Hamilton County voters will be asked a $264 million question on Nov. 6. That's the going rate for providing health care to the poor over the next five years. The question: Should county residents tax themselves to pick up the tab for those who can't pay for their own health care?

        The answer has been yes since 1966, the first year the health and hospitalization levy was created. Voters have approved the levy every five years since, sometimes with an increase.

        This year represents a big increase — about 25 percent over the $210 million generated during the past five-year cycle.

        Officials with University Hospital and Children's Hospital Medical Center, the two institutions that have shared the proceeds from the tax, say the increase is necessary to keep up with inflation. University typically receives about 80 percent of the levy, with Children's getting the rest.

        Hospital officials wanted the issue on the May ballot, so that if it were defeated they could place it on the November ballot. Commissioners balked, and hospital officials reduced the amount of the tax by about $30 million to make it more palatable for voters.

        About the same time, Dr. Kevin Martin, a vascular surgeon and former member of the county's tax levy review committee, said the hospitals were turning a profit off the indigent care they provide. The review committee found that not to be the case after an audit of both hospitals' records.

        Al Tuchfarber, a University of Cincinnati employee

        who acts as spokesman for the levy, said about $500,000 will be spent on the campaign to pass the levy.

        “The last two times it has been more difficult to get the levy on the ballot,” Mr. Tuchfarber said. “There's just been an opportunity for a lot of different points of view to be put forward.”

        There is no organized campaign opposition to the levy, although the Coalition Opposed to Additional Spending and Taxes (COAST) has said it thinks the levy increase is too much. But COAST will not campaign against the levy, instead focusing on campaign finance reform in the city of Cincinnati.

        Scott Hamlin, chief financial officer at Children's Hospital, said passage of the levy is critical to both hospitals.

        “The scope of our services and the other items such as research and education would all have to be re-evaluated significantly,” if the levy were to fail, Mr. Hamlin said. “The levy provides us with an opportunity to see to all the needs of Hamilton County, and still pursue a mission, which is to be a leader in providing children's health.

        “That's a deep commitment.”

        And if the levy passes there will be, for the first time, competition from other hospitals to get some of those public dollars.

        TriHealth has taken out 3/4-page ads stating support for the levy, but saying that it should be shared with other hospitals providing indigent care. The ad encourages residents to contact county commissioners and urge the sharing of the levy.

        “It's good medicine and common sense,” the ad states. TriHealth hospitals include Good Samaritan and Bethesda.

        County commissioners have said they will consider the sharing of the tax revenue with other hospitals only after the election.

        “We're urging voters to support Issue 1. We think it's a good thing,” said Steve Schwalbe, vice president of strategy for TriHealth. “We do believe, however, that the distribution of those funds is unfair and outdated.”

        Mr. Schwalbe cited state statistics that University Hospital delivers 57 percent of the adult indigent care in the county. TriHealth hospitals handle about 17 percent of that care, he said.

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