Resolution 388-2009
RESOI.lUTION NO. 388 -2009
A RESOLlJTION OF THE BOARD OF COUNTY
COMMISSIONERS FOR MONROE COUNTY, f'LORIDA.
URGING 1l\1l\'IEDIATE PASSAGE OF COMPREHENSIVE
FEDERAL HEALTH REFORl\11.JEGISLA TION
WHEREAS. experts fronl across the political spectrum agree that Atnerica's
health sYStCI11 is deficient and financially unsustainable in its present configuration: and
WHEREAS, families in Monroe County are experiencing this crisis right no"',
confronting the high cost of health care that threatens their financial stability" leaves thenl
exposed to higher pretniutTIs and deductibles'l and puts them at risk for a possible loss of
health insurance~ and
WHEREAS, eJnployer-sponsored health insurance prclniulTIS have nearly
doubled in recent years 11laking it increasingly difticult tor employers, including county
gO\/cnllnents~ to provide health insurance coverage for their employees and retirees: and
\\'HEREAS., tnillions of Alnericans do not have health coverage" or have
inadequate coverage and as our econolnic challenges Inultiply, the problenl of health care
access gro\vs., further straining counties" capacity to provide care for the uninsured.
undertnsurcd and medically indigent: and
WHEREAS., data collected froln the 2007 l\1onroe County Health Risk Survey
data indicates that 25~/O of those surveyed \vere diagnosed \vith hypertension., 3 70/~ \vith
high cholesterol., 12~/o with diabetes and 9~,'O reported sut1ering frOITI heart attack.. angina
or stroke: and
WHEREAS, the Florida Keys are experien<:ing a 6.2~~ unetnployment rate (May
20()9)~ and
WHEREAS, an estinlatcd 290;() of the residents of the Florida Keys have no
health insurance: and
WHEREJ.\S., county officials are electcd to protect the health and \velfarc of their
constituents: and
WHEREAS~ 60% of t\1onroe County's contribution to thc Health Dcparttnent
can be allocated to direct patient care: and
WHEREAS. the clinical/public health prognltTIS of Monroe ('ounty cost
approximately S4.()OO..OOO~ and
WHEREAS. Monroe County also contributes the following to countywide non-
profit health service agencies: Rural Health Net\vork ($333.,600).. \\'otnanKind
($70~OOO).. Good Health l~linic ($35JJOO).. Florida Keys /\rea Health Education ('enter
($35,000 - children'ls medical services)., AIDS Help ($25~500 - health care services t{)r
folks with HI\l/AIDS), Florida Keys Healthy Start ($5,,000 - health care screenings"
preventive services" and education to pregnant WOll1en and toddlers)., Easter Seals
($10'!000 - special health care services filr disabled)'! and Guidance Clinic/Care Center
($1..060..520 ~- 1l1ental health care): and
\\'HEREAS, Monroe ('ounty"s Prison Health Services cost the County
approxi"tnately $2.600,000 per year~ and
\\'HEREAS, the Monroe County Health Departlnent is currently covering
revenue shortfalls through reserve funds. depleting those funds and expecting a $300..000
deficit f()r these progralTIS this fisc.al year~ and
WI-IEREAS'I the Monroe C\)unty Health Departtnent is requesting a budget
increase from the county to avoid cutting back on services and to be prepared f()[ a
potential s\vine tl u vaccination of county residents~ and
WHEREAS., the National Association of Counties (NACo) Health Systern
Ref()nn Working Group., appointed by President Don Stapley in July 2008 and chaired by
President-Elect \'alerieBrown,! has held three regional hearings to explore the health
crisis and to hear what county otlicials believe should be done about it and has
SUITIInarized its findings in Restoring the PartnerslllJ.1.for Anlcrican Ilea/tll: ("Olllltics in a
21s1 ("enlltl)' Ilea/tll s..vstef11 which was approved and adopted by resolution of the NACo
Health Steering Comlnittee and Board of Directors on March 9.. 2009.
NOW 'rHEREFORE BE IT RESOL "ED by the Board of County
COlTItnissioncrs of Monroe County that:
Section t. The Board of County COlTIlnissioners of Monroe County hereby endorses the
follo\\'ing aspects of NACo's health ret()nn principles~ namely., that reform legislation
should
A. restore the partnership between county and federal governnlents~
B. provide access to affordable., quality health care to all legal residents~
C. invest in public health, including health pronlotion and disease and injury
prcvention~
D. stabilize and strengthen the local health care safety net system, especially
\1edicaid and disproportional share hospital (DSH) payments~
E. ensure that county health agencies have the resources to nleaningfully use health
inf()nnation technology;
F. enable elderly and disabled persons to receive the services they need in the least
restrictive environnlent: and
G. refi)nn the delivery and financing of health services in the jail systelTI.
Section 2. The Board strongly urges the 111 th C"tJngrcss of the lJnited States to enact
cOtnprehensivc health reform legislation without delay before the end of its first session.
