A BRIEF FOR THE BOARD — PREPARED OCTOBER 28, 2026
A Brief for the Board: what the Plan Year 2027 record shows — and two rules for the decisions ahead.
Fresno Health Costs is an independent watchdog project built entirely from documents the County of Fresno and SJVIA published themselves. This brief reads the Plan Year 2027 health renewal record in order and asks the Board of Supervisors to adopt two standing rules for Plan Year 2028 and beyond: every option weighed before a health action is approved, and no group carrying an increase alone — with the burden of every item printed on its face, as a share of pay.
$12,442,479
Reserves documented above SJVIA’s own IBNR and stabilization targets (April 13, 2026) — never weighed in the open against the plan-design cuts that were made instead. About $1.5 million was applied to premiums.
27.9% vs 3.0%
The same $10,699 Kaiser HMO Family premium as a share of gross pay: 27.9% at the entry step of the pay ladder, 3.0–3.8% for the County Administrative Officer at the top.
125 of 132
County job classifications whose Kaiser HMO Family premium sits above the federal affordability benchmark (10.22% of income, Rev. Proc. 2026-26) at midpoint salary.
The one-page summary handout carries this two-minute comment and the asks for the written record. The print view is the full brief, formatted for paper.
The spoken comment — two minutes
The two-minute comment written for the Board’s public-comment period, drawn from the brief’s executive summary. The full brief accompanies it.
Chair Bredefeld, members of the Board — thank you.
I’m a Fresno County employee. I built Fresno Health Costs on one rule: use only the documents the County and SJVIA published themselves.
I’m here about Plan Year 2028 and beyond, because this year’s record shows two failures — and both are fixable.
First: choices were made, never weighed. The one plan that told a family, however sick the year gets, your costs stop at $1,000, was eliminated — and no document prices keeping it. Reserves topped twelve million dollars above the safety targets — never weighed against the cuts.
Second: nobody measured who would carry the increase. Premiums are flat dollars; pay is a ladder, climbed by people who answer the County’s phones and staff its counters. The family premium, $10,699 a year, is 27.9 percent of an entry-level paycheck — 3.8 to 3 percent at the top. Against the County’s own salary schedule, it breaks the federal affordability index — 10.22 percent — in 125 of 132 classifications.
So I’m asking you to adopt two rules for every health decision from here on, and to publish the consultant reports with the packets that cite them.
Rule One: every option weighed. Nothing eliminated, redesigned, or shifted until the alternatives are priced and printed side by side.
Rule Two: no group carries an increase alone. Every item should show, on its face, what it costs each group as a share of pay — so the burden is decided in the open.
Three numbers, from your own record: $12,442,479 in reserves, never weighed; 27.9 percent against 3 percent — one premium, bottom and top of the ladder; 125 of 132 classifications over the affordability index.
The records are public; this brief just reads them in order.
Thank you.
The record, in brief
Six points in the Plan Year 2027 renewal at which the analysis that would have informed the decision was never produced. The full brief argues each from the documents; the sources are named in its footer.
- Rates set with no margin. USI’s preliminary renewal report (July 17, 2026) states: “The 2026 medical premium equivalent rates did not include margin, thus making the annual budgeted accumulation $0 for the budgeted medical reserve.” The bad year arrived: an eleven-month deficit of $23,051,228 and a loss ratio of 108.6% (File 26-1229).
- Three baselines, never reconciled. The same renewal is described as +29.2% (preliminary, blended), +26.7% (before design strategies), and 37% (self-insured plans only). No document prints them side by side with their scopes labeled. As adopted, the renewal landed at +16.55%.
- Reserves documented; design cuts chosen. Reserves stood $12,442,479 above IBNR and the stabilization target on April 13, 2026 (May 1, 2026 cash-flow projections). About $1.5 million was applied to premiums; permanent design cuts did the rest.
- A medication benefit removed against the consultants’ own caution. USI’s pharmacy report warned, verbatim: “If AOMs are excluded, member alternatives should be defined before the change.” Removal was approved the same day, on a third, unreconciled figure — while the same authority’s Kaiser program kept the coverage.
- The richest plan eliminated, not repriced. The Yosemite EPO — the only design capping a family’s year at $1,000 — was eliminated; Sierra and Pismo were modified. No document prices keeping Yosemite. The cut then spread to the Kaiser HMO (USI letter, September 8, 2026).
