In the latest twist on three-strikes-and-you're-out rules, a Hillsborough County commissioner wants to deny health care coverage to repeat criminals who are poor.
Commissioner Jim Norman is pitching a proposal that would remove people who have been convicted of three or more crimes from the county's indigent health care plan. He would include people convicted of some misdemeanor offenses.
Norman says it's an effort to trim costs in a program that continues to operate in the red after repeated efforts in recent years to rein in spending.
"Why should we continue to treat people who commit crimes?" he said. "Wouldn't it be something, too, if the crime rate went down because of this?"
He has asked the county's internal performance auditor to analyze how many of the roughly 15,000 residents who use the health plan would be disqualified and how much it would cost to screen them. The rule wouldn't apply retroactively, only to people who commit new crimes after the rule passes, if it does.
With health care costs rising, Norman said, the county faces some tough choices. "Why should we cut services for law-abiding citizens?"
Supporters of the indigent health care plan, which gives free primary health care to the county's poorest residents, have been quick to pan Norman's idea.
"I think that's the most economically unsound idea I've heard in a long time," said Phyllis Busansky, the former Hillsborough County commissioner credited with developing the plan. "If you're outside the health plan and get sick, that means taxpayers in the long run pay more for you to go the emergency room.
"Let them writhe in the street and get sicker and sicker until they have to go to Tampa General Hospital for brain damage or heart disease," said Busansky, giving her take on Norman's proposal. "I don't think you're allowed to shoot them, right?"
The health plan is paid for through a half-penny sales tax and was created in 1991 in large part to address the county's skyrocketing costs to subsidize emergency room care. It was meant to make it affordable for people to get basic health care so they won't use emergency rooms as their main doctors or put off treatment until it becomes an emergency.
Norman said he got his idea after an activist who has frequently railed against the board and who acknowledged receiving treatment for AIDS through the health plan was arrested for prostitution.
He first floated the proposal at a Saturday commission meeting. Fellow Republican Ronda Storms was quick to seize on the connection, quickly sketching a hypothetical situation similar to the allegation against the activist, Mauricio Rosas.
"Now they're creating possibly more patients for us who might come under our care," Storms said. "People who perpetrate those kinds of crimes ought to feel some sort of other ramification from their government if they are creating more difficulty for society as a whole."
Attempts to reach Rosas were unsuccessful. However, it appears he would not be disqualified under the proposal as a result of the charges in March of prostitution and criminal transmission of HIV, since he entered a pretrial intervention program that avoided conviction, according to court records.
But Democrat Commissioner Jan Platt, a long-time supporter of the health plan, largely echoed Busansky by saying that Norman's proposal is ill-advised.
"They're going to have to be treated somewhere and the health care plan is the most cost-effective way to treat them," she said. "Otherwise, they're going to the emergency room, which is the most expensive place to treat them. We can't let them die in the streets."
The indigent health plan is heralded as a model nationally, but has been a source of controversy locally since not long after it was created. Norman has been at the center of several efforts to modify it.
After it was created in 1991 with the aid of legislators who approved the sales tax, the health plan quickly built up mammoth reserves in six years topping $150-million. An increasingly conservative legislative delegation raised questions about whether the tax should be reauthorized.
Norman led the charge in 1997 to lower the sales tax to a quarter cent. He also pushed to use the money it raised to pay for other health-related programs, including, coincidentally, medical treatment for inmates in county jails.
The reserves depleted to precarious levels and Norman initially fought hiking the sales tax back to a half-cent until it became clear the program would soon begin losing money. More recently, the county has cut administrative costs and made eligibility for aspects of the program tougher.
To qualify for the program, a single person must earn $8,980 or less, a family of four, $18,400 or less.
But skyrocketing medical costs, increased enrollment and state demands requiring local governments to pay more to receive federal Medicaid money have continued to push costs for the program higher. So the county has had to tap another $6.9-million of its reserves to meet costs of nearly $100-million.
The remaining reserve is expected to be about $12.9-million by year's end, slightly lower than the county's goal.
It's not clear whether Norman's proposal will make a dent. Mathews, the performance auditor, said she has not yet researched the number of users of the health plan who would be disqualified.
Just finding that out could be costly. The Florida Department of Law Enforcement charges $23 per name to do a criminal background check. Governments get no break on the fee.
As Busansky sees it: "He's spending more money to spend even more money."
"I'm open to ideas on parameters of the proposal," Norman said. "I'm not open to changes to the proposal itself."
The proposal is reminiscent of the state's list of felons barred from voting, which has been discarded due to its inaccuracies. The health plan would face similar questions: How often would the background checks get conducted? What happens when someone claims they are wrongly included on the repeat felons list, and must prove this while they are ill?
David Rogoff, director of the county Health and Social Services Department that oversees the health plan, said he is taking a wait-and-see approach before making a recommendation.
"Let's determine whether it's viable to do before we get into a discussion of whether its a good or bad thing," he said.
Dena Gross Leavengood, facilitator for the Hillsborough Health Care Coalition, which monitors the program, sees reasons to be concerned. The program faces big challenges, particularly in rising health care costs. The community needs a large-scale discussion, possibly a summit, about what it wants the health care plan to be.
She is concerned that it is being nickled-and-dimed to death.
"I really just think people are looking for straws, to sort of put their finger on some sort of problem with the plan that can be excised," she said. "It's not seeing the forest for the trees."