With Friday's passage of the state budget and Tuesday's approval by Gov. Rick Scott, Manatee County now has clarity on the indigent health care issue that has dogged the county for years.
Since the Florida House is loathe to embrace billions in Medicaid expansion money under the Affordable Care Act, the county can dismiss Obamacare as a potential game-changer in the health care costs of the working poor who are uninsured or underinsured. But there is a one-year reprieve on the Low Income Pool, a federal-state-local partnership based on matching funds.
For the upcoming fiscal year, Manatee County commissioners put health care funding on their priority list, and county Administrator Ed Hunzeker proposes spending $6.9 million in reserves to cover the county's portion of the matching funds. That figure duplicates the county allocation last year.
The county's health care trust fund, established with money from the sale of the then-county owned Manatee Memorial Hospital, ran out of funds this year. The county cannot afford to sit on the sidelines any more, waiting for the community to devise a solution.
Fortunately, there is one multifaceted proposal now on the table, thanks to a panel of community leaders which formed last November to bring more transparency and accountability to the program. The Indigent Health Care Committee presented the commission with concrete plans earlier this month.
The panel proposes the establishment of a seven-member Indigent Health Care Board to monitor expenditures, with each county commissioner appointing one member, none of whom could receive indigent health care money. That would eliminate conflicts of interest.
Initially, funding would come from the county revenue generated by property taxes. But in his presentation, semiretired Dr. Craig Trigueiro recommended a referendum for a one-half cent sales tax. The surtax would carry a sunset provision after six years as a test to prove its value. Should the program succeed, voters would be asked to renew the surtax.
At the current sales tax collection rate, $26 million annually would be raised.
Manatee County's current sales tax of 6.5 percent is lower than the 7 percent charged in Sarasota, Hillsborough and Pinellas counties. Manatee would not be at any economic disadvantage should the rate rise to 7 percent.
Two years ago, the county floated a half-cent sales tax vote for health care, but it was linked to property tax reductions, a complicated ballot issue that failed to gain traction. Another surtax referendum, under less confusing circumstances, merits a vote. Manatee County cannot afford to dip into reserves year after year, and property tax revenue is already stretched thin. We need a solid funding source for indigent health care like other counties in Florida.
The committee's proposal also calls for additional funding for specialty outpatient care in order to improve outcomes and brings savings elsewhere in the program. Currently, the payment pool for private physicians who provide specialty care typically does not last long, this year running out in April.
On accountability and transparency, the plan eliminates block grants in favor of health care claims to be filed with a third-party administrator. The county switched to block grants to reduce the administrative cost of a claims process.
The hospitals could submit individual claims once again, but those medical reports amount to a far greater sum than the block grants. Manatee Memorial Hospital, the county's safety-net hospital, writes off tens of millions of dollars in charity care annually.
Currently, all medical providers submit monthly reports to the county, and those are audited for independent verification. Accountability does exist today. But if an audit trail is necessary to build public confidence in the system, then by all means adopt one.
The county reimbursement rates to hospitals, physicians and other medical providers are based on the low rates mandated by Medicare and Medicaid. The Indigent Health Care Committee also calls for the lesser amount of those two federal programs.
Congratulations to the committee for promoting a positive plan and initiating discussions on this tough public policy issue. The public will be able to weigh in come August during county commission hearings.