KANSAS CITY, Mo. – Discussion about the costs of providing unreimbursed medical care to low-income patients tends to focus on hospitals and clinics.
But the debate over renewal of a city health tax has highlighted the fact that unpaid bills and low Medicaid reimbursements burden ambulance services, too.
“I think ambulance service throughout the country is often overlooked,” said Kansas City Councilman John Sharp, “both as an essential public safety service and as a health safety-net provider.”
Sharp retired in 2003 after a dozen years as executive director of the nonprofit Metropolitan Ambulance Services Trust, which provided ambulance service to the city for more than three decades until it merged with the Kansas City Fire Department in April 2010.
Sharp chairs the council’s Public Safety and Emergency Services Committee.
He also sits on the Finance, Governance and Ethics Committee, which last week recommended that the full council place on the April ballot an initiative to renew the health tax for another nine years.
Council action could come as early as Thursday, and with nearly all council members and the mayor as cosponsors, Sharp said passage of the measure is all but assured.
The property tax in question, approved by voters in April 2005, assesses 22 cents per $100 of assessed value.
Of the roughly $15 million a year it generates, about 85 percent goes to Truman Medical Centers and safety-net clinics, such as Kansas City CARE, a free health clinic. About $2.4 million a year goes to ambulance service.
The tax is in addition to a permanent health levy of 50 cents per $100 of assessed value. Together, the two taxes generate about $50 million annually.
Kansas City has about 75,000 uninsured residents, Dr. Rex Archer, city health director, told the committee.
“That is basically one full council district,” he said.
Sharp said without the money from the extra health levy, the costs of uncompensated ambulance services could drain resources from other initiatives, such as improving response times.
According to data Sharp presented at last week’s finance committee meeting, the fire department provided $10.5 million in ambulance services to Medicaid patients in fiscal 2012. Medicaid reimbursements covered about a quarter of the cost, according to the data.
Sharp’s figures showed the fire department collected even less, about 9 percent, of the roughly $12.1 million in ambulance services provided to the uninsured.
Adding to the strain on the ambulance service, Sharp said, were uninsured individuals who call emergency medical technicians to help manage chronic conditions such as diabetes or asthma.
That’s a problem for ambulance providers throughout the region, said Dan Manley, health care system program manager for the emergency services program at the Mid-America Regional Council.
In those instances, he said, “it takes emergency units out of service to be able to manage these situations or these incidents, when they may be missing the opportunity to deliver emergency care” elsewhere.
Safety-net advocates said ambulance personnel provide services that might go unnoticed by the general public.
Sheri Wood, chief executive of Kansas City CARE, said clinic workers periodically call ambulances to take patients to the hospital.
And, Archer said, prior to the establishment of MAST, the network of private companies serving the city avoided parts of town where patients were more likely to be uninsured.
Some supporters of the levy have argued for a four-year renewal, especially given the possibility that the Missouri General Assembly will expand Medicaid coverage this year to qualify for federal funding through the Affordable Care Act.
City Finance Director Randall Landes told the committee that at any time during the life of the levy the council would have the option to reduce the assessment or choose to not levy it at all.
Finance Committee Chairwoman Jan Marcason called the nine-year timeframe “a cushion” to see how the Affordable Care Act affects the population of uninsured and underinsured residents.
At any rate, she said, authorizing the April vote would be just a precursor to the campaign for voter approval.
“We get it on the ballot,” she said, “and the work begins.”