You can’t compare what isn’t getting measured
| AFSCME's 2026-2027 contract passed, barely, as only a couple hundred more voted to accept the tentative proposal than voted to reject. An AFSCME vote to 'strike' (reject the tentative proposal) signals willingness to wait during continued efforts to negotiate something acceptable. What passed was an un-raise not even close to the rising cost of living. Zombie voting, ballot box tricks, ghost electors, none of that had anything to do with it. The only zombies here are distracted members walking around under an impression dues payers need not vote because... they pay dues, their dues will vote for them. There are places, entire countries, that voting is mandatory, but AFSCME has no such requirement, nor any duty to serve in labor activity, as the Teamsters require. Did the hundreds of hours of negotiation that may legally be kept entirely confidential under PELRA law in Minnesota result in anything of value, for any state employee? The times they are a-changin', changing ways that ordinarily common gets can no longer get got. It is getting harder to keep what one already has. Possibly negotiators believed agreeing to continue medical insurance benefit plan stability would allow the most members possible to pull through, to survive by keeping their jobs and staying afloat. These are proving to be unprecedentedly strange, uncertain and troubling times. Were negotiators razzed, shanghaied, confused, misled, lulu-gigged, buffaloed or asleep in comas? We don't know, although judging by the low vote turnout, some members were. The buck either starts or stops at the contract ballot box. Confidentiality, folks. If that is the reason we don't know, it's public employment collective bargaining law in this state unless negotiators, both sides, agree otherwise in writing. See 2026 Schedule of Benefits On the schedule, fine print mentions "embedded deductibles" negotiated to continue from the previous contract, appearing in the final agreement as a benefit chart for services incurred on pages 605-606. 1 Circumstances, choices and incentives that allow paying less for less insurance are not a substitute for real hard cash payroll raises. Nobody is ever fooled by cheap, easy or dodgy gimmicks, it's always the current affordability of the current economy, stupid. Circumstances? What could be a circumstance? Recurrent road maintenance budgets have been sacrificed to cover one-time project construction shortfalls. Infrastructures relying on economic cooperation, by sharing investment in physical facility and pooling operating responsibilities, have lately not united common civic and community values and goals anything close to what everyone had hoped. The fad for roundabouts, instead of normal traffic lights? More than a few result after adding the total of three levels of government transportation traffic funding revenue streams and budgets - city, county and state - passing the cash hat three ways and then coming up short with less than the one million dollars that is the current cost for one 4-way electronic traffic semaphore signal light system. Bada bing bada boom, another roundabout appears. There are different ways work is offered, where it is and who is willing to work in gig mode at wages offered. After the COVID pandemic, A.I. and remote work reduced commute traffic but doubled down on delivery vehicles, this has re-centered family living for working people, changed the entire job marketplace with many lasting economic effects. Counties fall back on the state to handle on-boarding unemployment insurance, including processing applications, performing means testing, screening for fraud and work-ability or other evidence of eligibility necessary to administer social programs. Why is there demand for social programs beyond the means of counties to administer? Of the many involuntarily quarantined out of their workplace, many of those who remote worked and tasted relief from the grindstone of daily commuting now find wages they had back then are not worth going back for. Employers so love it when payrolls shrink, and there you have it. A whirlpool of circumstances. The longer one stares at supermega-campus or multi-state hospital systems, the more one is likely to find ever deepening, interwoven and cozy health plan integrations. Health care provision and coverage things aren't the same, get harder to appear as non-profit entities, start converging and overlapping after upscaling. Acting on cut-offs, closings and what could be the start of rationing requires doing more than nothing. Changing to a clinic or plan that actuarials moved to a better tier, with lower deductibles and out-of-pocket maximums, can 'feel like' getting up to a 12% net pay increase. Some individuals report cost of their plan coverage for 2026 will rise over 50%, what size raises could cover that? In a recent Gallup poll of 18,400 workers in many kinds of employment, only 40% said their jobs "provide financial well being, safe and respectful workplaces, some control over their work, a voice in decisions that affect their job, and opportunities to build skills and advance." Those five criteria for defining a 'quality' job become four if union membership denies, tunes out, abstains and neglects to claim the most basic affirmative right any individual worker can ever make: a contract vote on an individual level that 'says' whether or not a proposed contract upholds acceptable workplace quality in fair pay, predictable hours and access to advancement. Union membership is a 'registered citizenship' that gives a right to vote on contracts, dues 'buy' the right to participate by voting personally - and here it is: exercising one's right to vote and personal health wellness stability have been strangely yet provably connected. | |
