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Election 2019: County commissioner candidates forum highlights county nursing home, home rule

The Sentinel - 11/1/2019

Nov. 1--Questions over the ability of the county to maintain its nursing home and the possibility of home rule highlighted some of the voter interests during a candidates' forum Tuesday in the race for Cumberland County commissioner.

The forum, organized by Carlisle'sYWCA and League of Women Voters chapter, featured all four of the candidates who will appear on the Nov. 5 ballot for county commissioner: Republican incumbents Vince DiFilippo and Gary Eichelberger, and Democrats Jean Foschi and Michael Fedor.

The question on Claremont Nursing and Rehabilitation, the county-owned home, was likely the most pressing of several policy matters presented, given that the county's preliminary budget materials earlier this month said the facility is "facing many challenges and obstacles" and will require a taxpayer subsidy in the near future if financial trends do not change.

The candidates also fielded questions on the idea of a home rule vote, struggles with affordable housing and transportation, job growth, and the need for more renewable energy.

Claremont

Claremont, however, is one of the few matters that is fully under the commissioners' control. While many of the county's social services are prescribed and funded by state law, the nursing home is discretionary at the county level.

Claremont is self-sustaining in the sense that it does not require a routine contribution from the county's general fund, which consists of income the county generates itself, mostly via county property taxes.

If and when nursing homes require a tax subsidy, local governments have often sold them to private operators.

"We've been able to retain ours, and that has not been an easy thing," Eichelberger said. "It is not a secret ... that [Claremont's] reserves are declining. The economics of skilled nursing are changing dramatically. It is a very hard business to sustain."

Eichelberger was the only candidate to state specifically that he would not be in favor of using general fund property taxes to subsidize the facility.

Fedor was the most explicitly opposed to any divestment, saying that a "robust option" from a public facility was needed to encourage private nursing homes to keep up their quality of care.

"We have to resist the temptation for privatization of these services. ... What we don't need are privatization schemes in search of problems," Fedor said.

DiFilippo and Foschi said that the nursing home was not a "core function" of county government, but was nonetheless worthwhile.

"It's not a core function, but our county nursing home is important," Foschi said. "It's a well-priced facility and I'd like to see the staffing levels go up, and an effort be made to advertise the facility in the way that advertising is done for private facilities in the area."

If Claremont doesn't try to compete, it will be difficult for the home to tackle its capital expenditures. The county's 2020 budget includes $1 million of unanticipated costs for the facility, centering around a critical ceiling replacement, Foschi said.

DiFilippo said Medicare and Medicaid reimbursement rates have been flat for years; three-quarters of Claremont's residents are paid for by Medicaid, according to the county's budget notes.

"In my opinion, as long as we can keep our nursing home operating efficiently, I will certainly support it," DiFilippo said. "We are reviewing what all we can do to keep the nursing home operating in the black."

Complicating the issue is the state's transition to a "managed care" model for long-term care benefits, which will hit the Midstate in 2020 after having been rolled out in the Philadelphia and Pittsburgh areas in prior years.

The new system means that most Medicare and Medicaid long-term care benefits will no longer be fee-for-service, but will be paid into health care plans under the state's Community HealthChoices network. These plans will be managed by outside companies, who will negotiate with providers for rates.

The managed care model, which is underway across the nation, is intended to combine several benefit cash streams and make billing easier, but has been criticized for adding a for-profit middleman.

The outcome for Claremont is uncertain. The home is still negotiating rates with the insurance companies running the managed care plans, county Finance Director Dana Best said earlier this month, and the county's preliminary budget materials are just estimates at this point.

But the managed care change is viewed with skepticism by many, including Eichelberger.

"The move to managed care has made the job very difficult. That's why you've seen so many counties get out of the business," Eichelberger said. "The state is essentially trying to drive them out, in the opinions of many of us."

Home rule

The candidates also faced a question about home rule, a policy that would likely be an even longer-term undertaking than Claremont's financial woes, but equally as impactful to the way the county is run.

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Under Pennsylvania's 1972 home rule law, municipalities and counties can move to adopt their own local government charters, taking them out from under the control of most parts of the state's county and municipal codes, which otherwise dictate the structure of local governments.

To do so, the county commissioners would need to vote to put a home rule study question on the next ballot; voters could also force a referendum via petition. That referendum would be accompanied by the election, on the same ballot, of home rule study commission members.

That commission would develop a home rule recommendation and a home rule charter, which would need to be approved by another referendum.

"Would this work for Cumberland County? Honestly, I don't know, but I'd be willing to look at it and willing to listen," DiFilippo said when asked if he would support forming a home rule commission.

"I certainly am in favor of whatever the people of Cumberland County would like to do," Foschi said.

Fedor more explicitly opposed, and Eichelberger supported, the notion of home rule. The contention centered on the ability of home rule counties and municipalities to define how many elected officials they have, and how they are elected.

The county could, under home rule, increase the number of commissioners and/or create electoral districts for each commissioner, instead of electing all of its commissioners at-large.

"If we start to explore ways to make local government carved up in one more way ... it could just divide us further," Fedor said, something that makes him "skeptical" of a home rule charter.

"If a population-based districting system was put in place, we would have more representation, not less," Eichelberger said.

Eichelberger said partisan interests were opposed to home rule. In the current setup, the top three vote-getters out of the two Republican and two Democratic nominees are seated as commissioners, guaranteeing a seat for the minority party. Given that Republicans have a numerical advantage, this provides a safety net for Democrats, Eichelberger said.

On the other hand, home rule would mean that the county could eliminate certain elected row offices and replace them with appointed staff. Eichelberger said he had bucked his own party in supporting this, since the row office seats have historically been easy wins for the GOP.

"We just don't need many of these row offices," Eichelberger said.

Other issues

Other questions on Tuesday covered familiar ground for the candidates. All four were critical of Capital Area Transit, the public transportation agency that includes Cumberland County, as well as Dauphin County and the City of Harrisburg.

The county's dissatisfaction with limited public transit options caused the candidates to note that they may, in 2023, be faced with a tough decision when the county contract to participate in CAT is up for renewal.

"If things aren't looking good here soon, my vote will be to get out of CAT and go in a different direction," DiFilippo said.

The candidates also spoke broadly on reducing poverty and homelessness in the county, where it was emphasized that the county's housing authority and other social service programs are often at the whim of state funding, of which Cumberland County receives proportionally less than other counties due to the state's "hold harmless" clauses that prevent it from cutting funding to counties despite population changes.

"A lot of that money is going to where the population used to be, not to where it is today," Eichelberger said.

DiFilippo and Foschi also said the county could push municipalities to allow for denser development, helping to alleviate the county's affordable housing shortage by relying less on single-family homes.

"Revising zoning ordinances to include and provide for higher density housing would be one way we could address this situation," DiFilippo said.

"We can lead the pack in the elimination of 'not in my backyard' attitudes when it comes to affordable housing," Foschi said.

The housing crunch is arguably the most pressing social issue for Cumberland County. In the most recent federal Analysis of Impediments to Fair Housing report between 2000 and 2012, the county lost 64 percent of its rental housing under $500 per month, and 25.7 percent of rentals under $700. Over the same period, inflation-adjusted median income in Cumberland County fell 2.2 percent, but median rents climbed 7 percent.

A recent study by the Federal Reserve Bank of Philadelphia found that 66 percent of families in the Harrisburg-Carlisle metro region who made 80 percent or less of the median income were paying over 30 percent of their income in rent during the 2012-16 survey period.

In the 2007-11 data period, that number was 61 percent. The gap between affordable rent and actual rent for this group has widened to $190 per month, the Philadelphia Fed found.

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