‘Art of Compromise’ needed to pass behavioral health tax increase

Finally, Council passed an ordinance to adopt a one-tenth of one percent tax for behavioral health.

First, a little history.

In 2016 I introduced, and Council supported, the idea to conduct a study on Pierce County’s behavioral health system. In 2018, I requested an addendum to that report.

The study acknowledged we have several great providers making good efforts in Pierce County, but we lacked a systemic approach to addressing patient needs. There were also recommendations for how to improve the system.

Also in 2016, I introduced an ordinance to pass the behavioral health tax. At the time we received numerous emails, heard from behavioral health providers and held a town hall meeting where 500 people showed up, the majority of them to show support for the tax. When it came time for Council to act, the ordinance failed by one vote.

I brought forward the ordinance again in March 2020. We saw support from 16 of our local school district superintendents, the majority of our local police departments, and again heard hours of public testimony. But before we could vote, Council postponed action on the ordinance for another study, this time with the request to develop a plan for how the money would be spent.

That plan was presented in October 2020, with findings very similar to those presented four years ago.

The ordinance before Council this week for a vote came from Councilmember Dave Morell. I co-sponsored the ordinance, but with reservations. Although it authorizes the behavioral health tax, it also makes it contingent on the state of Washington authorizing Pierce County to restructure the delivery of Medicaid dollars from the current system to a pilot Accountable Care Organization (ACO).

Under this structure, local partners get to decide how Medicaid dollars are spent. Pierce County would oversee a board made up of local health care service providers, hospital representatives and community partners to determine how to allocate the funds. The Washington State Health Care Authority must sign off before the ACO can be created, and before the behavioral health tax is collected. If approved, Pierce County would be the first in the state with such a program. If rejected, the behavioral health tax will not be enacted.

I support the concept of an ACO. However, I would not have made collection of the behavioral health tax contingent on the state’s approval of the ACO. I would have had two separate ordinances on parallel paths: one for the development of the ACO, and one for implementation of the tax.

As I prepared for Tuesday’s meeting where I would cast my vote, it became clear the supermajority of Council favored Morell’s ordinance. (A supermajority, or five votes, is required for any tax increase.)

While, I do not like making collection of the behavioral health tax contingent on state approval of the ACO, this was so important to me that I practiced the “Art of Compromise.” I supported the ordinance and its conditions because it gets us through the door and into the room to work together in order to further the development and implementation of the  plan, to work on improving the system, and to evaluate, adjust and make necessary changes.

I end my term and thankful this has finally passed. This will now go forward to the new Council in 2021. I am confident that this Council will advocate for the state to accept our proposal for an ACO and will bring the behavioral health plan to fruition.

If the state does not agree, then we are back to square one. We will not see any additional revenue. What we will see is continued and growing numbers of people suffering from behavioral health conditions with no hope on the horizon.