The 17-member Oversight Committee for Alameda County’s 2004 Measure A health services sales tax presented its first year of findings to the Board of Supervisors Health Committee this week, concluding that while funds were spent in compliance with the measure’s purposes during the ’04-’05 fiscal year, there were “inconsistencies” in expenditure reporting from organizations receiving Measure A “which did not allow consistent scrutiny of all fund recipients.”
In addition, the Measure A Oversight Committee raised concerns about the auditing mechanisms of the county’s Health Services Agency, the process for determining future Measure A fund allocation by the Board of Supervisors, and even about the composition of its own membership, with the report raising concerns that the presence of some committee members representing Measure A recipients creates “a potential for the appearance of conflict of interest,” and that, in addition, the committee “do[es] not reflect the diversity of Alameda County’s population.”
Of the 17 current members of the oversight committee, only three are women, and two are ethnic minorities.
While Health Committee chair Supervisor Alice Lai-Bitker told Oversight Committee chair Larry Platt that “the good news is that we’re in compliance” with Measure A spending, both Platt and Alameda County Health Care Services Agency Director David Kears came under sharp questioning by Board of Supervisors President Keith Carson on details of the report.
The Essential Health Care Services Measure A was passed by Alameda County voters in March of 2004, authorizing a one-half cent sales tax increase to supplement indigent health care in the county. 75 percent of the revenue is allocated to the Alameda County Medical Center, the county’s primary indigent health care agency, which operates Highland Hospital in Oakland and several medical clinics throughout the county. 25 percent of the revenue is allocated by the Board of Supervisors to various public and private health care agencies and organizations in the county.
This week’s oversight committee report, which took a year to produce, only deals with Measure A expenditures in fiscal year 2004-05, the first year the sales tax increase went into effect.
The report found that of $95.7 million in Measure A sales tax revenue collected in that year, $71.8 million went directly to the county medical center, with $20 million allocated by supervisors to various agencies and organizations addressing eight areas of county health concerns. Of the $14 million of that $20 million actually spent in the first year, $5 million went to primary care clinics, $4.5 million to private and non-profit hospitals, $2.3 million to Alameda County behavioral health providers, $1.4 million to emergency room on-call physicians, $541,000 to school-based health centers, and $358,000 to public health. $10.8 million of that $14 million was spent to maintain existing health services, with the remaining $3.2 million for expansion of services.
Platt told members of the supervisors’ Health Committee this week that some of the problems in the “inconsistency” cited in the report on expenditure information could be blamed on the committee itself learning how to ask the right questions.
“We’re hoping to do our part by refining the reporting format in the future,” he said. He noted, however, that the committee “had to ask some providers three or four times before we got an answer. With some of them we want to be a little more tough in the future.”
Platt said that the committee wanted the information because “part of our oversight function is not just finding out what went wrong but also what went right, and how Measure A money was spent. We want to be able to report back to the voters some of the wonderful things that were done with the money.”
One specific concern raised but not answered in the report was that the county was using the influx of Measure A money to the Alameda Medical Center to shift county money out of the ACMC budget.
The report said that the oversight committee could not conclude if this was being done, noting only that “the committee needed more information to determine whether Measure A’s prohibition against ‘supplantation’ of ongoing Alameda County funding provided to ACMC by the new sales tax receipts was being honored. Measure A was very clear that the new tax revenue was not supposed to substitute for ongoing county funding but was supposed to supplement the county contribution to ACMC.”
And on the composition of the committee itself, while Kears conceded that the oversight committee did not reflect ethnic or gender diversity, he said that “we had a diversity of opinion and perspective, ” and Platt added that there were divisions within the committee over some of the issues and findings.
In the area of auditing organizations on how the Measure A money was actually spent, for example, Platt said that “some of the members,” including himself, were “more or less comfortable that we were relying on the auditors from the HCA [Health Care Services Agency]. But there were other members who wanted feedback from an independent auditor to better educate us and reassure us of the validity of the HCA and [medical center] auditing process. There are some cynics and skeptics among us.”
But while Platt said that it was “the county auditor who suggested we might want to hire our own auditor,” he said that the committee’s oversight function was limited by the language of Measure A. “The measure had very few details in it about spending,” Platt said. “It only said that the money should be spent on indigent health care. It didn’t give the oversight committee the discretion to say whether this program was better than that program, or to suggest how the money might be better spent. We were told by the county counsel’s office that we have a very narrow area of oversight.”
With supervisors already beginning preparation for a new round of Measure A allocations in next year’s county budget, both Lai-Bitker and Carson were concerned about how soon the committee’s report would be ready for the ’05-’06 expenditures.
When Platt suggested that the new report might take “maybe nine months; I know you’d like to get this out by June, but the problem is having to hear from so many recipients,” Carson told him “it’s important to push for a report for sooner rather than later. You’ve worked on this for a year, and you’ve now got a roadmap. It may be shaky and dusty and unclear, but it’s still a roadmap.”