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Item O3BOARD OF COUNTY COMMISSIONERS AGENDA ITEM SUMMARY Meeting Date: _October 21, 2009 Bulk Item: Yes X No Division BOCC Department: DIST 3 Staff Contact Person/Phone #: C.Schreck x 3430 AGENDA ITEM WORDING: Approval of a resolution of the Board of County Commissioners for Monroe County, Florida, urging immediate passage of comprehensive federal health reform legislation ITEM BACKGROUND: Congress is considering comprehensive federal health reform legislation. The National Association of Counties maintains county governments are integral to America's current health system and will be crucial partners in achieving successful reform. They have requested county governments consider passing resolutions urging the passing of comprehensive federal health reform legislation. PREVIOUS RELEVANT BOCC ACTION: CONTRACT/AGREEMENT CHANGES: STAFF RECOMMENDATIONS: TOTAL COST: 0 INDIRECT COST: 0 BUDGETED: Yes No COST TO COUNTY: 0 SOURCE OF FUNDS: na REVENUE PRODUCING: Yes _ No x AMOUNT PER MONTH Year APPROVED BY: County Atty C OMB/Purchasing Risk Management DOCUMENTATION: Included x Not Required DISPOSITION: Revised 1/09 AGENDA ITEM # RESOLUTION NO. -2009 A RESOLUTION OF THE BOARD OF COUNTY COMMISSIONERS FOR MONROE COUNTY, FLORIDA, URGING IMMEDIATE PASSAGE OF COMPREHENSIVE FEDERAL HEALTH REFORM LEGISLATION WHEREAS, experts from across the political spectrum agree that America's health system is deficient and financially unsustainable in its present configuration; and WHEREAS, families in Monroe County are experiencing this crisis right now, confronting the high cost of health care that threatens their financial stability, leaves them exposed to higher premiums and deductibles, and puts them at risk for a possible loss of health insurance; and WHEREAS, employer -sponsored health insurance premiums have nearly doubled in recent years making it increasingly difficult for employers, including county governments, to provide health insurance coverage for their employees and retirees; and WHEREAS, millions of Americans do not have health coverage, or have inadequate coverage and as our economic challenges multiply, the problem of health care access grows, further straining counties' capacity to provide care for the uninsured, underinsured and medically indigent; and WHEREAS, data collected from the 2007 Monroe County Health Risk Survey data indicates that 25% of those surveyed were diagnosed with hypertension, 37% with high cholesterol, 12% with diabetes and 9% reported suffering from heart attack, angina or stroke; and WHEREAS, the Florida Keys are experiencing a 6.2% unemployment rate (May 2009); and WHEREAS, an estimated 29% of the residents of the Florida Keys have no health insurance; and WHEREAS, county officials are elected to protect the health and welfare of their constituents: and WHEREAS, 60% of Monroe County's contribution to the Health Department can be allocated to direct patient care; and WHEREAS, the clinical/public health programs of Monroe County cost approximately $4,000,000; and WHEREAS, Monroe County also contributes the following to countywide non- profit health service agencies: Rural Health Network ($333,600), WomanKind ($70,000), Good Health Clinic ($35,000), Florida Keys Area Health Education Center ($35,000 - children's medical services), AIDS Help ($25,500 - health care services for folks with HIV/AIDS), Florida Keys Healthy Start ($5,000 - health care screenings, preventive services, and education to pregnant women and toddlers), Easter Seals ($10,000 - special health care services for disabled), and Guidance Clinic/Care Center ($1,060,520 — mental health care); and WHEREAS, Monroe County's Prison Health Services cost the County approximately $2,600,000 per year; and WHEREAS, the Monroe County Health Department is currently covering revenue shortfalls through reserve funds, depleting those funds and expecting a $300,000 deficit for these programs this fiscal year; and WHEREAS, the Monroe County Health Department is requesting a budget increase from the county to avoid cutting back on services and to be prepared for a potential swine flu vaccination of county residents; and WHEREAS, the National Association of Counties (NACo) Health System Reform Working Group, appointed by President Don Stapley in July 2008 and chaired by President -Elect Valerie Brown, has held three regional hearings to explore the health crisis and to hear what county officials believe should be done about it and has summarized its findings in Restoring the Partnership for American Health: Counties in a 21" Century Health System which was approved and adopted by resolution of the NACo Health Steering Committee and Board of Directors on March 9, 2009. NOW THEREFORE BE IT RESOLVED by the Board of County Commissioners of Monroe County that: Section 1. The Board of County Commissioners of Monroe County hereby endorses the following aspects of NACo's health reform principles; namely, that reform legislation should A. restore the partnership between county and federal governments; B. provide access to affordable, quality health care to all legal residents; C. invest in public health, including health promotion and disease and injury prevention; D. stabilize and strengthen the local health care safety net system, especially Medicaid and disproportional share hospital (DSH) payments; E. ensure that county