Proposition 414

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On Tuesday, Maricopa County voters will vote on Proposition 414, which would create a special healthcare district to save its hospital and integrated health system. The proposition would also create new property taxes for homeowners in Maricopa County. HORIZONTE examines its impact on Hispanics in Maricopa County.Special guest Roger Hughes, Executive Director of St. Luke’s Health Initiative, discusses both sides of the issue.

>>Jose Cardenas: Good evening, I'm Jose Cardenas. Welcome to "Horizonte". Come Tuesday, Maricopa County voters will be asked to vote on a proposition that would create a special taxing district to fund the county's health care system. Tonight, we'll look at proposition 414 and its impact on Hispanics in Maricopa County. And we'll hear from Henry Cisneros about his views on politics, housing and more.

>>Jose Cardenas: On the surface, Maricopa County voters face a simple question, should a special health care district be created and a new property tax added to pay for and run what is now the Maricopa integrated health system or should the Maricopa County board of supervisors continue to be responsible for funding it. Paul Atkinson has the story.

>>Reporter: Maricopa Medical Center is the backbone of Maricopa integrated health services, the county's health care delivery system. About 20,000 people are treated each year at the 541 bed, including hundreds of prison and jail inmates. The hospital features one of five trauma units in the valley. It sees about 50,000 people annually. Its acclaimed burn center is one of two facilities in the state that can treat burn victims. Last year, it treated about 600 burn victims on an inpatient basis and 2500 on an outpatient basis. The Maricopa medical center serves as a teaching hospital.

>>James J. Kennedy: We have 205 residents as we speak, all of them in specialty training in 7 different specialties. About 50 percent of these will stay in the valley. That's important because Phoenix is no longer really a draw for physicians seeking a new place to practice as it was 10 or 15 years go.

>>Reporter: The Maricopa integrated health system offers inpatient and outpatient psychiatric care at two facilities. This one in Mesa and another at its east Phoenix campus. The system has 11 family health centers throughout the valley. Offering primary care for children and adults, many feature dental care and pharmacies.

>>James: The largest number of patients we see really are AHCCCS patients and a large number of those are our own insurance plan, the Maricopa health plan.

>>Reporter: The last two years, Maricopa integrated health services has lost $24 million, causing the county to look at various options.

>>Fulton Brock: We looked at selling the hospital, privatizing the hospital, doing everything we could to change our delivery system, to make it attractive. And we discovered that there is no interested, legitimate party in buying the county hospital.

>>Reporter: County supervisors asked the citizen task force to come up with a solution and came back with a recommendation to create a special health care district funded by property tax. The county asked the legislature to create a district, a provision of the 2000 healthy Arizona initiative, prop 204 relieved Maricopa County from having to provide health care services above and beyond indigent health care after July 1, 2006. The county wants to continue to treat all patients, not just those who can't afford it. Lawmakers approved a special health care district for Maricopa County. Contingent on a public vote. The special health care district would be allowed to impose a secondary tax on homeowners at a rate that would cost the owner of a $150,000 home almost $22 a year. Lawmakers cap the amount of property taxes at $40 million, the first year. The special district can also borrow against future taxes in the form of bonds to use for construction.

>>Fulton: Once a health care district is voted and established, revenues can be pledged against institutional financing to allow a new facility. Experts tell us it's more cost effective to build a new building, smaller more modern building, rather than renovate a 50 year design.

>>Reporter: State senator Dean Martin voted against authorizing a special health care district for Maricopa County

>>Dean Martin: a brand new property tax is not the way to fund this. A property tax is the worst thing we can do to Arizona. Maricopa County and the valley have the third highest commercial property tax rate in the nation. When we are trying to attract manufacturing jobs back, to start adding a new property tax is the wrong direction.

>>Reporter: Chuck Jones is a Phoenix homeowner and property tax watchdog.

>>Chuck Jones: I don't understand, we're talking about a board of five elected officials who will serve without pay. How much time are they going to spend each year without pay to oversee what is nearly a billion dollar system above and beyond what the current CEO and his staff are already doing?

>>Reporter: Jones is concerned as what starts out a small property tax may grow out of control.

>>Chuck: They're telling me a $21, $22 a year average tax on a $150,000 home. In year 20 what's the most I can pay? I know after alt fuels which was supposed to cost no more than 10 million and wound up costing 140 million, if that went 14 times past, is my $20 going to 320 in year 20? And no one will tell me.

