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Faced with overburdened emergency rooms and sharp drops in state and federal funding for the poor, some local governments are providing health care for their uninsured residents — in some cases with surprising success.
Florida's vast Hillsborough County — a community the size of Rhode Island — raised its sales taxes to buy medical coverage for 29,000 uninsured low-income residents in the Tampa area. The scheme has dramatically lowered hospital admission rates and reduced complications from treatable ailments, such as diabetes and asthma. It also saves the county $50 million a year in property taxes that finance local public hospitals.
The county's benefits “package” — including preventive care, pharmaceuticals, referrals to specialists, hospital services, home health care and vision and dental coverage — rivals the most expensive plans of private health insurers. And yet it costs taxpayers virtually nothing.
Meanwhile, the emergency rooms at Tampa General Hospital are no longer overrun. And the county's costs for covering the uninsured are down from $600 a year per uninsured patient to $262, and average hospital stays are down to only five days — about half what they used to be. Complications from asthma, which accounted for nine in 10 visits to emergency rooms, now amount to fewer than one in 100 visits. Diabetes also is being detected earlier.
“We give better health to more people for less money,” says Toni Beddingfield, community relations director for Hillsborough County's Department of Health and Human Services. “We've saved property-tax dollars — and we've saved lives.”
Local officials from around the country began taking note of the Hillsborough HealthCare program even before the federal Health Resources and Services Administration two years ago endorsed it as a “model that works.”
Similar experiments are under way in other urban areas that have large numbers of uninsured citizens, including Miami, El Paso, Texas, Augusta, Ga., and Kansas City, Mo.
Communities are trying other approaches as well. In Jackson, Miss., and Washington state, public health programs for the poor are financed with money from the $246 billion settlements in the huge 1998 class action lawsuit against tobacco companies. In Portland, Maine, and Detroit, hospitals pool their money to provide primary care — keeping people healthier and out of hospitals.
But Hillsborough is trying to make do with money from the sales tax alone. Since 1999, the Robert Wood Johnson Foundation has been encouraging other communities to follow suit, as have the Ford Foundation and the National Association of Counties.
Tampa's program grew out of the increasing burden of providing care for an estimated 117,000 uninsured residents — nearly 14 percent of the county's population. With health-care costs escalating 17 percent annually, community leaders worried that property taxes would not be able to support the care of the poor forever.
In 1991, the state legislature agreed to a half-cent increase in the sales tax to start the new program. Despite a drop in funding to a quarter-cent after the program reported a surplus in 1997, it still manages to serve the same number of patients, who can earn no more than the federal poverty level — $8,500 for an individual, $14,500 for a family — in order to qualify.
Chief among the beneficiaries are men and women who don't qualify for federal and state medical safety nets like Medicaid and Medicare — mainly mothers of children, young working men and middle-aged women.
All receive care through a network of five hospitals and 1,700 physicians. Generally, doctors are reimbursed at 75 percent of Medicaid rates. The doctors and hospitals bill the county directly.
County officials say the biggest fear when the program started — that it would attract people with HIV, sapping the system of resources — never materialized.
Beddingfield acknowledges that because of politics and other factors most communities may find it difficult to start a local health-care program by raising sales taxes. And yet, she argues, they should try.
“What's the alternative? Raising property taxes? Letting all these people fall between the cracks? Filling emergency rooms and ending up having to spend far more money than you could save?” Emergency room care is far more expensive than primary or preventive care in a doctor's office.
Back in his days as a state legislator, U.S. Rep. Jim Davis, D-Fla., enthusiastically backed Tampa's program. Now, he says proudly, “It's really working. It's made the difference we all expected to see.”
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