Sunday, November 9, 2008

Tax Hike for Trauma Care a Hard Sell, Says Senator

A tax hike to boost trauma network funding would find little public support, a state senator said in late October during a forum on Georgia’s trauma care system.

While lawmakers last year debated a $10 increase in car tag fees to pump money into Georgia’s network of hospitals providing trauma care, that proposal failed to pass. The Legislature did, however, give the state trauma commission a one-time allotment of $58 million to distribute.

With health advocates saying a permanent funding solution is needed, a number of proposals have emerged, including hikes in taxes paid on insurance premiums and motor vehicles. But a tax increase should be the last resort, said Sen. Preston Smith (R-Rome).

“On most of the examples given to you today on the screen, there were two words beside each of the bullets and those words were ‘tax increase’ and that’s going to be a very difficult sell regardless of the merits of the argument for which you’re making the case,” Smith said during the forum at Georgia State University. “It is very difficult to turn back to the tax payers and say ‘This is an important need and we want you to bear more of the burden to provide [for] that need.’”

The forum, hosted by the Andrew Young School of Policy Studies with support from the Healthcare Georgia Foundation, was held to explore ways to fund the state’s trauma network, distribute the money fairly and make hospitals and healthcare providers accountable for the dollars spent. It was the third such forum the school has hosted this year.

Panelists included state Rep. Mickey Channell (R-Greensboro); Jim Craig, director of Health Protection for the Mississippi Department of Health; Gov. Sonny Perdue’s policy director Hanna Heck; and Georgia State associate economics professor Jim Marton and associate professor of health administration Patricia Ketsche.

Ketsche and Marton presented a report prepared by the Andrew Young School’s Fiscal Research Center which recommended a flat tag fee of $14 per vehicle, noting the fee would generate more than $100 million a year, a figure some say might be necessary. The report, prepared by economists Peter Bluestone and Robert Buschman, acknowledged however that the fee might not keep up with the rising cost of care over time.

The second-best funding mechanism would be an increase in the car tax rate. The least-preferred method, based on factors like revenue growth, how many people would be expected to pay in, impact on consumer behavior and ease of collection, would be surcharges on traffic tickets, the report said.

Smith said a number of possible funding mechanisms should be explored, including an idea to use money generated from tickets written by the Georgia State Patrol, which has always gone directly to the jurisdiction in which the violation occurred.

“There is a tremendous amount of revenue being generated for the benefit of locals, none of which goes to trauma care,” Smith said.

The trauma network in Mississippi, Craig said, is funded by a combination of fees on tickets for moving violations, DUIs and speeding, an increase in car tag taxes and other sources, including a fee on the purchase of all-terrain vehicles.

Craig said the state also requires hospitals to participate in the system to their full capability or face substantial fines.

Channell, who chairs the House Appropriations subcommittee on healthcare, said he was open to the idea of exploring mandatory participation.

“I think that we need, potentially, to look at reorganizing or organizing in a different fashion,” he said.

Heck, Perdue’s policy director, said the governor has concerns about dedicating new funding streams that bypass legislative review.

“By the very nature of going through the legislative appropriations process, we subject those funds to review, and say ‘are they being used in the right manner for Georgia? … Are they providing value?’”

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