>>Reporter: Senator Martin suggests voters reject the prop 414 in favor of a better alternative.

>>Dean: Do you want to raise property taxes to pay for the hospital? If you vote no, and you vote not to raise property taxes, I can guarantee you the state will be back here in special session or regular session looking for another way to keep that hospital open because we can't afford to let it close.

>>Reporter: Maricopa medical center staff say the closing of the hospital would be devastating to the entire health care system in the valley. That's why it must be saved. A yes vote would insure that.

>>James Kennedy: If we were not here, I cannot describe and I think it's hard to understand how the other emergency rooms would be swamped, the trauma system would break, it would not function any longer, somewhat like what has happened in the Tucson area recently. In Maricopa County it would not function. The pediatric population would suffer, neonatal intensive care units would be quickly overrun here in Phoenix. We would have to transfer patients -- I'm a grandfather. My grandkids would have to go perhaps to other states for their care.

>>Jose Cardenas: Earlier today, a valley-wide group of Latino leaders held a press conference to discuss the impact of prop 414 on the Latino community. Joining me tonight is Roger Hughes, executive director of St. Luke's health initiative. Welcome to "Horizonte".

>>Roger Hughes: Thank you.

>>Jose Cardenas: Tell us what the St. Luke's health initiative is.

>>Roger Hughes: St. Luke's health initiative is a public foundation that was formed through the sale of the St. Luke's health system in 1995 when it was a nonprofit corporation to a for-profit corporation. The net proceeds of that sale created the endowment that St. Luke's health initiative uses today for work and health policy, public education, advocacy and community development around community health issues primarily focused on underserved populations.

>>Jose Cardenas: Tell us what the benefits would be if prop 414 is approved.

>>Roger Hughes: The primary benefit is that the Maricopa integrated health system will have a dedicated funding source to pay for the care of people who currently are unable to pay for it or access care themselves. That population is primarily a working poor population, as you might imagine, because of the county's catchment area. It's heavily Hispanic. The county will be able to continue operating one of the country's best regional burn centers. It will continue to operate a series of 11 clinics as was discussed in the setup piece, but you have to put it in the context of the fact that what's different about the county hospital from other health care providers in Maricopa County is that roughly 30 percent of its inpatient and outpatient population are self-pay or uninsured. And they're responsible for their own health care bills. That compares to about 10 percent on average in other Arizona hospitals. That figure is up to 57% of people who are uninsured going into the emergency rooms. So having a dedicated funding stream for that particular population if they were not to get services there would simply spill off into other health care facilities where you would have the same exact problem. So the issue is providing an identifiable and permanent source of funding to help subsidize the care for people who are unable to access it on their own.

>>Jose Cardenas: What are the best arguments against proposition 414?

>>Roger Hughes: I think the most substantive argument, from my point of view, is whether or not creating a taxing district is the best way to provide for what is really a statewide and even a national problem, which is how do we provide health care coverage and access for people who cannot afford it on their own, whether it's a temporary condition or a more permanent condition. There are those who would argue that simply by creating a hospital taxing district we are taking health care out of the very real political tradeoff processes of scarce sources for a variety of public funding, whether it's transportation or the environment or a host of other issues, that ought to be the responsibility of the county board of supervisors to make those decisions in light of how it's going to allocate resources, compared to these other needs. There is also the argument that if more of the money that is currently going into the state general fund through the hospital disproportionate share program, if more of that money was directed to the county, we would have, we would have more of the resources that we would need without going to the taxpayers, in this case property taxpayers, for the increased resources.

>>Jose Cardenas: The coalition for Latino political action say closing the health system would have a devastating effect on the Latino community. Do you agree with that?

>>Roger Hughes: I do agree with that. It's because the Latino community, particularly the lower income Latino community, is a recipient of a lot of uncompensated care support that is currently spread out over what we call the Maricopa County safety system. If the Maricopa medical center were to close, that would vastly constrict the safety net system. The fact of the matter is, in other hospitals, other free or reduced fee clinics, they don't have the resources to take care of the minority groups they are taking care of now. To unleash thousands of these people, whether it's saint Vincent de Paul, La Fuentes in Guadalupe or others, other emergency rooms and centers, that would be a major impact.

