Let counties spend more on mental health, advocates ask legislators

Advocates for improved mental health services pleaded with legislators Wednesday to let counties collect more property taxes to support the effort.

"This isn’t just a tax issue. This is an issue of life or death,” Travis Stanley, pastor of Norwalk Christian Church, told senators. Stanley, representing the community group AMOS, said he often speaks to church members who can’t find mental health services. He criticized a state law capping the amount counties can collect for such services to the amount they collected in 1996. That cap applies even to counties that have gained substantial population since then.

“Keeping the cap at 1996 levels — when I was 16 — has killed people. People have lost their lives because of this,” he said.

Lobbyist Susan Cameron, representing Iowa sheriffs and deputies, said her members are tired of seeing health care facilities close inpatient psychiatric units. Sheriff’s departments often have to drive long distances to find open beds for troubled residents. But Cameron said health care facilities need steady payments for such services.

“You can’t offer beds if you aren’t sure you can pay the bills,” she said.

But Marty Schwager, representing Farm Bureau, told legislators that the overall need for such revenues is dropping. He said 36,000 Iowans used mental-health services financed by the property tax levies in 2013, compared to fewer than 20,000 in 2015. That was mainly due to the expansion in Iowa’s Medicaid program under the federal Affordable Care Act, he said. About 150,000 more poor Iowans now have health insurance because of the Medicaid expansion.

The testimony came in the second of two hearings Wednesday on Senate and House bills that would give many counties more flexibility in setting such rates, but wouldn’t substantially increase the statewide total of how much property tax revenue is spent on mental health care.

Iowa counties use property taxes to finance many services for residents with mental illnesses. The system is a vestige from the days when many such residents lived in “county homes.” In 2013, the state organized counties into 13 regional authorities. Counties belonging to each region pool their property tax revenues. That has led to inequities, because the 1996 cap prevents some counties from taxing residents as much as their partner counties do. The bills, Senate Study Bill 1187 and House Study Bill 194, would let counties within a mental-health service region equalize their property tax levies, but wouldn’t let them raise much more in total than the $114 million they now collect.

Sen. Randy Feenstra, a Hull Republican, warned activists that if they want the inequities fixed, they should support his bill.

“This is the last train out of town,” he said.

Both of Wednesday’s subcommittee meetings were packed, proving a Statehouse maxim that no matter how arcane the subject, a bill can draw a crowd if tens of millions of dollars are on the table. Feenstra had to find a bigger room for his meeting.

One of the stickiest issues involves Polk County, which serves as its own mental-health region. The county mental-health authority is spending $7 million more per year than it’s taking in. Executive Director Susan Osby explained that’s because the county can only collect as much as it did in 1996, when it had 30 percent fewer residents to serve.

The legislative bills would address this issue by effectively taking $7 million from the county’s public hospital, Broadlawns Medical Center, and giving it to the local mental-health authority. Broadlawns’ budget has been in the black in recent years, mainly because many more of its patients have Medicaid coverage under the Affordable Care Act. Osby said Broadlawns gave her agency $4 million last year to help prevent service cuts, but she said it’s not fair to expect the public hospital to keep doing that. She and others noted that Congress is threatening to repeal the Affordable Care Act.

Feenstra said he was negotiating with Broadlawns’ leaders over the issue.

“What’s in the bill will not be what happens,” he said.