Health Care Discussion Skidmore College Faculty Meeting May 15, 2019

Thanks! Acknowledge deep personal, emotional, and real pain associated with individuals’ health and well-being. Thank you Tillman, for sharing your wife’s and your family’s story. Acknowledge private and personal nature of health care and health care coverage. Appreciate persons’ willingness to open up their vulnerabilities or protect the vulnerabilities of others who may not be in a position to speak for themselves. Acknowledge decision-making at Skidmore is deeply personal because we are interconnected in so many ways. e.g., I think I knew almost everyone who spoke at the health care fora. Thanks to HC subcommittee members, members of IPPC, Donna Ng and the President and President’s Cabinet. I do think it is helpful to view each other as colleagues rather than as adversaries in the context of difficult decision-making. Impressive – Many persons have supported options and alternatives which go against their best interests.

The Process IPPC discusses health care matters and alternatives and decides a subcommittee is needed to conduct a deep dive into this matter. The charge. Narrow vs. Broad – Narrow Pro – allows subcommittee to focus and allows community to focus Con – potentially ignores other areas of cost savings and other budgetary concerns; ignores total compensation framework

The Process IPPC also makes the decision to increase representation by adding two staff to the Budget and Finance Subcommittee. The subcommittee is diverse with respect to many, but, not all key dimensions of health care. Health Care Subcommittee & IPPC Inter-Play – ex. Advocacy for persons at lower bands; repeal of any changes to out-of-pocket maximums; emphasis on Skidmore community as a sharing community in the context of discussion around a user-oriented cost-sharing philosophy. HC Subcommittee & IPPC both add value. Health Care Subcommittee and IPPC both stressed community involvement/input, frequent updates and allowance of time for employees to make decisions with respect to open enrollment etc.

Values & Other Themes Increase Premiums vs. Reduce Coverage vs. Premium Subsidies (Employer Absorbs Costs) Should Skidmore seek alternative strategies to avoid significant increases in health care premiums and employee cost sharing? Is providing health care a strategic priority for the college? Where does it rank as a strategic priority? This question is beyond the scope of the subcommittee. However, it may be a worthwhile discussion for future bodies to consider. How should we value health care in the context of other strategic priorities? Goal-Orientation Should we aim for a certain amount of cost savings on an annual or overall basis or target a certain ratio of college vs. employee contributions?

Values & Other Themes Relative Standing on Income Earnings Would we favor a system where we have four bands with persons in the two higher bands receiving disproportionally higher percentage increases in premiums? For example, the maximum increase for persons in the lowest bands would be 5% while the maximum increase for persons in the highest bands would be 15%. Higher Premiums vs. Increased Deductibles and Co-Insurance Avoid dis-incentivizing persons to use insurance (Avoid deductibles and co-insurance as much as feasible) vs. User-Fee Oriented System (i.e., Cost of the Plan vs. Cost of Using the Plan) What is our community value in this area? – Seems we lean toward the collective/higher premiums.

Values & Other Themes Per-person premiums for employee only plans vs. per-person premiums for family plans What is our community value? – Seems we lean toward supporting families and their situations. Other examples – tuition reimbursement, day care, etc.) Would we favor applying deductibles and co-insurance to only non-Skidmore employees (spouses/partners and children) who are carried on Skidmore’s health insurance coverage?

Values & Other Themes Spousal Coordination With respect to have internal spouse coordination do our values suggest taking the average of employee’s salaries rather than charging them at the salary of the highest paid spouse/partner? Should we treat internal and external spousal coordination cost-sharing issues differently or the same? What types of strategies/tactics (rebates, surcharges etc.) should be used to encourage non- Skidmore employees to select insurance through their own firm or organization? Skidmore would no longer be the preferred employer with respect to health care. What is our community value? Should Skidmore be the employer of choice with respect to health care? Is it fairer to consider average salary when remedying the current situation of working spouses/partners here at Skidmore?

Values & Other Themes More Analysis is Needed – Keep Everyone Informed All community members should engage in the identification of alternatives, questioning of our values etc. Conduct impact analysis and communicate potential results to community prior to implementation. Conduct Disruption Analysis, as necessary. Being Proactive vs. Reactive Easier said than done for most organizations and firms. Having said that, the administrative segment of health care costs (self-pay vs. alternatives etc., stop loss collective, consortium) and the college’s overall budget parameters need to be part of any accounting with respect to long-term health care costs, savings, hedging, etc.

Future Work Aligning Decision-Making with Community Values Community Input and Involvement Administration-HC Subcommittee-IPPC Inter- dependence Salary Bands Spousal Coordination – Various forms; Alternatives etc. Cost of the Plan Cost of Using the Plan – Plan Design Administrative Structures

Thanks!