health agencies have the resources to meaningfully use health infonnation technology; F. enable elderly and disabled persons to receive the services they need in the least restrictive environment; and G. reforn the delivery and financing of health services in the jail system. Section 2. The Board strongly urges the 1 11 `" Congress of the United States to enact comprehensive health reforn legislation without delay before the end of its first session. Section 3. Upon adoption, the County Clerk is hereby directed to send a copy of this Resolution by United States mail to National Association of Counties c/o Ed Rosado, P.O. Box 549, Tallahassee, Florida 32302-0549; Congresswoman lleana Ros-Lehtinen, 2470 Rayburn H.O.B., Washington, DC 20515-0918; Senator Bill Nelson, United States Senate, 716 Senate Hart Office Building, Washington, DC 20510; and Senator Lemieux, United States Senate, 356 Russell Senate Office Building, Washington, DC 20510. Section 4. This Resolution shall be effective as of the date of its adoption. PASSED AND ADOPTED by the Board of County Commissioners of Monroe County, Florida, at a regular meeting of said Board held on the day of , 2009. Mayor George Neugent Mayor Pro Tern Sylvia Murphy Commissioner Heather Carruthers Commissioner Mario DiGennaro Commissioner Kim Wigington ATTEST: Danny L. Kolhage, Clerk LOW Deputy Clerk BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA ME Mayor George Neugent MONROE COUNTY ATTORNEY A,P, PROVED AS T( FORM: CYN I HIA L. HALL - ASSISTANT COUNITY ATTORNEY __�'� � ` i NAI'O National Association of Counties The Voice of America's Counties Restoring the Partnership for American Health Counties in a 21st Century Health System Full Partners: County governments are integral to America's current health system and will be crucial partners in achieving successful reform. At the most basic level, county officials are elected to protect the health and welfare of their constituents. County governments set the local ordinances and policies which govern the built environment, establishing the physical context for healthy, sustainable communities. County public health officials work to promote healthy lifestyles and to prevent injuries and diseases. Counties provide the local health care safety net infrastructure, financing and operating hospitals, clinics and health centers. County governments also often serve as the payer of last resort for the medically indigent. County jails must offer their inmates health care as required by the U.S. Supreme Court. Counties operate nursing homes and provide services for seniors. County behavioral health authorities help people with serious mental health, developmental disability and substance abuse problems who would have nowhere else to turn. And as employers, county governments provide health benefits to the nearly three million county workers and their retirees nationwide. Clearly, county tax payers contribute billions of dollars to the American health care system every year and their elected representatives must be at the table as full partners in order to achieve the goal of one hundred percent access and zero disparities. Local Delivery Systems — Access for All: NACo believes that reform must focus on access and delivery of quality health services. Coverage is not enough. County officials, particularly in remote rural or large urban areas know that even those with insurance may have difficulty gaining access to the services of a health care provider, which can be exacerbated by the severity of their illness. Local delivery systems should coordinate services to ensure efficient and cost-effective access to care, particularly primary and preventive care, for underserved populations. County governments are uniquely qualified to convene the appropriate public and private partners to build these local delivery systems in a way that will respect the unique needs of individuals and their communities. A restored federal commitment to such partnerships is necessary for equity's sake. Public Health and Wellness: NACo believes that a greater focus on disease and injury prevention and health promotion is a way to improve the health of our communities and to reduce health care costs. Disease and injury prevention and health promotion services can be delivered by a health care professional one patient at a time. Local health departments, in partnership with community based organizations and traditional health care providers, deliver community -based 25 Massachusetts A venue, NIV I Suite 50011fashin ton, DC 20001 / 202.393.6226 / Fci-r 202.393.2639 / www.naco.org, prevention services targeted at an entire population. Population -based prevention services can save money by keeping people healthy and reducing the costs of treating unchecked chronic disease. These critical services include assessment of the health status of communities to identify the unique and most pressing health problems of each community and health education to provide individuals with the knowledge and skills to maintain and improve their own health. The public health response to emergencies should be fully integrated into each county's emergency management plan. Local public health considerations likewise should be systematically integrated into land use planning and community design processes to help prevent injuries and chronic disease. Policies are also needed to address health inequity, the