AZTEC — San Juan County's worst case scenario as its leaders struggle to accommodate the Safety Net Care Pool is the county would raise taxes and still have to reduce its payments to the providers compensated in its Indigent Health Care Fund, said Jack Fortner, commission chairman.
"It looks like any reasonable solution will require, possibly, a tax increase," he said on Tuesday in a special meeting county officials and health care providers attended.
The meeting continued a conversation from a June 5 meeting in which commissioners were briefed on options to lessen the county's expected indigent fund debt.
The Safety Net Care Pool, which passed in the last legislative session, mandates the county dedicate about $3.2 million a year — or one-twelfth of 1 percent of its gross receipts taxes — to a statewide fund that pools money from New Mexico's counties and distributes it to hospitals. The indigent fund compensates hospitals, clinics and other health care providers by partially covering uninsured medical bills for county residents.
Under the statewide pool's current distribution formula, San Juan Regional Medical Center will receive no money.
None of the options discussed in the June 5 meeting prevented the indigent fund from entering debt. Some of the options included reducing the fund's reimbursement rate from 70 to 33 percent.
"What happens if we reduce it to just the 33 percent?" Fortner asked Mike Renaud at Tuesday's meeting.
Renaud is the northwest regional director of Presbyterian Medical Services, one of providers covered under the county's indigent fund. He answered a "significant number" of those who live in the community would lose health care coverage.
The uninsured will struggle, he said. More people would flood the emergency room, he said. More would be jailed, he said. Detention center costs would rise, he said. Law enforcement and court system costs would also increase, he said.
"We know all of these things to be true," he said.
Fortner turned his questions to Kristine Carlson, Totah Behavioral Health Authority director. The PMS-run agency helps about 150 people a month find jobs, housing, case management services and treatment for alcoholism. Many of the organization's clients sleep outside.
"How many of those people would die?" Fortner asked.
Carlson responded: "About 10 percent."
Four Winds Recover Center is a residential detox program, and the number of clients it serves recently rose about 10 percent, said its director, Jolene Schneider.
One option outlined at the June 5 meeting was to cut $200,000 in annual compensation to the detox center, and Fortner asked how that would affect the organization.
Schneider said the center would have to eliminate four beds, leaving them with only eight.
The other closest detox centers are in Gallup and Durango, Colo.
County Executive Officer Kim Carpenter said several counties plan to join a lawsuit against Gov. Susana Martinez, challenging her authority to line item veto several clauses in the legislation that imposed the statewide pool.
He said Hobbs County has been the most "combative" of the legislation. Its commissioners indefinitely tabled an ordinance that would have guaranteed payments to the statewide pool.
"My opinion is to let them file," Fortner said, adding that San Juan County's legal department could then review the lawsuit and decide if it should join.
Fortner said the Legislature "passed the buck" to the counties, forcing them to raise taxes. But after the meeting, Carpenter said Martinez is to blame.
"This was driven by the governor," he said.
Commissioner Scott Eckstein said in the meeting no matter what the cuts are, there will be unforeseen and far-reaching effects.
"What other questions do we have?" Fortner said, as discussion dwindled.
Eckstein quipped, "How difficult will it be to make San Juan County its own state?"