>>Jose Cardenas: Let me ask you this, in the few seconds we have left. Are the undocumented people who use the hospital service a significant part of the financial problem? Do you think the immigrant sentiment will have an effect on the vote?

>>Roger Hughes: I think it's always going to have a certain amount of effect on votes like these because it's easy to demonize -

>>Jose Cardenas: But are undocumented significant part of the problem?

>>Roger Hughes: We estimate 10 percent of the uninsured or uncompensated care in Arizona.

>>Jose Cardenas: Thank you, Mr. Hughes for joining us on "Horizonte".

>>Jose: Last week I had the opportunity to talk with Henry Cisneros, former secretary of the U.S. Department of Housing and Urban Development and president of Univision about politics, immigration issues, housing and the Hispanic market. Let's go to that interview.

>>Jose: Thank you for joining us on "Horizonte". You have worn so many different hats during your career Mayor of San Antonio, potential candidate for president of the United States, secretary of the Department of Housing and Urban Development, the president and chief executive officer of Univision, the Spanish language media giant, and more recently you've been involved in urban planning and housing for your own company, American City Vista. I would like to draw on that vast repertoire of experience and ask you some questions and get your thoughts in a number of areas. First is your assessment of the race for the democratic nomination for the presidency.

>>Henry Cisneros: I think it's very vigorous. Some people have criticized it as a race in which individuals can't break out of the pack and therefore diminishing the people as if somehow they were not people of substance. I think that's totally wrong. Many of these are very, very strong people, Senator Kerry, Dick Gephardt, Senator Lieberman, any one of them are capable of being president of the United States and earned this country's respect with the long public service and seriousness of their position. I don't think it's a weak field at all. There are several who would be very viable candidates. I personally support Senator Kerry because I respect his war record and I respect his national security stance. I think that once those issues are leveled out with our present president, then the country can have the debate that it needs to have about how we blew our surplus and put the economy in this position that so many people are without jobs and how we're going to address education. That's a decision I have made. But I would certainly understand it if the democratic party decided it wanted to select Governor Dean or Representative Gephardt or Senator Edwards or one of the other major players. I think it's a strong field. Given where things are in the country today, we are as divided as we were in 2000 on the critical issues. The war against terrorism creates a sense of unity which is totally appropriate and I respect it. When you address the question of how that war on terrorism is being waged and how matters are going in Iraq and address those straightforwardly and then open the debate on the other questions of the deficit, education, jobs, the economy, how we treat our elderly and Social Security, I think it's a major opportunity to run a good, strong race.

>>Jose Cardenas: Do you see the Latino vote coalescing behind any particular candidate?

>>Henry Cisneros: I don't see that happening now, honestly, and I don't think it will. Not one of these candidates has such a breakthrough message or popularity that they are going to be the Latino preferred candidate. I think Latinos will coalesce around the final nominee on matters of education, how we address our elderly, critical urban and domestic programs, but it is also true in all honesty that President Bush will get a larger share of the Latino vote than Republicans typically do. Because of his personality and because Latinos tend to be so patriotic and we are in the midst of a national emergency.

>>Jose Cardenas: To what should we ascribe that 18% of the Latino voted for Arnold Schwarzenegger in the California recall election?

>>Henry Cisneros: I think they like action heros. Pure and simple. This is a lot of young people who simply didn't like the incumbent governor, were mad at him, as were a lot of other Californians -- Governor Gray Davis -- and Who were not enamored of Cruz Bustamante. He had never broken out as a charismatic figure. An action hero was too great to resist.

>>Jose Cardenas: Not too long ago you were discussed about being a candidate for vice-president of the United States, recently our governor has been discussed as a running mate. Do you see a minority or a woman on the ticket?

>>Henry Cisneros: I have always hoped it would happen. I don't think it will happen in 2004. That's my personal judgment. If there were to be a Latino, Bill Richardson is a logical choice. If there were a woman, senator Feinstein or governor Napolitano would be strong candidates. I think we're going to see a dynamic if we have a nominee who tends to be a person with a domestic background like a governor, for example, Dean, then that person will want to balance off with someone who brings an international military background and that's what makes General Clark so attractive. I think that calculation, more than the usually what state are you from, how do you balance it east and west or north and south or being a woman, or other factor. That's my immediate off the cuff analysis.

