This week, Marathon City Manager George Garrett distributed the financial information requested by the city council regarding the Middle Keys’ special taxing district to fund indigent and underinsured care at Fishermen’s Community Hospital. 

Baptist Health South Florida, the hospital’s parent company, provided quarterly reports describing the costs of care for the uninsured and underinsured for FY 2020. Baptist has billed Monroe County $2,258,598 for services rendered. In the same period, the Monroe County Tax Collector has collected $1,905,082 in taxes from the Middle Keys Health Care Municipal Services Taxing Unit (MSTU). The health system will only be repaid the $1.9 million, according to the laws governing the tax district.

I believe that this information, including the MSTU Agreement and the Baptist indigent care policy, should outline pretty well the status of funds coming in through the MSTU,” Garrett wrote in an email. “In making contact with Baptist Health on this issue I am assured that we will receive all quarterly financial reports as they become available in the future.

“Baptist Health and the foundation will be prepared to make a full presentation concerning the financials as well as the progress and projected opening of the new hospital at (the council’s) April 13, 2021 meeting,” Garrett said.

The $2.5 million charge from Baptist includes a 58% reduction in bills in accordance with the Part B schedule mandated by the Centers for Medicare and Medicaid. In order to qualify for the charitable rates from Baptist Health South Florida, Middle Keys residents must be at 200% of the federal poverty level for Florida and other eligibility criteria. 

The quarterly reports describe every uninsured and underinsured visit to the hospital, plus the costs charged by the hospital or doctors in the Baptist group and the amount, if any, paid by the patient. In the first quarter report, for example, Fishermen’s Hospital lists 132 uninsured patients and 434 underinsured patients. It also lists an abbreviated type of care provided.

The reports detail quarterly hospital charges (after the Medicare break) as high as $700,000 to as low as $437,000 per quarter and doctor charges from as high as $4,874 per quarter to as low as $3,453. Again, those rates describe the fees after Medicare and Medicaid discounts have been applied. 

The taxing district was conceived in 2018 when it was clear that Fishermen’s Community Hospital was completely destroyed by Hurricane Irma and needed to be rebuilt from the ground up. Baptist Health South Florida, the parent company, estimated it would cost $40 million. The City of Marathon officially supported the taxing district, which was then created by Monroe County. 


Every year, the county cuts a check to Baptist — not for the cost of the rebuild, because that would have required a voter referendum, but the cost of treating the Middle Keys’ underinsured and uninsured — via the special taxing district. The district was created by the Marathon City Council and Monroe County for properties between MM 47 and MM 63, which includes Marathon, Key Colony Beach and Duck Key. The county said the goal was to raise about $10 million over 10 years.

In March, the Marathon City Council directed staff to bring back two ordinances to its April meeting — one in continued support of the special taxing district and one that would cancel it. 

At the March meeting of the Marathon City Council, Councilman Dan Zieg said, “We were promised a full accounting from the hospital by May of 2020 and that report is still absent and evidently has not come forward on any level. We reminded the hospital representatives that this has to be reviewed on an annual basis. … We need to reconsider withdrawing the tax district.”

The hospital system did not have representation at the March meeting. Representatives from Baptist and the City of Marathon have since said it was a simple miscommunication. 

Should the Marathon City Council decide to extend the taxing district for another year, it will need to call a special meeting in order to ratify the ordinance before the start of the tax collection in May. 

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