“I successfully defended my dissertation titled: A CASE STUDY OF GROUP HEALTH INSURANCE COVERAGE AT ONE TEXAS SCHOOL DISTRICT, earning an Ed.D. from Lamar University. My dissertation was a single case study of group health insurance coverage at Raymondville ISD. “ – Ben Clinton
Ben Clinton, Deputy Assistant Superintendent of the Raymondville Independent School District in deep South Texas has successfully completed his dissertation titled: A CASE STUDY OF GROUP HEALTH INSURANCE COVERAGE AT ONE TEXAS SCHOOL DISTRICT, earning an Ed.D. Doctoral Degree in Educational Leadership from Lamar University
Describing his doctoral study Ben writes:
“This study asked why and how Raymondville ISD chose to offer an alternative to TRS ActiveCare. I interviewed five key individuals responsible for creating the Raymondville ISD partnership plan and reviewed plan documents to corroborate the interviews. “
“The study revealed that Raymondville ISD chose to offer an alternative because TRS ActiveCare was not affordable to many district employees. About 1/3 of RISD employees were not covered in 2018 when TRS ActiveCare was their only option. Since 2019, the first year RISD offered an alternative pan, 100% of employees have had health coverage. “
“The study also showed how the district used District of Innovation to gain an exemption from TEC 22.004(i), which had precluded them from offering an alternative to TRS ActiveCare. I also identified steps taken to create the alternative plan and the pieces that were used to construct the plan. “
“Finally, I concluded that Raymondville ISD was able to offer affordable employee health coverage by using a primary care focused plan that used reference based pricing and an open network without managed care contracts. “ – Benjamin Clinton, Deputy Superintendent of the Raymondville Independent School District
BACKGROUND
By Bill Rusteberg
Ben’s interest in solving health care for school district employees started in 2019 when district leadership came to realize all health care is, and must be, local. They realized cost and access to care can be better addressed through collaborative partnerships between plan members and the local medical community rather than managed by bureaucrats in Austin and other third party intermediaries.
Significant factors contributing to the district’s desire to find better health insurance was a general dissatisfaction with membership in the TRS ActiveCare government health plan particularly in terms of premium costs and the cost of using the insurance both of which were beyond the means of many district employees.
The first step towards solving health care seemed insurmountable. The Raymondville Independent School District, as a member of the TRS ActiveCare government health plan was precluded by statute from exiting the program or offering a competitive commercial plan alternative alongside it.
But that didn’t stop school officials. In their research they discovered a statutory exemption which they believed would allow the district to offer a competing commercial health plan along side TRS ActiveCare.
District officials had three goals in mind: Lower Costs, Better Benefits and 100% of all full time employees covered by the district’s health insurance. The later was important because one third of all full-time employees could not afford health insurance leaving them and their families uninsured.
The search for better health care started with a risk evaluation profile of the group demographics, applied empirical data specific to similar demographics in the same geographic area, and general provider acceptance of managed care and non-managed care reimbursement rates. Experience rating was not possible because TRS ActiveCare’s policy at the time was not to release a district’s claim experience.
A team approach was adopted comprised of an outside risk manager, legal counsel, actuary, local provider organizations and an independent TPA experienced in Primary Care Centric health plan management and Cash Pay Point-of-Service claim adjudication.
A health plan alternative achieving all three goals was implemented September 1, 2019. For the first time in 20 years all full time employees were covered by affordable health insurance. All financial barriers to health care were removed including deductibles, co-pays and co-insurance for those members playing by plan rules. A majority of plan members (76%) play by the plan rules. Plan members who don’t pay a $1,000 deductible, have co-pays and co-insurance responsibilities.
Going into their third year, plan contribution rates have remained static since 2019.
AND NOW, THE REST OF THE STORY
By successfully challenging the TRS ActiveCare health care monopoly for Texas public school districts, over 150 districts have followed Raymondville’s example, catching the attention of the Texas legislature.
Senate Bill 1444 was passed in the 2021 legislative session allowing TRS ActiveCare member districts, for the first time in 20 years, to exit the government program by ceding back local control of health care.
The Senate Research Center published their Senate Bill 1444 Analysis:
When researching methods to help teachers and school district staff save money it was noted that some of the school districts that have opted out of TRS Active Care have chosen health care options that save employees money on premiums and deductibles. The numbers illustrate that families save more on health plans outside TRS Active Care. S.B. 1444 is an effort to add local control to the health care insurance options.
Interested parties note that certain school districts are required to participate in the uniform group coverage program established under the Texas School Employees Uniform Group Health Coverage Act and contend that this lack of choice leads to high costs and reduced benefits for teachers. S.B. 1444 seeks to address this issue by removing the requirement that these districts participate in the program, authorizing a school district to elect not to participate in the program, and providing for a regional rating method for determining premiums.
(Source: Texas Senate Research Center 4/29/21)
As more districts explore their health care needs many more may find attractive alternatives. Ben’s presentation at the txEDCON TASA/TASB Convention in Dallas last year entitled Better Healthcare. Don’t Believe Me? Just Watch! is a powerful message towards that end. It’s an example of how one Texas school district revolutionized healthcare for schools by lowering healthcare costs while improving the quality of care at the same time.
ABOUT BEN CLINTON
In addition to his Doctor’s degree, Ben holds a BA in Economics, Rice University, Houston, TX
Benjamin Clinton, Deputy Superintendent of the Raymondville Independent School District.
T: (956-341-2095) E: clintonb@raymondvilleisd.org
