Ann Claussen, chair of the Keep Polk Kids Healthy. PAC and CEO of Central Florida Health Care, is at the Central Florida Health Care facility in Lakeland.
PIERRE DuCHARME/THE LEDGER
Polk voters to decide whether to keep sales tax for indigent care
By Marilyn Meyer
Putting aside the Donald vs. Hillary race and the congressional head butting about Obamacare, there is a health policy decision that is entirely up to Polk County voters: whether to extend the local half-cent sales tax for indigent health care.
Toward the bottom of the general election ballot is this question and a statement:
“Shall Polk County continue the existing one-half cent indigent care surtax to provide access to basic healthcare for indigent residents of Polk County? The 25-year extension will fund a broad range of health care services for low income Polk County residents, including the elderly and children.”
No organized opposition has emerged against the half-cent sales tax, which was first enacted by voters in 2004 to provide a health care safety net to poor, uninsured Polk residents.
A political action committee, Keep Polk Kids Healthy, formed in April to promote the tax. The committee, whose membership includes approximately 20 agencies that deliver health care to poor residents courtesy of the tax, raised $103,339, sent speakers to meetings of civic groups and city commissions, distributed flyers and mailers urging support of the tax and conducted two polls among likely voters.
“Both polls have shown very, very favorable responses for extending the tax,” said Ann Claussen, who chairs the political action committee.
The Lakeland City Commission, the Lakeland Area Chamber of Commerce and the Greater Winter Haven Chamber of Commerce have endorsed extending the tax.
The sales tax, which is paid by residents, snowbirds and tourists, raises between $32 million and $40 million a year, depending on economic conditions, said Joy Johnson, director of the Polk County Indigent Health Care Division.
In 2015, nearly 98,000 Polk residents were uninsured. More than 57,300 of those people met financial criteria that could make them eligible for services through Polk’s stop-gap Indigent Health Care programs. The programs served 42,867 residents that year.
Statistics compiled by the Indigent Health Care Division show that for every $1 spent, the indigent health care patients receive $6 in services. That statistic includes $14.5 million in services provided by volunteer work.
Although the Affordable Care Act (also known as Obamacare) has made a difference in who is covered by insurance, it does not reach all. Many Floridians remain uninsured because Florida was not among the 32 states that expanded Medicaid benefits to able-bodied adults who live at or below the poverty level — which includes about 40,000 people in Polk County.
To ascertain what would happen if the sales tax is voted down, the county contracted with the University of Florida Bureau of Economic and Business Research to perform an economic analysis. The conclusion was that the county’s overall property tax rate would have to increase from $6.78 on every $1,000 of taxable property value to $8.26 to raise the same amount of money the sales tax brings in.
One of the areas that the report cites as an example of impact is preventable hospitalizations: In the 14 years before the tax, preventable hospitalizations grew by 5.34 percent and in the 14 years since the tax passed that growth rate fell by 0.9 percent.
The report also attributes Polk's improving trend among Florida’s counties in health factors and outcomes over the last five years to the tax, but says that would reverse if the Indigent Health Care program went away.
Jose Rivera, 53, of Bartow is enrolled in the Polk Health Care Plan. He was diagnosed with diabetes 13 years ago and, in spite of taking insulin and medications, has had difficulty controlling it.
He said he is in pain from diabetes-related neuropathy, gout, arthritis and other issues. He uses a cane to walk and moves slowly.
“I can’t sleep; I can’t walk, especially when the gout swells up my legs,” he said. “I am trying to get Social Security disability but I am on my third try.”
He worked as a mechanic and technician until two years ago, when, he said, a workers’ compensation doctor said he could not go back to work.
“Sometimes I feel good, sometimes bad,” Rivera said. “Sometimes I feel power, sometimes my body is like junk.”
Rivera has been a patient at Central Florida Health Care since he moved to Polk County from Miami four years ago. He said he works closely with doctors and other clinicians trying to keep his blood sugar levels under control and managing severe nerve pain from the neuropathy, working to stave off attacks of gout and arthritis, and looking for a diagnosis of gut issues.
What the tax pays for
In fiscal year 2014-15, when the sales tax raised nearly $36 million, the county spent $14.2 million of it paying its share of state-mandated programs.
The biggest chunk — $10 million — covered Polk’s portion of Medicaid bills for very-low income children, elderly or disabled residents. Medicaid is a federal-state program and Florida has relegated part of its costs to counties.
