You’ll soon pay Pierce County mental health tax. But leaders must fix mistake first

Nobody likes to see their taxes rise at any time, much less 12 months into a pandemic in which tens of thousands of Washingtonians lost jobs and economic recovery remains spotty. This Editorial Board has voiced reservations about the Legislature advancing a capital gains tax and other tax proposals this year.

But taxpayer support of Pierce County’s woefully underfunded mental health and chemical dependency safety net must not — will not — wait any longer. After five years of dawdling and endless studying, county leaders voted in December to adopt a one-tenth of 1 percent sales tax hike.

It’s set to go into effect in July. That means we’ll soon pay a penny on every $10 purchase for behavioral health services like every other major county in Washington already does, including those governed by Republicans. (Here’s looking at you, Spokane and Yakima counties.)

But it came with a catch. Republicans on the Pierce County Council provided the key fifth vote only after the tax was paired with a complete transformation in the way the county serves Medicaid recipients.

They wanted the Washington Health Care Authority to grant approval for a new oversight structure, known as an accountable care organization — or ACO.

Approval for Pierce County’s ACO pilot project must come by April 15 or — poof! — the tax would disappear before it starts.

Fortunately, this impractical precondition and impossible deadline will soon be repealed. County Council members will take their first look at an improved version of the ordinance Tuesday with a final vote expected March 23.

Good for them. We appreciate that Republicans demanded regular audits and other provisions to ensure the new tax revenue is spent effectively. But it was naive to think the state would give the green light to this ACO experiment so quickly.

ACOs have been used with success in some states, including Oregon, but it’s largely unexplored territory in Washington.

Republicans were warned last year not to tie major Medicaid reform to long-overdue behavioral health funding. But they made the mistake anyway.

Now, county leaders plan to set up an alternative, known as an Affordable Care Network, or ACN, which is locally controlled and doesn’t need state or federal approval.

A letter in favor of the move has been signed by care providers who cover more than 85 percent of the county’s more than 230,000 Medicaid clients. They say the ACN will allow them to make decisions based on real-time data, fill healthcare gaps, offer competitive contracts for small providers and spread cost savings in the community.

“This allows Pierce County to control its own destiny,” Council member Dave Morell, R-South Hill, told us Monday, “and we don’t have to involve the state at this point.”

Morell is the sole Republican from last year’s council still in office. In January, council control switched from Republican to Democrat.

We give him credit for threading a political needle; he won’t let the tax die as the result of an arbitrary deadline, even as he continues pressing for better service delivery, fiscal accountability and keeping Medicaid dollars at home rather than lining insurance companies’ pockets.

He’s partnering with three new council members — fellow Republican Hans Zeiger, and Democrats Jani Hitchen and Ryan Mello — to sponsor the ACN alternative.

“In the last year we’ve learned to pivot and to be nimble,” Morell said. “This is another case of pivoting.”

Meanwhile, the spending plan remains a work in progress. For the first 12 months, an estimated $12 million in revenue will be divided among several programs. The formula is tilted toward acute psychiatric interventions — everything from a mobile crisis team, to intensive services for youth and crisis services for adults. Going forward, it makes sense to include more prevention programs.

The needs are many in addressing a behavioral health toll that’s only grown heavier during the isolation of COVID-19; an article in JAMA Psychiatry last month found an increase in US emergency department visits related to mental health, suicide attempts and overdoses last year compared to 2020.

The most important thing is to get the one-tenth of one-percent tax on the books this summer. No more delays, preconditions or impossible deadlines.

This story was originally published March 9, 2021 at 10:15 AM.