- New analysts, no independent check. USI became SJVIA’s consultant on June 1, 2026 and presented the preliminary renewal six weeks later. The County’s own RFP 26-074 documented the independence problem by seeking an independent consultant for exactly that reason.
Rule One: Every option weighed
A board can only choose among the options put in front of it, priced. In Plan Year 2027, the decisive options never reached that form:
- Retention vs. elimination. Yosemite could have been kept and priced on its own experience — the rating practice SJVIA itself adopted in 2024 — with the County contribution pegged to a benchmark plan and enrollees paying the difference. No priced version appears in any renewal document.
- Reserve draw vs. design cut. The documented reserve cushion could have been drawn down further, or the redesign phased over two years — the staggered, reserve-smoothed approach the authority itself used for Plan Year 2026. Neither mix was priced beside the one adopted.
- Management vs. removal. The medication benefit could have been managed — prior authorization, step therapy, continuation criteria — instead of removed. No managed alternative was priced beside the removal.
The ask: an options analysis attached to every future health action — each plan elimination, design change, or cost shift presented with its alternatives priced and printed side by side. No budget item reaches the dais without a fiscal impact statement. Health coverage — the largest benefit cost the County carries, felt in every paycheck — should not be the exception.
Rule Two: No group carries the increase alone
No renewal document breaks the renewal’s cost by enrollment tier, job classification, income, or utilization — and none runs an affordability test of any kind. The renewal was scored in aggregates. But premiums are flat dollars charged against a pay ladder of 132 classifications. At the premiums the Board approved on October 6, 2026 and the contribution schedule in File 26-1229, the Kaiser HMO Family premium costs an employee $10,699 a year — one flat amount that is, as a share of gross pay:
| Level (County Salary Resolution) | Share of gross pay |
|---|---|
| Office Assistant I / Social Worker Aide — entry step ($38,298/yr) | 27.9% |
| Social Worker I | 16.4–21.0% |
| Supervisor | 13.9–10.9% |
| Program Manager | 10.5–8.2% |
| Deputy Director | 7.1–5.6% |
| Department Head | 5.3–4.2% |
| County Administrative Officer | 3.8–3.0% |
Sources: Fresno County Salary Resolution §100 (updated August 3, 2026); Board-approved Plan Year 2027 premiums (October 6, 2026); contribution schedule in File 26-1229. Salary figures are published pay-range amounts, not any individual’s actual pay.
Measured against the standard federal affordability benchmark — 10.22% of income for plan years beginning in 2027 (Rev. Proc. 2026-26) — the Kaiser HMO Family premium is over that line in 125 of 132 classifications at midpoint salary. The redesign’s own costs fell the same way: on employees who cover dependents and on employees who use care. A family’s worst-case year — premiums plus maximum out-of-pocket — now runs to $17,083 (Cypress), $18,199 (Kaiser HMO), and $23,243 (Maple), in place of the eliminated plan’s $1,000 ceiling. At the top of the schedule, the same premiums are 3 to 4 cents of every pay dollar.
The asks: a household-impact statement on the face of every future health item — cost by classification and tier as a share of pay, scored against the federal affordability index, printed where the fiscal impact statement sits now; and burden-sharing structures evaluated as standing options in every renewal — including contribution designs tied to a percentage of pay — so who carries an increase is a decision the Board makes in the open, not a default the flat dollar makes in silence.
What the Board is asked to adopt
For Plan Year 2028 and beyond, three standing practices:
- Every option weighed. No health action — plan elimination, design change, or cost shift, at SJVIA or in a County contribution item — is approved without an options analysis: the alternatives priced and printed side by side in the item itself.
- No group carries the increase alone. Every health item carries a household-impact statement — cost by classification and tier as a share of pay, scored against the federal affordability index — and burden-sharing designs are evaluated as standing options, so incidence is decided, not defaulted.
- The working papers published with the packet. The consultant reports a packet relies on should be posted with the packet that cites them — beginning with the full USI final renewal report of August 21, 2026, the document that prices, or fails to price, every option in this brief.
File 26-1229, before the Board on November 3, applies the same flat contribution schedule at every level of the pay ladder. Whatever the Board decides on that item, the two rules are how the items after it can be decided better: with every option on the table, and every burden in plain sight.
The records are public. The responsibility is orphaned.
