While the state budget crisis gets most of the media attention these days, another crisis - the ailing state of health care both nationwide and statewide - continues to spiral out of control.

 

Teachers have traditionally taken solace in the thought that although they may be working in a profession that's spectacularly underpaid, at least they have good benefits. That assumption no longer holds true. Many districts are asking teachers to pay more in premiums or co-pays, and at the same time accept less in the way of medical services. And while health care may be considered a "fringe" benefit, it is hardly on the fringe when it comes to teacher concerns.

 

"It's always a big topic with members," says CTA President-elect Barbara E. Kerr. "In some areas, they are having to pay huge amounts out of their pay checks. It's a fight to keep teachers' health care benefits every time negotiators go to the table. It's past the crisis stage."

 

"Next year it's estimated that health care costs will rise 15.4 percent, including prescriptions," says Susan McClure, a health care consultant with CTA's Member Benefits Department. "Anybody you talk to in the insurance industry is anticipating double-digit increases for the next three to five years. Medical inflation is three times the rate of general inflation. I have seen some members of our chapters paying $400 a month out of pocket for family coverage because of increased costs - which is like taking a pay cut."

 

At the rate things are going, health benefit costs could double in three to five years. If it doesn't stop, by 2012, the cost of health care benefits could actually exceed the average teacher salary. The situation is even worse in rural areas, where there are few providers - and little in the way of competition.

 

Unfortunately, no federal assistance to states is expected in this area. Medicaid cuts lead to cost shifting and a further increase in the number of uninsured. An estimated 40 percent of Californians are presently without insurance.

 

There is some good news for educators, however: Ninety percent of K-12 teachers have medical coverage and it is available to 99 percent, compared with 70 percent of those working in the private sector.

 

Why is the cost of health care so high? Among the factors responsible for the dramatic rise in health insurance premiums are:

• Pressure on health plan profitability;
• Emerging medical technology;
• Pharmaceutical costs and utilization;
• Consumer demands;
• Managed care reform;
• High administrative costs;
• Fraud and abuse;
• Medicare reductions;
• An aging population.

"The state of health care is, in a word, disastrous," says Kelly Horner, manager of CTA's Negotiations and Organizational Development Department. "It's no longer a problem for the poor and the working poor. Now it's beginning to impact the middle class in our state."

 

For some teachers, health care benefits are in good or stable condition. For others, they're in critical condition and maybe even on life support.

 

Just as there is no one-size-fits-all approach to health care, there is no uniformity in benefits for teachers throughout the state. In spite of the pessimistic outlook, many chapters are making gains or holding their own. Many of the contracts that have been bargained recently include an agreement to continue district coverage - albeit sometimes with higher co-pays or deductibles. In other districts, teachers are paying a great deal more for health care and receiving less in the way of services. Some are threatened with losing health care altogether.

 

It is also worrisome for retirees - and those thinking of retiring. Many districts that offered retirees medical coverage in the past are opting not to continue the practice. Teachers who retire before age 65 could be left without insurance until they are eligible for Medicare.

 

When health care premiums went up in the Desert Sands Unified School District, administrators decided they would shift the burden onto teachers. To pay the difference, the district has deducted $103 per month from teacher paychecks this year. Needless to say, tempers of those who teach there are short.

 

It's a matter of respect, says Carole Bailey, president of the Desert Sands Teachers Association (DSTA), whose members teach in Indio, La Quinta, Bermuda Dunes, Palm Desert and Indian Wells. "Teachers are not being treated like professionals. Teachers have worked hard to raise test scores. We've volunteered countless hours and spent thousands of our own dollars to deliver a quality program for our students. In return, we get this."

 

The situation has created a financial hardship for DSTA members. Essentially, it's a cut in pay. "We're definitely going backwards," says Christine Duncan. With her husband, Keith Duncan, also teaching at Lyndon B. Johnson Elementary School in Indio, the deduction has hit them doubly hard.

 

"We are trying to save money, because we want to have kids," she says. "We only have one car, and we need a larger one. But now we are paying an extra $206 out of pocket, which doesn't seem fair."

 

The district's right to take money from teacher salaries was recently upheld in court, based upon the contract language. "That contract language has been in place for 20 years, but the district has never opted to take money from teachers' paychecks before," fumes Bailey. "When DSTA requested other options, including bids from other insurance providers, the district refused. We have offered to adjust co-pays and deductibles to offset costs, but the district turned us down. We've done informational picketing and now we're working-to-the-rule. We are in the middle of fact-finding and have an unfair labor practice filed with PERB. This will ultimately hurt students, because it will have a big effect on our ability to retain and recruit teachers."

 

To date, the district has taken half a million dollars from DSTA member salaries. There was no such deduction for administrators, but their co-pays were increased.

 

New Haven Teachers Association members have been picketing school board meetings and administration offices since the district refused to lift its cap on health care this year. Some members are paying hundreds of dollars out of pocket each month.

 

In 1996, NHTA members - and members in several surrounding districts - opted to roll health care into salary. In the case of NHTA, the district negotiated to match increases in health care costs dollar for dollar. But now the district is refusing to provide any compensation at all - and health care costs have gone up 23 percent.

