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Pinellas needs extra $3.3-million
to cover indigent health care

The increased costs reflect a combination of more people in need and the rising cost of health care.

By NICOLE JOHNSON
Published June 27, 2005

Pinellas County is dipping into its cash reserves for $3.3-million to cover an unexpected jump in the number of uninsured people seeking subsidized medical care this year.

There are about 2,900 people enrolled in the county's health services plan, and that number is expected to reach 3,000 before the 2004-2005 fiscal year ends in September, said Evelyn Bethell, director of the county's human services department.

By comparison, program administrators had expected to serve about 2,700 people this year, said Clark Scott, senior department administrative manager.

The program's increased costs are a combination of there being more people in need and the rising cost of health care, officials say.

In 2002, the county had to slow down enrollment because of budget constraints. That created a waiting list of sorts for people who needed services. With the county's finances in better shape, officials have started letting more people in.

Higher costs for things like tests, doctor's visits and medical equipment are driving up the cost of health care nationwide. Combine that with smaller state and federal contributions, and local governments end up picking up larger bills when it comes to health care for the poor.

"There are greater needs in the community, and as those needs continue to increase, the resources diminish," Bethell said. "A lot of times we're at the mercy of the feds and the state, and when they cut back on things, and the economy goes down, people find themselves without health insurance.

"Our program is not that big, so any little thing can affect it."

The nature of the program also gives county officials little choice but to pay.

"Our basic charge as government is to provide for the safety, health and welfare of our citizens," said County Administrator Steve Spratt. "This stands as a priority in my eyes and something we look to our reserves to fund."

The county currently keeps about $15-million for unforeseen expenses, said Jerry Herron, county director of the Office of Management and Budget.

"It all depends on the priority of the problem, and in this case you really can't not allow someone to have the operation or not pay for things they need when it's a life-or-death situation," Herron said.

The human services department's proposed budget for next fiscal year is $58-million, almost an 11 percent jump from this year. The health care program accounts for the majority of that increase, Scott said.

County commissioners will grapple with funding that request and dozens of others in the coming weeks when the county's proposed 2006 fiscal plan is revealed.

"The increase is largely because of that health care program," Herron said. "The general costs of health care inflation are starting to catch up with us and we just can't avoid the increases."

The indigent health care program functions as a typical medical insurance program except without a deductible. To qualify, a person must be considered below the poverty level, at least 18, a U.S. citizen and county resident.

To receive the benefits, patients must first go to one of six Human Services office locations, and be interviewed by a social worker. The social worker assesses their illness and assigns a doctor. The person is issued a program insurance card, which they can use at the doctor's office, emergency room and pharmacist.

But the program is not preventive in nature.

"Our managed health care is for people seriously ill," Bethell said.

On Monday, 51-year-old Terry Clark of Largo flashed the little blue card with his name and a thumbnail picture of his face while seated in the waiting area of the Clearwater Health Services office.

With the card, he's able to see a primary care doctor and get medicine for his bipolar disorder and high blood pressure, said Clark, who is unemployed.

Both conditions, he said, went untreated for years. He came to the county's health care program two months ago.

"I always thought it was funny that you had to crash and burn before you could get any help," said Clark, a soft-spoken man with a neatly trimmed salt and pepper goatee. "But it's still a good thing because even with a job nobody can even touch the cost of medical bills these days."

It cost taxpayers about $432 per person a month in the county's health care program.

With more funding, Bethell said the program could expand to provide preventive measures, but for now caring for the ill is primary.

Pinellas County is one of the only large urban areas in Florida without a dedicated funding source for insurance for the indigent. Both Dade and Hillsborough counties have dedicated sources. Hillsborough's program is backed by sales tax revenue.

County Commissioner Calvin Harris said that's something that may need to change. The answer could be in the Penny for Pinellas.

In the past five years, an optional one-cent local government sales tax has generated almost $600-million to pay for a new jail facility, arterial roads and endangered land. Voters must renew the tax in 2010.

Harris said the county should consider allocating some of the money to the health care program. But the tax is legally dedicated to capital improvements. A shift would require legislative and voter approval.

"It was already a problem in 1997 when I got here," Harris said. "So, we've talked about this problem for a long time, but haven't been able to address it."

Spratt said the change would require a balancing act.

"You'd have to figure out how you continue to fund those types of things that the public requires such as roads with the needs of a program like this," Spratt said. "We've got huge transportation and infrastructure needs."

- Nicole Johnson can be reached at njohnson@sptimes.com or 727 771-4303.

[Last modified June 27, 2005, 18:44:02]