October 16, 2013
Dear County Commissioners:
In the course of the campaign to ask voters to approve an $830 million bond issue for Jackson Memorial Hospital, a number of issues were raised that intersect with Health Foundation of South Florida’s efforts and concerns. With twenty years and more than $100 million invested in programs to improve health for South Floridians, the Foundation shares the vision of Miami-Dade Commissioners that all residents should have access to quality medical facilities that are up to and even above standard.� But as a grantmaker, our focus is also on checks and balances, seeing the details behind the bond issue and giving voters a clear understanding of what they are voting for in the special election November 5.
Complex problems are complex because they don’t lend themselves to quick fixes. Before just spending the funds, an independent citizens committee needs to review the need and the amount of the bond and how it impacts the community.
This issue has been rushed along without a public hearing and no language to provide public oversight to make the Jackson board and administration accountable for what and where new facilities will be built or existing areas renovated.� There is no transparency required from the Jackson board and administration; they simply make their plans and spend the money.
The bond issue does include a list of projects to be constructed but without detail, timeline or location.� It’s understandable how Commissioner Juan Zapata and others are put off by the $830 million price tag. There is no specificity for where the urgent care centers financed by this bill will be built.� Could those centers compete with existing hospitals for commercially insured patients or offer indigent care in locations where nearby community health centers currently serve that population? Where will a pediatric emergency room be built and would it impact neighboring facilities like Miami Children’s Hospital or other facilities in this community? Could a $70 million dollar rehabilitation demonstrate a cost effective revenue stream to support it?�
Also consider the issue of the Jackson employee cost structure which has been well documented at a much higher rate of pay than other private hospitals because of complex cases. There certainly won’t be complex cases at urgent care centers and Jackson will pay higher salaries for new employees magnifying a flawed cost structure for labor.�
We have seen a short term effort boost Jackson’s financial turnaround, but unforeseen factors and a well-known one, the Affordable Care Act (ACA), will affect sustainability and long term finances. As you know, this law allows newly insured patients the freedom to choose where they want to receive their care and greatly reduces Jackson’s annual funding from a multi-million dollar government sponsored low income pool and� “disproportionate share” fund to support indigent care.
Miami-Dade taxpayers have been here before when they approved a � penny sales tax for indigent care and a long list of other projects only to see the funds deposited in Jackson’s general fund--- with no accounting to the public. Let’s turn lessons learned into actions to ensure a more accountable, transparent course.
We ask you and your fellow County Commissioners to now publicly commit to an external oversight process led by a citizens group, with a transparent framework and a plan for implementation.
The right way to move forward this time is to take steps to give a very small number of people the big picture on what they are being asked to vote on, an $830 million bond issue for Jackson Memorial Hospital. Now, and on November 5 and beyond, let’s show taxpayers that their interests are protected.�
