Hiking property taxes, the need for a hospital in south Fulton County, financing a new jail — those issues, and others, confronted county commissioners Wednesday at a strategic planning session.

Senior county staff gave presentations on projects, priorities and finances during the commission’s non-voting work session in the afternoon. That included summarizing $578 million in capital projects due to be completed this year, or well underway.

The county has done well in the past five years, cutting the millage rate by 15% while improving customer service and nearly doubling the available fund balance to $224 million, County Manager Dick Anderson said. That occurred despite upheavals such as the incorporation of the city of South Fulton, the board of health separating from county government, a 2017 property tax freeze, multiple election disputes and the effects of COVID-19, he said.

“We have demonstrated an enormous capability to deal with these disruptive events,” Anderson said.

Even as the millage rate went down, county revenue went up by $150 million, allowing increased spending on services, county Chief Financial Officer Sharon Whitmore said.

Financial projections are based on assumptions from performance over the last few years. Whitmore said county revenue is expected to grow by 3% next year, with raises built in for county employees, including a cost-of-living increase every other year.

The county’s share of local option sales tax funds will rise from 5% this year to 12% in 2029, per recent negotiations, she said.

But expected new spending includes $100 million to improve access to health care, more than $200 million for a new county jail and other public safety projects, $174 million for employee raises, and some for other expense increases and election funding.

If the county does all that and the millage rate stays the same, by 2029 the county would run an illegal deficit, Whitmore said.

“From a revenue perspective, in order to fund all of these things that I mentioned, we would need to start looking at adjusting the millage rate quite significantly starting in 2024,” she said.

The county property tax rate now stands at 9.37 mills. Whitmore’s projection shows it rising to 12.57 mills in 2024, and gradually increasing to 15.1 by 2029. Each mill of tax brings in about $60 million, Whitmore said.

Health care funding drew the most discussion, tied to the closure last year of Atlanta Medical Center locations in East Point and Midtown. Nonprofit hospital owner Wellstar has said it took huge financial losses at both hospitals. That left Grady Memorial as the only downtown Atlanta hospital, and commissioners said repeatedly there is now no hospital in Fulton County south of Interstate 20.

Longer ambulance rides to the hospitals in north Fulton or other counties mean more people will die, Commissioner Marvin Arrington Jr. said. Critics of the hospital closures, including several commissioners, say shuttering hospitals that served largely minority populations while Wellstar kept open hospitals in whiter and wealthier areas amounts to discrimination.

The county is in the midst of contract negotiations for its annual funding of Grady Memorial Hospital, Anderson said. For the county to fully fund all public health needs would cost “hundreds of millions” for Grady alone, he said.

Some cities in south Fulton are discussing creation of their own special taxing districts to support a hospital, Wilmore said. The county looked at that idea county-wide in 2014, she said.

County staff said state law allows commissioners to levy up to 7 mills for a hospital authority, an idea Arrington seized upon. He suggested using the county’s taxing power to help fund a new hospital in south Fulton, with matching funding from the area’s cities.

Arrington said he will make that proposal every week “until it passes.”

Commissioners will discuss all those issues further in another work session April 12.