Seven years ago, health insurance premiums and deductibles were so high for San Marcos teacher Susan Seaton that she said she couldn’t afford her diabetes medication and she had a stroke.
This year, because of changes in her benefits under the only health insurance plan she can afford through the state, she’s spacing out her rheumatoid arthritis injections to make the medication last longer, against her doctor’s wishes. She’s spending a third of her paycheck to pay for the medication up front — $4,400 for a three-month supply.
“When the teachers of Texas are paid well below teachers in other states and their health insurance continues to rise, then you have to start making the hard choices. Do you pay for health care or medication, or do you pay for living expenses, or do you leave the teaching field?” Seaton, 49, said. “We’re at a tipping point.”
Teachers are having a harder time affording health care as costs rise and the state’s monthly contribution to teacher premiums is unchanged over the past 15-plus years at $75 under TRS ActiveCare, the teacher health insurance program run by the Teacher Retirement System of Texas. At the same time, teachers’ share of premiums has more than doubled since the program went into effect in 2002. Many school districts have raised their contribution from the statutory minimum of $150 a month, but with financial constraints from an outdated state school funding system, cash-strapped districts have passed on some of the increases to teachers.
With average pay about $6,500 below the national average, more Texas teachers are choosing the high-deductible TRS ActiveCare plan for its cheaper monthly premium but with limited coverage. When TRS ActiveCare started, a little more than 10 percent of teachers were in the high-deductible plan; this year, that figure has ballooned to more than half.
“When the state’s contribution doesn’t go up and school districts are hammered with their own budgetary issues, it only leaves the teacher, bus driver or cafeteria worker to make up the rest,” said Clay Robison with the Texas State Teachers Association, which for the past few sessions has lobbied the Legislature to increase its teacher health insurance contribution. “It’s eating away at their take-home pay.”
‘Not asking for the world’
About 442,000 Texas public school employees and their dependents are enrolled in TRS ActiveCare. Monthly premiums, after the minimum state and employer contributions are deducted, cost teachers between $126 and $489 for individual plans and up to $2,004 for family plans. The highest yearly in-network deductibles for individuals and families are $2,500 and $5,000, respectively.
Texas was 27th in the nation for teacher pay in 2016, according to the latest data available from the National Education Association. That year, the average teacher salary in the state was $51,890.
More than half of the state’s public school employees are on HMO plans regulated by the Texas Department of Insurance or plans through their spouse’s employer or through their school districts that have their own health insurance program.
The four biggest school districts in Central Texas — Austin, Round Rock, Leander and Pflugerville — have opted out of TRS ActiveCare, hoping to save money and have more flexibility to negotiate directly with insurance companies. Once school districts opt into TRS ActiveCare, they can’t opt out, even though the state’s teacher groups have asked the Legislature for districts to be able to opt out. The state still contributes $75 per month to employees in self-insured school districts, and school districts must contribute the statutory minimum of $150.
Due to rising health care costs, Austin school district employees saw increases in their monthly premiums this year, but the district also raised its contribution to $545 per month, more than any other school district in the state, according to district officials.
“Over the past three years, Austin ISD has kept increases to less than 5 percent through effective plan designs and employee education, which is remarkable in the industry,” said Fernando Medina, the district’s chief human capital officer.
Seventy-three percent of school districts contribute more than $150 a month per employee, according to a recent Teacher Retirement System survey, and many of them do it to ensure at least one of their health insurance plans has a $0 premium. Doing so helps keep competitive districts, particularly in urban and suburban areas, whose largest budget expense is paying for staff salaries and benefits.
“When costs increase for health insurance, it doesn’t just affect the health insurance benefit we can offer. It also affects the salary we can offer. The more the district must pay for health insurance, the less money it has to pay employees in their salaries,” said Tim Savoy, spokesman for the Hays school district, which contributes $351 a month to employee premiums.
The Del Valle school district, which participates in TRS ActiveCare, contributes up to $500 per month for employee premiums, but costs continue to increase for employees, said Michelle Cardenas, a prekindergarten teacher.
