A $35 co-pay used to cover Tracey Tyson's share of her annual physical.
But this year, the 29-year-old Strawberry Park Elementary School teacher will have to pay an out-of-pocket expense of $250 if she wants the routine medical check-up.
"I don't know if I'll get it this year," she said Thursday. "You don't want to sacrifice your health because of money, but $250 is a lot."
Tyson isn't alone.
The effects of rising health-care costs and dwindling coverage are being felt by most Steamboat Springs School District employees, many of whom must now weigh the benefits of preventative care with the hit on their wallets. Many employees also are seeking private insurance for their spouses and children.
There is little the district can do to curb the trend, say members of its insurance committee, which researches district insurance options and makes coverage recommendations.
"It's not a Steamboat issue, it's not a district issue, it's not a Colorado issue," said district payroll manager and insurance committee member Jeni Holloway. "It's all over the nation."
Contributing to the problem is the district's history of high claims, which scares off many potential insurance providers, Finance Director Dale Mellor said.
"The frequency of the big claims really hurts us," he said. "We don't just have one of them a year, we have three of four."
In fact, the insurance committee has been unable to attract any bids from providers in two of its past three attempts to improve coverage and reduce costs.
"Nobody's happy when you reduce their benefits and increase their premiums," Holloway said. "We try to explain that this is the option we have. We don't have people knocking down the door trying to insure us."
For more than a decade, the district has received coverage from The Urman Company, a Denver-based insurance provider. Up until last year, the Steamboat Springs School District shared an umbrella plan with the five other area school districts served by the Northwest Colorado Board of Cooperative Educational Services, or BOCES.
But school systems -- including the Hayden School District -- backed out of the umbrella coverage recently because they could get better benefits and cheaper rates without Steamboat's historically high claims holding them down.
"We were all living under those costs because we were in it as a group," Hayden Superintendent Scott Mader said. "We wanted better costs, so we felt we needed to break off."
Hayden did break off, and the result thus far is better coverage for its employees at rates lower than those paid by Steamboat school employees. However, the change hasn't prevented the rate increases seen throughout the country.
South Routt School District Superintendent Steve Jones said double-digit rate increases have been the norm during his tenure with the district. This year, that increase was only about 8 percent, he said, but deductibles have risen.
The budget crises plaguing many school districts have made it difficult, if not impossible, for districts to pick up a larger share of the premiums to help ease the burden on employees.
In Steamboat, a district policy that curbs salary and benefits spending at 80 percent of the district's revenue keeps additional contributions minimal. Any increased spending on benefits would necessitate decreased spending on salary because the district already is at the 80 percent threshold.
Still, members of the insurance committee say the district has done what it can to keep rates down. Faced with the option of a 28 percent rate hike to remain with its previous plan, a preferred-provider organization III plan, or only a 10.9 percent increase with a PPO IV plan, district employees chose the latter on the recommendation of the insurance committee.
But there was a trade-off with moving to PPO IV coverage: elimination of co-pays and a significantly more expensive prescription-drug package.
The result is teachers such as Tyson may have to make a decision between preventative care and holding on to more of their paycheck.
"I worry that people will be less likely to go to the doctor and do preventative health because of the out-of-pocket costs," Tyson said.
Steamboat Springs High School office manager Karen Campbell shares Tyson's concern.
Campbell, who is in her sixth year with the district, insures her husband and ninth-grade son under the district's coverage. As with other district employees, Campbell must pay $1,000 out of pocket before coverage kicks in. Separate $1,000 deductibles also apply to her husband and son.
"It's scary. I'd never not take my son to the doctor if he needed to go, but I think I'll be less inclined to go for myself," Campbell said.
So like many teachers and staff members, Campbell is looking to private insurance for her family.
"It's so expensive to maintain this coverage that we're trying to look into getting private insurance for my husband and son," Campbell said. "It seems like the insurance costs go up quicker than pay raises."
Each healthy family that moves away from district coverage ends up hurting the district as a whole, Holloway said. Healthy families help lower rates and increase benefits, she said.
"You can't blame people for going for a lower premium, but it's bad for the community," she said. "Every month people are dropping dependents (from district coverage)."
But employees themselves must stay with the coverage as part of the agreement with The Urman Company. Employees who don't cover spouses or children do not pay a monthly premium; those who do choose to cover family must share some of the cost of the premium with the district.
High school assistant principal Mike Knezevich admits he is one of the lucky ones. As a member of the district's administrative team, he is not subject to monthly premiums, though without any children it makes little difference at this point.
"I'm lucky," Knezevich said. "I can't imagine how someone that has kids can make ends meet. I've heard stories of people not going to the doctor because they don't want to pay out-of-pocket expenses.
"It's really a national crisis, it's not just us. But we've got to address it."
The effects of increasing costs and decreasing coverage could have a serious impact on teaching as a profession.
Knezevich, Campbell and assistant to the superintendent Anne Muhme said they knew of several instances when strong job candidates turned down district offers specifically because of the lack of benefits.
"Teachers don't get a lot of perks," Knezevich said. "Our benefits were really our only perk. If you start taking those away you really are going to start losing people, and this is just the tip of the iceberg."
Knezevich re-called a candidate who earlier this summer had to turn down a job he really wanted.
"He was so gung-ho," Knezevich said. "I set him up with a Realtor and everything. But when he did the numbers on health insurance, he couldn't make ends meet. Really the deal breaker was health insurance."
Members of the insurance committee say they will actively seek insurance bids for the 2004-05 school year, but past history warns them against being optimistic.
In the meantime, Holloway advises employees to learn the intricacies of their coverage so that they can use it wisely. But as some employees have indicated, the wisest use may be very limited use or no use at all.
And that begs a bigger question, Holloway said.
"If health insurance costs are gobbling up your salary increase, is it really a benefit?"
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