erin has shared with us that um you know those are definitely on the horizon. Um you know and as patents would um expire you know more and more. We also have been hearing that there's a pill form that's you know coming. Um but I I don't know. I'm hearing earliest. This is just through the media. 27 2020 27 at the earliest. Would there be an opportunity to revisit this once generics are on the market? Yeah. Couple thoughts on that. All right. So, we we talked about this a little bit at the committee meeting yesterday as well. So, one of the concerns was two things came up related to this. One of the questions was okay well if you do this for obesity management when are you going to do the same thing for diabetes right and I I don't know any insurance plan to include Medicaid which just Medicaid is just starting to exclude the the obesity management piece from from theirs um Medicare um I don't know any of them out there anybody out there that's excluding this for diabetes so that's going to stay Right. The other question was as we brought up okay you know this is cost very very costly right now but you know yes the the generics may be coming and so the question was asked what at what price point and and I think if you were to look at you know Chris talked about different districts out there who are some are excluding some are keeping I think a a significant piece of that is what the fund balance is within their insurance Some districts have a strong enough fund balance. Okay, we can afford to continue this until the generics might kick in. Unfortunately, in Still Water, like our regular fund balance in the general formula, our our insurance fund balance is much lower than we'd like to be. Um, so we need to be able to try and build that back up. Um, so that's where we don't have the option of um, you know, we could so we don't have the option of saying, okay, we want to keep it and keep our rates at a certain level. If we want to keep the GLPs, the rates are going to have to be this level because we don't have a healthy fund balance. And to get back to Sarah to your question too, um, it is a co-ay situation for those for those medications. So there's a generic copay, there's um a brand copay, and then there's the nonformulary not covered. So these would be moving into the non covered or they just wouldn't have a co-ay anymore. They'd be subject to the deductible. They would be subject to the deductible. Okay. Okay. So they're covered. It's just that people have to pay out of pocket for them. They would have to pay out of pocket. And so they could use their FSA if they had an FSA account to pay for that. They, you know, they would have that option. And they use their um it's a medical expense. So, I would guess that you know that you that you could do that. It's still a prescription. It's still a medical expense. So, I don't see any reason why you couldn't use your VA to pay for that. Right. Okay. So, I'm just Yeah, just want to make So, I guess that's my big question. Are they still on the formularity? It's just that they don't the co-pay is going away. So, people have more of a a responsibility up front at least until they hit their deductible. That's I guess that's what I'm trying to clarify. Yes. Okay. So, when they hit their deductible or their out-of- pocket max, would the drug be covered then? Um, I'm going to have to check on that because I I can see where where I could see where it could go either way and so I would want to be sure before I answer that. Okay. I think that could matter. I mean just in terms of it's it's about cost sharing and right yeah um can you just provide some and this might be a brief question uh but the you know obviously we're in a difficult financial situation as it stands currently what's the cause and effect of you know the 18% versus the 13 with no GLP you there's always unintended consequences. So, you know, I guess I'd just be interested in what does that look like and how does, you know, want to be extremely uh mindful of how it impacts individuals, but also then how does this impact, you know, the greater good of the students in the classroom? Is there a a impact on that because of these increased costs to the district? And what would that exposure look like? Um, if that makes sense. Marie and I were just talking about $2.4 million was the was the cost to the district. Um, which is not not figured into the budget that we currently laid out. So the 18% would would have a $2.4 million exposure to the district. Yes. Okay. which is not being accounted for in the current the 8515 if you kept everything that is cool. Yes. Okay. And what happens with the 8515 that that changes um again based on prior history still just but is there precedent of where that exposures passed along to employees. You know sounds like other districts do that but seem to me that seems like that would make sense until there would be but again I don't want to get ahead of myself. we need an MOU because our current agreements say here's the fixed amount we pay for the premium. Okay? And if we don't have anou, that's the fixed amount we pay for the premium moving forward until the new contract is negotiated. So by providing anou to the employees in an agreement that the district's going to increase the contribution