Travis County Commssioners Court
November 19, 2002
The Closed Caption log for this Commissioners Court agenda item is provided by Travis County Internet Services. Since this file is derived from the Closed Captions created during live cablecasts, there are occasional spelling and grammatical errors. This Closed Caption log is not an official record the Commissioners Court Meeting and cannot be relied on for official purposes. For official records please contact the County Clerk at (512) 854-4722.
Item 18
Number 18 is to receive briefing from hospital district task force with
emphasis on legislation and governance and take appropriate action. [one moment,
please, for change in captioners]
>> ... We appreciate the opportunity to come and just have
a visit. We anticipate that -- that this will be the first of -- of probably
several as we go along this path. Where we will need to come and talk to you
about -- about how we are moving along the path and get input from you and
move ahead. Our group was formed, as you all recall, this summer. It -- it
began as a steering committee that judge Biscoe and mayor garcia appointed.
It's got some 23, 24 people on it. And they are listed in the handout, just
for your reference. And the the initial focus and continuing focus of our
work as members of this steering committee was to study efficacy of a hospital
district in central Texas in terms of whether it would accomplish some discrete
health care goals for our community and if we felt that it would, design a
district from -- not only from the standpoint of legislation, but from the
standpoint of finance, scope of service and function to accomplish these objectives
in a financially responsible way and in a way that both the county commissioners
court and the city council would approve of. Because in the end we will need
to bring whatever potential solutions we have got to you. And in addition
to that, we will have to take them to the legislature, we will have to take
them eventually to the voters in November of 2003. If we can stay on schedule.
It's important we think to focus on what those goals and purposes were. When
we began, what are the discrete health care objectives that we have set out
for ourselves that you have helped out for us. The first one is to provide
adequate capability and capacity into the future for trauma care and emergency
care. It's very, very important, the sense that we have is that our trauma
and in there care facilities throughout central Texas are overcrowded. That
we are in danger of a system failure. Not just from the standpoint of overwhelming
indigent care, but -- but perhaps trauma care and emergency care that everybody
needs from time to time in the community. How do we add to what we have and
how do we do it in a financially responsible way? How do we expand the availability
of mental health and chemical dependency services in our community. These
are issue that's judge herman has spoken about frequently with passion. And
from his experience as the -- as the county probate judge, it's a need that
clearly is there and that we have -- intend to take into account in trying
to design the scope and service of the district. Thirdly, to expand the availability
of health care for people who are end gent or uninsurance -- indigent or uninsured
or underinsured and to find a way to integrate what we do now, which comes
from a number of different providers and a number of different ways some counties,
some cities, some non-profit, to operate them as efficiently as we can, and
in the context of -- of one health care district. Obviously, important goal
is to allocate the cost of these three major items fairly among all taxpayers.
We've had lots of discussions about the fact that people in the city of Austin
pay more taxes than those who live in Travis County and outside the city and
people in Travis County end up paying taxes for providers in -- in -- located
in Travis County to take care of a lot of people who don't live in Travis
County. One of the -- a couple of interesting statistics in that regard, the
st. David's hospital system people tell us that 37% of their emergency room
admissions at the 32nd street facility come from outside Travis County. The
brackenridge people tell us that 25% of their trauma admissions are people
from outside Travis County. And that 15% of their emergency room admissions
are from people outside Travis County. Many of these patients are not able
to pay. And the result is that -- that -- that either seton or the city of
Austin or st. David's or Travis County bears that expense in one way or another.
The question -- we question whether that's fair. Question how do you address
that. Obviously, an important goal is to -- to develop a system that's got
transparency. We had a consultant prepare a report that shows all of the public
dollars that go into health care and that are spent on health care from the
city of Austin, Travis County with arrows running all over in terms of going
into seton-brack, out of seton-brack, it's very difficult for somebody to
understand how public dollars are spent, what this is true spent for -- what
they are spent for and to have the public feel like or understand what they
are paying for. One of our goals is to come up with something so that we see
dollars going into one system, one place and then going out for a discrete
set of deliverables that people can understand so that the taxpayers can see
dollars coming in and going out against a set of deliverables that the public
has -- has set and has defined. The common buzz for that is transparency,
but it's basically getting what you are paying for and being able to demonstrate
to the taxpayers that that's what they are getting. Another important goal
here, obviously, is to set up a system that enable us to plan regionally and
to finance regionally. Everybody we have talked to, not just in Travis County,
but in the surrounding counties, understands that health care in central Texas
doesn't stop at county lines. That those are just artificial and don't really
mean anything. How do we build a system that -- that works regionally that
enables all of the players who need to be involved, talk to each other and
plan for facilities and to take care of -- of patients, indigent and otherwise
on a regional basis. That leads us to consider legislation and the design
of a system that's got a multi county facet to it. Obviously a big part of
any design that we come up with has got to be to try to find a way to -- to
pull patients who don't need to be in the emergency room, who could be treated
more effectively and at a lower cost somewhere else, out of those emergency
rooms. And finally, to introduce into the consideration, probably for a very
long-term planning process, the possibility of having access -- having academic
medicine in central Texas and increasing the role of academic medicine in
central Texas. Those are the goals and purposes that our group started out
with. You can see that the draft that you have in front of you is dated September
of 23rd. We've had these for some time. Of course judge Biscoe and commissioner
Sonleitner have been critical members of the steering committee, we appreciatate
your participation on the steering committee. As you all know, we started
with the steering committee of about 25 people. We have basically subdivided
ourselves, for purposes of -- of working groups, into five basic working groups
and we have added others, both -- the county has been very gracious to allow
some of its talented staff to -- to be a part of our working groups, as has
the city and seton and st. David's and others. But our five basic working
groups are our legislative and legal group that's been primarily designed
early on and involved in the design of some legislation that -- that david
hilgers is chairing and david is going to be prepared to talk to you about
that. Judge herman has been on that subcommittee. We felt that the governance
issues were important enough, particularly in light of the fact that both
the city and the county have interests in -- in what this is going to be.
