Wednesday, August 22, 2012

Health Care Millage, Otto Health Center, Parks Mowing Contract to Expire, Hawk Island Snow Park Hill, Lansing Township Request for County to Borrow Money

This week was a very busy week for the committees of the Ingham County Commission. This may be my longest blog yet (sorry about that). We spent many hours in committee this week!

In the Human Services committee, we once again considered the question of a millage for health care accessibility and services in Ingham County. The Ingham Health Plan (IHP) currently services those that make between $17,500 and $28,000. These people won't qualify for Medicaid under the Affordable Care Act (i.e. Obamacare), but also won't be able to afford what is on the exchange because of co-pays and deductibles. The millage would cover these people, and expands provider access to community health centers and to Ingham County health clinics. It would also repay doctors with a rate competitive to the state reimbursement and close to the medicare reimbursement rates. The IHP and Ingham Health Department staff argued that this is a good time to put this on the ballot. They said that even with the Affordable Care Act in place, and even if the state expands medicaid coverage to 138% of the poverty rate, there are still 8,000 uninsured people. If medicaid is not expanded, we will be in worse shape and there will be more uninsured people because only disabled or pregnant women or others in categoricals will be covered while the working poor would not be covered. IHP said that they will educate the community on what the Affordable Care Act covers and what it doesn't, so people will know what the millage will be used for. The said that wile there is still much unknown among the public about Affordable Care Act, they said that the November election is a time when more people come out and vote. They also said that that the ballot language explains exactly what is covered, and specifies that this millage does not cover things under the Affordable Care Act. They also updated us that they have lowered the rate they are requesting from .61 to .52 mills by decreasing slightly the increased rate to providers. They will look for a federal grant to cover the reduction. They said that those with $50,000 homes will pay $26 per year, and that they will pay this anyway in higher insurance premiums when those with uncompensated care go to emergency rooms. It will raise $3,349,779 in the first calendar year according to the current tax base, and will be a 3 year millage that likely couldn't be renewed because the percentages will change. They said that this millage develops the ability for people to have stronger and better health, and that there is a collective benefit to the community if we pass this. The Ingham Health Plan is the only place some people can go for health benefits. 40,000 people have benefited from this plan at one time or another. There is a benefit to society because people have medications through IHP and won't have to go to the ER. The IHP saves the lives of those that live and work in this county. Commissioner Vickers asked how much more the doctors will receive and who determines this. IHP staff responded that the State of MI has gone to the Medicare rate (which is 67% above IHP). The original millage request started there, but is now going back down to 60% in order to lower millage rate requested. Commissioner Vickers then said that the IHP is a great program, but that they don't need this increase.

I next commented that I believe that the Ingham Health Plan is a great program and Ingham County is a leader in providing a program for health care for its low-income working population. We have used federal funds for this which are now drying up. This program clearly needs the monetary infusion to remain viable and keep people out of ER’s and costing society more in higher insurance. That being said, I believe that there is considerable misinformation and confusion about the Affordable Care Act (also called Obamacare by some). I believe that people will not vote for this millage because they think that Obamacare will cover all people as a national health care. While we do not actually have universal health care – only those making up to 138% of the poverty level could be covered – people will not see it that way and will wonder why they should support a .52 millage for something that the federal government covers. I think that people are going to vote against funding for a necessary and great program, thus making it harder to go back to the voters in two years when we have a serious need because we can no longer fund the IHP. And it will be a negative commentary by the voters of a great program. Knowing that the Republicans would be voting against this, and the other two Democrats on the committee will be voting for it, my vote became deciding. I believe that the entire Board of Commissioners should be able to consider this question. All 16 Commissioners should be able to represent their constituents by having a say on whether this should be on the ballot or not. As such, I voted yes on this item to move it to the full Board of Commissioners for consideration. I also indicated a tremendous reluctance to have this go to the ballot now because I think it will fail and it would be better to do this in the future.

Commissioner McGrain commented that people are going to take risks by opting out of Affordable Health Care Act, and that the working poor are not being taken care of. He said that we need this and that he is supporting this in committee and on the Board floor. The vote in committee was 3-2 (yes: Tennis, McGrain, Schor no: Vickers, Dougan). I am not on the Finance Committee, so I don't know the discussion and vote in that committee on Wednesday. The language that will be on the November 6, 2012 ballot if passed by the full Board of Commissioners is as follows:

Shall Ingham County be authorized to levy up to 0.52 additional mills for the purpose of providing basic health care services to Ingham County residents whose incomes are between $17,500 to $28,000, and who are NOT eligible for Medicaid under the Federal Affordable Care Act, and who do not have medical insurance? If this proposal is approved, Ingham County will use these funds to help pay for doctor visits, generic medications, and essential care such as preventative testing and treatment for cancer, diabetes, heart disease and other serious illnesses for low-income residents whose employers do not offer health insurance or who cannot afford to purchase health insurance. This proposal would increase the Constitutional limitation of the amount of property taxes which may be assessed each year against all the taxable real and personal property in Ingham County by up to 0.52 mills ($0.52 per thousand dollars of state taxable valuation) as new additional millage for a period of three years (2012-2014 inclusive). If levied in full, this millage would raise an estimated $3,349,707 in the first calendar year.
YES [ ]
NO [ ]