systemic, avoidable, unfair and unjust differences in health status and mortality rates, as well as the distribution of disease and illness across population groups. Investing in wellness and prevention across all communities will result in better health outcomes, increased productivity and reduce costs associated with chronic diseases. Expanding Coverage: NACo supports universal health insurance coverage. Existing public health insurance systems should be strengthened and expanded, including Medicare, Medicaid and the State Children's Health Insurance Program (SCHIP). As states and counties attempt to shoulder their legislatively mandated responsibilities to provide care for the indigent and uninsured, federal regulatory barriers should be removed to allow flexibility and innovation at the local level. Furthermore, in the effort to expand coverage, reformers should not forget that the coverage must be meaningful, without imposing additional mandates on county governments. The benefit package must be defined so as to provide the full range of services people need, including prevention services, full parity for behavioral health, substance abuse and developmental disability services. Barriers to cost-effective treatments, like living organ donation, should be removed. Maintaining a Safety Net: NACo believes that the intergovernmental partnership envisioned in the Medicaid statute should be restored and strengthened. Local safety nets constructed under Medicaid should not be dismantled to "pay for" universal coverage. We must not allow the safety net infrastructure to be undermined. County hospitals and health systems, in particular, will continue to need extra support to carry out their missions to reduce disparities and serve underserved populations. Health Workforce: NACo believes that the health professional and paraprofessional workforce must be supported and enhanced. Every effort should be made to recruit, train, license and retain health professionals, and allied professionals and paraprofessionals, on an expedited basis. A large body of evidence supports the contribution of direct care staff, nurses and nursing assistants, to quality outcomes. Funding for existing education and training programs — in secondary, post -secondary and vocational educational settings — should be increased and targeted towards initiatives to expand and diversify the health workforce. Partnerships between local economic developers and workforce development professionals should be encouraged to meet growing health care sector demand. Targeted incentives including scholarships, loan forgiveness and low -interest loan repayment programs should be developed to encourage more providers to enter and remain in primary care and public health careers. Primary care providers should be empowered to — and compensated for — case management services. Health IT: The federal government should support the integration of health information technologies into the local health care delivery system. NACo supports the President's goal of implementing a nation-wide system of electronic health records in five years. NACo supports efforts to promote the use of a range of information technologies to facilitate appropriate access to health records and improve the standard of care available to patients, while protecting privacy. This includes deployment of broadband technologies to the widest possible geographic footprint. Other tools facilitate evidence -based decision making and e- prescribing. Using broadband technologies, telemedicine applications enable real-time clinical care for geographically distant patients and providers. Remote monitoring can also facilitate post -operative care and chronic disease management without hospitalization or institutionalization. Long Term Care: Federal policies should encourage the elderly and disabled to receive the services they need in the least restrictive environment. Since counties provide and otherwise support long term care and other community based services for the elderly and disabled, state and federal regulations and funding programs should give them the flexibility to support the full continuum of home, community -based or institutional care for persons needing assistance with activities of daily living. Nursing home regulatory oversight should be reformed in order to foster more person -centered care environments. Jail Health: Reforming America's health care system must include reforms to its jail system. Counties are responsible for providing health care for incarcerated individuals as required by the U.S. Supreme Court in Estelle v. Gamble, 429 U.S. 97 (1976). This unfunded mandate constitutes a major portion of local jail operating costs and a huge burden on local property tax payers. The federal government should lift the unfunded mandate by restoring its obligation for health care coverage for eligible inmates, pre -conviction. Furthermore, a true national partnership is needed to divert the non-violent mentally ill from jail and into appropriate evidence -based treatment in community settings, if possible. Finally, resources should be made available to counties to implement timely, comprehensive reentry programs so that former inmates have access to all the health and social services, including behavioral health and substance abuse treatment, to avoid recidivism and become fully integrated into the community.