Rita Madrid, a third-grade teacher at Sgt. Roberto Ituarte Elementary, normally paid about $100 a month to cover the cost of her son’s medication under the previous Socorro Independent School District health insurance plan.
After SISD changed its provider from Cigna to Aetna in January, the prescription cost rose to $1,823 a month.
“This is a 1,723% increase, which amounts to $21,876 per year in co-payments,” Madrid told the SISD trustees during a school board meeting in February.
Stories like Madrid’s led the SISD board to reverse some of the changes to the district’s employee health insurance plan during a lengthy meeting on March 21, reducing the cost of urgent care visits and generic medication co-pays.
Even with those updates, some employees are reeling from the transition.
“There’s a lot of teachers who are struggling with some of the prescription costs,” Madrid told El Paso Matters.
On Aug. 16, the board voted unanimously to switch from Cigna – the provider serving the district for at least five years – to Aetna, saving SISD $4 million in fiscal year 2023. During the 2022 fiscal year, the district spent more than $56 million of its $580 million budget in healthcare expenses, according to its 2022 Comprehensive Annual Financial Report.
However, the details of the new health plan and the impact it would have on employees weren’t discussed until Sept. 20 when the board held a workshop to go over the specifics of the changes.
Trustees during that August meeting questioned how the change would impact teachers and employees, but the district’s insurance consultant, Randy McGraw, said they wouldn’t know until the board chose a provider.
“Some of the things that you don’t see here are: What are the benefits going to look like? What are the payroll deductions going to look like? And the answer to that question will come after we have some additional meetings with administration on plan design changes and changes in payroll deduction, because we can’t decide what the plan design is going to be and how that’s going to work until we know who’s going to be the third party administrator,” McGraw said during the meeting.
While co-pays for prescriptions rose about $5 to $10 for most employees, some employees who take specialty medications have found that they are no longer covered. Some of these drugs include CellCept, which is used to prevent organ rejection after transplant, and Zoladex, which is used to treat certain types of cancers. Many were forced to find alternatives or pay the full cost of the drugs out-of-pocket.
Madrid said she attempted to find a substitute for her son’s medication but found the cost was even higher at $2,100 a month. She said she was able to get the medications covered through PrudentRX, a co-payment assistance company the district partners with, but is unsure when the help will run out.
“I’ve received mixed messages. One person told me that they have a max of $5,000 per year, but others that I have spoken to tell me that they have no max. So I don’t know. I’m kind of in limbo,” Madrid said. “I’m happy for the time that they’re helping me cover this, but I don’t know if I’m gonna get a bill after I meet that max.”
In another case, educational diagnostician Janet Escondrillas said she struggled to get treatment after an injury and had to go through obstacles to see her regular doctor.
“They let me know, ‘We do not just take that insurance. They won’t let you come here unless you go to this other doctor first,’” Escondrillas recalled during a SISD board meeting in March. “So I did. I called Aetna to find out what I needed to do. I did go to the doctor that they recommended but then I never got the treatment that I needed.”
SISD Board President Eduardo Mena said that many of the issues employees and staff are experiencing are a symptom of the transition and will eventually subside.
“We’re 5,200 employees, so there’s gonna be some growing pains as far as registering to the pharmacy, and sometimes, you know, people are always going to complain about something. I’m sorry to say that is true,” Mena told El Paso Matters. “But HR told me that we’re working with all the employees. … We will eventually resolve these issues and our employees will be happy eventually, and most of us are happy.”
Mena, who is running for reelection May 6, said he did not have a full understanding of the specifics of the new health plan.
“Whenever we approve something it’s not set in stone. We can always go back and adjust it just like we did (at) this previous board meeting. So if we feel that our employees are suffering a little bit too much or paying too much in health care costs, then we’ll make changes,” Mena said.
Once staff started coming forward with complaints on how the new system impacted them, some board members expressed a desire to reverse some of the updates they had previously approved.
“When the board sees $9 million every year being taken out of our unassigned fund balance, it freaks us out. So we tasked you with helping us decrease that, because our unassigned fund balance is going to run out. And that was very scary for this board,” SISD District 2 Trustee Cynthia Ann Najera told the district’s human resources director, Mario Carmona, during a board meeting in March. “When the board looks at the impact it’s going to have on our employees, it’s like, okay well no, nevermind, we change our mind.”
Under the new plan, most employees saw their premiums stay the same, while others saw them drop in cost depending on their plan.
Overall, deductibles rose anywhere from $50 to $250 for individuals and $100 to $500 for families under the new plan. Out-of-pocket maximums tripled from $200 to $600 for individuals and $400 to $1,200 for families.
Before the board reversed some of its changes in March, more than 2,300 employees saw their urgent care co-pays more than double from $35 to $75. It has since been reduced to $40 for most employees.
The new plan also expanded coverage in Mexico, allowing employees to see doctors across the border at no cost.
Carmona said employees were sent advance notification “to minimize disruption and encourage consultation with their doctor.”
But the president of the Socorro American Federation of Teachers, Veronica Hernandez, said many of the employees who were impacted the most never received that notice.
“A lot of our people are really unhappy with (the health plan) and said that we went from bad to worse,” Hernandez told El Paso Matters. “I heard from many of our members, they’re scared to speak up.”
Some of those who did make their voice heard, like teacher Gina Panfile, felt the $4 million in savings were negligible compared to the struggles they have experienced since the change took effect. Panile, who has epilepsy, said she saw her prescription rise from $3 a month to $180.
“We are a district with a half-billion dollar budget, the district saved .008%,” Panfile said during a March board meeting. “The savings does not seem to justify the financial, emotional and mental hardship that this has created (for) its district employees.”