The city owns the hospital, the county has a taxing authority in this area,
both need to have fair reputation on this, so -- representation on this, so
we created a separate working group, which raouf feel quintanilla has been
-- rafael has been chairing, going to talk to you about the legislation and
some specific issues that we hope that you will consider. We also have got
a finance committee that's designed to -- that's intended to -- to focus on
exactly what all of this is going to cost. What tax revenues would be available.
What the impact on taxpayers would be. To test a certain -- to run assumptions
and sensitivities on different possible approaches and to keep us advised
about -- of the financial aspects of what we are doing. We have a -- an --
a community education group, which is co-chaired by ed adams and susan dawson.
That is now doing, undertaking to do some sampling throughout central Texas
on what are the issues that are most important to potential voters in central
Texas. To potential patients in central Texas. And -- and identifying for
them certain needs that we are all aware of and basically asking them what
they are prepared to pay for. What they think is most important and we think
that will be important to us and to you, the results of that study, and --
in designing the scope of service of any hospital district and eventually
it will be important to the hospital district trustees in terms of designing
with the budget and how much of these things that we need we can afford right
now. And finally, we have a health care subcommittee that's got lots of physicians
and hospital folks in addition to people from government and business looking
at exactly from a health care standpoint you attack these goals and purposes,
how would you design a district that actually accomplishes these things from
a health care standpoint. That's a tall order. There are a lot of people involved
in that. Frankly that's -- that's going to take a while to finish. It's very
much a work in progress at this point. We are here today to answer any question
that's you have about our process, to be sure that you are fully informed
about what we are doing. Specifically we hope to discuss with you the legislation
that the legal and legislative committee has drafted. The reasons why we think
legislation is needed and should be proposed to the 2003 legislative session
to talk some about the governance issues that relate to that legislation and
relate to the commissioners court and the -- and the representation that you
all would have on -- on the proposed hospital district. And then to talk to
you some about budget and about -- about a request that we would make for
some financial help in terms of covering the expenses of the exercise that
we are involved in. At this point, I would -- unless there are questions that
you all would like to ask, I would like to -- to turn it over to david hilgers
to talk some about the legislation.
>> we -- -- forgive the numbers, one is 281, one is 286.
We felt that neither one really fit the situation that -- that Travis County
and the city of Austin had created for itself. 281 applies only to -- will
only allow you to create a county hospital district. The city of Austin is
outside of Travis County. It doesn't allow you to expand and add other counties.
So -- so we felt 281 was not the perfect fit for us. 286 does allow you to
expand and -- into other areas, but it calls for a number of things that we
didn't think fit our community. One was, you had elected -- elected hospital
board, we -- we thought that -- in -- around the state, an appointed hospital
board has worked better. The other aspect of it is the 281 is the most commonly
used, most of the hospital districts you will find in the state are 281's.
Therefore there have been a lot of amendments to 281 that are very beneficial
for hospital districts. So we couldn't just adopt 286 because it didn't quite
fit our needs, either. What we have done is tried to create something that's
a little bit different. It's basically modeled on 286 with the expansion aspects
of it. But taking what we consider to be the best parts of 281, added it to
286. Also changed to 286 to allow for appointed hospital board members as
opposed to elected hospital board members. And that's essentially the basic
changes that we have made. Now, there have had to be some changes obviously
in the way we expand. One of the big concerns that clark mentioned was that
we want to give the other counties the opportunity to participate. We don't
think it's politically feasible to tell them that they have to participate.
