Manatee County in tough spot on indigent health care with tight budget

June 23, 2013 

Tuesday's resounding defeat of the sales surtax referendum punched several big holes in Manatee County's lone budget blueprint. Since voters indicated a preference for the status quo instead of altering county revenue sources, county Administrator Ed Hunzeker must revamp his 2013-2014 budget.

That became clear at Thursday's budget workshop with county commissioners, as Hunzeker all but abandoned his three-way plan to swap out revenue sources. With the downfall of the half-cent sales tax increase to pay for indigent health care, the county administrator recommended the board table his idea for the second key part of the revenue plan -- the introduction of electric franchise fees in the unincorporated portions of the county. He also recommended his plan to free municipal residents of the costs of sheriff's patrols be set aside, too.

Without sales tax or franchise fee income, the county cannot afford steep property tax reductions, the third aspect to this revenue-neutral plan. The countywide millage rate, which has been stable since 2008, will likely remain at 6.2993 with property owners in the unincorporated area of the county charged a total of 6.9102.

Hunzeker's initial $517.8 million budget proposal neither grows government nor cuts services.

The administrator has enjoyed success at downsizing government over the past six years as the county struggled through the Great Recession. From fiscal year 2007 through 2013, the county collected $82 million less in property taxes, slashed spending by $142 million and reduced staffing by 277 positions.

But the budget is operating at a deficit, continuing to dip into reserves to balance spending. Should new spending occur, the county would be forced to dig deeper into reserves, cut programs or raise taxes, the latter implausible in the current tax-averse political environment. And Hunzeker cautions against additional reliance on reserves.

In a meeting with the Herald Editorial Board at the end of May, Hunzeker noted that over the past few years the county has "pretty well scrubbed any excess out of the budget" and "the next round would be painful."

Painful times could be coming.

County government must somehow account for the cost of health care services for the medically needy and working poor -- at $9 million, split between the county's three hospitals as well as physicians. The trust fund that covered those costs will be depleted by 2015.

By maintaining the status quo, "You'd still have a $9 million hole in 2015," Hunzeker stated last week in the wake of the sales surtax vote. "You'd have one year to figure it out."

At this point, the county administrator added that he had "no suggestions" about how to pay for indigent health care. He's not alone in that regard.

The health care community and other stakeholders spent years on the development of a solid framework to provide health care to the poor while lowering costs. Now greater public input should be sought as details are ironed out.

The sticking point will be how to pay.

Should ever more painful service reductions emerge as an answer, the county must address the consequences on economic development and our quality of life. Would detrimental impacts stunt job growth as businesses react negatively to any diminishing appeal of Manatee County?

The county needs pragmatic leadership and vision, not politics and ideology. We need solutions, not slogans. The "cut the waste" and "cut the fat" catch-phrases amount to timeworn sound bites considering the deep spending reductions in Manatee County over the past six years.

All segments of this community should be represented at the table during the search for a solution -- everyone with an open mind.

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