Miami-Dade voters will go to the polls in November to decide whether to increase their property-tax rates to pay for a major overhaul of Jackson Health System, the county’s public safety-net hospital system, after Miami-Dade commissioners agreed on Tuesday to call a special election.
The commission voted 9-1, with Commissioner Juan C. Zapata dissenting, to set the election on Nov. 5 for a referendum on a proposed $830 million bond to pay for improvements to the hospital system’s aging facilities, purchase equipment and expand services. Commissioners Bruno Barreiro and Barbara Jordan were absent from the vote. Commissioner Esteban “Steve” Bovo was absent from the meeting.Jackson officials told commissioners the improvements are necessary for the hospital system to better compete with local private hospitals, and to position Jackson for changes to come with federal healthcare reform.
“It’s Jackson’s time now,” said Darryl Sharpton, chairman of the Public Health Trust, the board that governs Jackson. “We simply cannot afford to stand still.”
Sharpton said the $830 million bond will help Jackson decrease its reliance on public funds — including about $335 million from Miami-Dade property taxes and a half-penny sales tax — and attract more paying patients who would help offset the high cost of providing healthcare to the uninsured and indigent.
Jackson Health System has only recently begun to turn around a financial crisis that saw the hospital system lose $419 million over three years. During that time, Sharpton said, Jackson has been unable to invest in its infrastructure while other hospitals forged ahead.
“Every hospital in our region is running at top speed to meet the changing needs of healthcare consumers,” he said. “Jackson cannot afford to continue to just stand still in this marketplace.”
Mayor Carlos Gimenez, who does not cast a vote, said afterwards that he supports improvements to Jackson’s aging facilities but expressed concern about the amount being requested.
“I think without a doubt, Jackson needs it,” Gimenez said. “I’m OK with it going on the ballot, and once approved to see if all that money needs to be spent.”
Gimenez also questioned the effects of federal healthcare reform, which will provide insurance to more previously uninsured individuals. He said no one knows whether, given a choice of where to seek healthcare, those people will continue to use Jackson or take their business to other local private hospitals.
Zapata, the sole dissenting vote, said he was concerned that a special election in November, when only four other municipalities are scheduled to have elections, would result in low turnout and not be truly representative of the community’s wishes.
“Having it in an off year,” he said, “I can tell you there isn’t anything else on the ballot in my district [West Miami-Dade, parts of Kendall] and I don’t know if folks are going to go out and vote for this.”
Penelope Townsley, Miami-Dade’s supervisor of elections, said an estimated 15 to 20 percent, or 180,00 to 240,000, of the county’s 1.2 million registered voters have historically turned out for special elections.
Zapata said he was also concerned that Miami-Dade voters may be feeling financial fatigue, facing higher water-and-sewer bills to pay for infrastructure improvements, higher tolls on Florida’s Turnpike and local toll roads, and other projects.
“I think it’s just a little too much,” he said.
Commissioner Xavier Suarez also voiced concerns about low voter turnout in special elections, but sided with the majority in approving the referendum. Suarez also said he had reservations about some of the projects proposed by Jackson administrators, which includes everything from $70 million for a new rehabilitation hospital to $14 million for new elevators to $156.6 million for new computers and software to integrate electronic medical records.
The proposed improvements would take place across Jackson’s main campus in Miami’s Civic Center, and its satellite hospitals in North Miami Beach and South Miami-Dade.
“I don’t like the mix,” Suarez said. “If I was voting on this in the private sector… I would tell you that I would never want to see 20 percent, or $166 million, spent on IT [information technology].”
Carlos Migoya, Jackson’s chief executive, told commissioners he believes Miami-Dade voters will see the bond as an investment in a vital public service, and he predicted they will approve the referendum.
“We believe that last year voters took a great position on education,” he said, referring to November’s passage of a $1.2 billion bond referendum for Miami-Dade County Public Schools. “We believe they will take a great position on healthcare.”
Like Gimenez, Zapata also said he was concerned about the uncertainty of changes that will come with federal healthcare reform, which will move hospitals and physicians away from fee-for-service payments to quality- and outcome-based measures.
“It’s hard to have clarity,” Zapata said. “My gut tells me we’re going to be making a significant investment dealing with a lot of unknowns, and that makes me hesitant.”
Migoya said he expects federal healthcare reform to cost Jackson about $100 million a year, due to declines in Medicaid reimbursements as the state moves Medicaid beneficiaries into a managed care program that will allow private insurers to compete for their business. The competition will force hospitals to accept lower reimbursements for services, Migoya has said.
Commissioner Chairwoman Rebeca Sosa said she will call for public workshops on the proposed projects and bond referendum prior to November’s election so voters and the public can learn more and comment about the plans.
“So no one can say the commission moved this very fast and didn’t allow public hearings,” she said.
Commissioner Audrey Edmonson, who sponsored the resolution calling for the special election, said if voters approve the referendum she will push to increase the county’s administrative oversight of the bond money and how it will be spent.
Edmonson said she wants to require the Public Health Trust to work on the overhaul collaboratively with county staff andthe mayor’s office prior to receiving financing for the projects. Edmonson said she will also ask for quarterly and annual status reports on the projects, which are scheduled to be completed by 2024, according to a preliminary list provided by Jackson administrators.
“We need to ensure to taxpayers that the funds are used as they’re intended to be used,” Edmonson said.