Hospital District Ballot Question
Town Hall meeting provides evidence that passions run high over proposal
by Fred Couzens The View News
Boulder City Hospital officials opened a hornet's nest of unrest July 30 when they held the first of what could be several Town Hall meetings concerning the Nov. 4 advisory question on whether a Boulder City Hospital District and tax should be created.
More than 70 local residents, many of whom were either hospital board members, hospital foundation members or employees, filled the Boulder City Library's two meeting rooms as Hospital Administrator Tom Maher kicked off the public relations campaign that stressed the need for a hospital district.
He mentioned the quantifiable benefits of having an open hospital -- easy emergency room access, first aid at events and public outreach on health aid -- and other pluses that can't be quantified, such as enhanced property values, the security of having quality health care close to home and a facility paramedics can access quickly in life-threatening situations.
"About 76 percent of the people we see are from Boulder City and the other 24 percent are from Henderson or are tourists," he said. "This is a limited growth market. Our demographics show 30 percent of our patients are over 65, which is twice the number of those in Nevada and the United States, and 60 percent are over 45, so we do have an aging population here."
Other than fighting market issues like the demographics, having a small service area, limited growth and proximity to the larger metropolitan area, Maher touched on "the challenges of cost cutting and revenue and price increases," billings that fall short when collected revenues are tallied, competition that leads to cost increases, subsidies that lead to financial viability, facility maintenance, and programs and services.
But the hornet's nest got stirred when Maher also talked about the 15-cent per $100 of assessed value tax and listed several "fear factor" issues if there was no hospital district.
Those issues include an average half-million-dollar loss for eight years, negative cash flow by 2012, elimination of nonrevenue generating activities like health fairs and flu shots, emergency surgeries and intensive care services, selling the facility to a private hospital corporation and "the consequence of closure" locally.
Some of the ripple effects from closing hospital doors, Maher said, would include the displacement of 43 long-term care patients, the loss of jobs for one-third of the staff that lives in Boulder City and the compromising of emergency/paramedic response.
The hospital estimates the 15-cent tax would generate $105 annually on a home with a $200,000 taxable value, and would raise $263 each year for a home with a taxable value of $500,000. Only property owners in Boulder City would be affected.
Even though most of those attending the Town Hall meeting expressed the view that the hospital was a luxury they could ill afford to lose, the estimates on the new tax burden didn't sit well. When it came to talking about taxes, property owners spoke out loud and clear.
"Why do the homeowners have to carry the burden?" asked Boulder City resident Mark Koenig. "Have you thought about a sales tax? I got my tax bill last week and if you add the 3 percent for their increase, my bill will go from $150 to $185. And each year it will go up 3 percent, so as a retired person in 10 years I'm going to have to pay $900 more in county tax for your program."
Koenig, who used to live in Alaska, mentioned a program there where people were taxed an extra half-cent of sales tax and "it worked out to be wonderful" because it taxed everybody, not just property owners.
At least three other speakers from the audience echoed Koenig's sentiment for seeking a sales tax increase instead of a property-based tax, a possibility Maher said could be studied.
"Yes, I'm willing to look at the sales tax increase," Maher told City Councilman Travis Chandler after the meeting. "The problem, though, with a sales tax is that it's not stable like the property tax, but I'm open to any alternative that will make this work."
Another speaker challenged the hospital trustees regarding their actions and reluctance to open the financial books to the public.
"You say you've had a ... shortfall since 2000, and you have this board, so why is it nothing has been done about this until now?" asked Jenny Tipton of Boulder City. "Will the financial statements... be available for Boulder City residents?"
"By appointment, you can come in and see the audited financial statements," Maher answered. "As for the first question, I've only been here 15 months so I can't speak for my predecessor."
When the questioning about the past -- the pre-Tom Maher era -- got heated, the administrator dodged all queries, saying he couldn't talk about what former administrator Kim Crandall did or didn't do.
Maher conceded to the group that the hospital district needs to go on in perpetuity and not be dissolved in 10 or 15 years, that the 15-cent rate could increase and that the Clark County Commission will be the controlling factor regarding tax distribution.
"There's no sunset clause on this," Maher said in response to a question. "If the voters of Boulder City want to close (the district), they can put it on the ballot. What this is is it's the issue of a small town hospital and the reality is that it has to be subsidized. Clark County will act as the hospital board of trustees..."
Some brought up insurance issues and the fact that some insurance companies don't recognize the hospital, while one woman made a bleak reference about a possible closure.
"If Boulder City Hospital closes, we're moving," said Melanie Springer, a Boulder City resident and hospital worker who verifies insurance coverages for patients. "The point is that if the facility is no longer in existence, my husband and I have made a plan to move. We won't live in a town without immediate medical service."
Summing up the Town Hall gathering, Maher said there was "a negative pall over the meeting" and estimated a 60-40 percentage split among those in attendance with the majority opposed to creating a hospital district.