So we really essentially are giving them an option to join this hospital district
over time. They can do it when we have the first vote or they can choose to
do so over time at -- at later years. So we had to craft legislation that
allowed for that flexibility. Essentially what we try to do is to create something
that -- that fit our community, that had the most flexibility possible for
our hospital district. We did not want to go in and hamstring the hospital
district board with our preconceived ideas of what was supposed to happen.
We wanted to go in and say, "this is a very complicated area, things change
on a yearly basis, you are going to need to be able to make decisions on a
yearly basis as to what the hospital district needs to do." But we want to
have oversight, we want to have the city council and the county commissioners
to have oversight over your board members and to be able to have some significant
say in what goes on with the hospital district. Now, just so you will know
a little bit about 286 and how our kind of mongrel legislative process worked,
if the hospital district is created, then city and the county have to put
in their health care assets, so brackenridge hospital goes in, all of those
-- all of the hospital district, the -- the city clinics will go in and community
clinics will go in. All of the money that is now available in -- in any funds
for health care will go into the hospital district. Typically the timing would
be if we had an election in November, the -- it would go into the -- the hospital
district would start in January. Now, we are not talking about this hospital
district taking over brackenridge hospital. We are talking about continuing
the situation as it exists now and allow that hospital district to make decisions
over time as to what the best way to deliver health care in the community
is. I think that we have -- charles bailey of the Texas hospital association
has looked over this legislation. We had -- david escobela from the county,
the city attorney, rafael was there, we had judge herman, we had a number
of people look at this. We had also people outside of the committee who I
have a great deal of confidence in as being -- doing a lot of hospital district
work. I represent a number of hospital districts outside of the city as --
and a couple of other lawyers do, I ran this by them as well to try to avoid
the problems that some of the other hospital districts have had. We are still
getting comments. It is not quite finalized. The city and county, as rafa
rafael are going to tell you need to make a decision about how this board
is constituted before we can actually file the legislation. We are inviting
everybody's comments that we can to try to make sure that we get the best
legislation possible. But my overriding goal is to, number one, take it as
flexible as -- make it as flexible as possible. Not reinvent the wheel. We
have 286 there, not to come in and say we have a whole new way of doing things,
but take 286 and modify just what we need to modify it. Take that to the legislature
so we don't have a significant number of what are are you doing, you are trying
to create something entirely new for the legislature and also give the outside
counties the comfort that we are not trying to dictate to them what they are
going to do with their health care, but only allow an option if they want
to take that option to come in. Now, the legislative committee did not deal
with governance. That was so important we needed rafael to take care of that.
He's going to talk about how his committee worked and what the structure was.
>> could I ask a real quick question before you move off.
Would whatever we filed be considered a local bill --
>> yes, that's the goal yes,.
>> since we are trying to do kind of an offshoot of 286,
what other large counties are out there that are 286's. None, none. Okay.
I'm trying to think of who we might be thinking about right now who might
be our allies, either through [inaudible] or urban counties that we can start
having good discussions with early.
>> commissioner Sonleitner, most of the hospital districts
were created back in the '50's and under 281 to 286 didn't exist. So really
there are no significant hospital districts. There are some who wish they
had it because they are now bexar county, for example, is taking in many more
people outside of the county, than just bexar county. They can't operate outside
of the county now. Maybe we don't really have anybody. They might want to
switch after they see the legislation, but we don't know right now. Good morning,
the issue of governance, the committee included representatives from the city,
the county, the major hospitals, the -- we also have several attorneys, several
hospital districts throughout the state. So we were able to draw the expertise
of quite a few people who have actually had experience in working with hospital
districts. And the consensus of the group was that we wanted a -- a board,
we wanted to be governed by the board that would be as -- as professional
as possible. By professional I mean that with -- would not be necessarily
be holden to any one group that would have the interest of the entire community,
that would have some business expertise, some -- some [inaudible] expertise,
so we wanted a balanced board. We are allowing for the expansion into other
counties, we wanted to provide a mechanism by which other counties could also
be represented on the board if they chose to come in. And finally, we didn't
want a board that would be so large that it would be unwieldly. So given our
parameters, we came to the conclusion that we wanted a board of no more than
15 members, that we wanted it to -- to be appointed so that -- that elected
officials would have the -- would have the knowledge, the right to make those
payments, we wanted it to be balanced in terms of population. So -- so we
looked at the population numbers for the whole area and came to the conclusion
that if -- if you divide the population into increments of 100,000, Travis
County as a whole would be entitled to nine of the 15 board members. Williamson
county, if it comes in, would be entitled to three board members. That's 12
and then the -- the other counties hays, caldwell and bastrop would each get,
you know, one apiece. Dave hilgers, after looking at that model, you know,
raced questions -- raised questions about what happens if the population changes
dramatically, how do we handle that? Because our -- on our recommendation
was going to be that we only look at changing the makeup or the -- or the
breakdown of the board every census. So we wouldn't look to change it anyway
until the next 2010 census. And rather than trying to pinpoint exactly how
that ought to work, which would become very complicated, you will find language
in here that says that if after publication of the population data, the ratio
of the population at any one county has increased or decreased by 20%, from
the ratio of -- of the 2,000 census, then the board itself will adjust and
if they can't work it out amongst themselves, then they can petition the court
in Travis County to work it out. Also, of course, they -- there will be an
opportunity to go back to the legislature in the next 10 years. But -- but
then we came to the issue of how would the board members from Travis County
be appointed? Obviously, there was an interest in both the city and the county
having a -- having a say in the -- in the appointments. The city obviously
owns the hospital. So one of the things that we are here, maybe to try to
get some guidance from you, either this morning or soon, is what you as commissioners
court would be willing to agree to on the -- on the appointment of the --
of the nine from within Travis County. You know, obviously, we -- we the committee
has looked at -- at all kinds of scenarios, but -- but after hearing from
several people, we -- you know, we would like to suggest that you consider
a scenario of the city appointed -- the city council, the commissioners court
-- the city appointed four, the city council, the commissioners court appointed
three and together the city council and commissioners court appointed two.
