Almost 19,000 Monroe County voters on Tuesday approved a nonbinding referendum to keep the county-operated air ambulance in the Florida Keys skies, even if it means paying an extra tax.

That was the easy part.

Now the County Commission must hammer out a plan to levy a tax fraught with confusing verbiage that some voters said they didn't fully understand as they left the voting booth. How, when and where the tax will be levied is still up in the air, said Karl Borglum, Monroe County assistant property appraiser.

Once commissioners decide how the tax will be levied, they then must go to each municipality in the Keys and ask their governing boards to pass an ordinance that would give the county jurisdiction to impose the tax, Monroe County Attorney Suzanne Hutton said.

Funding for Trauma Star will depend on the newly seated County Commission's ability to weigh taxing politics, voter approval, legal wrangling and public safety.

Legal issues

To fund Trauma Star, the county has proposed levying a 15 cent tax per $1,000 value of home south of Mile Marker 95, and a 7.5 cent tax per $1,000 value north of Mile Marker 95. Property owners in the former would pay about $52 a year and those in the latter would pay about $27.

The tax would be less for Upper Keys residents because they already are part of the Key Largo Fire Rescue & Emergency Medical Services District, a special health-care taxing entity that is the payer of last resort for patients evacuated by the Miami-Dade Air Rescue to Ryder Trauma Center and Miami Children's Hospital.

"We would need to enter into what's called an interlocal agreement with the Key Largo Fire Rescue & Emergency Medical Services District," Hutton said.

In other words, the county would ask the Upper Keys district whether it agreed to the tax. Commissioners must come to terms with how the tax will be levied fairly, especially in light of the strong Upper Keys opposition to the referendum.

Some say the tax is unfair because it would charge Upper Keys residents less, even though the district hasn't assessed the tax since 1995 because the patient usually is billed, collection rates are high and the district has ample reserve funds.

Other say it's not fair, for example, if Key West opts out, leaving Marathon property owners to subsidize them.

"Remember that this is nonbinding and ultimately it's up to commissioners how this will work," Borglum said. "It might have been the intent to have communities opt in or out, but until the commissioners finalize that -- they have to create and make the final decision on what's going to happen. It's still up in the air."

Fairness issue

Commissioners could tweak the tax, but there was nothing on the ballot that mentioned that some communities, such as Key West, Islamorada or Marathon, could vote to opt out of the tax, Borglum said.

"I have not seen those options on the referendum, and there was no indication that this was an optional thing for various municipalities," Borglum said. "I think the language simply said, 'Do you favor legislation, an ad valorem tax, for the entire county?' But remember, too, that this is a nonbinding referendum, so the County Commission could still change that."

Hutton said each municipality will have that option once the County Commission puts a plan in place and asks each town to pass an ordinance supporting the tax.

County Mayor Mario Di Gennaro said every community in the Keys should pay the tax.

"The public has spoken and the majority of Keys residents want this program up and down the whole county, not just in the Middle and Lower Keys," Di Gennaro said. "As far as I'm concerned, I want it countywide. It needs to be countywide, otherwise it would place a heavier taxing burden on those [municipalities] that opt in. I couldn't justify that on my conscience."

Di Gennaro added, "It's very clear that this is a service for the entire county and all municipalities."

County Commissioner Sylvia Murphy, who represents the Upper Keys, was and remains a vocal critic of Trauma Star and the referendum, which she said was poorly worded and hastily executed.

Murphy said it remains unclear how, where and when the tax will be levied, but "it's going to have to be everybody or nobody. You can't pick and choose. You can't say, 'You don't pay the tax so we're not going to pick you up.'"

Two issues are at play, Murphy said.

"The first one is, 'Are we [the County Commission] going to accept what the public said they want?'" she said. "The second thing is how much of the referendum we're going to pass and how we're going to do it, what the parameters will be, what the money can be used for and who is going to oversee this program."

County Commissioner George Neugent, who has been discussing the issue with Hutton, said what the County Commission agrees should resemble what voters think they're getting.

"Whether or not we can establish a countywide tax that communities can opt in or out of is a legal question," Neugent said. "This is going to be a sensitive matter especially in Islamorada. The majority of people in the county passed it. But again, we have to sit down and hammer this out and find something acceptable to everyone, including Upper Keys residents."

Keys communities

The Islamorada Village Council has not yet discussed whether or not it would pass an ordinance in support of the tax. Instead they waited to see how voters reacted, said Mayor Cathi Hill.

The referendum was met with strong opposition in the Upper Keys before the election. Ultimately, it passed with 55 percent of the vote, but 54 percent of Upper Keys voters cast a "no" ballot.

"This issue has a complicated history in the Upper Keys," Hill said. "And we [Village Council] decided not to discuss the matter until after the election."

Hill said the issue has yet to be scheduled for discussion, as the council is awaiting the County Commission's next move.

"I will tell you that I personally voted no on the referendum," Hill said.

Marathon Mayor Pete Worthington said he would not support opting out of the tax.

"I don't know how that would go over with the people in Key Largo, but we're trying to pay for a service that includes the whole county," he said. "Marathon would support the tax. The voters spoke, and I think rightly so. This is a very important service to the county."

Worthington said he and the Marathon City Council will await the commission's decision, but it's his position that the tax should not be levied against one community and not another.

"This is the reason we got the program," Worthington said. "You have to ask yourself, 'What's the value of a human life?'"

Key West City Manager Jim Scholl said the decision to opt in or out of the tax will have to be decided by the county.

"Whatever the legal- and voter-decided requirements are, then that's what we'll support," Scholl said. "Personally, I support it, because it's cheap insurance. Nobody likes to pay for something they're not going to use, but this is a life or death decision. I think this is an important resource the county needs."

Hill said the issue of fairness is overblown.

"That brings our autonomy into play and why Islamorada voted to incorporate -- so we can make these decisions independently and do what's best for the people of Islamorada," Hill said.

Murphy wasn't as sure.

"If Trauma Star is able to pick up patients in areas that are decidedly not paying the tax, and if in fact the helicopter does pick those patients up, then this whole thing is null and void," she said.

alinhardt@keysnews.com