Fulton’s case for new Grady revenues

I love Grady Memorial Hospital. I have worked diligently to ensure Grady’s success. I believe in the mission of the hospital and have chosen to be a patient there because of its high quality of care, and because I believe it is critical that Grady has patients that help the hospital financially.

I believe Grady is the most important thing Fulton County funds; that includes physical health and mental health. Since I came into office in 2007, Fulton has invested more than $466 million in Grady. But I don’t believe we are mandated to fund Grady, and that puts us in a tough financial position.

Fulton faces a significant budget shortfall in 2014; 2015 looks worse.

We have not increased our millage rate since 1991 despite the Great Recession and revenue policy changes from the General Assembly.

Since 2006, the Legislature has cut our annual budget by $64 million. In 2006, it slashed the county’s share of the sales tax formula from 35 percent to 15 percent, for a $40 million annual reduction. In 2009, it increased the county’s homestead exemption from $15,000 to $30,000, resulting in a $24 million annual reduction. In 2014, the county faces a further annual cut of $48 million if the Senate approves legislation already approved by the House.

Fulton is the only one of five core metro Atlanta counties that did not increase its millage rate since the beginning of the 2008 economic downturn. We used our reserves instead of raising taxes, waiting for property values to rebound. We cannot do this anymore.

Fulton must create a new sustainable business model. We are working to that end. But expecting us to meet constitutional obligations to the jail, the courts and the health system while the General Assembly removes tens of millions from our budget is unrealistic.

Grady also faces tough times. Georgia’s failure to expand Medicaid significantly affects Grady. The Affordable Care Act (ACA) reduces health care costs by incentivizing the right care at the right time at the right place, a culture shift for the patients who use Grady staff as their primary care physicians.

Regrettably, these savings are attained in part by decreasing existing reimbursements and supplemental payments, which significantly affects safety-net hospitals. By 2018, Grady’s loss alone will be over $45 million per year. Finally, Georgia is considering a change in one of its formulas that could cut funding to Grady by $24 million a year.

So, Fulton reaches a crossroads. Shall we maintain our current course, which will likely require $25 million in cuts to Grady this year? Or shall we consider a dedicated revenue stream of funding for Grady through the establishment of a hospital assessment that pays for both operations and debt?

I believe Atlanta can’t live without Grady. But why is it that Fulton County and, to a lesser extent, our friends in DeKalb, are the only governments expected to stand with Grady? We ask citizens to contact their representatives and senators in the General Assembly and ask them to support Grady by supporting Medicaid expansion and not further cutting Grady or Fulton County.

John Eaves is chairman of the Fulton County Commission.