Cole County faces difficult choice over rising health insurance costs

JEFFERSON CITY, Mo. (KMIZ)

The Cole County Commission will have to decide how to balance next year’s budget as the county’s health insurance costs continue to rise.

During a Cole County Commission meeting on Tuesday, County Auditor Jay Moore said the county’s health insurance reserve fund will have dropped from $3.2 million in 2023 to about $900,000 by the end of this year. That includes a one-time transfer of $580,000 to cover health insurance costs.

Moore said the county’s health insurance expenses for 2027 were originally projected at $5.3 million. He told ABC 17 News those projections will likely change when he returns to commissioners next week with an updated health insurance plan.

Randy Lueckenotte with Acrisure Insurance also presented commissioners with information about employee benefit renewals Tuesday. Acrisure recommends increasing health insurance rates by 20% for employees.

The potential increase comes as the county has already shifted some of the cost of health insurance to employees.

Before 2025, the county paid the full cost of employees’ health insurance premiums, according to a county open enrollment document. Where it used to pay the full cost of claims, the county now pays health insurance claims up to $85,000 per employee, after which a third-party reinsurance company covers the costs.

Cole County Western District Commissioner Harry Otto said the county introduced the reinsurance company because expensive procedures, such as chemotherapy and major surgeries, could significantly increase the county’s costs.

“It’s not unheard of to incur a half-a-million-dollars of expenses in one year for one person. So we couldn’t stand that risk,” Otto said.

But the county’s health insurance fund has continued to lose money.

The county finance department reported the health care fund was losing more than $100,000 a month during the second half of 2025.

As a result, the Cole County Commission voted in October 2025 to increase employee premiums to $50 per person each month. The commission also increased the amount each county department pays into the health insurance fund by 20%.

Moore said most county employees currently pay $50 a month for health insurance, up from $25 a month last year.

The central debate for commissioners now is who will pay for additional increases in health insurance costs.

“The choice becomes who pays for it: the county versus the employee. That, in my mind, is the choice that we have in front of us going forward,” Moore said during Tuesday’s meeting.

Moore said the county could also consider reducing the number of employees or hours worked, or reducing the services provided through employee health insurance plans.

Cole County Health Director Kristi Campbell said the county has already struggled to recruit staff and that reducing benefits could make recruitment even more difficult.

Otto said the county has also eliminated some health insurance programs that were deemed unnecessary, including a $15,000 wellness program that he said primarily provided employees with fruit during the workday.

“People can get their own bananas, their own apples … we were picking away at things that weren’t necessary,” Otto said.

The county has also looked to other sources of revenue to help offset health insurance costs.

Otto said the county had been using revenue from a 3% marijuana sales tax to help cover health insurance costs. Cole County voters approved the tax in 2023.

However, the Missouri Supreme Court ruled last year that counties and cities cannot “stack” marijuana sales taxes. Before the ruling, marijuana customers could have been charged a 6% state tax, a 3% county tax and a 3% city tax.

As a result, Cole County can collect its marijuana sales tax from dispensaries in unincorporated Cole County, but not from dispensaries within Jefferson City limits.

Otto said the county had to return about $500,000 to the Missouri Department of Revenue after the ruling.

“That was painful because we thought we found a good place for it,” Otto said.

Moore said the county’s financial challenges are ultimately tied to health care becoming more expensive.

Moore and Cole County Finance Director Jessica Bryant are scheduled to present an updated health insurance budget to commissioners Oct. 13.

“At that meeting the County Commissioners are expected to approve next year’s health care plan and the cost split between the County and the county employees,” Moore told ABC 17 News in an email.

Otto expects employee premium rates will continue to increase over time as health care costs rise.

The Cole County fiscal year resets Jan. 1. Moore is scheduled to present a draft 2027 budget in early November, with budget hearings scheduled for Dec. 1 and 2.