Appointing two. 4, 3, 2. But, you know, here to -- to -- to consider, take
back to the committee whatever you can guide us with, if we -- this is a key
point in moving forward with the legislation.
>> > I have a few questions I need to ask before I give an
answer. Before I even do -- I need to although at it. That is -- I need to
look at it. That is some of the comments that have been made before. As you
know, we have -- transportation, congestion situations and a lot of things
that we basically have been going through the regional approach on a lot of
things. However, I'm concerned about the 286 proposal versus the old 281 that
was discussed as far as creating a district. The implement -- implications
of who would actually participate in the sharing, if it comes up on the 286,
the sharing of the taxes that would be partly necessary, I think, to support
the district. What I'm saying is that this area, which is a regional situation
regardless of whether we like it or not, folks are coming in from several
varied counties, coming here to brackenridge and other hospitals that's in
the area, I mean, we definitely do have the persons that are using the --
the service of health care here in Austin. However, as far as -- I need to
try to focus on this more than anything else -- looking at the taxing implication,
if we are saying taxing to support the district, then of course howwill that
be done? Especially if we are looking at board questions that may serve in
the regional approach of all of this from Williamson county, from hays county,
from caldwell county, travis and Austin, how will that be dispensed? And if
-- if what you are suggesting, if you are saying that of course we are looking
at the assets of what's available now, and the -- in -- and the district I
guess taking control of the rural clinics or the hospital, brackenridge, things
like that, as far as the revenue that goes to continue to fund these particular
facilities, how would that offset the tax base? That would be required to
accommodate the district in itself. Again, looking at 281, looking at the
tax base for bexar county, I guess the other counties that actually have districts,
I guess dallas county and others, it ranges -- and el paso, I guess it ranges
from about 20 cents per one hundred dollar value or --
>> 25.
>> 25 per one hundred dollars value, I guess that would be
overlaid on what we are dealing with property taxes now. We are talking about
another overlay of property taxes on what we have to do. So now if that is
the case, by having to the assets -- by having the assets that would be available,
assets meaning the funding of the city and also the county, districts -- not
districts, but the hospitals, the centers, the rural clinics, also the hospital,
by having the funding geared to that, how will that offset that tax base and
what is the recommended money collections as far as taxes on property valuation,
how will that be done? There have to be somewhere where there has to be an
offset somewhere. I'm trying to find that and especially with the expansion
in the 286 taxing area that we are looking at, who will have the ability to
pay, who will put it into the pot in other words. I'm really not getting a
clear picture of that funding and -- and that's where I think we need to be,
as far as I'm concerned.
>> well, 281, and the taxing issue on 281 and 286 is not
really any different. In other words, if you had a 286 or a 281. So -- there
are two different scenarios. 281 would be only the county. Would not include
all of the city. Which is a problem. Because we can't go outside of the city
line. So right now we would have a district that where we had the city of
Austin outside it. Which is a -- which is a problem, small problem now, maybe
a larger problem later on. But the tax is determined in both of those scenarios
by that board. In other words, so that -- that board is -- now. The -- the
question that you are asking is, right now, is estimating that about five
cents of the city taxes and about one cent of the county taxes are dedicated
to health care.
>> uh-huh.
>> we are not talking about -- there's no discussion of any
kind of tax increase or -- in our proposal. The hospital board would make
those decisions over time. The city and the county have to determine what
they want to do -- they no longer will be responsible for funding health care.
Neither the city or county will be responsible for that once this hospital
district is in place. Though those tax dollars and what that tax rate, what
happens to them, we can't control that. That is the city or county decision.
We have no way to -- to impact that in any way, shape or form.
>> right.
