1. Alternative EMS Tax Structure “No Out-of-Pocket” for District Residents Presented to the Coast Life Support District Board of Directors September 19, 2011

2. 2 Is This Our Community? Why does our Community have a publicly-funded emergency response system that: Cares for its members in their darkest hour, and then hands them a bill for $4000? Can only survive if at least 400 of its members seriously injure themselves or fall ill every year?

3. 3 Outline Background Alternative EMS Tax Structure Tax Change Impact to Residents Benefits of Alternative Structure First Year Scenario Recommendation

4. 4 Background Ambulance rates are beyond means of most residents –FY11 average transport bill $3749 –Most residents who have insurance either have deductibles >$5000 or 20% co-pay CLSD Board has no flexibility in budgeting or taxes –Operating at “bare bones” quality ALS/BLS service –Tax rates are pegged at maximum authorized Cannot lower without reducing services Cannot raise to increase services if needed Parcel tax categories are complicated and hard on business –Business do not benefit more from higher tax rate –Ambulance billings go to patient, not businesses

5. 5 Alternative EMS Tax Structure No “Out of Pocket” cost to District taxpayers and residents –Similar to REACH or CALSTAR memberships –District still bills insurance, Medicare, Medicaid Will not bill patient for deductibles or co-payments Simplify property tax categories from eight to three –Based on After-Hours Urgent Care tax model Not Buildable – Zero Units Vacant, Buildable – One Unit Developed – Two Units Set maximum per-Unit rate to fund EMS system even with low use –Fund like a fire department: Not dependent on call volume to maintain quality operations –Board adjusts tax rates annually based on: Budget needs Previous year’s collections

6. 6 Maximum Tax Change Impact at maximum rate of $120/unit Current CategoryUnitsTaxNew Category UnitsAnnual Tax Annual Tax Change Ag/Timber/Vacant – Not Buildable0$0Not Buildable 0$00 Vacant Buildable1$32Vacant Buildable 1$120$88 Single Family Dwelling3$96Developed2$240$144 Ag w/Development – House or Outbuildings 4$128Developed2$240$112 Duplex6$192Developed2$240$48 Trailer Park/Apartments/Institution8$256Developed2$240-$16 Store/Commercial Enterprise10$320Developed2$240-$80 Hotel/Motel/Restaurant/Golf Course/Gas Station/Theater 20$640Developed2$240-$400

7. 7 Example: First Year Scenario Estimate Based on Current Year Performance Tax rate set by budget and need: –Current 2011-2012 EMS budget:$1285K –Forecast Collections: $420K –Forecast Tax Need: $865K –2012-13 Tax Rate Needed: ~$80/unit – or ~$160/developed parcel Change in your taxes for next year –Increase over 2011 rate for single family dwelling: ~$64/yr –Decrease in taxes for local businesses to help local economy

8. 8 Example First Year Scenario Estimate Based on Current Conditions Current CategoryUnitsTax @ $32/unit New Category UnitsTax @ $80/unit Annual Tax Change Ag/Timber/Vacant – Not Buildable0$0Not Buildable0$00 Vacant Buildable1$32Vacant Buildable 1$80$48 Single Family Dwelling3$96Developed2$ 160$64 Ag w/Development – House or Outbuildings 4$128Developed2$ 160$38 Duplex6$192Developed2$ 160-$32 Trailer Park/Apartments/Institution8$256Developed2$ 160-$96 Store/Commercial Enterprise10$320Developed2$ 160-$160 Hotel/Motel/Restaurant/Golf Course/Gas Station/Theater 20$640Developed2$ 160-$480

9. 9 Benefits of Alternative Structure No “Out of Pocket” cost to District taxpayers and residents –At current charges, family break-even point is seventeen years, even at maximum tax rate Board has ability to make financial and tax choices –Service improvements –Community programs District is not dependent on accidents and illnesses to financially survive

10. 10 Multi-Year Projection Estimate Estimated Tax Rate for “No Out-of-Pocket” EMS Service Year20122013201420152016201720182019202020212022 EMS Budget ($000) 12851336139014451503156316261691175918291902 Minus Forecast Revenue ($000) 420433446459473487502517532548564 Tax Needed ($000) 8659049449871031107711241174122712811338 Per Unit Tax $80$8286$90$94$98$103$107$112$117$122 Developed Parcel tax $160$164$172$180$188$196$206$214$224$234$244 Assumptions: Budget growth at 4% annually Revenue growth at 3% annually No significant change in population or insurance mix No significant change in services

11. 11 Hard Questions What happens if we don’t do this? –We go back to the voters anyway in 1-2 years, just on financial need alone. This is an opportunity for a game-changer. What about Medicare? Isn’t that already “no out-of-pocket”? –“Treat and Release,” currently $352, is not covered by Medicare –If anybody needs to support a robust ambulance service, it’s the Medicare population. Why are we asking for $120/unit if we only need $80 next year? –We don’t want to go back to the voters any more times than absolutely necessary—elections are very expensive. –CLSD Board are elected officials who care about tax rates. –Unlike county, state, or federal taxes, every penny of the EMS tax goes to service for our community.

12. 12 Recommendation Pass board resolution for No Out-of-Pocket EMS –Specify alternate structure and maximum rate Target measure for Spring 2012 Special Election –Include with No-Cost AHUC change measure