to X then okay we're helping them out to some degree. Now when we come to negotiations they may say guess what all right we want to stay at 8515. Okay great well we have to figure out how we're going to you know what are we going to give up to keep that arrangement. Um, so yeah, I mean this is it's complicated by a number of different factors here. Um, so I hope that helps. It is complicated because we don't there's decisions that haven't yet been agreed upon that we have to make assumptions. Correct. You may have answered that question. Let me try. Um, so we might have making a decision here, right? And how is that separate from any negotiations with all the the the the units? Um the negotiations is based on is is figuring out what portion will the employees pay versus the district. So you what we're asking you to do today is to set the premium amount for the next basically school year. All right? And so regardless of what's in the employee contract, uh this is the new amount of the premium. Okay, historically the district has said if this is the amount of the new premium, okay, we contribute 85% of that and it automatically goes up. What we're saying right now is this is the amount of new pre the new premium. We were to continue with the same relationship, that would be another $2.4 million hole in the budget. So we are going to have to take a look at what percent we can afford um to to continue to uh work with our employees on on insurance. Then does that get balanced out the next negotiation or Yeah. So the next negotiation takes place. So like say we start negotiating next fall um and we said well we've you know agreed to a 6 and a half% increase to the district contribution and then a unit could say okay well that's fine. Um or they could say well we want a full 8515 arrangement and then okay well that's going to cost x amount of dollars to do that and there'll be less money over here then for salary etc. So that's where um that's what we're that's what we're working through. Okay. And for for me I worry because we hear at the board table a lot about like our um non employees um parents custodians food service and these kind of premium increases are going to only exasperate our ability to retain employees. I mean, I can't help but think of like how that could impact if you know, you mentioned I think it was 90 versus 3,000 and it's hard to remove the human cost. Obviously, there's 90 people that are benefiting, but there's a lot of people who are going to be cast on small salaries that are under kind of where we, you know, in comparatively maybe to other districts that are going to be taking more responsibility and how might that affect our ability to hire paras, hire food service, hire custodians. I don't know. Just a consequence, I guess. And uh from a healthcare compliance standpoint is I'm assuming there's no issues in excluding certain um prescriptions or procedures. I guess I don't know how that would work just from a from a liability standpoint for the district. Um I'm thinking of you know what that could be impact. I guess I don't know what that would be. I just want to be mindful of you know Yeah, I think that um you know we we trust that um um Aaron is um an expert in his field and in his business and so um I he would not have made such a recommendation I I if if he thought there we were putting the project at risk. Okay. Yeah. So that's that's part of that relationship of him and obviously doing his due diligence to provide the best feedback because he's managed he manages the the compliance for our whole plan. He makes sure that you know we have you know all the eyes dotted, the tees crossed and um that we are following all of the compliance timelines because there's different reporting we have to do. So um we have to trust his expertise um in advising us with insurance matters and and has this been vetted through our legal services through like Nick? No. Okay. Are relying on our insurance insurance? Okay. Okay. Yes. So, the delta between the two for the the district is about $600,000. Is that the right way to think about that? Um, I guess I'm not actually No, it's not. Sorry. 600,000 times the the split of the 8515 would be the exposure, right? So, sorry, I don't know. Could you could you restate that, Parker? Sure. Uh, medications look like cost about $600,000 from slide. Um, why the focus on GLP weight loss drugs that title that slide. Um, so if it's about $600,000, if right now that ex we're translating that into a premium increase or delta between those two and the the district exposure be 85% of that currently. Yes. Well, that's if you know if we if we come to an MOU and we would agree to 85%. Yes. Right. assuming status quo. Um, so that would have some impact. It's like where the difference is like $450,000 for the district or something like that. Okay. Um, so obviously the special session was called for this. Um can you just share some insight to in terms of this time sensitivity around this and reason for it and obviously you're coming to us today for a reason. Yeah. So um we are coming to you today um because we are in a time crunch. Uh we do have to get open enrollment um up and running. Um and we use an outside agency to outside vendor to process that um and so we are shooting for open