Should it cost an extra $100 a month out-of-pocket for Hamilton County public school teachers and employees to keep their spouses on the school district's health plan, raising the monthly cost to $533 for families?
Or should spouses who can get health care through their job be booted off the school district's health care plan while pharmacy co-pays are increased for every school employee?
Those are the two options the school board will choose between on Aug. 28 to shave about $5 million off the district's current $50 million annual health care cost.
"There's no way around this," school board Vice Chairman George Ricks said of the cost-cutting. "So to try to figure out what's best for everyone is what we're trying to do."
Some board members said they were ready to vote Thursday, but they voted unanimously to hold off until Aug. 28 since that was announced as the date for a special meeting to decide the matter.
"Our teachers don't know about this. They've had no input," Sandy Hughes, president of the Hamilton County Education Association, the teachers' union, told the board.
The decision will affect 1,700 of the district's 4,678 employees whose spouses are covered by the school's health plan that doesn't quite reach the "Cadillac" category, school officials say. But it is superior to many plans offered by other area employers.
The burden would fall differently depending on which option the board chooses, said the district's health care consultant, Ed Adams.
Since most employees don't have a spouse on the school's health plan, the $100 monthly out-of-pocket increase wouldn't affect them, he said.
"Two-thirds of our employees would not be affected under option one," Adams said.
School employees could still get school insurance for their spouse under option two - provided they signed an affidavit swearing that the working spouse couldn't get health care through their job.
"The issue is, you need to administer it, and you need to police it," Adams said.
And since just about every school employee gets at least one prescription annually, Adams said, most employees would pay more out-of-pocket under option two. It would increase the cost of co-pays to $10 for generic prescription drugs, $30 for name-brand drugs and $50 for preferred drugs.
Both options have things in common. They would switch school employees from BlueCross BlueShield of Tennessee's premium Network P to Network S, which would save the district about $1.3 million. And both proposals would increase the cost of emergency room visits to $250 for employees on the HMO plan from $100 now.
Adams said a committee looking at cutting health care costs was open to "out of the box" solutions including a wellness clinic - possibly a mobile one, since the district is large and its employees are spread out.
"That's not a crazy option, really, when you think about Blood Assurance," Adams said, referring to the buses used for blood drives.
The school district last year introduced a high-deductible plan for low-income employees that was required as an option under the federal Affordable Care Act, Adams said. Only 11 of the district's 4,678 employees signed up.
District 2 board member Jonathan Welch made a motion for the district to create a health savings account under which employees could make pretax contributions to cover the deductible, but it failed.
In other business, the school board voted to sell Piney Woods School in Alton Park that's been vacant for a decade to Calvary Chapel, a church at 415 Broad St. that plans to refurbish the building. Opposing that were Ricks and Welch, who wanted the building to go to the Alton Park Development Corp., which proposed opening a market and offering vocational classes there.
And School Superintendent Rick Smith announced that enrollment was up by 241 students over last year, for 42,741, according to 10th-day enrollment figures.
Contact staff writer Tim Omarzu at email@example.com or twitter.com/TimOmarzu or 423-757-6651.