6 Ways Cities Can Ease Unfunded Health Care Obligations: Pozen

As a result, even cities with the worst-funded pension plans can boast funding levels of 50% or 60%, while the average city only has a 5% funding level for health care obligations, according to Pozen.

Unlike pension obligations, cities can usually modify their health care obligations, Pozen said. He offered six strategies that cities have used to ease the burden of healthcare obligations they couldn't meet.

1. First, many states have reduced the benefits they offer new municipal employees. Unfortunately, it may take several years to see the results of this strategy, Pozen said.
2. Some have required employees to join Medicare when they reach age 65, although some are still paying a "significant portion of Medicare premiums for their retirees," Pozen wrote.
3. Under the Affordable Care Act, cities could require retirees under age 65 to get health insurance through exchanges. Some could be eligible for partial federal subsidies for their premiums.
4. Cities could amend their policies by increasing deductibles and co-payments, or cut back on what they cover like dental or vision benefits.
5. Cities could raise the number of years an employee has to work before earning retirement benefits.
6. Finally, they could fund health care obligations in advance, similar to how pension obligations are funded. Funding from general municipal revenues and employees could be invested in a separate trust.

Ultimately, reducing the health care obligations cities owe their public retirees is critical, Pozen wrote. "Although such reductions will be politically controversial, they are necessary for most cities—in the short term to avoid a spike in the interest rates paid on their municipal bonds, and in the long term to avoid a fiscal crisis like the current one in Detroit."