This fight in the Legislature over control of Fulton County’s government is about to graduate from a bitter local fracas into a near-nuclear case of mutually assured discomfort. With statewide implications.
The coming escalation can be summed up in three words: Grady Memorial Hospital.
Last week, House Republicans shoved through H.B. 541, a measure that would double homestead exemptions in Fulton to $60,000 – resulting in a $48 million-a-year drop in property tax revenue available to the county commission.
It is an article of GOP faith that, with north Fulton entirely citified, the often dysfunctional commission that rules Georgia’s longest county should be reduced to a shadow of its former self. A dozen or so pieces of legislation have been launched to accomplish this.
H.B. 541 targeted the money. House Republicans believe in this measure so fervently that they threatened to torpedo a raft of Democratic legislation in order to shake loose the needed support from the minority party. Even so, Speaker David Ralston, R-Blue Ridge, was required to cast the 120th vote.
The bill is now in the hands of the Republican-controlled Senate.
But late last week, Fulton County Commission Chairman John Eaves told me that, if it’s passed into law, one of the surest victims of H.B. 541 will be Grady hospital. The $50 million that Fulton pays each year for indigent care (DeKalb County currently pays $11 million) is the largest chunk of discretionary spending in the Fulton budget.
“Any reduction of revenue at this point means a reduction of support for Grady hospital. I don’t know how much. But it will be impacted and we will not be able to provide the level of funding that we have provided,” he said.
Fulton County’s indigent contract with Grady expires at the end of this year. “As we renegotiate, we may not choose to do what we’ve done in the past,” Eaves said. “We may walk away from it, or we may change it greatly. But that doesn’t mean people who are uninsured are going to stop going to the hospital.”
Eaves is already attempting to deliver that message to Lt. Gov. Casey Cagle and Senate President pro tem David Shafer. "I'm hoping that they will understand that, where the county can't continue to fill the void, the state's going to have to jump in," he said.
That would take the debate to a new level.
Neither Cagle nor Shafer has taken a public position on the bill. And there’s always the suspicion that, when budget cuts loom, only the most dire solutions are advertised. Witness those White House tours.
But we’re also led to believe that the governor’s office doesn’t think Eaves is bluffing. Consider that a severe reduction in Fulton County support for Grady would undercut the hospital bed fee pushed through by Gov. Nathan Deal at the outset of this legislative session. Much of that cash was targeted for Grady.
Also consider this irony: One of the implications of the Affordable Care Act is that federal money to hospitals that treat the indigent will be reduced over the next five years. Grady anticipates a $45 million-a-year loss by 2018.
At the same time, we have Deal’s decision not to expand Georgia’s Medicaid rolls under Obamacare. At best, the governor says, that would cost the state an extra $4.5 billion over 10 years.
But shunning the upfront cash that Washington is offering for Medicaid expansion means that Grady – and hospitals like it – will become more important when it comes to health care for the uninsured, not less.
In the House, the Republican effort behind H.B. 541 was ramrodded by Majority Whip Edward Lindsey, R-Atlanta, who is a likely candidate to replace U.S. Rep. Phil Gingrey – should Gingrey run for the U.S. Senate.
In the Senate, H.B. 541 will be carried by another possible congressional candidate, Sen. Judson Hill, R-Marietta – chairman of the Atlanta-Fulton County Senate delegation. Hill said he was unaware of any claim that the Fulton County cuts would affect Grady.
“I can say that I did have a meeting earlier this session with the CEO of Grady – a general briefing. I don’t recall any conversation related to the potential financial impact of property tax relief passing,” Hill said.
Moreover, Hill said the three-year phase-in of the property tax exemption was designed “to provide time for Fulton County and the community to adjust to the tax benefits that they would be receiving.”
As in the House, a two-thirds majority in the Senate would be required to put the issue before Fulton County voters on the November 2014 ballot. Hill anticipates that H.B. 541 and other Fulton County bills will move quickly – the Legislature is on track to adjourn March 28.
But the GOP appetite for passage may not be as strong in the Senate as it was in the House, and Democrats have promised to lock down their votes.
The GOP has a supermajority in the Senate, but some Republicans are whispering that, because the issue can’t be resolved by voters until next year anyway, there is time to examine the impact H.B. 541 might have on Grady.
Others are quietly pointing out that a $60,000 homestead exemption essentially means that the owners of houses worth less than $150,000 will pay little or nothing in property taxes.
And those houses are located primarily in south Fulton – which could mean that the burden of paying for what’s left of Fulton County government would still fall on residents and businesses in Atlanta and north Fulton.
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