Buncombe Commissioners

• DOT to include alternative 4b in connector study
• County gets clean bill of financial health
• Board bids farewell to Ramsey, Young

Nov. 18 was the last meeting for Buncombe County Board of Commissioners Chair Nathan Ramsey and longtime Commissioner David Young. Nonetheless, the board had some major business to deal with.

Foremost was a proposal to expand the county’s ability to provide health services to the un- or underinsured via an agreement with Western North Carolina Community Health Services, which runs two nonprofit clinics in West Asheville. Similar agreements with other health providers may follow.

An array of local heavy hitters, including officials from Mission Hospitals, members of the county Board of Health and a representative of Pisgah Legal Services as well as county staff, all spoke at length about the need to bring the clinics on board to help serve the Health Center’s expanding clientele.

The county’s health services are pretty well maxed out, but the demand keeps growing, reported Department of Social Services Director Mandy Stone.

“I stand before you tonight to tell you we have maximized our capacity—we can’t get any more efficiency out of our current structure without more resources,” she declared.

And with the worsening economy, added Stone, demand is only going to increase, as even many people with full-time jobs now lack adequate health care.

Under the proposed plan, the county would get more health care for every tax dollar spent, she noted, because the federally qualified clinics, which receive federal grants and meet certain Medicaid and Medicare requirements, get reimbursed at a significantly higher rate than the county does; they also offer services and hours not available at the county Health Center.

“We see a Medicare patient at the Health Center, we’re going to bill $60 and be reimbursed at $31,” she explained. “For the same level visit, a federally qualified clinic will get $90 plus a cost settlement. The reimbursement rates are triple or double what was available to us.”

Many of the county’s health-care partners endorsed the idea, and Mission Hospitals helped fund the study that produced this recommendation.

“We need to do these kinds of things—the amount of money saved can be quite large,” noted George Renfro, vice chair of the hospital’s board, adding that he hoped the expansion of county services would take some of the pressure off Mission’s emergency room.

“We have the problem that so many of the un- and underinsured go there to get their primary care, because they don’t have the money for it,” said Renfro. “We’re looking at people [in the order] they came in; the delays that creates can be a problem. People sometimes leave without care. They’re there and they suddenly decide the pain in their shoulder or chest isn’t so bad. They go home and have a massive heart attack when that could have been prevented; the health-care costs go up. If we can use federal dollars to help provide additional locations or additional care, of course we endorse that.”

But the plan’s potential benefits extend beyond health care, Charlie Owen of the Asheville Area Chamber of Commerce’s Business Healthcare Roundtable told the board.

“The business community would support this,” he said. “We could be a model for businesses that are looking to come here, because their health-care costs would go down. We could say, ‘Hey, we’ve got a great health-care benefit in this community. We take care of citizens.’”

The Rev. L.C. Ray of New Mt. Zion Missionary Baptist Church, who serves on the county Board of Health, enthusiastically maintained that WNC Community Health Services is equal to the task.

“The less-fortunate members of the community, we daily find them having problems with dental concerns and health care, especially mental-health care—this is a huge concern,” said Ray. “I’ve been briefed numerous times on the different options. The best means of maintaining our safety net is to center the delivery of the indigent health services [at the West Asheville clinics]. They represent the best. I’ll say that again loudly: They represent the best means of using growing federal funds to support low-income members of our community.”

Board of Commissioners Vice Chair (and Chair-elect) David Gantt had originally advocated delaying voting on the plan until the new board is sworn in, but after hearing the presentation, he had a change of heart.

“We still have 40,000 people that don’t have health insurance, and that’s growing,” noted Gantt. “We’re revered across the country for our health care, and I think you haven’t let us down. I’m convinced.”

For his part, Young said he was pleased to be able to vote on the matter at his final meeting.

“This will change the face of health-care delivery in our county,” he proclaimed.

The commissioners unanimously approved the proposal, allowing county staff to begin drawing up specific plans for such a partnership.

And since the incoming board will have to approve any formal agreements, leases or other arrangements, it won’t be shut out of the process.

Meanwhile, the county will continue to offer all of its current services at the Health Center, Stone told Xpress later.

“That would all still be ours—this would be an expansion, just so we could access those federal reimbursements,” she said.

In the money?

Despite the nation’s grave financial woes, the county’s finances remain sound, and Buncombe passed an audit of its books for fiscal year 2007-08 with flying colors, Finance Director Donna Clark told the board.

“Net assets increased $20.2 million due to factors such as increased tax revenues, increased program revenues and just plain controlled spending,” said Clark. “Are we solvent? Yes.”

However, the fund balance—the county’s rainy-day fund—decreased by just over $1 million.
Part of that decrease, said Clark, is due to the fact that the county has to wait until the end of this fiscal year to receive an anticipated increase in sales-tax reimbursement from the state. In the meantime, the county must borrow from its fund balance to make ends meet. The rest of the decrease stems from increased expenses.
Clark added that the fund balance is still far above the state-required minimum.

The county’s debt load also increased, to $202.4 million, due primarily to capital projects such as the new animal shelter, the College Street parking deck and school construction.

As might be expected, the county’s return on its investments decreased. But the drop was not substantial, and most of the investments are still sound, said Clark.

“I’m proud to say that out of all this, we got our 29th consecutive award from the Government Finance Officers Association—and we fully expect to receive our 30th,” she reported.

Changing of the guard

Both Ramsey (who’s chaired the board for eight years) and Young (who’s served on it for 16) made brief statements at their final meeting.

“I’ve been humbled to serve you as chairman for the last eight years. The honor defies my ability to express it,” said Ramsey. “To serve the county where I grew up, attended public school, graduated from college, met my wife and expect to spend the rest of my life is an honor I will forever cherish.”

Ramsey thanked his family, whom he said had pitched in to help run their dairy farm when his duties as chair occupied his time.

He also thanked his fellow board members, saying, “While we haven’t always agreed on policy issues, I respect your commitment to this county. Friendship truly can transcend politics.”

Gantt, who defeated Ramsey in the Nov. 4 election, praised his former opponent. Apart from the campaign, the two often found themselves on opposite sides of issues such as zoning.

“We’ve had some hard votes, and you always did what you thought was best for the community, and that’s all you can ask from a public servant,” Gantt observed, adding, “I’ve always appreciated your leadership.”

And while Young preferred to save his full remarks for a farewell event for both men planned for the following evening, he did say, “It has been an honor and a privilege.”

Building bridges

The board also heard a presentation by county engineer Mike Goodson on “alternative 4b,” a potential route for the I-26 connector proposed by the nonprofit Asheville Design Center and endorsed by the city of Asheville. The city and county teamed up last year to hire a consultant to address technical concerns about the plan (see “A Bridge Too Far?” July 30 Xpress).

The controversial project has drawn criticism from local groups, who say the plans proposed by the N.C. Department of Transportation call for too many lanes and would negatively impact both the community and the environment. The DOT, said Goodson, has agreed to include alternative 4b in an environmental-impact study along with three of its own plans (alternatives 2, 3 and 4).

Unlike the other plans, alternative 4b would separate local and interstate traffic and require less land, leaving more available for future development, proponents say. However, it would also be the most expensive option, with an estimated cost of $423 million. The projected cost of the other plans ranges from $221 million to $368 million, said Goodson.

The commissioners will probably need to endorse one of the alternatives within the next year, said Goodson. The DOT will make the final decision, with construction now expected to begin in 2015.