A second resolution considered in the Human Services Committee (and considered in County Services the next night) which garnered significant discussion and comment was the resolution to convert the current student-based Otto Community Health Center to a general community health center and employ a full-time physician. The Ingham County Health Department, in partnership with community members and other organizations, established the Otto Community Health Center in 1996 to address the need for access to health care for students attending the C.W. Otto Middle School of the Lansing School District. In 2003, Otto was designated as a Federally Qualified Health Center Look-Alike site. The C.W. Otto Middle School was closed by the Lansing School District in June 2012. Because of the need for service of the population on the northside, the Human Services committee considered a recommendation to authorize the transition of Otto from a School-Based Health Center that serves the adolescent population to a Community Health Center, which will serve the general population.

In response to a 2011 study completed by Capital Link, a non-profit organization dedicated to assisting community health centers in planning and financing capital projects, the Ingham Community Health Center Board of Directors recommended to us that the Otto Community Health Center remain open as a community health center that serves the primary health care needs of medically vulnerable residents on the North side of Lansing. The 2011 study revealed that one of the greatest needs for primary health care services is on North side of Lansing. The Lansing School District has agreed to allow the Ingham Community Health Centers to continue to run Otto as a primary health care service site for the general population surrounding the health center. Otto currently provides primary health care to approximately 300 adult patients each year. This resolution allows the Ingham Community Health Center to provide primary health services to approximately 800 new patients through much needed increased capacity. This is essential as all of our current Community Health Centers are challenged to accept new patients. Current staff of the Otto School-Based Health Center Network will be realigned to a new school-based health
center, which will be located within the Lansing School District’s Eastern High School as required by the Michigan Department of Community Health. To effectively provide primary health care services for the general population at the Otto Community Health Center, existing positions will need to be realigned within the Community Health Centers, including an existing clinic assistant and a nurse. A vacant Program Specialist position will also be reassigned to Otto. A Primary
Care Physician position will also be established.

Significant public comment was heard on this issue. Several people spoke about the need because the health centers are full. This will allow for 300 additional adults that don’t have service without Otto. They need to be able to serve more clients and need more resources for the northside populations. Many people walk to the clinic, and will not be able to get to Eastern. Also, Eastern is not accepting adults, so there will be a loss of service. Ingham has a commitment of equitable access to health care that other counties don't have. Ingham Health Plan representatives also told us that they rely on Otto to meet capacity needs. Commissioner Vickers asked several questions, including if we will be the only entity in the school. The answer is that we will, and that the area is separated and has its own gates and heating. Having someone in the building will be helpful to the community so that the building doesn't become blighted. Commissioner Dougan asked about the effective date of the switch. The answer is that it just stays open, as long as this resolution is passed. The School Based health center moves over to Eastern at beginning of school year, and the transition of Otto is the same date. The resolution passed Human Services and County Services unanimously.

In County Services, one item which was significant by our non-action was an issue that you may remember from a few months ago - the agreement between Ingham County and the City of Lansing for the Maintenance of Certain City Parks. The contract, which had significant controversy because of the Lansing parks employees that were laid off, was not acted on and not renewed. It will expire on September 30, 2012. The City indicated that they did not want to renew the agreement with us, and they will instead include these parks in the vendor contract for the other City parks. The County would likely have not renewed the contract as well, so this worked well for both parties.

We passed two resolutions dealing with the Hawk Island Snow Park. It has been determined the Hawk Island Snow Park would benefit significantly from the expertise and involvement of Ryan Neptune, an internationally known figure in the winter sports community, and his company, Superparks LCC (Planet). His company manages and oversees many ski resorts and events around the United States including one in Gaylord, Michigan. The County Services Committee passed a resolution entering into a contract with Superparks LCC (Planet). Planet would be responsible for working with and managing partners for the Hawk Island Snow Park in the seasonal preparation for all outside operations with respect to the venue and would look to hire as many local seasonal workers as possible. Planet would report directly to the Parks Director and areas of management and oversight duties would include, but would not be limited to: vehicle and slope maintenance, lift operations, grooming, snowmaking, terrain and tubing park crew, risk management, ski school, rental, food and beverage and retail. Planet would also help design, consult, and explore the development of alternative action sports related venues to be added on the hill such as mountain bike trails, skateboards, BMX, and Zip Line type venues with the prior approval of the Parks & Recreation Commission. In addition, Planet will make recommendations regarding marketing materials and the cost of all marketing will be paid by Planet. The gross receipts collected at the Hawk Island Snow Park, with the exception of vehicle entrance fees, would be split in the amount of 25 percent to Ingham County and 75 percent to Superparks LCC (Planet). The term of the contract would be for 3 years terminating on August 31, 2015 with a two year option to renew. Commissioner Vickers was concerned that events and tournaments at the Snow Park will be done at the expense of our residents being able to use the hill. Our parks staff, though, said that any competitions and tournaments would draw people to the Snow Park to learn about the event and to see the snow boarders and competitors. Commissioner DeLeon asked about the problems with the construction of the hill and wanted to know if this is a response to these problems. Our staff indicated that there were safety issues because of the evolution from the tubing hill to something greater. We identified all the things needed to be done and things that we will want to do down the road, and this will ensure that it is safe. The vote on this resolution was 5-1 with Commissioner Vickers indicating concerns.