Section 3. Lpon adoption.. the ('ounty ('Icrk is hereby directed to send a copy of this
Resolution by lJniteu States Inail to National Association of Counties c/o Ed Rosado..
P.O. Box 549.. Tallahassee, Florida 32302-0549; Congresswoman Ileana Ros-Lchtincn~
2470 Raybunl H.G.B... Washington~ DC 20515-0918: Senator Bill Nelson., Llnited States
Senate.. 716 Senate Hart Office Building., Washington., DC 20510: and Senator Letnieux.,
Llnited States Senate., J56Russel1 Senate Office Ruilding.. Washington" DC 20510.
Section 4. l'his Resolution shall be ctlcctivc as of the date of its adoptjon.
PASSED AND ADOPTED by the Board of ('ounty C\)fTIlnissioncrs of Monroe ('oullty..
Florida.. at a regular I11eeting of said Board held 011 the ?l_s t day of _Dc t:ob~_~ 2009.
Mayor (~e()rge Neugent
rvlayor Pro TelTI Sylvia Murphy
('ot11missioncr l-lcathcr l'arruthcrs
C\nTIluissioner t\1ario Di Gennaro
C~olnmissioner Kim \Vigington
Yes
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No
Yes
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Yes
No
BOARD OF COlJNTY COl\1l\tIISSIONERS
OF MONROE COlTNTY, FLOR'IDf\
A TTESA Danny L. K~~~g~cr~.A 1 j;..,.,... Lc '()~,~
By: ~a& Qc ~ By:
Deputy Clerk
Mayor George Neugent
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MONROE COUNTY ATTORNEY
iYi'PRO~ED AS-, TC/FObY:
Ct.. /lLi&A-fi/ ", ' "
CY"JT~11A L. HALL
ASSIS ANT COUNTY' A1TORNEY
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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
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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.
MONROE COUNTY COURTHOUSE
500 WHITEHEAD STREET, SUITE 101
KEY WEST, FLORIDA 3::\040
TEL. (305) 294-4641
FAX (::\05) 295-3663
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BRANCH OFFICE:
PLANTATION KEY
GOVERNMENT CENTER
88820 OVERSEAS HIGHW A Y
PLANT A TION KEY, FLORIDA 33070
TEL. (305) 852-7145
FAX (305) 852-7146
BRANCH OFFICE:
MARATHON SUB COURTHOUSE
3117 OVERSEAS HIGHWAY
MARATHON, FLORIDA 33050
TEL. (305) 289-6027
FAX (::\05) 289-]745
CLERK OF THE CIRCUIT COURT
MONROE COUNTY
www.clerk-of-the-court.com
ROTH BUILDING
SO HIGH POINT ROAD
PLANTATION KEY, FLORIDA 33070
TEL. (305) 852-7145
FAX (305) 853-7440
March 3, 2010
National Association of Counties
c/o Ed Rosado
P.O. Box 549
Tallahassee, FL 32302-0549
Congresswoman Ileana Ros-Lehtinen
2470 Rayburn H.O.B.
Washington, DC 205 I 5-0918
Senator Bill Nelson
United States Senate
716 Hart Office Building
Washington, DC 20510
Senator Lemieux
United State Senate
356 Russell Senate Office Building
Washington, DC 20510
Dear Senator Lemieux,
Enclosed please find a copy of Resolution No. 388-2009 urging immediate passage of
Comprehensive Federal Health Legislation.
This Resolution was adopted by the Monroe County Board of County Commissioners at a
Regular Meeting in formal session on October 21, 2009 Should you have any questions please
feel free to contact me at (305) 295-3 I 30.
Danny L. Kolhage, Clerk
of Court and ex-officio Clerk
to the Board of County Commissioners
by:
JhaL.fu.~
Isabel C. DeSantis
Deputy Clerk
cc: File
MONROE COUNTY COURTHOUSE
500 WHITEHEA [) STREET, SUITE 101
KEY WEST, FLOI{IDA ~~040
TE L. (:\05) 294-4.641
FAX (305) 295<~663
BRANCH OFFICE:
PLANTATION KEY
GOVERNMENT CENTER
88820 OVERSEAS HIGHW A Y
PLANTATION KEY I FLORIDA 33070
TEL. (305) 852-7145
FAX (305) 852-7146
BRANCH OFFICE:
MARATHON SUB COURTHOUSE
3117 OVERSEAS HIGHWAY
MARATHON, FLURIDA 33050
TEL. (305) 289-h027
FAX (305) 289-1745
CLERK OF THE CIRCUIT COURT
MONROE COUNTY
www.clerk-of-the-court.com
ROTH BUILDING
50 HIGH POINT ROAD
PLANTATION KEY I FLORIDA 33070
TEL. (305) 852-7145
FAX (305) 853-7440
March 3, 2010
National Association of Counties
c/o Ed Rosado
P.O. Box 549
Tallahassee, FL 32302-0549
Congresswoman Ileana Ros-Lehtinen
2470 Rayburn H.O.B.
Washington, DC 20515-0918
Senator Bill Nelson
United States Senate
716 Hart Office Building
Washington, DC 20510
Senator Lemieux
United State Senate
356 Russell Senate Office Building
Washington, DC 20510
Dear Senator Nelson,
Enclosed please find a copy of Resolution No. 388-2009 urging immediate passage of
Comprehensive Federal Health Legislation.