>>Jose Cardenas: Moving from politics to immigration, though they're interrelated, at least in this sense, there seems to be a rising tide of anti-immigrant sentiment. Do you see that having impact in the upcoming presidential election?

>>Henry Cisneros: I think there is not a rising tide against immigrants. I think that there is a tremendous appreciation for what immigrants mean in this economy and what they have meant for our cities and so forth. I do think that it is in some places pretty sharp as in Arizona. Where we have seen the vigilantes across the border and some of the statewide targets against immigrants, beginning to rear their head again. Sentiments against immigrants seem to be sharpest when two circumstances exist. One, when the economy falls off, then people feel that there's too many workers and that they're not as needed as they are at other times and there is kind of an anti-immigrant moment. The other is in places where there are a lot of immigrants, like crossing points in Arizona. I would say across the country there is not an anti-immigrant sentiment. In fact many appreciate what they bring into this job, what they bring in economic vitality, energy, the vitality of small businesses and whole neighborhoods and cities. Chicago is thriving today because of their immigrants, the biggest turnaround in 50 years. New York reached 8 million people for the first time in the 1990's, because of immigrants.

>>Jose Cardenas: Do you support guest worker program?

>>Henry Cisneros: I would support some kind of a guest worker initiative, a break with a lot of Latino leaders. I don't think we're going to have blanket amnesty or blanket immigration reform and therefore we need to do something about the condition in which too many Latino workers live in this shadow economy. I don't support the details of the McCain initiative. I have great respect for Senator McCain and respect him for raising the subject, but I do believe that we need, we as Latinos need to be open and need to be precise in laying out what kind of immigration initiative we want. I think it' imperative that we not leave our workers in the condition in which they are working today.

>>Jose Cardenas: You have a long history of involvement with housing issues, as Secretary of Housing and Urban Development and recently with your company American City Vista. What do you think are the most pressing issues and what do you think are the solutions?

>>Henry Cisneros: Many minorities who want to be home buyers are denied access to the American dream. That's wrong. Homeownership is more than just about putting a roof over your head. It is that and it's the honor of having your family in a home that you own. It is America's first and principal savings and wealth strategy. That is the way most families begin their status. Everything else is debt and credit card and school loans. Equity in a home is ownership and wealth. For most Americans that is the sum total of their net worth. When we have a national homeownership rate of 68%, and the white ownership is 74% but the Latino home ownership rates and African American rates are 20 points under the national average, that's more than denying people the honor of owning a home, it is denying them the first step on the ladder of middle class savings and upward mobility and that's wrong.

>>Jose Cardenas: A couple of weeks ago, Phoenix hosted the U.S. Hispanic Chamber of Commerce convention. More recently, the local Hispanic Chamber of Commerce released its annual Hispanic marketing and demographics report. You have been involved in matters as president and CEO of the Spanish language broadcasting company. What do you see in terms of the market and what that means for the United States economy?

>>Henry Cisneros: The Hispanic market is nothing short of a phenomenon. It is hugely growing, 38 million, now the largest minority in the United States and growing to about 63 million in the next couple decades and up to 98 million by 2050. It is not only growing in population but growing in economic capacity, rapidly growing the fastest middle class in the country, fastest growth of small business, fastest home ownership in the country. It' going to be one of the economic engines that powers this country. That's what makes the opposition to immigration so perplexing. People opposed to Latino immigrants just don't get it in terms of how powerful this is for America. We have traditional American population declining in numbers and aging. Here we have the young population that wants to work, willing to pay taxes, raise their children, invest in communities, start businesses, fuel the future economy of America, one might call its saving grace of the nation in terms of energy and enthusiasm, all the things that traditionally built America. When we oppose immigration and oppose that dynamic, you end up, I think, hurting the country. The one caveat in all of this is we have to make sure that the public schools stay strong and education is available to these Latino populations. If we can do that, then I'm convinced America's best days are yet ahead and Latino immigrants are going to be part of the story.

>>Jose Cardenas: Dr. Cisneros, thank you for sharing your thoughts with us today on "Horizonte".

>>> Please join us next week for in-depth coverage of issues affecting the Latino community. I'm Jose Cardenas.

Roger Hughes.: Executive Director, St. Luke's Health Initiatives;

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