In 1991, the House Fiscal Agency reported that health insurance costs for public school employees rose 801 percent over the previous decade.³⁶ By comparison, expenditures for state employees’ health insurance rose 269 percent over the same period. The rising cost of health insurance in general can be attributed to any number of factors: inadequate reimbursements for Medicare and Medicaid, expanded ranges of covered losses, the price of new medical technology, the costs of malpractice insurance, and so on. But why are health insurance costs for public school employees rising at such a rapid rate? The two most obvious reasons relate to the MEA: unionization and MESSA. Since unions such as the MEA historically obtain more insurance benefits from their employers than non-union employees, typical insurance costs among unionized employees are 24 percent higher than average.³⁷ With MESSA, the preexisting high costs are amplified, because the greater than average insurance benefits are purchased from an MEA subsidiary which has secured market predominance through the union's bargaining leverage. There is diminished incentive for MESSA - the largest administrator of insurance benefits to school districts - to economize and minimize the costs of its benefit packages, since a school district's choice of insurance administrator is not based solely upon cost effectiveness. With the MEA demanding greater than average insurance benefits from school districts, and with no need for MESSA to minimize costs in a competitive manner, school districts inevitably will incur higher overall costs for employee insurance.