Prop. 480 stirs debate over county health care

East Valley Tribune
Sunday, October 5, 2014
James Anderson

Maricopa County residents will decide next month the role the county should play in Arizona’s health care system, which is already affected by state and federal health care programs.

Proposition 480 is a $935 million bond request that would go to the Maricopa County Integrated Health System (MIHS) and would tax properties for the next 27 years. The funds are divided into separate projects: $138 million to improve outpatient facilities; $226 million to construct a behavioral health hospital; and $571 million to replace the Maricopa Medical Center, which includes the trauma center and Arizona Burn Center.

Kevin McCarthy, president of Arizona Tax Research Association President and committee chairman for No on Prop 480, said the bond forces taxpayers to fund duplicate health care systems. He called MIHS “a throwback to a bygone era,” and he said increased funding would thrust an unnecessary burden on county taxpayers.

The dominant system in place is the Arizona Health Care Cost Containment System (AHCCCS), Arizona’s version of Medicaid. McCarthy said AHCCCS relieved county hospitals of the burden of caring for the poor when it was first implemented.
“There was a time in our history prior to the creation of AHCCCS where the counties were the payer of last resort, where county governments — much to their chagrin — were responsible for paying for the health care of the poor,” he said.
He said most of the counties quickly closed their hospitals after AHCCCS, with Maricopa being an exception.

“So one of the many questions is to what extent should Maricopa County taxpayers continue to duplicate funding for low-income health care that they’re already paying for in federal taxes and state taxes?” McCarthy said.
But proponents of Prop. 480 say state and federal programs like AHCCCS and the Affordable Care Act are insufficient. The problem is that not all members of the indigent population are insured by those programs.
Maricopa Health Foundation president Tom McKinley said MIHS provided $150 million in uncompensated care last year. That number does not include AHCCCS patients, whom private hospitals are required to serve.
“The Affordable Care Act will never solve poverty,” he said.

Terence McMahon, chairman of the Maricopa County Special Health Care District, said the county hospital serves the uninsured while the private hospitals don’t.
“I know they have said, ‘Oh, we’ll take up the slack,’ but they haven’t done so in the past and there’s no reason to believe that they will in the future,” he said.
McMahon and McKinley said the county hospital provides unique services private hospitals and AHCCCS cannot match. They emphasized the teaching center, which they said promotes education in a manner unparalleled by the private sector. McMahon said Maricopa trains approximately 5,500 health professionals every year.

“The private side has no motivation,” McKinley said.

Prop. 480 proponents also emphasized special services of the MIHS Maricopa Medical Center. It is one of the 10 trauma centers designated by the state as Level I and contains one of Arizona’s two burn centers.
McCarthy, however, said the national popularity of those services means that Maricopa Medical Center should not be funded at the county level.

“If this is a needed hospital — whether it’s to perform as a burn unit or play a behavioral health role — and if this is an asset the taxpayers are responsible for, it’s a state asset. It’s not a county asset,” he said. “They [taxpayers] will tell you quite probably that there are people from all over the state that use that hospital, people from all over the Southwest that use the burn unit.”

McCarthy said what motivated him to join the opposition to Prop. 480 was the sheer cost of the bill.McCarthy and the Arizona Tax Research Association said the 27-year total will amount to $1.6 billion when interest is added.
“Quite frankly, we’re just staggered by the amount of money that is being requested here and in lump sum,” he said.

But McMahon said McCarthy was blowing the bond cost out of proportion.
“When you multiply a 30-year tax, you get kind of a large number, but really the cost to the average homeowner in the county is probably going to be about $20 a year, which I would venture to say is not anywhere near a massive tax increase,” McMahon said. The Yes on 480 committee says the property tax amounts to “$13.74 yearly per $100,000 of assessed valuation.”

“When you look at the cost of this for the individual taxpayer, it’s a no-brainer,” McKinley said.

McCarthy said it makes perfect sense to publicize the 27-year total, and he said Yes on 480’s main tactic is to hide the true long-term cost of the proposal.
“They’re characterizing this as a cost of a cup of coffee,” he said.

McCarthy said another telling strike against the proposal is its reception from the Arizona business community. He cited major Valley hospital organizations — Dignity Health, Banner Medical, Tenet and Scottsdale Lincoln — that have not voiced support for Prop. 480.
“They failed to secure the support of any business organization that is of any note on a countywide basis,” he said.

McMahon said although the proposal wasn’t getting verbal support, at least it wasn’t getting much dissent. He said the private hospitals haven’t campaigned against it.

“They’ve said they have some questions about how the money would be spent, but they haven’t come out, as far as I’m aware, and said, ‘No, we’re absolutely opposed to this,” he said.

Hospital executives expressed concerns about the bond request to the Arizona Republic editorial board, but none of them officially oppose it. Banner Public Relations Specialist Sue Breding said the company is not commenting on the proposition.

McMahon said he was pleased the Arizona Chamber of Commerce hasn’t chosen a side. The only chamber of commerce to speak out has been the Gilbert Chamber of Commerce, which announced its opposition on Prop. 480 Oct. 1. A statement from the chamber said it needs “a more clearly defined itemization for use of funds.”

“Without a specific outline for use of this bond, voters are not given the opportunity to prioritize the services provided and facilities at which the money will be spent,” Chamber CEO Kathy Tilque said in the statement