Editor's note: This version has been changed to correct that on Nov. 6, 2001, USJHSD voters approved a mill levy of 3.884 mills and authorized the district to de-Bruce through Dec. 31, 2006.
At its meeting on Tuesday, July 28, the board of directors for the Upper San Juan Health Service District (USJHSD) — which operates as Pagosa Springs Medical Center (PSMC) — unanimously approved going to the district’s voters to seek a continued waiver from the Colorado Taxpayer’s Bill of Rights (TABOR).
The waiver would allow the district to continue to collect, retain and spend all revenues generated from its existing mill levy — an exemption from the provisions in TABOR.
The waiver is also commonly known as “de-Brucing,” named after TABOR proponent and author Douglas Bruce.
As Chief Administrative Officer Ann Bruzzese explained to the board, the question is asking voters to continue something the district has always had.
In her presentation to the board prior to the vote on the ballot question, Bruzzese explained PSMC has grown strategically since 2008, with its growth outpacing inflation and population.
She also noted the district was formed to provide ambulance, hospital and medical services, and PSMC provides ambulance and EMS services at a loss of more than $2 million per year currently.
Bruzzese then explained a little more about TABOR, informing the board that one of the main goals of TABOR is to limit growth of government to inflation and population growth.
Bruzzese also explained that PSMC is outside TABOR already.
According to her presentation, governmental entities are outside TABOR if they have voter approval of a waiver from TABOR or are entities like PSMC that are enterprises that receive less than 10 percent of revenues from governmental sources like taxes and Colorado Department of Local Affairs grants.
“PSMC is not like other governmental entities that rely only on tax revenue,” the presentation states, adding, “Less than 10% of PSMC’s revenues are from taxes and governmental grants.”
It adds, “More than 90% of PSMC’s annual revenues are payment for services — like a business.”
Bruzzese also answered the question of why the district should worry about de-Brucing if it is already outside of TABOR, explaining it is about risk and grants.
Bruzzese explained the continued waiver would maintain the ability to receive government grants, explaining PSMC has received $6,441,008 in matching grants toward ambulances and hospital facility improvements.
She added it would also minimize risk that “quality” funds from Medicare and Medicaid would be recharacterized as a grant, explaining the quality funds have not historically counted toward the 10 percent maximum of tax and grant revenue.
Bruzzese’s presentation indicates that, if not exempt from TABOR and if not an enterprise, PSMC’s sustainability would be at risk:
“• Strategic growth would be restricted even if necessary for sustainability or for community need.
“• Operational stability may be harmed as medical staff labor costs and supplies often exceed inflation.
“• Financing capital-intensive operations of EMS/Ambulance and the hospital.”
Bruzzese also outlined the results of a survey of potential voters, explaining the majority of respondents had a favorable view of PSMC and confidence in PSMC’s handling of finances.
The presentation notes that, of those responding to the ballot question, twice as many stated they would vote yes versus no, though some were uncertain.
The presentation also indicates that communication about EMS and medical services resonated with voters, but that a high percentage of voters do not understand that PSMC and the USJHSD are the same.
Following Bruzzese’s presentation, the board voted unanimously to move forward with the ballot question.
The ballot question asks voters: “WITHOUT RAISING TAXES, SHALL THE UPPER SAN JUAN HEALTH SERVICE DISTRICT (WHICH OPERATES PAGOSA SPRINGS MEDICAL CENTER AND PROVIDES EMS/AMBULANCE SERVICES, HOSPITAL AND OUTPATIENT MEDICAL CARE TO THE COMMUNITY) BE AUTHORIZED TO CONTINUE TO COLLECT, RETAIN, AND SPEND ALL REVENUES OF THE DISTRICT IN EACH FISCAL YEAR HEREAFTER WITHOUT REGARD TO ANY REVENUE OR SPENDING LIMITATION CONTAINED IN ARTICLE X, SECTION 20 OF THE COLORADO CONSTITUTION OR SECTION 29-1-301, C.R.S.?”
PSMC’s history of de-Brucing
According to Bruzzese and the district’s resolution regarding the election, on Nov. 6, 2001, USJHSD voters approved a mill levy of 3.884 mills and authorized the district to de-Bruce through Dec. 31, 2006.
On May 2, 2006, the resolution notes, the district’s voters allowed the mill levy to be pledge as security for the 2006/2007 bonds to finance construction of PSMC.
On Nov. 7, 2006, the voters approved extending the de-Brucing through Dec. 31, 2016, and on Nov. 8, 2016, voters approved extending it through Dec. 31, 2026, it indicates.
randi@pagosasun.com
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