>> so that has to come from other bodies. What we are saying
is that our county, that our hospital district board will make decisions on
-- by people appointed by you aren't city on what needs to be -- and the city
on what needs to be done about health care and how to fund it. We are not
making any decisions about that, not making any choices about that. We don't
have the power to do that.
>> I wasn't trying to put you in the position to do that.
That wasn't my point. It was the point I think of disclosure, as far as where
we are, looking at the other scenarios based on the 281, where -- looking
at those counties, how the taxing implication is done there and then looking
at this and seeing what the taxing implication would do here under the 286
scenario. And then again as far as the board members, the way you structured
out the governance of this, as far as the -- as far as the appointing, the
commissioners court having the ability to appoint, blah blah blah, all of
these types of things here, also having the ability to issue or levy tax,
I'm wondering if accountability will come into play. Once the person is appointed,
how long are they there -- a person being appear pointed to a bored and --
appointed a to a board for cesarean term. If they don't do the job in a satisfaction
factory manner, how is that addressed, there's a lot of still gray areas to
me and I'm basically just wanting to see what type of authority, with that
the tax -- with that type of authority to tax, it comes to be a point of accountability.
Who is going to be accountable to who? Would the voters -- who have to pay
the tax, the property owners who have to pay the tax, whatever funding mechanism
there is going to be because if they levee it, it will come from ad valorem
taxes, who is saying who is there, who is doing the best job, how would they
be relieved of that -- of those type of decisions?
>> well, 281, we use the mechanism --
>> 286.
>> we use 281 as far as appointment of the board members.
281 appointed board members, we basically took 281 put that into 286. We didn't
try to change that in any way as to how their terms and responsibilities and
who could appoint them and how -- how long their terms were, how they could
be removed and so forth. We just used 281 in that scenario. The 286 question
you asked, if other counties came in, which is certainly -- I wouldn't expect
that to be right away. Politically it will take some time for people to want
to come in. But if they came in, they would participate in making the decisions
as far as a tax rate would -- would be concerned. And a tax rate would have
to be uniform throughout the district. So all of the counties would have to
pay the same rate.
>> okay.
>> let me say -- commissioners, I don't think it was said
that -- I think rafael mentioned up to a 15 member board, Travis County stay
with us nine, three from Williamson county, one, one, one from the other three.
I don't think specifically he said that those other counties don't get an
appointment if their county doesn't vote to come into the district. So if
Williamson county, for example, did not vote to come into the district, they
wouldn't get their three appointees and they wouldn't pay ad valorem taxes.
So then it would be a 12 member board if the other counties did get in. I
think what dave just mentioned is that what we foresee in the initial creation
of this district is it will really be, most likely, a nine member board composed
of Travis County with the city and all of the cities in Travis County and
also that part of city of Austin that is in Williamson county and I believe
in hays, too. But there would be a nine member board and then the question
that will be coming up is how we in the city allocate those nine board members.
>> I guess my bottom line question is a matter of beingability.
In other words if you are -- being beingable. Accountable. If you are in a
position to levee taxes against the district, appointed versus elected, what
will the decision -- because someone -- I may be -- some folks out there that
are able to levy taxes and stuff like that against property owners, but [inaudible]
my familiarity [inaudible] elected positions.
>> I think there are models out there and I will get them
to you of political subdivisions of the state of Texas that are appointed
by these that are able to assess -- obviously capital metro is an appointed
one that assesses sales taxes. [multiple voices] esds that you appoint right
now, you appoint the commissioners for those esds and they assess ad valorem
taxes. They serve for a term, if they don't, what if they don't do their job
in the interim, the law provides for malfeasance, misfees misfeasance of office,
if their actions are so far out of the norm that would allow them to be removed.
>> I guess I'm trying to pin this answer down. As far as
appointed versus elected, what was the -- I'm hearing suggested appointed
other than elected. I'm wondering why.
>> the can he considered -- lots of ideas on that. The overwhelming
-- the committee considered and the overwhelming finding was that those boards
that are appointed tend to be, you know, better governed. That was the opinion.
[multiple voices]
>> that wasn't the universal opinion. That was one. I remember
my thoughts that came up was costs, if you are going to have elections, I
think they can set those with the uniform election date, but their costs go
along with that, administering those offices. That was one. But it was mostly
to take as much of 281, take the benefits of each, take 281 which is appointed.
Seemed especially I think that the city, from what I learned from their attorney,
were favoring that -- that correction as well.
>> and keep in mind these are terms that -- the terms that
you are proposing would last four years and so -- so you and the city would
-- would have the opportunity to -- to appoint new people if you weren't satisfied
with the performance of the first group.
>> well, but if we talk about the capital metro model, then
you have a mixture of elected and appointed and so -- so that's another way
to look at it.
