Counties May Face Higher Bills State Wants To Shift More Of Burden For Indigent Health Care To The Counties

Counties may be asked to pay more for indigent medical bills, but they won’t get relief from restrictions on county taxing authority, a top Batt administration official said Thursday.

Outgoing Budget Director Dean Van Engelen acknowledged to legislative budget-writers that some counties are having trouble paying the first $10,000 of medical care for the poor as required now.

That’s because of the state cap limiting budgets that are financed by property taxes to no more than a 3 percent increase per year.

But to suggestions that the situation only would get worse if the county share were increased to $15,000 or $20,000 without the ability to generate more tax revenue, Van Engelen indicated Gov. Phil Batt remains adamantly opposed to exceptions to the 3 percent budget cap.

“No question that under a 3 percent cap, they’re going to have to do some maneuvering,” Van Engelen told the Joint Finance-Appropriation Committee.

He said, however, that the Batt administration believes the program, through which the state picks up indigent medical costs above $10,000, is meant to protect counties from insolvency in catastrophic cases, not to shield them from paying medical costs for the poor.

But Idaho Association of Counties spokesman Tony Poinelli said counties still are paying two-thirds of all indigent health care costs and would fight any attempt to increase that burden - even if counties were to get higher taxing authority.

Legislators all but ignored the governor’s call for raising the $10,000 limit a year ago.

But Van Engelen said the state’s share of catastrophic health care costs are expected to rise from about $7.4 million this year to more than $10 million next year.

In comparison, counties are paying between $19 million and $20 million a year on indigent medical bills that Poinelli said are averaging around $17,000 to $18,000. Doubling the counties’ responsibility in each case to $20,000 would increase the counties’ payout to $25 million and would cut the state’s to $5 million, he said.

Counties “will have to either cut from other programs or other offices,” he said. Or counties would have to borrow against future tax collections to cover the payments and operate in debt, Poinelli said.

And giving counties the authority to raise property taxes above the 3 percent cap would force dramatic increases in what most agree is the state’s most detested tax, Poinelli said.

But Van Engelen argued that raising the counties’ share of indigent health care costs would make them more conscientious about monitoring the bills.

Poinelli said, however, that counties already are keeping close track of the bills since they pay the first $10,000 and are looking for every possible source of payment, such as insurance.