enrollment May 5th and we need to um get uh rates established. We need to haveus in place and then all of that has to be loaded into um into that system so that all of our employees can open enroll before they head out um for the summer. So that's the timeline. We need to have the rates established um pri you know obviously at least a couple of weeks prior to May 5th in order to make sure that we have everything up and running for open enrollment. But we also have to get the MLUS in place. Yes part of that before all that happens. Yep. A lot of moving parts. There are a lot of moving parts. So obviously staff doesn't this is a board decision. Um does staff have any thoughts that they would like to share? I think there's two ways to look at it. I mean I think you've got two different uh recommendations here. You have the fiscal recommendation which is purely looking at the numbers and you know looking at the numbers from the district level and and the financial stress we're under that says okay this is the most prudent thing to do to exclude the G update then you have the human recommendation and that is what the insurance committee is is weighing and saying okay this impacts people's lives and as as such um you know we don't think you should be excluding um any of this uh so I got the Aaron Casper I got a question for him on the line so I will right back okay um really quick can I ask um hey here's a quick question for him sorry can I ask um so we know it's covered for diabetes regardless like if the decision today it's not changing diabetes will be covered for these because it's a medical, you know, condition. What about if if there's some sort of I mean, there's a process, I'm assuming, within our plan where a doctor recommendation, they they'd be able to petition for coverage in certain situations that maybe aren't as black and white. Does that process exist? Yeah, there isn't. There's definitely an appeal process uh through Blue Blue Cross Blue Shield. So if a if a if a member um was um not happy with any um denial of medical treatment whether it's you know GLP1 or you know a procedure or any of that there's definitely an appeals process that folks can go to. Mhm. I'm still struggling with terminology though here because we we say we're talking about excluding but is it are we excluding it or are we saying you need to pay you're not going to have a co-ay for it anymore and you're going to need to pay for it out of I I guess is it still on the formulary just okay so I think that matters a lot to him. So he said that it's no longer um there's no discounts to it as for being part of our plan anymore, but you are able to use VIA dollars. You are able to use flex dollars to pay for it. So um Okay. So, you can continue to, but there will be no discount on it is because it's we're not officially offering it as an option, but you can certainly use um the medical um accounts, savings account or viva um to help pay for it. And how does that apply then to like out of the max deductible? Yeah. So, again, looking at that, if a participant hits that now, is the district on the hook? No. Or is it they're still the participant is still required to covered out of pocket on correct after they've after they have used their flex and their vehic. Okay. So it is it is truly not covered then. Correct. Okay. Unless it's a unless it's diabetes or Y. decisions you just trying to re recap for it in my mind. Uh you said there's like 60 people that might be affected 90 by 90. Okay. And can you take a typical example? So right now they would be paying nothing because it's covered uh they'd be paying a co-ay so like $20. Okay. And then if this goes through now, they could be paying worst case $1,000 a month until well, the cost of of the one that is most commonly prescribed is around $9,800 a year. Okay. And the district would save how much money if with this? Half a million dollars. Half a million. Okay. Um, so it's my understanding, and correct me if I'm wrong, but for Medicare purposes, just looking at just a a baseline, GLP1s are covered for, um, diabetes, I think maybe like cardiovascular, but not for weight loss, right? Okay. And so, um, is cardiovascular then part of this or would just want to be diabetes only? Um I mean cardiovascular would be included in this. I mean it's it's a it's a medical purpose. The only thing that's really excluded is is weight management weight specific. So if there's underlying heart issues obviously cardiovascular which could lead to heart attacks obviously is you know horrific for the person and the family but obviously huge costs for the plan also. Yeah. But that would also still be included. Okay. to that point. Then if there was a medical necessity recommendation from a provider to use the GLP1 for say like a mental health condition or something else that might not be diabetes um or cardiovascular disease. Is there a path to coverage in those cases? I don't know that there's a path to coverage. I think the review um process that cross is instigating for that um for those medications would would come into place. Okay. So, they might Okay. They I guess my is is there still a medical is it going to be covered if it's determined to be medical medically necessary by Blue Cross after they review it? I think if