>> well, again commissioner, excuse me, let me just say that
in the experience -- what I think hospital boards are -- hospitals are essentially
businesses in many ways. I mean, they are running a business, the county has
some aspects of that, but you have got to -- a much broader range of things
that you do and hospital district is a very -- a very -- you have seton, you
have st. David's, you have very professional management and operations. And
the experience has been that when the commissioners appoint, all 281 were
appointed by the commissioners, all of the hospital district boards are appointed
by the commissioners. The commissioners do a little better job of appointing
what I would call hospital professionals to that board than the election of
officials. That's -- that's been the experience. Commissioners have done a
good job at that. We have some small communities, which mostly small communities
too elect their board members. Those that have tended to fail. There are a
lot of hospital districts that have had to close and close their hospitals
because they aren't been run properly. That just has been the experience.
What we wanted to do is take the best of 281, which had been that experience
of appointed board members and put it into this 286 because that seemed to
work, at least in all of our experiences of people out there in the field
doing this, that had worked the best.
>> my final question. That is with the six cents available,
the six cents that's available, one cent from the county, five cents from
the city as far as moneys made -- that we are actually putting in there to
provide and support the health care services such as this here. Of that, in
looking at, as you stated earlier the possibility of board members having
the ability to levy tax, with the increased growing need for services, as
far as health care is concerned, it's continually growing, and finally if
-- and if Travis County end up and the city of Austin end up boring the nine
-- bearing the nine membership phase itself, what is the projected increase
as far as revenue that you looked at as far as the model is concerned, looking
at the numbers of growth and the continued demand on our health care system,
just based on the 6% -- six cents funding that we are looking at now and all
of those components that -- that I just put before you, have there been any
projection of growth and demand on the health care system and still other
counties in -- probably 10 county area, still may be using Travis County.
>> right now we know that if we use the same tax rate, that
we have right now, which is -- it would be an additional $6 million to the
hospital district. That would be what would be available if we kept that same
tax, in other words, that just shifted to the hospital district at this point.
We have not made -- again it has for the been the hospital district steering
committee's responsibility, to make a decision on how -- what kind of expansion
should be done, where we should go with that. We don't feel that we really
are the people who should be making that decision at all. We feel like the
people that you appoint are going to be the people that need to make the decisions
on how the hospital district should be run, whether it should expand, how
it should meet the community's needs. Reality of those -- those community
needs are going to be there where whether we have a hospital district or not.
The costs are going to be there. The utilization was going to be there, whether
we have the hospital district or not, the question is what's the best way
to create an entity that can handle that and make decisions about it and --
and -- it's our steering committee's belief that unless we have somebody who
is focusing on health care, you guys have a lot of responsibilities, the city
has a lot of responsibilities, they -- they have essentially said we can't
run a hospital, we want to turn it over to somebody else. But -- but it's
our belief that somebody needs to be in that position of making those decisions,
coordinating those decisions, there's so many things that can be done -- so
many -- government making decisions about how to provide health care. I can
list about a dozen right off the top of my head of things that can be done
that somebody focus odd that could do that is much harder for the city to
do at this point.
>> that was my final question, thank you. [one moment please
for change in captioners] .
>> and we don't suspect that other counties are spending
their misdemeanants. Travis County -- that is already considered that we've
got a good blending of city and county resources and the partnership that's
been developed with the e.s.d.s and the small cities. That is something also
not be talked about going intro this health care district that would main
a part of the responsibility of the city of Austin and Travis County on their
individual tax rates. The other thing that is being -- that I don't want to
be misunderstood because when you see rates like 15, 18, 20 cents in some
of these other counties, there is a tremendous difference in the average appraised
values of homes in Travis County versus those other places. And they are averaged
appraised values range tprad the -- ranged from the high 80s to $120,000 to
their typical appraised value which then if you apply a 15, 20, 25-cent tax
rate, it is a much different number than if you were applying that same 20-cent
to the average appraised value in Travis County which we all know is in the
$167,000 range and is rapidly shooting up. A lot of folks might be put off
could they put a 15, 20-cent rate. The reality is we are talking about very
different financial situations going on in those districts. The other thing
that needs to be talked about is that some of those districts have plugged
in different kinds of expenditures. I think we've learned that is it none
or -- I guesses none have a children's hospital in their health care district.
But bexar county has a different set of things they pay for than, say, harris
county. There is not one model about what's in and what's out. I don't want
these numbers be thrown around of 5 cents, 1 cent, whatever, that somehow
we're talking apples and oranges in terpbls whaf are the meanings of those
kind of things and what it would impact of lowering somebody's property tax
rate and overlaying what may or may not occur with the hospital district and
there would still be remaining responsibilities and expenditures for both
the city of Austin and Travis County regardless of whether this district is
formed or not.
>> did we give the other committee members opportunity to
give comments?
