After Health-Care Reform Is Signed, Will We Need Public Hospital Districts?

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House Majority Whip James Clyburn and Speaker Nancy Pelosi, after last night's passage of the health-care reform bill.

​The U.S. health-care system has a tradition for cruelty toward the uninsured, and in Broward and Palm Beach counties, public hospital districts were created to deal with them. In exchange for treating the uninsured those districts could pocket hundreds of millions in tax dollars.

But after President Barack Obama signs the health-care reform bill this week, the numbers of uninsured will plummet. That's because the vast majority of uninsured patients stand to be covered under the terms of the new legislation, a number that's roughly 32 million nationwide.

So does that mean the districts will stop collecting tax dollars? It's still too early to tell, but let's consider the impact of the reforms and the possible scenarios for the future of local health-care, after the jump.

There are three public hospital districts between the two counties, each of which collect a portion from the property taxes paid in that district.

The Palm Beach County Health Care District received $146 million from the county's taxpayers in 2008, the most recent fiscal year for which statistics are available. UPDATE: A spokesperson for the district, Robin Kish, sent this note in response to my question about the impact of health-care reform:

Our safety-net agency will monitor the details of the Federal health care plan as they emerge and as changes are implemented in the State of Florida over the next four or more years. In the meantime, the demand locally on our programs continues to grow and we will continue to serve our residents who qualify.

Broward County is divided between Broward Health in the northern half and Memorial Healthcare System in the south. Memorial collected $60 million last year from taxpayers in South Broward. Taxpayers contributed $192 million last year in North Broward, where there are more uninsured patients. The district has budgeted $170 million in tax revenue for the current fiscal year.

Kerting Baldwin, the spokesperson for Memorial Healthcare, says that she knows of no district lobbying effort for or against health-care reform and didn't want to venture a guess about what it might mean for South Broward. Broward Health's spokesperson, Sara Howley, says officials at Broward Health are also in wait-and-see mode.

"It is certainly very premature to even consider the fact that we will not need public hospital districts," Howley said in an email today. "In fact, not all of the population will be covered / served by reform, so we stand ready -- as always --- to cover the gaps. The need may be far greater for our services pending the details of the reform."

According to a source, Broward Health has in the past considered a reorganization that would make it a private nonprofit -- even before the health-care reform legislation was crafted and passed. In that scenario, the district would sell itself to a foundation. In this scenario, the district would finally be free from its rather disastrous history of mingling politics with health care, because the Florida Governor would no longer be appointing commissioners, nor exert influence in the hiring of executive staff. (Howley denies that there have been any formal plans or discussions of Broward Health going private.)