 

"The current offer is zero in health care and zero in salary," says Don Heinsohn, NHTA president. "But it's not fair to let health care cost increases devour our salaries. We believe that health care for every employee is a right, not an option or a discretionary expense. Teachers make a clear choice to work in a profession where the pay is not commensurate with their education. All we ask in return is some kind of decent retirement and decent health care."

 

If the district wins, Heinsohn fears it could be the beginning of the end. "The district is proposing that every member pay every dollar of increased health care costs out of pocket for the rest of their career. For them, a permanent cap means a permanent cap. But we want the district to continue its 40-year commitment to covering the health care costs of our members. We have backed away from salary increases - unless there's a surplus."

 

Members of the Sweetwater Education Association (SEA) in Chula Vista are also protesting over cutbacks in health benefits. More than 1,000 educators held a rally at the district office - the largest turnout in history for SEA. And in the middle of every week, it's "Black Wednesday" - teachers wear black and conduct informational picketing. The association's contract expired in June and negotiations are at impasse. In January, the district imposed health care benefit cutbacks costing some SEA members as much as $146 per month. The district has offered a 2 percent increase to the health care cap, but costs are projected to rise at 20 percent for the next few years.

 

"Even at a time when the state is facing a deficit, this district is carrying reserves far in excess of the state mandate," says SEA President Chuck Patterson. "It's clear they have the funds to provide employee health benefits and settle this contract."

 

"We understand that health care costs have gone up, but eliminating health care benefits will not help the district keep the quality educators that our students deserve," adds Bargaining Chair Nancy Cummins-Slovick. "That is neither smart nor fair."

 

Health care cuts despite a huge reserve is also the story in Stockton. Members of the Stockton Teachers Association are frustrated by the district's demand to place a cap on what it pays for health benefit premiums - despite having $33 million in unrestricted reserves. Members, who protested in February, say the district is exploiting the state budget crisis as an excuse to punish and intimidate educators.

 

Members of the Association of Placentia-Linda Educators (APLE) received a 2 percent salary increase at the bargaining table that was equal to about $80 per month. The bad news was that the health insurance employee contribution jumped from $90 to $450 a month for those who elected to stay in the PPO plan.

 

"Their deductibles and co-pays also went up," says Lloyd Porter, a CTA Board member who belongs to APLE. "The result is that our salaries were effectively decreased by more than 12 percent. Teachers' options were to leave the health benefits program, step down to a less expensive, less desirable HMO plan or bite the financial bullet and pay five times what they did the year before for coverage."

 

Porter represents an area that includes 18,000 teachers in more than 20 school districts located in Orange and Riverside counties. "Negotiations in several of these districts are stalled because of the rising cost of health benefits," he says.

 

In rural areas health care choices for teachers are even leaner because there is less competition. The 35 chapters in Modoc, Siskiyou and Shasta counties have only three choices for health care. There are no HMOs available in any of these counties. Out of the 35 chapters, only two are not paying out-of-pocket expenses for health insurance premiums every month. Several are paying $225 to $250 per month and the numbers are anticipated to rise in the future.

 

This fall, the Health Plan of the Redwoods in Sonoma County closed down, forcing thousands of participants in that plan to pay much higher premiums to for-profit health plans without gaining any benefits. The move has forced some rural chapters, like Valley of the Moon in Sonoma, to go back to the bargaining table and reopen the issue of health benefits. The members who belonged to the health plan were able to transfer to another one that has higher premiums and higher co-payments. The district agreed to pick up premiums for six months, although it has declared an impasse in negotiations.

 

For community college faculty - especially part-time faculty - employer-provided health care is usually nonexistent. Even though part-timers (also known as "freeway fliers") may teach at several campuses, they may not be provided health care coverage by any of their employers.

 

An exception was made when the Continuing Education Faculty Association at Rancho Santiago Community College District bargained a health care reimbursement plan for its 887 teachers at 50 sites in lieu of a salary increase.

 

"It's very stressful for part-timers, many of whom commute between different college districts. They are not provided employer health insurance because they are considered part-time, even though they may work much more than 40 hours a week," says association president Dave Hall. Under the new plan, teachers without insurance from a spouse or other employer can apply for up to $1,000 a year from a special fund.

 

"We tried begging and it was not forthcoming," says Hall. "We were willing to forgo a salary increase or a percentage of our salary increase to fund this reimbursement plan. It's that necessary and that immediate a need. It's sad, but it's a foot in the door for getting our members insurance. Just because we are part-timers doesn't mean we should be treated as second-class citizens."

 

Sometimes the health care of teachers can be jeopardized by fraud and abuse. Rick Ziel, president of the Monterey Bay Teachers Association, says teachers were shocked to discover that the business officer had taken money the district had set aside for teacher health benefits and used it for other things.

 

"Basically, we were a self-insured district at the time," he recalls. "The business officer had taken money out of our health and welfare fund to the tune of $10 million in 1998 and used it for other district costs. We didn't think that was right, so we sued. With the money they've taken, plus interest, they owe us $15.6 million." Teachers won the court case in March 2001.