Carter's budget eyes a better St. Paul

Opinion editor's note: Editorials represent the opinions of the Star Tribune Editorial Board, which operates independently from the newsroom.

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St. Paul Mayor Melvin Carter has the right 2024 budget priorities: public safety, infrastructure and operational improvements. How those areas are funded is open to debate, and taxpayers should weigh in while the budget process continues.

On Thursday, Carter proposed a 2024 budget that would raise the property tax levy to $208 million, a 3.7% increase from this year. But the owner of a median-value St. Paul home (about $267,400) would see a $26 decrease next year due to growth in the commercial and industrial sectors.

That's a welcome decrease from 2023 when the levy increased by 15% due to inflation and a change in how street maintenance dollars are collected. Additional local government aid funds from the state Legislature and federal recovery funds also contributed to keeping Carter's proposed 2024 increase relatively modest.

Promisingly, Carter would spend about half of the $13.6 million the city is receiving in state aid on gun violence intervention efforts over the next three years. The funds would bolster police efforts to prevent and respond to crime and maintain a gun diversion program.

Carter told Star Tribune Editorial Board members that his goal for fixing the city's crumbling streets over the next 20 years depends on voters agreeing to impose a 1% hike in the sales tax. The Editorial Board will have more to say about that proposal before Election Day.

One of the most intriguing and potentially economically impactful parts of Carter's spending plan is his proposal to use $1.1 million in federal recovery funding to provide up to $110 million in medical debt relief to St. Paul residents. The mayor wants the city to partner with RIP Medical Debt, a national nonprofit that buys hard-to-collect medical debt and negotiates payoffs at rates approaching $1 for every $100 in uncollected debt.

Health care systems would identify patient debt that would be eligible for relief and could participate in the city's effort. Those with medical bills could not apply directly for the assistance; they would be informed by mail that their debt had been canceled as a tax-free gift.

A survey from KFF, an independent source for health policy research, polling and news, found that nationally about 41% of adults currently have some debt caused by medical or dental bills. Yet the likelihood of having health care debt is not evenly distributed. Uninsured adults, women, Black and Hispanic adults, parents and those with lower incomes are especially likely to say they have health care-related debt.

By RIP Medical Debt's estimates, St. Paul's poorest and most debt-ridden residents likely hold over $100 million in medical debt. Eliminating that bill has great potential to help thousands of city residents improve their economic status and not have to choose between paying medical bills or other more immediate needs.

"I am proposing a one-time, $1 million investment of American Rescue Plan funds to purchase and completely eliminate all of it," Carter said during his Thursday address. "Patients in our city will be free from an economic stressor … and feel comfortable seeking medical services."

Carter told the Editorial Board that if the burden of medical debt is relieved, more people could seek the health care they might have been avoiding because they owe providers.

Started in 2015, RIP has successfully worked with other nonprofits, such as churches, to pay off medical debt. More recently, the organization has worked on programs with local governments, including communities in Ohio and Minnesota. We hope more will consider the option in the future.

Next week, St. Paul City Council members will begin budget discussions with department leaders. After that work, the council will have until Dec. 13 to offer any changes to the proposal. The final budget is scheduled to be adopted by the end of the year.