Blue Cross determines that it's medically necessary through their process, you know, then they would cover. Okay. Any additional questions? Yeah, hard discussion. So um ideally if you would like a vote today there any um thoughts from the board on motions how they want to proceed additional conversation I can start a conversation I don't necessarily have motion at this point um I'm really struggling with this um definitely weighing a lot of the uh Uh I feel like we are really in uncharted territory with having to eliminate a particular drug for use. Um I know it's not completely going away. Um and that I feel like is a heavy decision. Um I also I much better understand the financial impact from the presentation and kind of how this is going to work in real life. Um and I'm super concerned about this as well. And there's so many variables that will factor into that decision and and the implications of that decision as well. So I am really struggling. Um I think at this point I'm maybe leaning more towards the like prioritizing the financial impact. Um especially looking at the survey and kind of the wider reaching impact this will have on everybody. Um, and also I do have a hope that once generics are back in the picture that we could potentially revisit um, in the couple years, but I also don't want to necessarily wait and try to bridge that gap because I don't know when those are coming. Um, and if only one gets approved or I mean that I feel like that's a risky risky proposition as well. Um, so I guess I'm not quite sure where to land yet, but that's at least my thought process. Um, and I'm super curious how everybody else is processing this as well because yeah, I could go either way at this point. Yes, director. Um, and I just to clarify a previous discussion. So regarding um the 18% increase based on the assumption of the status quo 8515 the district would have an additional uh exp um uh of debt of essentially 2.4 million on top of the existing 5.4 for the district. The total cost of the 8515 is 2.4 million. With the 6 and 12% contribution that the district has been proposing, that contribution's about 1.2 1.3 million. So that additional cost would be about 1.1 million. But the 6 and a half% is based on a future negotiation approval process that's not yet gone. And if they don't approve it, they don't get any increase. Okay. So there's a a kind of a stop loss for the district from Yeah. I mean, the current contract language is X. Okay. We're proposing X plus 6 and a half%. If they don't agree to it, it defaults to X minus it defaults to X. Just really quick just to follow up and then Park Parker has his hand out. Um the 1.2 to 1.3 the six and a half is that in the budget that you presented with the council. Correct. Okay. Just to clarify that correct. Thank you very much Parker. Go ahead. Hey thanks a lot and and Katie, thanks for kicking off the conversation portion of this. Um for me uh I struggle with the survey versus an investment committee recommendation as well. Um the to me with what happens in the survey uh people may answer what is best for them but I think that what I struggle with how that will actually be represented when people are talking. Um and um while I don't want to discount that at all, I do do struggle with going against the investment committee after they have taken that survey into account. Um and that that makes me a little bit hesitant to to to change to the um the excluding the GLP ones. Director. Yeah. Um I would kind of echo a lot of the comments Director Hawker made. Um this is a heavy decision. It impacts people's lives and um you know personally. So it's just something that uh that can't be ignored. It's also hard because we have the fiduciary responsibility like it's what's in the best interest of the district as a whole. Um, and I think the challenge for me is that financially we're just still in a in a tough spot that I think we're making progress, but it's going to take time and some continued difficult decisions that we've already seen, you know, through the priority based budgeting how hard those decisions could be that directly impact people's lives already. Um and so you know as I look at it from an economic standpoint you know what impacts what decision benefits the greater greatest good. Um you know I think just because of the variables that we have. Um I would you know similar to director Hawker lean more towards taking the fiscally prudent approach as challenging as it is. um you know with the understanding that the GLP1s would still be covered for diabetes, cardiovascular and then obviously the hope would be um through the gift of time we could revisit this and make it more widely accessible for um you know all participants once we're in a better spot. So that's kind of where I'm at right now is as hard as it is. Um you know in addition to $1.2 $2 million exposure that's not being accounted for. Again, I don't see how that doesn't impact the classroom. And again, you know, I I've stated before, my northstar is it's about the kids. And um you know, I don't see how that's not going to negatively impact the kids, which unfortunately does impact though, you know, many individuals. Thank you, Dr. F. And one of the things that I think is important to to recognize is if the