This Resolution was adopted by the Monroe County Board of County Commissioners at a
Regular Meeting in formal session on October 21, 2009 Should you have any questions please
feel free to contact me at (305) 295-3130.
Danny L. Kolhage, Clerk
of Court and ex-officio Clerk
to the Board of County Commissioners
by:
~c.~
Isabel C. DeSantis
Deputy Clerk
cc: File
MONROE COUNTY COURTHOUSE
500 WHITEHEAD STREET, SUITE 101
KEY WEST, FLORIDA 33040
TEL. (305) 294-4641
FAX (305) 295-3663
BRANCH OFFICE:
PLANTATION KEY
GOVERNMENT CENTER
88820 OVERSEAS HIGHW A Y
PLANTATION KEY, FLORIDA 33070
TEL. (305) 852-7145
FAX (305) 852-7146
BRANCH OFFICE:
MARATHON SUB COURTHOUSE
3117 OVERSEAS HIGH\'\' A Y
MARATHUN, FLORIDA 33050
TEL. (305) 289-6027
FAX (305) 289-1745
CLERK OF THE CIRCUIT COURT
MONROE COUNTY
www.clerk-of-the-court.com
ROTH BUILDING
50 HIGH POINT ROAD
PLANTATION KEY, FLORIDA 33070
TEL. (305) 852-7145
FAX (305) 853-7440
March 3, 2010
National Association of Counties
c/o Ed Rosado
P.O. Box 549
Tallahassee, FL 32302-0549
Congresswoman Ileana Ros-Lehtinen
2470 Rayburn H.O.B.
Washington, DC 20515-0918
Senator Bill Nelson
United States Senate
716 Hart Office Building
Washington, DC 2051 0
Senator Lemieux
United State Senate
356 Russell Senate Office Building
Washington, DC 20510
Dear Mr. Rosado,
Enclosed please find a copy of Resolution No. 388-2009 urging immediate passage of
Comprehensive Federal Health Legislation.
This Resolution was adopted by the Monroe County Board of County Commissioners at a
Regular Meeting in formal session on October 21, 2009 Should you have any questions please
feel free to contact me at (305) 295-3130.
Danny L. Kolhage, Clerk
of Court and ex-officio Clerk
to the Board of County Commissioners
by: ~a.LJC. ~~t;;.)
Isabel C. DeSantis
Deputy Clerk
cc: File
MONROE COUNTY COURTHOUSE
500 WHITEHEAD STREET, SUITE 101
KEY WEST, FLORIDA 33040
TEL. (305) 294-4641
FAX (305) 295-:~663
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B RANCH OFFICE:
PLANTATION KEY
GOVERNMENT CENTER
88820 OVERSEAS HIGHWAY
PLANTATION KEY, FLORIDA 33070
TEL. (305) 852-7145
FAX (305) 852-7146
BRANCH OFFICE:
MARATHON SUB COURTHOUSE
3117 OVERSEAS HIGH\V A Y
t\.1ARATHON, FLORIDA 33050
TEL. (305) 289-6027
FAX (305) 289-1745
CLERK OF THE CIRCUIT COURT
MONROE COUNTY
www.clerk-of-the-court.com
ROTH BUILDING
50 HIGH POINT ROAD
PLANTATION KEY, FLORIDA 33070
TEL. (305) 852-7145
FAX (305) 853-7440
March 3, 2010
National Association of Counties
c/o Ed Rosado
P.O. Box 549
Tallahassee, FL 32302-0549
Congresswoman Ileana Ros- Lehtinen
2470 Rayburn H.O.B.
Washington, DC 20515-09 18
Senator Bill Nelson
United States Senate
716 Hart Office Building
Washington, DC 20510
Senator Lemieux
United State Senate
356 Russell Senate Office Building
Washington, DC 20510
Dear Congresswoman Ros-Lehtinen,
Enclosed please find a copy of Resolution No. 388-2009 urging immediate passage of
Comprehensive Federal Health Legislation.
This Resolution was adopted by the Monroe County Board of County Commissioners at a
Regular Meeting in formal session on October 21, 2009 Should you have any questions please
feel free to contact me at (305) 295-3130.
Danny L. Kolhage, Clerk
of Court and ex-officio Clerk
to the Board of County Commissioners
by:
~c.~
Isabel C. DeSantis
Deputy Clerk
cc: File