By Tim Bonfield
Enquirer staff writer

Hamilton County commissioners are planning to launch a new review group to re-evaluate how the county spends more than $200 million a year in special taxes for health and health-related services.

Potentially affected are more than 70,000 uninsured people in Hamilton County, every property owner in the county and several of the region's largest health-care services.

The proposal, to be circulated today by Hamilton County Commissioner Todd Portune, would create a five- to nine-member Health Care Review Commission that would spend several months next year studying how the county spends money from six special levies.

"The basic idea is, if we had it to do all over again," Portune said, "would we spend this money the way we are today?"

The levies to be studied include taxes for indigent care, senior services, children's services, mental health, mental retardation and the Drake Center.

Combined, they generate more than $200 million a year.

"As stewards of these funds ... we owe the taxpayers a duty to constantly examine and re-examine our efforts," Portune wrote in today's proposal. "I believe we need to take a different look at how we are spending and investing public money in health care."

Portune contends that the commission can find ways to reduce the amounts charged for the levies, yet still pay for ways to improve health-care services.

Much of the new commission's focus would be on the indigent care levy, which pays for care provided by University Hospital and Cincinnati Children's Hospital Medical Center - and comes up for renewal again in 2006.

By itself, that levy generates about $53 million a year.

Critics say the levy is outdated because it covers care at only two hospitals and does not pay for doctor care or other outpatient services uninsured residents may need.

They also note that Children's failed to spend more than $1 million of its allocation last year, and returned it to the county.

In fact, the TriHealth hospital group, which runs Good Samaritan and Bethesda North hospitals, continues to pursue a 2002 lawsuit over the way the levy funds are spent.

"Our position for the past several years has been that we think the levy can be improved. We have felt all along that the problem with the levy is that the money doesn't follow the patient," said Steve Schwalbe, vice president of strategy, communications and public affairs at TriHealth.

Fresh thinking needed

Trey Daly, an attorney with the Legal Aid Society of Greater Cincinnati, also says the time has come for the county to consider fresh ways to address rising concerns about indigent care.

In Hamilton County, about 61,000 adults and 13,500 children lack health insurance, Daly said. With health-care costs rising in the past several years, the number of uninsured people has been growing.

Some communities in other states have used local tax funds in combination with payments from small business and premiums charged to individuals to create special health plans for uninsured working people, Daly said.

Re-evaluating how local tax levies work could provide the seed money to launch such a program here, Daly said.

Portune, a Democrat, is launching the commission proposal amid his campaign to be re-elected in November. However, the members of the commission would not be appointed until after the election, the proposal states.

The proposal already has support from a second member of the three-member body - Republican commissioner Phil Heimlich, who is not up for re-election this year.

Questions on spending

"We spend hundreds of millions of dollars on health care," Heimlich said. "And if the recent Drake levy debate is any indication, there are a lot of legitimate questions about how that money is being spent."

In fact, rapidly rising spending on special tax levies has generated so much controversy that officials have debated lumping all the levies together on a single ballot. Critics of that idea have said there is too much risk that all the levies could be voted down at once, creating massive disruptions to services.

Heimlich said he supports creating the review commission, but not necessarily any new ideas for spending the money. If there are savings to be found, his first choice would be to reduce taxes, he said.

Although Portune's proposal will be distributed today, no date has been set for when county commissioners would create the new review group.

Health-related levies

Hamilton County's health-related levies

Levy	Effective millage	Annual cost*	Levy expires
Drake Center	0.91	$26.78	2004
Mental Retardation & Developmental Disabilities	2.86	$84.15	2004
Indigent Care Levy	2.40	$70.62	2006
Children's Services	2.20	$65.22	2006
Mental Health	1.36	$40.02	2007
Senior Services	0.88	$25.89	2007

*Annual cost to the owner of a $100,000 home

Source: Hamilton County Auditor's Office

E-mail tbonfield@enquirer.com