9-03-2026 12:41am

High Medical Claims Put Pressure on Warren County Health Insurance Fund

Beth Callahan Editor

LEBANON, OH— Warren County officials are preparing to put additional money into the county’s self-funded health insurance program after a series of high-cost medical claims pushed expenses above projections and depleted much of the fund’s financial cushion.

During the Warren County Board of Commissioners’ Sept. 2 meeting, Fiscal/Supply Manager Lisa Dickerson and Benefits and Risk Manager Tammy Whitaker told commissioners the county could finish 2026 with health care expenses approaching $17 million, compared with approximately $15.3 million originally budgeted.

Three people covered by the county plan have each reached the plan’s $325,000 individual stop-loss threshold this year. Together, claims involving those three members have approached $1.5 million. Another group of high-cost claimants has generated about $3.1 million in expenses, officials said.

Commissioner Tom Grossmann asked county officials to explain the self-insured system for the public, noting that it differs from traditional health insurance in which an employer pays premiums to an insurance company that assumes the financial risk.

Under Warren County’s self-insured plan, the county essentially acts as its own insurance company, paying employees’ medical claims while an outside company processes them and provides access to negotiated health care networks. To limit its exposure to exceptionally expensive claims, the county also purchases stop-loss insurance, which Grossmann described as essentially “insurance on our insurance.” The county must first pay qualifying claims before receiving reimbursement from the stop-loss carrier.

Grossmann said the arrangement allows the county to benefit financially during years when claims are lower than expected, rather than paying a fixed premium that includes an insurance company’s profit margin. At the same time, he acknowledged that self-insurance carries additional risk when several unusually expensive claims occur in the same year.

Officials initially discussed an operational transfer of approximately $5 million into the health care fund. The proposal was intended to cover an estimated $700,000 to $800,000 year-end deficit while also rebuilding reserves and providing cash to pay claims during the opening months of 2027.

Commissioners Shannon Jones and Dave Young questioned whether the county should transfer the entire amount now rather than address the immediate 2026 shortfall and consider reserves as part of the 2027 budget process.

“I want to know what it is you really need in cash between now and the end of the year,” Jones said during the discussion.

Deputy County Administrator Susan Walther said officials brought the matter to commissioners before requesting formal action because the county’s health care reserve has declined significantly during recent years.

“We need to create a reserve again which has dwindled over the last couple years,” Walther said.

No transfer was approved during the discussion. Dickerson said officials would review the figures, determine how much money is needed for the remainder of 2026 and return to commissioners with a proposed operational transfer.

The county health plan covers about 2,000 people, including employees and dependents. As of August, 915 county employees had elected coverage through the plan.

Commissioners also indicated broader discussions about the county’s health plan are likely later this fall. Young said commissioners will need to examine the plan’s design, while Jones said officials need a clearer picture of long-term spending trends, reimbursements and employee premium contributions as costs continue to increase.

Whitaker told commissioners Warren County has historically compared favorably with other public employers in Ohio, offering relatively strong benefits while maintaining lower costs.