district um the board were were to exclude the GLPS for the obesity management piece. Um it's not like we don't have other options for folks. This seems to be, you know, this is a a I'm not it's not a magic. This is very effective for some people, but there are also other programs out there that may be not as effective, but we will certainly provide those opportunities to folks and and work with them as part of this. So, you know, it's I don't want to make it sound so crass that okay, um we're not going to cover these anymore and good luck. finding, you know, take we we have um with our insurance plan and with our insurance um provider, there are other options out there. They're maybe not as effective, but I just want to make that clear, right? Yes, sir. Um, I'm struggling to I I I feel like I feel like I can't responsibly vote either way right now just based on the information I have. I I think I could probably benefit from just having a little bit more information. Um, and time to kind of think through some of this. Um, I I don't know if others maybe I'm just slow at processing. some of this, but I I um I think there are questions about that I have about some of the um assumptions about how some of the uh differences in the plan that's in effect now um could impact this. And I I just I don't I think there are just pieces I feel like I'm missing. Um, and while I understand that this is a I mean plans all over are looking at carving out or or or reigning in um coverage for GLP1s for weight loss because of expense. Like that is just everywhere right now. So it's not I don't have any concerns necessarily from that perspective. I just it's almost like I feel like I I just need more time and a little bit more information to make a responsible decision one way or the other. So if the decision went one way, there's going to be a financial something that we have to address. If the decision goes the other way, there's going to be a personnel personal uh issue to to address. Um, right now something's in place. There's momentum one way. So, we're kind of looking to maybe scratch that record and then that stop. And then that's where I get a little bit concerned. Say, whoa, wait a minute. You know, like kind of like what you're saying. It's like all a sudden on a short moment's notice where we're looking to make a decision and I might just want a little bit more. What is our timeline uh for this decision? Does it have to happen today? Can it even happen next week? Well, I I don't know. I mean, yeah, you can you can wait a few days, but it's going to push everything back. We have we're going to have to again we're we have to identify what our exposure is as a district. So, we sit down and you know 6 and a half% is our is our proposal at this point. You approve it at a certain premium. Okay. We have to go look at that and we have to sit down and we have to get approval from the bargaining units. Um, so yeah, I mean you could take some more time, but I mean I it's and I don't know how much time is going to help solve it. Okay, and and that's the bottom line is you have twothirds of your employees. Okay, it's almost 70% have said uh based upon a survey we provided exclude GPS. you have a an insurance committee that has said keep gops and that's where it's at at the end of the day you know and the insurance committee is much more focused on impact on personal lives I I think the the um overall district survey is okay impact on my my individual life u and so I mean we could we could wait a few more days but Um it you know and again I mean I think you can this is a as Sarah as you just mentioned this is just a hot button issue uh in society right now and it's unfortunate that you know we're not there to the generic local yet we're not to the to the lower price point but so that's we'll we'll react to what you decide as a board but it just puts much more pressure on us to um and it'll put more pressure on you um if you delay this because suddenly okay well now the board is you know you're going to you you will hear okay the board has not made up their mind and so now suddenly you will get from both sides okay over the next number of days um and that's fine if that's what you as you want to do as a board but um Right. I mean, it's it's it's up to us what we want to do. Um, for me, I this is like an unbelievably difficult decision in so many ways. Um, because we're talking about people, right? And people's lives, and I think we've all been probably touched by obesity in one way, shape, or form in our families and in our friends um with our friends. But at the same time, I remember when I ran for the board, um I really felt like we were committed to turning us around to a better fiscal spot because the the challenges that we're facing are getting worse. They're not going away and they require really tough decisions that just don't feel good. But it's that fidiciary responsibility that we have to make these tough decisions. So, um I'm we can do whatever the board wants, but um I'm going to go ahead and make a motion um that no one wants to make uh to exclude and go with the 13%. And we can still continue conversation and I know this is really difficult and I don't want to be the person doing this. Um, but I don't know what time gives us. And if