Central Health defends tax hike of 5 cents, or 63 percent [Austin American-Statesman]By Mary Ann Roser, Austin American-StatesmanMcClatchy-Tribune Information Services
Aug. 19--The suspense is over, until Nov. 6.
The Central Health board agreed Wednesday to ask Travis County voters to support a 5-cent property tax increase -- a 63 percent bump in the tax rate -- for medical school training, securing a site for a new teaching hospital and various health care projects.
With that decision made, Central Health President and CEO Patricia Young Brown discussed the tax, medical school and other topics with the American-Statesman last week. Chief Financial Officer John Stephens and Chief Communications and Planning Officer Christie Garbe joined in.
Voters created the Travis County Hospital District, now Central Health, in 2004 to take over city and county health services for low-income residents. Since then, the board has sought relatively modest property tax increases while expanding an array of services thanks to rising property values and federal windfalls.
Now, the board says it needs more money to capitalize on the so-called 1115 Medicaid waiver, which frees the state to try out projects aimed at keeping low-income and chronically ill people healthier and out of the hospital.
That waiver was approved around the same time state Sen. Kirk Watson, D-Austin, began to champion a medical school and new teaching hospital, among other projects, to replace University Medical Center Brackenridge, which Central Health owns. Seton Healthcare Family operates the hospital and has agreed to spend $250 million to rebuild it.
The University of Texas System Board of Regents has pledged $25 million annually to support a medical school and another $5 million a year to buy equipment for eight years.
The regents have asked Central Health to come up with a $35 million annual contribution.
Here is an edited account of last week's interview:
Why should Travis County taxpayers help pay for a medical school?
What residents are paying for is health care delivery to the community. We're not building buildings.
What we're proposing to do is pay for care through medical school faculty, residents (doctors in training) and medical students.
We're also trying to leverage an amazing opportunity we have been presented ... (with) the 1115 transformational waiver to essentially support this new delivery system, the expansion of services and the creation of a new teaching hospital and new medical school.
All of these bring more services to our community.
How is a medical school part of Central Health's mission?
Those faculty, residents and medical students will provide care to people who need it most.
You are limited to spending money in Travis County. Won't residents in other counties benefit from a medical school?
Yes, but it's no different here than it is anywhere else. As for payments for care at the hospital, we pay for Travis County's (needy) residents only.
How many people are you serving now, and what percentage are U.S. citizens?
In fiscal year 2011, Central Health funded health care services for over 77,000 people in Travis County.
That includes 29,000 people with no form of health insurance (self pay) and 27,000 Medical Assistance Program enrollees. Approximately 65 percent of MAP enrollees are U.S. citizens and legal residents.
Why seek a tax rate increase of 5 cents, which will raise about $54 million? A 3.5-cent increase would raise more than the $35 million UT asked for.
We're not raising funds to support the medical school directly. We are trying to raise public funds to maximize the federal waiver money.
We're not pegging it to a medical school. If the tax rate is approved, we would begin using that as our local match (to the federal money).
What if the tax fails? No medical school?
We haven't had that discussion.
We've questioned the closed meetings on all of this. Why do you say they were necessary?
Because we are in very significant negotiations that are not appropriate for an open meeting setting. We are continuing to receive legal advice.
Our negotiating position does not need to be revealed to voters, and the executive sessions will continue. We have to negotiate legal documents.
I feel we have been painted with an unfair light that we are somehow doing something unusual for government agencies. We're not.
Is a medical school necessary? Won't Travis County benefit from the new school in Round Rock?
Both mutually benefit our community. Round Rock has third- and fourth-year students.
The UT school is focusing on specialties, as well as primary care, and you have the research component.
Some doctors say there's no physician shortage here. What evidence do you have to the contrary?
That might be a reasonable thing for a doctor in private practice to say, but it's not true for people who don't have insurance or have limited insurance.
There is a strong argument we need a medical school to grow the medical professionals that we need. (A Seton-paid study by Navigant Consulting Inc.) says we will be nearly 800 doctors short in 2016.
When you look at the demographic growth that's projected, it's not going anywhere but up. If people are not healthy and productive, that becomes a drag on your economy and quality of life.
What if the waiver expires in 2016 as scheduled and Central Health is on the hook for its $35 million annual commitment to the UT system?
That's another reason for putting that to voters. If the federal funds do dry up in the future, it leaves us with a larger tax base locally for that $35 million piece of committed funding (for the medical school).
Doesn't Seton pay now for medical education in its partnership with UT Southwestern?
They pay the cost of the GME (graduate medical education), and the GME is going to continue to expand. This (local tax) recognizes a combined effort. What we do is come in and pay for (the medical care residents provide Central Health patients).
Don't you contribute to that now?
We support some of the residents' training because they are out in our clinics, but we have a limited role in it.
With the federal health care law, won't you have fewer uninsured people?
That remains to be seen. The governor has said we won't expand Medicaid, and then there's the health insurance exchange, which will be handled at the federal level. Those people may seek care in our clinics.
We think we are going to have more people to serve overall but probably fewer of them will be uninsured.
What if the health care law is repealed?
It makes us more of an important safety net.
Are you concerned that in this economic climate voters won't support a tax hike?
We're getting very significant amounts of support. It's quite extensive.
Contact Mary Ann Roser at 445-3619.
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