Fresno Unified has something that is rare in California public education: a truly self-funded health plan.

That may sound like an accounting detail, but it isn’t. It is a values choice. Self-funding means Fresno Unified is not simply purchasing insurance and handing control to a corporation. The District pays medical claims from its own health fund, with a third-party administrator handling paperwork. In plain English: the money is public, the accountability is public, and the control is local.

Twenty years ago, around 2004, Fresno Unified was in real fiscal distress. Many people feared the district was on the verge of insolvency, and runaway health-care cost increases were widely seen as part of the problem.

Labor and management chose a different path: shared decision-making to manage the self-funded plan more efficiently and responsibly. That effort became the Joint Health Management Board (JHMB). In a January 2015 Fresno Bee op-ed, district and JHMB leaders credited this approach with saving $132 million while improving employee health care and stabilizing costs. That public success story is worth remembering, because it shows what local control can achieve.

Local Control Is a Core Value

Local control has long been a core Fresno value. We fight for it in curriculum, staffing, and governance. We should care just as much about local control in health care, because health care is where people are most vulnerable, and where delays and denials can do real harm.

That is why the District’s decision to move retirees/future retirees into Medicare Advantage was not a minor “plan update.” It was a fundamental shift in how care is delivered and who decides. Under the old structure, Medicare paid first and Fresno Unified’s plan supplemented it. Under Medicare Advantage, a for-profit insurer sits in the middle. Even if benefit summaries look similar on paper, the decision-making system is different: prior authorization, network and referral rules, medical-necessity determinations, denials, and an insurer-run appeals process.

This is not only about financial risk. It is about control. When you replace a locally governed, publicly accountable plan with a private insurance model, you hand real power over care decisions to an insurer whose business model depends on controlling costs. Profit is no longer incidental; it becomes part of the equation.

For those of us who spent our careers advocating for local control, it is discouraging to watch the district and unions drift in the opposite direction, often relying on the guidance of insurance consultants and carriers. The incentives here are not mysterious: the insurance industry earns more when districts move away from direct self-funding and toward products that can be sold, renewed, and managed for a fee. Medicare Advantage is exactly that kind of product.

Fresno Unified Must Protect Self-Funded Health Care

When the Joint Health Management Board was created, one underlying commitment was that Fresno Unified would remain self-funded, with the elected School Board as the final decision-maker. Today, retirees/future retirees have been moved out first. That should concern everyone, because once one group is transferred to an insurance product, it becomes easier to argue that “alignment” or “simplification” requires moving others as well.

This is not an anti-union argument. It is a pro-union, pro-public accountability argument. If we care about local control, we should protect the structures that keep decisions local, especially when those decisions affect people’s health and dignity.

Fresno Unified should be proud of its self-funded plan. It is one of the few remaining examples of a public system designed to pay for care, not pay for profit. The question is whether we will protect that legacy, or quietly outsource it away, one population at a time.

About the Author

Larry Moore is a retired teacher and former president of the Fresno Teachers Association. He represented the Roosevelt High region on the School Board from 2008 through 2012.