we decide as a board that we need more time, I'm fine with that, too. Um, so, and I would say with a deeply heavy heart, I will second the motion. Okay. So, we have a motion and a second. Um, continue discussion. Yeah. Sorry. So, I I know it's our decision. Um, want to offer a recommendation administration. The only recommendation I'm going to offer you is the insurance committee recommends to keep GOPS. The employee survey recommends to discontinue GOPs. That's the recommendation. Follow up on that. So there there's a difference out there. You know, if I'm out there talking, I'm going to hear this, I'm going to hear that. So the insurance committee, how is that made up out of the employee group? Um, excuse me. It's from representatives of all the bargaining. All all the bargaining units are represented on the insurance committee and you mentioned even retirees earlier. Yes. Okay. Um, and going back to that committee, it sounds like the makeup of the committee has pretty much stayed continuous for a while. Um, but the new member is Aaron, correct? Yes. The consultant. Yes. Consultant. Yeah. Um and he just kind of does research and brings forth ideas for um he's an expertation. Yeah, he's an expert in his in his field and he yes, he brought us this recommendation. He said this is this is the lever you can pull. Um and he has gone through the explanations. He's laid out all the claims history over the last 24 months. He's identified how we determine what our um claims projections are going to be. Um and he's given us all of the numbers. Um and and then those are all in a presentation with the committee. So um the committee can ask, you know, as many questions as they want. And in my past experience, I've never known an insurance committee to to be as engaged as as this one is. I mean, they they do they ask a lot of questions and they have um a lot of history with um this organization and and have been through a few quite a few changes with them. Okay. So, I guess the way I'm starting to process this is looking at the new information coming into this committee. Um, does Aaron then make a recommendation of where to go or does he have a vote or like how does that relationship work in this particular committee? He doesn't have a vote. But he, you know, he he recommended that we um that we what we presented to you today. So he recommended that, you know, we we look at um cutting the GLPS for weight loss to save that half million dollars unless we just want to go with the straight 18%. Um because we're not because of the shortfall in our revenue and and in our plan, you know, this is where based on all of the numbers and that he's run, this is where we need to be with premium increases. Okay. Thank you for that. And I appreciate having kind of him bringing forward a solution to especially the financial piece of this. Um, and I appreciate that that was presented to the committee members and I'm sure that was a tough decision for them to weigh as well. I'm glad they asked lots of questions. Um, and I and I understand where they went as well. So, thank you for answering. Again, a super difficult decision and one that there might be some legitimate disagreement with in terms of priorities. I mean, we just have to probably look at making a decision as quickly as we can with the information we have and supporting the majority um position. Um there is a motion and a second. Um and something I just don't want to minimize is also the significant complex process that's involved that steps have to be made to get to the next step to get the next step and and so forth and every day does negatively impact that. So, um I don't think any of us on a surface all would really understand the the difficulty that might still involve. So, um I know it's hard for everybody. Um Oh, I was just going to ask Sarah, you mentioned that you need more information. Um what if you like just so staff would know maybe what more additional information you would need? I not to put you at Sorry. I just I mean I think that that answer sort of I mean is it I I I feel like um there's a lot of information um a lot of I think questions I have um that I think just in terms of some of the underlying assumptions and uh what this really means that I think would be helpful for me to be able to think about and then ask um before before voting. So, I don't think given what I know this minute, I would feel comfortable voting for any sort of change. Even though I recognize that we've got to be really budget conscious, I just I don't I don't I don't feel like I have that I'm equipped to vote for any sort of change. Okay. Today, this morning. Thank you. and uh chair McKis just provide some insight in terms of what vote options board members would have if it did come to vote. Yeah. So if we so we have a motion in the second to vote on um if it if it passes then the change is made. If it fails then the floor is open for another motion. Um there can also be um a motion like we can table it. Um but right now we have the motion in the second to vote on and board members could abstain as well or no. Yeah, you can. Um yeah, you can Yeah, just to make sure everyone especially the new you can vote for it against it. You can abstain. Um let me Hold on. Hold on one second because I you just