>> commissioner, that's a very good point you make in records
to the 5 cents and the 6 cents t. Latest statute currently exists in the way
we've structured it is whatever money is being spent. And it's easier to say
it's 5 or 6, and that money goes over and we would assume that the hospital
district would have that 6 cents as its rate. We would also assume that whatever
that penny in the county and the city, they would lower their tax rates by
that. And it's the a very good point about this 20 cents. It would never need
to be 20 cents because of the property values, if it ever. But at the same
time, we're not discussing how much the rate ought to be. We think whatever
money comes over, obviously the second year you would think that you would
need that, so we're talking about the minimum. And, you know, I don't even
foresee any tax rate increase for a while because, frankly, if we doubled
the tax in the very first year, people wouldn't be able to spend it, they
wouldn't know how to spend it. It takes too much time to sort it all out and
get a plan. The general idea would be to do that and the accountability --
appoint these people for terms that are staggered.
>> judge, I would like to introduce my friend and colleague
lowell leverman who is vice chair and has just joined us. Would you want to
make a comment?
>> no, I really don't have a comment. Grateful to be the
opportunity to be here to discuss this. I will say this, clark, that the committee
has worked very hard to get to this point.
>> we'll need you on that mike to -- [multiple voices]
>> Travis County fans will be able to hear you.
>> I understand. The steering committee and the committees
a that make it up have worked very hard to get to this point. It's a very
complicated issue. Commissioner Davis has asked very rel vent questions, questions
that have got to be answer to do the satisfaction of the citizens of our county
and the counties adjoining us. Actually, let's face it, brackenridge hospital
and the trauma care service that it and the other general hospitals in town
provide is really extended over a 13-county area. So the four or five-county
area that we're talking about are the principal users, but it extends beyond
that. We have felt and have long felt, years ago before you were born, I served
on the Austin city council. And I did that for six cheerful years. And I will
say that the council, even at that time, was understanding very well that
we were supplying medical services to counties that were not participating
in the cost of those services in any way. And in fact, at one pointed I was
dispatched by my colleagues on the council to visit with various county judges
and other city and county officials in the surrounding counties. My best memory
from the early and middle '70s is that I was given a one-way ticket back to
Travis County, Texas. [laughter] and without any positive response at all
or any sense that there was any obligation from the out lying counties. I
think that's changing over time, most assuredly it is, and the t.a.c. Committee
put in place by the former mayor of Austin has worked hard with the officials
of the surrounding counties and other experts to come forward with a regional
plan. And it's going to be a good one. They are not all the way there yet
at all, but it has raised, I think, the profile of the need for our joint
efforts in terms of health care, trauma care, indigent care, those things
that we're obligated to do. The money must come from somewhere. The governance
must come from somewhere, and the appointed governmental panel is important
because, let's face it, frequently people who are best equipped and best qualified
to run very refined and very distinct styles of organizations are not necessarily
electable. And so that's why appointing the wisest, the best qualified among
us to do these things is a matter of high urgency. I would urge the commissioners
court to work on that as promptly as possible so that we can be prepared to
go to the state legislature with this excellent -- with this excellent work
that david and the committee have done. And they have done yeoman's service.
We have met with our legislative delegation at least once as a group, and
it was a very, very satisfactory meeting. There was a tremendous sympathy
for the obvious need for what we were about and a tremendous sense of urgency
about getting it done for us at the statehouse. So we were greatly encouraged,
weren't we, david, by their response, their recommendations and suggestions.
>> yes, I thought that that was -- in fact, everybody was
very enthusiastic about it.
>> they were indeed. So thank you each of you for hearing
us and we very much appreciate your urgent attention to the matters before
us here. Because we are -- it's time and past time since the early '70s that
we get this job done as other metropolitan counties have around our state.
So thank you for permitting me to visit with you.
>> thank you.
>> I have just a few quick questions. How do we determine
that application of the same tax rate county-wide, I guess, would yield an
additional $6 million?
>> this was the finance committee that did that work. I think
it's just an extension of that tax rate on the broader tax base, on the difference
between the tax base, the county-wide tax base and only that tax base that's
in the springfield.
>> okay. Is that reduced to a, I guess, writing in a little
piece of paper that could be shared with us?
>> it is. It might be 5.986 or some number like that. I mean,
gary, I think --
>> we can certainly get to you the work that's been done
to date. I think it's very important to understand that that's very preliminary
work and that it would be very premature for us to project at this point what
the tax rate would be. And while I think there's going to be a lot of work
on that in terms of us thinking about different ways to address the current
situation and how much did that cost and what kind of tax rate is required
to do that, and asking the electorate would they be prepared to do that. I
think the way you've got to look at this is on the long term, which is over
the long term, there is going to be a cost of addressing trauma and emergency
care and indigent care and the behavioral health issues that are before us.
There's no question about it. It's going to have to be met whether it's met
by the county and the city or the out lying counties separately and they all
try to get together at different times in different ways with different tax
rates and build some scheme that looks like page 54 of our consult's report,
which is very difficult to understand; or whether you try to do it all through
one entity that's transparent where you see what the cost is and everybody
who is benefitting from it pays the same tax rate across the board.
