Kansas City’s health levy has long funded ambulance services and other care for residents without insurance or a means to pay. A portion of that levy is temporary, and it expires next year.
While much has changed since the levy was first introduced, city leaders and proponents of the tax are pushing to renew that temporary portion for nine more years. The full council is slated to take up the proposed renewal later today, and doing so could pave the way for a popular vote on the tax this spring.
UPDATE (January 17, 2013): The city council passed the levy this afternoon 12-0, moving it to a popular vote in April.
The health levy is a property tax that brings in about $50 million annually, with about $15 million of that coming from a temporary levy passed by voters in 2005. The money goes to Truman Medical Centers, a main hospital for low-income residents, city ambulance services, and health clinics that provide care to thousands of low-income residents.
“We have in Kansas City about a sixth of our population that’s uninsured, without health insurance,” says Councilman Ed Ford, a member of the city’s health commission and one of the leading advocates of renewing the levy. “Over the last nine years, safety net providers have provided 45,000 Kansas Citians with health services. So it’s very needed. And without these funds, it would place such a burden on Truman and others that they might not be able to keep their doors open.”
Recipients of the funds say it’s important to continue the levy because demand for medical care has gone up in recent years. Factors include the economy, people postponing care until their situation worsens and changes in Medicaid, the state’s public insurance program for the poor and disabled. The state scaled back eligibility in 2005.
Ford says one complicating aspect of the current discussion, one that wasn’t present in 2005 when the temporary levy first passed, is the federal health law. The U.S. Supreme Court upheld it this spring. More people are expected to gain private coverage as a result. Even so, Ford and others say the transition is complicated, will take a while, and is full of uncertainty.
For one, they don’t know whether or not Missouri will expand its Medicaid eligibility, a now optional provision of the federal law.
“That’s a game changer,” says Ford.
An expansion would provide a lot more funding through the state for health care for low-income residents. There hasn’t been much support from key state lawmakers.
Proponents say they don’t want to wait until the legislature reaches a final decision, before moving to renew the nine-year levy.
“We don’t want to run the risk of it expiring,” says Councilwoman Jan Marcason, whose finance committee moved the measure out of committeelast week. Members didn’t want any chance of gaps, short term and long term, in ambulance and other health services.
Elections also cost the city about $500,000, so Marcason says it’s also cost effective put the renewal on this April's ballot, which already includes two other measures.
And even if the state expands Medicaid, the levy will still be needed, says Ford.
“We believe a Medicaid expansion will cover about one third of the uninsured that the safety net providers are currently providing services for,” says Ford. “So we’ll still have a majority of citizens who are uninsured will remain uninsured.”
The city’s fire chief says the cost of providing ambulance services, in particular, is a lot more than what Medicaid pays them for the service.
Ford, Marcason and others say in the event the levy is no longer necessary, the city council has the power to terminate it.
Meanwhile, council members and health providers haven't been the only groups assessing the temporary levy. The Citizen’s Commission on Municipal Revenue, a mayor appointed group that reviewed all city revenue needs last year, also weighed in on the levy. Members heard from the city manager in the spring, who raised concerns about whether the city should be taking on health care, as opposed to infrastructure and other city priorities.
Tim Kristl was on the commission (he’s also a former board member of a northland clinic that gets health levy funds). He says proponents laid out a compelling case for a renewal. He backed it, as did the entire commission, but they never addressed a time frame of more than four years.
“The testimony that we received [from the director of Truman Medical Centers and the chair of the city’s health commission] was that Obamacare would be picking up the main impetus of cost within a year or two of now, actually. And that the health levy would need some kind of bridge to get it to when Obamacare would really be in full swing,” says Kristl. “So our thinking at the time was we needed at least a couple of years. So we opted to go for four years, which is what they requested.”
The group, however, issued its recommendation before the Supreme Court ruled on the law and made the Medicaid expansion optional. Kristl says that means the four year recommendation is somewhat outdated.
“Personally, I still think nine years is too long,” says Susan Stanton, who chaired the commission.
Kristl says he hasn’t made up his mind yet, but that either way, it will be a tough decision for voters.
And it’s a decision that’s likely to happen soon. The full council is slated to take up the renewal this afternoon. All but one member has backed the measure. If approved, residents will be asked like they were years ago when the temporary levy was first put to a vote, whether or not to help fund health care in Kansas City.