| Embedded Plan Structure Unpacked | In auto insurance jargon, policy coverage limits or deductibles can "stack". When health insurance embeds an individual deductible within a concurrent family plan, the single deductible precedes on top of the family deductible, which applies to the total combined expenses of all members. Any one or combination of covered members' cost can serve to meet the family deductible so that everyone benefits once that number is met. Once the individual hits their limit everything is free for that individual but if the other family members continue with medical needs, they can still have bills up to their own individual limits or until the total family limit is reached. Well that sounds dazing and confusing. Embedding of deductibles is actuarial magic best pulled off with large, mostly healthy groups, and the State Minnesota has over a hundred thousand public employees. Not only does it take magic wizardry keeping that many employees working under one contract, it is magical thinking that one individual person, negotiating solo, could ever get an insurance premium discounted more at retail than 100,000 can in bulk at wholesale. Why bother mentioning any separate family plans, if for some choosing that can cost more buck but returns less (or the same) bang? The Affordable Care Act 'fix' required 'family' OOP max coding nominally appear systemically across the entire ACA-verse, in every open enrollment insurance offer, because insurance industry 'buy-in' was contingent on the 'family' business from what ACA would do. Statistically, in practice, family coding is a useful fiction that in the State health plans offers little value for ‘families’ of less than three members: single parents, childless couples or any kind of family short of minimum actuarial reproductive critical mass. 2 The full effect of the 2025 U.S. Congress not renewing the sunsetting $1 trillion ACA subsidies to states, that unfortunately is timed exactly coincident with peak years of baby-boomer retirements, is not yet clear. |
| Employer pros and cons 3 | Embedded plans have significant cost savings for employers that are blessed with a mostly healthy workforce. More complex to administer than traditional plans, offering an embedded plan risks dissatisfaction among employees who already face, or believe might be coming, unavoidable medical expenses. Traditional plans are simpler but cost more than embedded plans, and a workplace benefit less easy to explain is going to be harder for attracting and retaining experienced top-tier talent if doing so puts off younger workers, some who face extra expenses in starting families. Doing that affordably has meant the average age of first time parenthood is rising. Involved insurance plans require more time and more expensive expertise to finesse communication with employees, potentially putting more confidential health information in play, even if that is not intended. |
| Employee pros and cons | Minnesota's new Earned Sick-Safe Time law helps child-rearing parents in the private sector, name one working parent who has never had to struggle finding affordable daycare or decent health care insurance. 4 Embedded plans are the most complex health insurance structure, with both family and individual deductibles to consider. In a workforce with less healthy worker demographics, families with high medical expenses can experience more stress from unplanned higher upfront costs. But when open enrollment occurs in a time of health care and insurance market unpredictability, the savings by re-shuffling the provider or plan deck can amount to hundreds of dollars a month. |
Health Care Homes, Chapter 358, Article 2 (SF 3780) added Minn. Stat. §§ 256B.0751; 256B.0752; and 256B.0753, become effective August 1, 2008, the start of many sweeping health care reforms. Nothing seems to stop health-care delivery and related costs steadily inflating. At some point on 'non-profit' balance sheets came an abrupt cliff-drop for health system entities. Large sunk costs in bricks and mortar expansion, perennially unresolved troubles with over-worked, under-paid staff that includes doctors legally bound by non-compete agreements. Things get desperate when the busiest office at a hospital is its legal department. Finally a whistle blew to wave the dreaded rationing flag postponed by the Affordable Care Act. Out the window went performing medical miracles for low wages and any widely recognized, evidence-based and credible way for comparing clinic systems under criteria such as State of MN “Health Care Homes”.
Have statewide health measures by way of care quality studies merely been virtue signals to grandstand that government cares? Have unprofitable, un-elected non-profits, in disconnecting fixes by the elected, cured shortfalls of being too big to fail, with a side effect exposing there isn't enough charity or tax revenue in the world to cover the worst sacred-versus-secular wound ever. The material versus the spiritual is an unwinnable war.
Ending educational liaisons with university medical schools happened exactly as workers who are young, old, working or looking for work have never been more aware AI is likely to increasingly displace educated, skilled, trained, effective, compassionate and caring human healers and everyone else that works for a living.
References
1 https://www.reddit.com/r/HealthInsurance/comments/1m40l3a/i_dont_understand_the_point_of_family_deductibles/
2 https://www.cbo.gov/publication/59899
The Demographic Outlook: 2024 to 2054 | Congressional Budget Office
3 https://www.google.com/search?q=embedded+deductible+fertility+profitability+analysis
4 https://jamanetwork.com/journals/jama-health-forum/fullarticle/2838753
Improving Implementation of Fertility Preservation Benefit Mandates