Despite worries that thousands of displaced welfare recipients could become their next clients, Hillsborough County commissioners on Tuesday reluctantly approved a plan that would cut in half county health care funding for the poor.
The new measure, which appeared to be the only plan that some members of a Republican-controlled state legislative delegation will support, would mean tax cuts for Hillsborough residents.
The plan cuts to a quarter-cent the current half-cent sales tax levy for the county's indigent health plan. If the Legislature approves it, Hillsborough's sales tax rate would drop from 7 percent to 6.75 percent. The plan commissioners passed Tuesday also would reduce by half the $26.8-million in property taxes levied to subsidize medical care for about 27,000 of the county's neediest residents.
"The Legislature that enacted welfare reform seems to be oblivious to health care consequences," said Commissioner Ed Turanchik, who voted for the measure despite fears it will eventually cripple the health plan and "abandon working men and women."
"What seems to be driving this isn't any consideration of what happens to families," he said.
Even with the drastic cuts, the renewal of the health care tax _ which expires next year _ could be doomed. In Tallahassee, legislators generally will defeat any local bill if it lacks full support from the local delegation. State Sen. Charlie Crist, R-St. Petersburg, said Tuesday he will reject any plan that doesn't provide for a voter referendum.
"Without a referendum, it's still a tax," Crist said.
Led by state Sen. Tom Lee, R-Brandon, Republican legislators who insist on the tax reductions want to slash the $130-million reserve fund that has accrued since the county began levying the half-cent tax in 1991. Their plan, if approved, would eliminate the reserve at the end of seven years.
County officials cautioned that the reserve could be exhausted much earlier if people who are pushed off the welfare rolls under new reforms can't find decent paying jobs with health insurance. They say a reserve is crucial to handle a sudden influx of clients, expand the program's eligibility to cover more of the working poor, or keep the program running if the Legislature fails to approve the sales tax extension.
Commissioners told County Administrator Dan Kleman to tell legislators that the commission wants the ability to raise the tax back to a half-cent when the need arises.
The county's health care program was developed to treat poor residents in clinics rather than high-cost hospital emergency rooms. A recent performance audit determined the program met its most critical goals by reducing overall costs through a wellness program and minimized emergency room visits for non-emergency conditions.
Under state law, taxpayers must pay for health care for the county's poor. Commission Chairman Dottie Berger warned that failure to renew the sales tax could mean property taxes would rise.
"I agree with our chairman that it's this year or never," said Commissioner Jan Platt, who said it is too risky to hope that next year's legislators will support the plan. "Get something on the books that could be amended at a later time."
"I do not agree with cutting it back at this point," said Phyllis Busansky, the former county commissioner who now runs WAGES, the state welfare-to-work program. Busansky, who still sits on the county's health care advisory board, said she anticipates many former Medicaid clients will turn to the county for health care in the next 15 months.
"We've got a lot of people on different pages up here," said state Rep. Sandy Murman, D-Tampa, who said the Republican plan to lower the tax has not been embraced by the divided Hillsborough delegation.
Renewing the half-cent sales tax has been a political disaster for county officials. Rep. Elvin Martinez, D-Tampa, originally a supporter of the plan, became an opponent after the county's lobbyist asked a Republican to sponsor the bill in the House.
Several members see the extension as a new tax. The measure died last year in an apparent retaliation by former Senate President Jim Scott against Sen. John Grant, R-Tampa, for Grant's support of a rental car tax. Scott's law firm represented Alamo.
The plan also took a beating Tuesday at Tampa General Hospital, where the finance committee of Tampa General's public board grappled with the problem of getting many poor people to comply with county guidelines that would provide them with health care coverage.
Board members were stunned to discover much of an estimated $11-million charity care expense for the past five months isn't covered under the county indigent plan because about 95 percent of their indigent customers refuse to comply with basic paperwork requirements, such as giving their real name and providing proof of residency in Hillsborough County.
"So we're being screwed by the county," said trustee John Howley.
Other trustees cautioned against blaming the county for the behavior of people who don't comply because of cultural reasons or other limitations.
"Most don't function in the same way we do," said board member Lois Nixon. "For some of these people, to manage records is a foreign concept."