had thinking through um director so that your um your comments about needing more time and more um this is a lot of information to process and this is definitely not our usual process of getting a really heavy presentation and then having to make a decision at the board table. Um, and I can definitely sympathize uh with wanting more time. And as the conversation is progressing, um, I'm definitely thinking, as much as I want more time, I don't necessarily feel like it is needed for me at least to make this decision. Um, since it's going to be a heavy decision either way. I mean, people are going to be affected, impacted in both directions. And I want to respect the process of hold start rolling after this and give um our staff the time to really use that to make the the best financial decisions or human factors. I mean all the whatever decision we go with I feel like as from a governance level we really I would like for us to make a decision and move forward with it to let our our staff kind of deal with the management implications of it even though there are definitely things that I don't understand and clearly you have more background on this and probably others Christie as well. Um, so this is I feel like this is way out of my league um, professionally, but um, in terms of allowing our staff to kind of work out the bugs and figure out the logistics of this, um, even though yeah, I would love more time to process um, I also feel like it's important to make a decision today. That's just where I'm landing on that. Pete, and I'm I'm fine with that, too. and I tend to uh go with the the staff that lived with it have been been thinking this through and there's a majority of staff and I'll tend to go with the staff. So just to make sure I understand the clarification a yes vote is going to be for that 13 versus the 18%. That's the motion. Yeah. Yes. Yes. I guess two things responding to to you Pete. You know the staff voted one way or indicated. I'm sorry. But that said, they don't have as much information as the as the insurance committee does. They don't ask all the same questions that the insurance comm's uh you know quandry of of wanting more information. There are so many stories behind every one of these success successful uses of these drugs for weight loss that are beyond just vanity, right? Every one of these has, you know, lifestyle changes, the ability to do things they haven't been able to do in years, medical conditions that aren't exacerbated by having, you know, carrying more weight. So, it is hard. I mean, that's that those all that backstory is what's hard for me, right? That that's where it gets hard to be like, well, you know, we need to, you know, we need to save money. Um that said, at some level that's kind of where where where we are, you know, at in in our current budget uh uh position right now. And so I think that in the end the the financial considerations are are important and probably more so. And I don't think that the benefit of time would just make me think more about about it without ever coming to any more of a comfortable decision to it. So, and I also want to acknowledge that we've received some emails um from last night and and still coming in from like you said, director, real people with real positive impact from these drugs. and it is um it's impactful like so I appreciate I want to acknowledge those emails and and just I appreciate those and it just is these are really difficult decisions but I wouldn't have made the motion if I didn't feel like from a fidiciary standpoint this is that important to get us on the right trajectory um and that yeah these are just really difficult difficult decisions and So yeah, I would echo that. Cherry Sherman just you know obviously I would second it um but I didn't think it was was unfortunately needs to be done as difficult as it is but you know I think from a a board member expectation especially for board members I know everyone has to you know vote their conscience um and you know their individual vote is theirs. Obviously the expectation was obviously whatever outcomes gets uh set by the board then we all are in support of that in unison. I think that's such an important part of the board has done really our current board has done a really great job with so um doesn't make it any easier. It's Yeah. Yeah. It's hard. Yeah. I respect everyone here at the table and everyone's going to bring in their own personal experiences and professional expertise and knowledge. So, um, however, this will come, but I appreciate the dialogue and the conversation. Um, and certainly the staff's time involved in working through all these really difficult and complex conversations. Um, any other comments? We do have a motion and a second and a lot of us probably have to get to work. Um, uh, so I will I think we're ready for a vote just to see where we are at right now. So, we have a motion in a second to um support the 13% um and that will maintain the GLP1 coverage for medical purposes, not for weight loss purposes. Just to be clear on that. Um all those in favor of supporting the motion, raise your hand and say I I opposed. Nay. And then abstensions. Okay. Motion passes. Um, again, heavy heart in this decision and um, yeah, just a heavy heart. So, with that, we're