FILED FOR THE RECORD — NOVEMBER 1, 2026
Filed with the Board of Supervisors
On November 1, 2026, this brief and its one-page summary were filed with the Clerk of the Board of Supervisors for the record of the November 3, 2026 meeting, Agenda Item 9 (File 26-1229), and sent the same day to all five district offices and to the County Administrative Officer. Both filings are published here in full, exactly as sent — beginning with the first one.
The first letter — October 24, 2026
The first written submission from Fresno Health Costs to this Board: sent October 24, 2026, to all five district offices and the Clerk of the Board, Clerk-stamped October 26, 2026, and included in the November 3 meeting packet. It was written before the tentative agreement, on the County’s first-offer numbers, and is published here exactly as filed.
From: [email protected]
To: District 1; District 2; District 3; District 4; District 5; Clerk/BOS
Subject: The Public Records of the healthcare cost increase
Dear Members of the Board of Supervisors,
Ahead of Monday’s bargaining session on the County’s Plan Year 2027 health contribution, I am writing to put the public record — and the people behind it — in front of you directly.
The record is the County’s and SJVIA’s own. SJVIA’s board packets show the preliminary 2027 renewal was +29.2%. It was brought down to +16.55% for the Anthem plans not by the County paying more, but by cutting coverage: SJVIA’s August 21, 2026 packet records the removal of GLP-1 (anti-obesity medication) coverage from the Anthem plans, the elimination of the $0-deductible Yosemite EPO, and new deductibles on the surviving plans. The full timeline, with a link to every source document, is on the site’s Paper Trail.
What those numbers mean at the kitchen table, county employees are now saying in their own words — published with their permission:
- Monica, Office Assistant II, covering herself and three children: premiums rising from $50.70 to $170.51 biweekly, copays from $15 to $25 — while working two jobs.
- Lakeisha, Office Assistant II and single parent of four: $192.64 biweekly, $385.28 a month, on one income — “barely surviving now.”
- Elisa, Office Assistant: “I would just be working to pay my insurance. How would I pay for groceries and my monthly rent payment?”
At the published 2027 rates, the cheapest family coverage costs $398.21 biweekly — $10,353 a year — before a single copay. No employee should have to choose between health coverage and rent, and no increase in employee pay is on the table to absorb this.
The ask is simple: when you sit down on Monday, reach a contribution agreement that keeps coverage affordable for the lowest-paid classifications who keep this county running. The documents, the math, and the voices are all public now. We ask that the decision be worthy of them.
Respectfully,
Robert Brewer
Fresno County Health Cost Watch — fresnohealthcosts.com
Email 1 — The filing (to the Clerk of the Board)
To: Clerk of the Board of Supervisors
Subject: Written comment for the record — November 3, 2026, Agenda Item 9 (File 26-1229): A Brief for the Board, from Fresno Health Costs
Clerk Seidel and members of the Board —
Please include the attached brief in the meeting record for November 3, 2026, Agenda Item 9 (File 26-1229).
“A Brief for the Board” is submitted by Fresno Health Costs (fresnohealthcosts.com), an independent watchdog project built entirely from documents the County of Fresno and SJVIA published themselves. It reviews the Plan Year 2027 health renewal record and asks the Board to adopt two standing rules for future health decisions: that every option be weighed and priced side by side before approval, and that every health item show its cost to each group of employees as a share of pay, so no group carries an increase alone.
A one-page summary is also attached.
Respectfully submitted,
Fresno Health Costs
fresnohealthcosts.com
Email 2 — Courtesy copies (to the five district offices and the County Administrative Officer)
Subject: For the record, Nov 3 Item 9 (File 26-1229) — A Brief for the Board, from Fresno Health Costs
Chair Bredefeld, Vice Chair Chavez, and members of the Board —
The attached brief was filed today with the Clerk of the Board for the record of the November 3, 2026 meeting, Agenda Item 9 (File 26-1229). I am sending it to your district offices directly so it is in your hands before the meeting.
The brief reviews the Plan Year 2027 health renewal record — entirely from the County’s and SJVIA’s own published documents — and asks the Board to adopt two standing rules for future health decisions: every option weighed and priced side by side before approval, and every health item showing its cost to each group of employees as a share of pay, so no group carries an increase alone.
A one-page summary is attached with the brief.
Respectfully,
Fresno Health Costs
fresnohealthcosts.com
Attachments to both emails: A Brief for the Board (full brief) and the one-page summary — the same documents published on this page.