Accountability key in Manatee health care sales-tax debate

Health care levy questions include who controls it

skennedy@bradenton.comJune 2, 2013 

MANATEE -- County Administrator Ed Hunzeker is urging voters to approve the half-cent sales tax increase to pay for indigent health care during a June 18 election.

If they do, the county would collect the same amount of money taxpayers are already spending, butHunzeker wants it usedmore efficiently, he told the Bradenton Herald last week.

The longterm goal would be to "shift how much money we spend on the emergency room, versus how much we spend on preventive health care," he said.

Now, Hunzeker says, "38 percent of what we spend is on hospital and hospital-based physicians; and we spend (less than) 3 percent on community health prevention. I would like to rotate those two in the long run."

Because hospital emergency rooms are expensive, the county health care plan calls for diverting patients with minor ailments to walk-in clinics and community care.

That's what Hunzeker is hoping will insure continued care without raising taxes while the uncertainties of state and national health care reforms play out, he said.

Some expressed mixed feelings about passage of the surtax, saying they are skeptical whether the county will insist on accountability in spending over the $23 million annually it would raise.

One veteran doctor, who asked to remain anonymous because he works for a hospital that would benefit from the surtax, said he was uneasy about supporting it, based on many years of practice.

"The giant 'if' is if you can get medically indigent health care consumers to not go to the ER," when a less expensive setting would do just as well or better from both a medical and fiscal standpoint, he said Friday.

"If the tax is passed, that's a gigantic 'if,' and how do you motivate and change such behavior? Plus, if it doesn't pass, these people will continue to get health care in the same system as now: They're not going to go without health care," he added.

Other doctors have made similar comments to The Herald, but declined to state them publicly.

Dr. Richard Conard, a founder of what is nowBlake Medical Center, said he supported the surtax in theory but not in practice because he opposes the way it has been proposed and managed.

The retired doctor suggested a third-party "accountability committee" to oversee the money generated by the surtax to "prudently structure how we're going to deliver and pay for health care in Manatee County with those surtax funds.

"I don't feel the county administrative staff should have any control over it," he added.

His view was countered by Manatee County Commission Chairman Larry Bustle and by Manatee Memorial Hospital chief Kevin DiLallo, both supporters of the surtax who defended the county's record in separate interviews.

DiLallo acknowledged that what a hospital charges and what its final reimbursement is "has no relevance" in the modern marketplace, adding, "I'm surprised a physician would even bring it up."

"Any physician knows what they charge, even they don't get reimbursed; negotiated rates occur," DiLallo said.

The county has negotiated its own rates, different from those paid for patients covered by the federal Medicare health insurance program for seniors and its counterpart for the poor, the Medicaid program.

As for a prognosis, DiLallo said, "I think from the accountability side, the county has a plan they have reviewed, and will implement as we go forward with county health care in the future."

Money the county set aside for indigent care in 1984, resulting from the sale of Manatee Memorial Hospital, is expected to run out in 2015, he noted.

"I think it's fiscally prudent management," DiLallo said. "$45 million lasting 31 years in health care is probably something you will not see in any other county government."

Bustle also expressed confidence that the county would carefully steward the money if voters OK a sales tax increase from 6.5 percent to 7 percent.

"It's based on a lot of accountability, as far as the paper trail is concerned," said Bustle. "I'm very comfortable the money is being spent properly, being spent judiciously, and all we have to do is find a source for the money instead of that corpus from the sale of the hospital."

Last year, the county spent $24.2 million on all of its health care programs, according to documents provided by Hunzeker.

Of the total, $9.2 million, or 38 percent, paid hospital or hospital-based physicians, documents showed.

Just $618,316, or 2.55 percent, paid for walk-in clinics and HIV/AIDS.

About $5,423,005, or 22.38 percent, paid for care for jail inmates; 20.5 percent went toward Medicaid; $1.5 million, or 6.12 percent, was spent on substance abuse; $1 million, or 4.47 percent, went to community health prevention; and $819,351, or 3.38 percent went for mental health.

A few other small categories made up the rest.

In a $517.8 million budget unveiled last week, Hunzeker recommended shifting the cost of health care away from property taxpayers, who he says would get generous tax breaks if the sales surtax passed, to a broader range of payers, such as tourists, renters, even the poor contributing to their own care.

Under Hunzeker's plan, the amount of money spent on health care would remain the same; what would change would be who pays for it, he said.

Asked how federal health care reform might affect Manatee County, Hunzeker noted that until the sweeping changes called for in President Obama's Affordable Care Act are funded, all bets are off.

"The last time I checked, it's going to take an appropriation from Congress, and I don't see this Congress doing anything to help that plan get funded," he said.

Asked what decisions would be made after the election to prevent the county from again running out of money for the poor, Hunzeker replied, "I don't see that happening."

"We'll fund what we fund until our role in health care is clear, and until the feds and state do, we're going to keep funding what we do," he said.

The county will also try to work with health care providers to "work more efficiently by getting people out of the ERs and into some other setting," he explained.

It's the working poor who benefit most from the county's assistance, Hunzeker said. Some hold two or three jobs, but make too much money to qualify for federal or state assistance, he said.

During the recession, they flooded emergency rooms. The county could have preserved money in its health care trust fund if it had chosen to do so, he said.

"We would still have a solvent fund, I agree, we would have $60 million in the bank, and a community in distress," he added.

"Is that the role of government, a community in distress?"

Sara Kennedy, Herald reporter, can be reached at 941-745-7031. Follow her on Twitter @sarawrites.

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