The rest of the mandated fees paid for health care provided to indigent Polk residents when they were out of the county (nearly $2.5 million); some alcohol, drug abuse and mental health services (more than $1.1 million); and a portion of the Florida Department of Health’s environmental health services, community disease control and primary health care services ($379,300).
After Polk County’s Indigent Care Division paid the bills for the mandated programs, the staff of approximately 60 workers administered the remaining $25.9 million to provide additional direct health care for uninsured, poor people under two programs — the Polk Health Care Plan and Community Partners.
The county spends less than 7 percent of the sales tax revenue on administrative costs, Johnson said. The finance team takes care of budgeting and paying bills; a provider services team contracts with partner agencies; a member and social services team determines patient eligibility, sets up appointments and provides social case management services; a medical management team determines medical necessity for specialty treatment, authorizes hospital care and provides community health education and case management services; and an operational support team keeps the technology platform working smoothly.
Providing direct care
To qualify for the Polk Health Care Plan, applicants must be uninsured, have an income at or below the federal poverty level ($11,880 for an individual, $16,020 for a family of two, progressively more for larger families), have limited assets, be between 19 and 64 years old, and working, looking for work or have a disability excuse from a doctor. Some 6,000 residents belonged to the plan in 2015.
The criteria to qualify for services through the Community Partners program are not as stringent: a patient’s income can be up to 200 percent of the federal poverty level.
The contracted network includes about 200 providers: physicians, dentists, laboratories, imaging centers, the Florida Department of Health in Polk, all five local hospitals, free and volunteer-run medical clinics, and colleges and technical programs for medical professionals in training.
With the partners, “sometimes we negotiate fee for services and pay invoiced bills and sometimes the money is capitated funding, meaning we pay the agency a set limit and the agency has a goal to see as many patients as possible through that funding,” Johnson said.
“The public-private partnerships offer different services, often depending upon what volunteer positions they can recruit. It is another layer in the safety net. If the patients have a need that is not covered by the Polk Health Care Plan or they cannot qualify for the plan, they may be able to get help through the partners,” Johnson said.
Some agencies received both mandated and discretionary funds from the tax: for example, Tri County Human Services and Peace River Center received more than $3 million to provide mental health and substance abuse counseling, of which $1.1 million was mandated, Johnson said. And the county health department receives funds above the mandated amount to provide primary care and dental services, she said.
Donors to the cause
Ann Claussen, chief executive officer of Central Florida Health Care, chairs the political action committee, Keep Polk Kids Healthy.
Central Florida Health Care is a federally qualified community health clinic group, meaning it is eligible to receive federal grants. It operates nine clinics in Polk County and has contracts with the county to provide services to Polk residents who earn up to 200 percent of the poverty level and to those who qualify for services through the more stringent Polk Health Care Plan.
Polk County Supervisor of Elections records show that, as of the end of September, the PAC had raised $103,339. At the end of the last reporting period the PAC had spent only $3,805. But Claussen said that does not reflect expenditures as the campaign has ramped up in the past month: two polls among likely voters, printing and sending mailers, and printing flyers to distribute to patients at the various clinics and provider offices.
“When distributing the flyers at the clinics, we help them to understand they are recipients of the tax and encourage them to vote,” Claussen said.
The biggest donors were hospitals and health systems — accounting for some 90 percent of the donations: Lakeland Regional Health, $40,000; Bay Care Health System (parent company to Winter Haven Hospital and Bartow Regional Medical Center), $28,000 spread over three donations; and Heart of Florida Regional Medical Center in Haines City, $12,500 spread over two donations.
Among the other major donors were some of the partner agencies that receive distributions from the sales tax funds: Central Florida Health Care, $10,000; Talbot House Ministries of Lakeland, which operates a free clinic, $1,099; Lake Wales Care Center, a free clinic, $1,500; Lakeland Volunteers in Medicine, a volunteer-run medical clinic, $2,500; Angels Care Center of Eloise, a free clinic, $1,500; Peace River Center, a mental health organization, $2,000; and Tri-County Human Services, a behavioral health agency, $2,100.
The PAC also received 14 donations of $500 or less.
— Marilyn Meyer can be reached at firstname.lastname@example.org or 863-802-7558. Follow her on Twitter @marilyn_ledger.
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