>> I understand.
>> and building a structure here that does that is the key
point.
>> I understand and I won't hold you to it. But is there
draft legislation -- I know there would be holes in it, but can you share
that with us?
>> yes, judge, I would be glad to give it to you.
>> okay. Have we discussed whether city of Austin, the proposal
of [inaudible] for the city, for the county, we appoint two together?
>> we have -- we're actually going before them tomorrow in
a work session, but that has been discussed with them and we don't have any
confirmation what the council would do.
>> that was also what came out of not from the council but
a council subcommittee has requested that we consider that.
>> so they have not formally rejected my suggestion of one
for the county and one for the city? [laughter]
>> respectfully. [laughter]
>> but on that same vein, if we're talking about equal partnerships
and people feeling like there's not something stacked against them, why wouldn't
we be looking at three Travis County, three city of Austin, and three consensus?
>> well, we're not here to advocate for any particular one.
>> but you were asking for our input, and I think judge Biscoe's
suggestion was interesting, but I'm just -- I'm reversing the roles here of
the sense activities we heard related to the r.m.a. Discussion about somebody
feeling like they had an upper hand. If we wanted to eliminate that, why wouldn't
you say it's equal, three, three, three.
>> you mean city and county to let you know that by when?
>> obviously we're trying to wrap up the legislation so that
we can, you know, get with the delegation as soon as possible.
>> it is now the legislative council sitting there essentially
waiting.
>> by 5:00 next Tuesday?
>> that would be great.
>> that would give us a chance to discuss it at the next
meeting.
>> we would greatly appreciate.
>> .
>> we would indeed.
>> there are alternatives, commissioners, three, three, three,
four, four, one, four, three, two. All of those. But we need to get somewhere
on that, a decision both by the city and the county so that the legislature
saying what are those numbers.
>> I understand. Anything further today?
>> I just had one -- I guess we're going to tkwoeupb -- we've
been talking health care and i've listened carefully and I hear health care,
eupbd general seu. Does that satisfy you that this includes the mental heart
part as -- mental health part?
>> the pheupbl health -- mental health care system is probably
-- probably underestimating indigent. One of the things the doctors and people
that work at brackenridge, psychiatrists, everybody involved said that's a
major missing piece in this community, alcohol and drug -- chemical dependency
and mental health, mental melt being number one. It's just not there. It would
address the issue. That is a very serious issue. I can tell you last Wednesday
we had a meeting with the state hospital and they said we were on drive-by,
which means you can't take anybody there for children. All children will either
go to el paso or wichita falls. And within two or three days, we're probably
going to drive by the adults. And that's the kind of problems that we're having
on the mental health side. But the trauma center, emergency centers, you know,
you can't separate those out from me with insurance and those without insurance
or underinsured. They all need to be there. Because we've had situations in
the last few months, and you all have read about them, where the helicopter
had to take someone down to san antonio or somewhere else because we either
didn't have the room or didn't have the doctors available. And some of that
is a money issue. And they are on the verge, I keep hearing out of the emergency
room, we're almost ready to close this place down, we have a large accident
with four or five cars. So it would address my issues.
>> okay. I'm also glad to see dr. Crocker, who is in the
emergency room, talk about the people who don't belong in the emergency room.
They belong somewhere else, you know, so their needs will be taken care of.
>> we need an urgent care center to divert some. And I think
I saw on the health care committee that might divert 10 to 15 piers in el
paso, the hospital district is essentially set up, urgent care centers across
the street from the emergency room. It costs about 350 to $500 for a child
ear infection to go into the emergency room, 40 bucks to go to the urgent
care center. Plus, you don't have to wait seven hours.
>> right.
>> and saves everybody money, it's better health care. But
in order to do that, you really have to have somebody, a rational system that
somebody is in charge. That's where the hospital -- because you can make that
decision and fund it.
>> okay.
>> we'll have another discussion real soon.
>> thank you.
>> thank you all very much.
>> a couple of details, your honor, one is is that I'm going
to be forward forwarding to you this afternoon suggested [inaudible] for the
initial phase of this along with the request for funding. I assure you we'll
not be asking the county to pay more than the city. We would appreciate your
taking a look at that, and we also -- the steering committee has decided that
it thinks it would be wise to add to its ranks some people that would make
us more representative. And we're putting together a list of those folks and
since you and the mayor appointed that group she we thought it would be appropriate
that we submit to you for consideration the other folks that we would like
you to think about and we'll get that to you. We would appreciate your letting
us now your thoughts. Thank you very much for letting us come.
>> thank you all very much. Appreciate you coming by. All
in favor? That passes by unanimous vote. Commissioners Moore and Davis absent.
Last Modified: Wednesday, April 2, 2003 10:25 AM