The Jackson Health System, plagued by years of multimillion-dollar budget deficits, is barely back in the black and already asking taxpayers for $830 million bucks. This is problematic.
There’s no question Miami needs a strong, efficient and competitive Jackson to ensure the continuation of the excellent medical care it provides, especially to the poor and uninsured. But there’s a limit to the public’s generosity. Jackson already gets $335 million a year from property and sales taxes. With this latest request for tax money, many residents may feel they’re not just being nickel and dimed to death, but dollared and assessed to the point of no return. This Jackson bond issue will be a hard sell.
There’s no good time to ask residents to raise their property taxes, even for a worthy cause, but this particular moment is among the worst in recent memory. Voters last December approved a $1.1 billion school bond issue that will hike property taxes by about $50 a year for the average homeowner. Voters said Yes by a large margin, but only after several consecutive years of big improvements in student test scores, the elimination of “F” schools and the inspired leadership of Superintendent Alberto Carvalho re-energized teachers and united the School Board.
Last November voters also said Yes to a straw ballot question that creates a no-kill county animal shelter and low-cost or no-cost spay and neuter services. Details on how to accomplish this are still being worked out, but it will cost the average homeowner roughly $20 a year.
Then there are the higher water and sewer bills Miami-Dade home owners will soon be getting because fixing the county’s decrepit and accident-prone pipes and pumping stations will be extremely expensive. In April, county commissioners approved issuing $1.6 billion in bonds to overhaul the system. Taking a shower, flushing the toilet or washing your car will cost everyone more in the years to come.
And then there are smaller, but niggling expenses that keep going up, too. Like the higher toll fees imposed by MDX, something that especially irritates residents in Southwest Miami-Dade who can’t get to and from work without driving on MDX freeways.
Miami-Dade Commissioner Juan Zapata noted all these higher taxes and fees before he cast the lone No vote last week to putting the Jackson bond-issue question on the November ballot. He and Commissioner Xavier Suarez also questioned whether it makes sense to put the Jackson question on a countywide ballot when only four cities — Miami, Hialeah, Miami Beach and Homestead — will be holding municipal elections. Opening voting precincts in the rest of the county will cost about $2.5 million.
Here’s the point: For some time now Miami-Dade residents have been asked to pay higher taxes for a variety of things and they’re tired of it. Miamians are suffering from tax fatigue. Just as Jeffrey Loria and the unconscionable Marlins Stadium deal screwed the pooch for the Dolphins and Sun Life Stadium upgrades, the school district bond, water and sewer bonds and other taxes and fees will make it very hard for Jackson to get the money it wants.
Do they need $830 million? Some of it, but perhaps not all. The Jackson Health System’s physical plant is run down, suffering from delayed repairs and replacement of aging equipment. They want to spruce up patients’ rooms — I’ve been in one and while the care was excellent the room was not.
They also need to buy new computers (but $160 million in IT?), build out more ICU beds, improve the ERs, build a rehab hospital ($70 million) and 10 urgent care centers around the county, install new elevators and so forth. It’s a long list, and CEO Carlos Migoya can defend every item on it. But as Mayor Carlos Gimenez says, perhaps the best route is to upgrade the areas where Jackson excels and let other, privately run hospitals take the patients for their areas of expertise.
The dilemma Jackson faces is the possibility of those other hospitals luring away Jackson’s now-uninsured patients when the Affordable Care Act kicks in next year and insures virtually everyone. When that happens, some patients who live a distance from Jackson’s facilities may choose to go to a nearby hospital or clinic. One that’s newer, shinier and closer to home.
Jackson has put together an experienced team of political operatives to run its pro-bond issue campaign. Without a long ballot with other races or issues, the Jackson question should get voters’ attention. That is, if they turn out to vote. The county’s election department predicts a turnout of between 15 percent to 20 percent. Do we really want a small percentage of voters to decide Jackson’s financial future?
CEO Carlos Migoya and Public Health Trust Chair Darryl Sharpton say they can’t wait ’til next year. “Jackson’s time is now,” Sharpton says. But the time doesn’t seem ripe for yet another tax increase, even a modest one — about $10 to $20 in the first year and $48 at its height for the average homeowner.
If you’ve been a patient at Jackson — and I have — you may be inclined to say Yes to the bond because of the high quality of medicine Jackson provides. For anyone with a serious trauma injury, the only choice is Jackson’s Ryder Trauma Center. Other departments excel, too. Jackson’s leaders are counting on a huge reservoir of community support from everyone who’s ever made contact with Jackson. But even they may be skeptical.
This is going to be a tough sell.