This story was originally published by EdSource.
Twin Rivers Unified School District teachers in Sacramento spent 12 days on strike in March, in part, because healthcare premiums for some teachers and their families had reached $1,600 a month — a growing burden now fueling labor battles in school districts across California.
Little Lake City teachers in Sante Fe Springs, Norwalk and Downey walked out of their classrooms for 10 days; Natomas Unified teachers in Sacramento for seven days; and Dublin Unified, West Contra Costa Unified and San Francisco Unified teachers for four days this school year.
All six unions ended their strikes with health coverage victories. Other unions reached agreements with their districts on improved health benefits at the bargaining table; some are still trying.
As school districts grapple with declining enrollment, expiring federal aid and rising pension costs, healthcare premiums have become one of the most contentious issues in labor negotiations. Teachers say escalating out-of-pocket costs are swallowing salary gains, while district leaders say schools can’t continue to shoulder the entire cost of employee health benefits without having to cut elsewhere.
Teachers in Modesto City Schools have been negotiating a contract with their district since the fall. The sticking point: health benefits. Teachers would like the district to pay more toward rising health benefit costs, which some of them say are now more than their mortgages, according to the Modesto Bee.
The cost of health benefits has surged nearly 500% since 2013-14, far outpacing school funding growth, according to School Services Inc., a California education consulting firm.
During the 2024-25 school year, California school districts, on average, spent 8% of their average daily attendance funding on health and welfare benefits for school employees, according to a report released recently as part of the Getting Down to Facts III collection of education research.
Health premiums outpace salary gains
The average healthcare premium for a public school employee increased 14%, while teacher salaries increased by 10% between 2018 and 2022, according to a National Council on Teacher Quality study.
Since then, insurance rates have continued to increase at a steady pace.
A July 2025 survey of nearly 2,000 California teachers found that 69% said that high, out-of-pocket costs for often inadequate healthcare benefits were eating into their paychecks.
“Health insurance premiums are rising faster than teachers’ salaries are increasing, and so this is, of course, making it harder for teachers to be able to afford to stay in the profession,” said Heather Peske, president of NCTQ.
The popular perception is that California public school teachers have generous healthcare benefits, but the reality is that some teachers pay as much as $1,600 per month in out-of-pocket costs, said California Teachers Association President David Goldberg.
Teachers feel that budgets “have basically been balanced on their backs for years,” Goldberg said during an EdSource Roundtable in February. “About a third of the association’s members report that they’re living paycheck to paycheck and are even delaying needed healthcare.”
Paul Bruno, assistant professor at the University of Illinois Urbana-Champaign, says teacher salaries have been mostly flat over the last 20 years as unions and school districts have prioritized health benefits during contract negotiations.
“Teacher compensation has gone up pretty substantially, it’s just not in salary,” said Bruno, lead author of “District Dollars 3: Recent Patterns in California School District Finances, Trends in Teacher Compensation, and Within-District, Between-School Spending.”
Higher rates are impacting district budgets
California school districts are also struggling financially. They have lost average daily attendance funding due to declining enrollment, and federal Covid dollars. At the same time, districts are paying more for pensions, healthcare, supplies and special education.
Between the 2004-05 and 2024-25 school years, healthcare costs for California districts increased 46%, or $6,345 per teacher, according to Bruno’s research. Medical benefit costs increased 52% to $18,839 per teacher, while the cost of dental and vision plans dropped slightly.
Although the cost of health benefits has increased in all industries at a faster rate than inflation most years, schools are harder hit because they generally are responsible for a larger share of their employees’ benefit costs than most other industries, according to the report.
The pain is not spread equally
Health benefits, which are collectively bargained between local districts and their teachers unions, vary greatly across the state.
About half of the state’s districts that reported data to the state during the 2024-25 school year paid between 70% and 90% of their teachers’ health benefits; about 13% of the districts paid the entire cost, according to a California Teachers Association analysis of benefits data submitted to the state by 783 school districts.
It is unclear how many California districts, if any, require teachers to pay the full cost of the insurance.
Agreeing to pay 100% of health benefits can put a district in the position of shouldering the entire cost of increases, Bruno said. It also removes incentives for employees to select less expensive health plans, he said.
Kern County is the gold standard
Kern County schools are the most generous to their teachers in terms of health benefits, with 18 of the 37 districts that reported data to the California Department of Education paying 100% of their teachers’ health premiums. Another 15 of the county’s districts reported paying between 90% and 99.58% of teachers’ health benefits.
“Not only do we have our benefits 100% paid for, we have extremely good benefits. Like we’re talking gold plan PPO benefits,” said Megan Harwell, president of the Kern County Education Association, the union for the county Office of Education.
Kern County school districts have paid a majority of teachers’ health benefits for as long as Harwell, a special education teacher, can remember. But the issue still comes up annually during contract negotiations because of rising costs, she said.
“So, it’s never been a given,” Harwell said. “It’s always been something we’ve fought very hard for.”
This year, the Kern County Office of Education paid approximately $1,700 a month for health benefits for each of their teachers and their families, Harwell said. Next year, the cost is expected to be about $2,000.
Harwell said Kern County teachers are often shocked to hear that teachers in other school districts pay between $500 and $1,700 a month for their family’s health benefits.
With healthcare costs soaring, holding the line on health insurance premiums should be a priority for teachers, even if it means accepting a smaller pay increase, Harwell said.
“Because if you open that floodgate, then when does it stop? Like, it’s $50 now, but next year it’s going to be $100, then $200, then $300 and then whatever we get in COLA (cost-of-living adjustment) will be eaten up by the amount of money we’re paying for our benefits,” she said.
Districts could share costs
Bruno said the share of health insurance costs covered by school districts declined during the early 2000s. The trend leveled off around 2012, however, as California increased state funding for education. Since then, school districts have consistently covered about 85% of employee health benefit costs, he said.
But, this school year some districts have asked teachers to pay more for their health insurance.
Peske said shifting more healthcare costs onto teachers could make it harder for districts to recruit and retain teachers, especially if benefits become less competitive. Instead, she said, district leaders should negotiate for lower-cost insurance plans, seek better rates from providers or partner with other districts to buy insurance at lower prices. The state could also help school districts improve their rates, she added.
“States are in a particularly unique and favorable position to negotiate better health insurance rates for their employees,” Peske said. “So, for example, the state of North Carolina provides state-level health insurance. So, they’re able to negotiate a plan with much better rates since they have many more employees, obviously, than a single district does.”
Peske acknowledges that a statewide program could be difficult in California, where each district has its own collective bargaining agreement with its teachers.