Cardenas, 35, said her midlevel plan has limited her to more expensive prescription drugs and longer wait times to get procedures like a CAT scan approved, and only Seton hospitals are considered in-network, Cardenas said.
“I literally tell everyone if I fall in Houston, just drive me back to Austin,” she said.
Seaton said that the San Marcos school district gave salaried employees a 2 percent raise this year but that most, if not all, of the raise went to pay for increases in health insurance costs.
Killeen music teacher Rick Beaulé, 46, has seen his deductible this year increase from $6,500 to $7,350. Beaulé, who has diabetes, met his deductible in 2016 and will meet it again this year after recently having surgery on a hernia that damaged an esophageal valve. His take-home pay is $3,100 every month, which doesn’t include what he spends on school supplies. Last semester, he spent about $120 on materials to build a device to teach students about sound waves.
“We’re not valued. We’re not respected, and we’re not funded. It has been set up so that we are treated and viewed as inconvenience to the taxpayer,” he said. “We’re not asking for the world. We’re asking to be fairly compensated.”
What the state can do
Since the structure of teacher health insurance programs varies from state to state, it’s hard to know whether Texas teachers are worse off than those in other states, but the fact that the state has not increased contributions while health care costs have risen does not look good, said Joel Solomon, senior policy analyst with the National Education Association.
Ann Fickel, associate executive director of the Texas Classroom Teachers Association, said TRS ActiveCare plans should offer better coverage, including more reasonable deductibles, out-of-pocket maximums and premiums. She said teachers shouldn’t have to choose high-deductible plans with the worst coverage because that’s all they can afford.
Ultimately, she would like to see the state offer a high-quality, no-cost, employee-only plan to teachers, just as it does for state government employees, including those who work for the Texas Education Agency. When TRS ActiveCare was created, the district and state contributions were sufficient to offer teachers at least one no-cost plan.
Faced with a tight budget cycle next legislative session as well as pressing financial issues such as Hurricane Harvey recovery, school funding problems and ensuring the retired teacher health insurance program stays solvent, the Legislature will be hard-pressed to boost the state’s share of teacher health insurance premiums.
“Teachers know that everybody has high insurance and high medical costs and they’re not the only ones in this situation, but the problem is when we’re getting to a point where teachers can’t afford to be in the profession, that’s going to affect everybody,” Fickel said. “If teachers are having to quit because they need more money or they need better benefits, then you are going to have kids in classrooms with unqualified teachers or kids in giant classrooms because there aren’t enough teachers.”
|How much Texas teachers pay for health insurance|
|Texas teachers have a choice of three health insurance plans through the Teacher Retirement System of Texas. Compared with the insurance program for Texas state government employees and other employer-sponsored programs nationally, Texas teachers must pay a higher share of the premiums. The state’s monthly contribution of $75 per district employee has not changed since 2002, but many school districts have increased their contributions from the required minimum of $150 per month. The following chart reflects the maximum monthly premium a teacher must pay.|
|ActiveCare 1-High deductible||ActiveCare Select||ActiveCare 2||State government employees||*National programs|
|Employee only premium||$351||$514||$714||$622||$580|
|Employee pays||$126 ǀ 36%||$289 ǀ 56%||$489 ǀ 68%||$0 ǀ 0%||$109 ǀ 18%|
|School district/state pays||$225 ǀ 64%||$225 ǀ 44%||$225 ǀ 32%||$622 ǀ 100%||$471 ǀ 82%|
|Employee pays||$1,091 ǀ 83%||$1,364 ǀ 86%||$1,779 ǀ 89%||$595 ǀ 33%||$504 ǀ 31%|
|School district/state pays||$225 ǀ 17%||$225 ǀ 14%||$225 ǀ 11%||$1,217 ǀ 67%||$1,119 ǀ 69%|
|Source: Texas Classroom Teacher Association|
|*PPO data was pulled from a 2016 Kaiser Family Foundation survey of 1,933 randomly selected public and private employers’ health insurance programs.|