It was also determined the snow park hill at Hawk Island has significant soil erosion issues. We passed a resolution approving a contract with Anderson-Fisher for the grading, scarification, polymer, drill seed, mulch, and mulch anchor necessary to correct the soil erosion and safety issues. The contract with Anderson-Fisher & Associates, Inc. of Mason, Michigan for the grading and landscaping of the Hawk Island Snow Park will be in the amount of $42,712, with an additional contingency amount of $6,500. Total project cost will not exceed $49,212.

Finally, we considered a request from Lansing Township for Ingham County to loan the Township the money to cover environmental clean up costs so that the Former Anchor Motor Freight/Lease way Properties can be redeveloped. The request made was for Ingham County to borrow $400,000 to $500,000 from the Michigan Department of Environmental Quality Revolving Loan Fund. The fund offers low interest rates to local units of government (i.e. no payment for 5 years and an interest rate of 1.6%). The township does not wish to borrow the funds themselves because they are too close to their debt limit due to previous borrowing for projects like the expansion of the Eastwood Towne Center. The Township Planning Director said that they have identified a developer and want to get this going quickly. $500,000 is what they are estimating for contamination issues, and DEQ is supportive of using the Revolving Loan Fund for this site. The Township said that the funds would be paid back over ten years with tax capture from their Brownfield TIF (tax increment financing) District.

Several questions were asked about this proposal. I asked them how they would pay back the money when the Township doesn’t actually have a Brownfield district set up. They said that they are planning to create one and will capture the taxes using what they will set up. I also asked how they know that it will be $500,000 in costs, and if they have done a baseline environmental assessment. They said that it is an estimate, and that they had not done a baseline assessment. The costs could actually be much more than that, and that will be known after the baseline assessment is done. The Township representative estimated that would take two months, although that may be very optimistic. Finally, I asked why the Township took the property from foreclosure when they could have left it to the County Land Bank. They took the property knowing that they would have to ask to borrow money to clean it up. It could have been cleaned up by the Land Bank, which has resources at its disposal. The Township representative expressed concern that the property would be purchased at auction by a speculator and sit vacant before the Land Bank could get it. I indicated that the Land Bank could have bundled the property with others, which would likely keep it with the Land Bank.

Commissioner Vickers asked how close the Township is to its lending cap. The Township representative said that they were about $6 million from their cap. Vickers then suggested that $500,000 will not put the Township close enough to the lending cap to worry. And indicated a concern with the County lending money to municipalities. There were also significant concerns that approval of this could set a troubling precedent. Commissioner Grebner indicated he assumed we were providing full faith and credit for a better rate. He expressed concern with lending money to municipalities, as this is a dangerous precedent and other municipalities in Ingham County would come to us next for similar loans. He also pointed out that the County may need to borrow money for cash flow, and can't afford to lend money. He preferred a plan where the Township spends the money but the County pledges full faith and credit for a better rate to the Township. Staff agreed, and indicated in a memo that while the County has pledged our full faith and credit in the past to townships, this has primarily involved water system upgrades that are paid back with assessments to their local users. Commissioner Celentino indicated the necessity of the Township to have this property redeveloped and back on the books. He indicated support of the Township in the request, but asked them to go back and come up with a more solid plan and the county could decide to accept or reject it at that time. There were also suggestions that the Township could partner with the Land Bank if necessary. This item was for discussion purposes only and was not voted on.

We also had a quick discussion during the “announcements” period about a request made from the City of Lansing to put a countywide parks millage on the ballot for November. Because the request was made this week, it is going directly to Finance for consideration tonight. The request seems to have a .50 millage to fund regional parks such as the River Trail, Ranney Skate Park, existing county parks (Hawk Island, Burchfield), and others. There was speculation over what this could cover and whether or not the Finance committee will pass this to the Board on Tuesday. The Finance Committee is meeting tonight and I have no information on the discussion, but I expect to report on this next week if the proposal makes it to the full Board floor.

As you can see, it was a long week. I am tired. More to come next week when we take all this up on the Board floor!

1 comment:

  1. just wanted to say thanks for such a detailed writeup and as always, your honesty and full disclosure make your blog one of the most informative and entertaining out there. Keep doing what you're doing!

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