Travis County Commssioners Court
November 26, 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 A1
A1 is to discuss, approve, take appropriate action regarding funding matters and take appropriate be. We don't have that request for funding. We have basically a letter with the amount to be used. We talked last time about the makeup of the -- and the committee [ inaudible ]
>> the other thing is that we would commit to the city of Austin of who would reside in the city of Austin. And typically we make our appointments, I don't know if we go out of the way to go outside the city of Austin. That didn't strike me as being unreasonable.
>> very reasonable.
>> if you look at the population of the city of Austin and its percent of Travis County. I did indicate to them that I would bring that to the court after chatting with commissioner son night looitner.
>> actually, the recommendation we had last week of how about three-three, three, puts people off dead center and all of a is sudden, four-four-one makes a lot of sense. I would put that in the form of a motion that this court officially endorse the idea that on the hospital board makeup that it would be four Travis County appointments, four city of Austin appointments, one consensus appointment with two of the Travis County appointments being city of Austin residents.
>> if it materializes.
>> if it gets to that point.
>> they're talking about doing a feasibility study right now. My hope is in addition nad to the hospital district, if they see other actions we ought to take to improve the health care costs that we would get those relations recommendations too. Until a study is done, there must be six or seven committees working on it, and every time the big committee meets we talk about expanding it to include more. There are elected officials, citizens, people from the health care area, advocates, and I think they're trying to get some consumers to provide input also.
>> there's even being talked about that this draft legislation is something that you get the enabling legislation passed during this session, but it wouldn't necessarily be one where the trigger gets pulled, if indeed that feasibility study comes back and says not at this time, but I think there's a great desire to get the legislation piece accomplished so that at whatever point in the future it is appropriate that at least that piece of it, otherwise you have to wait every two years to be able to go to the legislature and get something that happened there. So at least it would prepare the area for a hospital district, but leave totally open as to when the voters might have that proposition placed before them. There is no presumption that it would be November, although it could be. But there's work to be done no matter when a trigger gets pulled.
>> the main issue that they addressed last week for y'all was the idea of what the board's obligation should be in terms of numbers. The two competing interests were four city, four county, one joint appointment city and county and then a proposal out of the subcommittee and the city council of four-three-two. But in the interim of the last meeting, some discussions I understand between some members of the taskforce and the city council, the recommendation had come back what about four-four-one, four city, four county and one joint. But out of the four county appointments, two of those -- all of those four would still be county appointments, but a condition of understanding from the county that out of the four appointees, two of them would reside within the city limits. So that's what's before you at that point. I attended a meeting this morning with the legislative commission, and a few other issues that they wanted you to consider. And i'll run through those. Something that continually seems to crop up is the idea of what is the outcome of one, the county clinics, and two, starflight. I had understood when we initiated all of this that starflight was not to be included, but it keeps cropping up, and they asked me to ask commissioners court is what's your position is with both of those currently. Thirdly, there was concern last week -- two concerns. One was the idea of the board being elected or appointed. Secondly, I think they had the concern regarding dissolution -- I don't want to call it sunset, but some kind of a process where it's relooked at. And what the legislative committee was suggesting to consider, one, was to create -- there was also a concern, and I need to talk to the city and the public, the concern of an appointed board making decisions about tax increases. And that maybe that's more -- something for an elected. Even though there's not a constitutional issue, there is a legal issue and you can find that throughout state and local government. But the recommendation I think they're asking for you to consider is a creation above the board, the appointed board of a super board, which would be composed of two county elected officials, two city elected officials, and if any other counties get involved, one, one and one. And that super board would only have these two powers at this point. One, veto authority over any tabs increase voted on -- tax increase voted on by the hospital board. In other words, they could veto, should the board approve a tax increase. And two, dissolution. It's always been in the legislation, the petition process for dissolution, but also to grant that super board the authority on a majority vote to -- that's what they discussed, majority. I'm not sure if they would go to majority or super majority. Out bu some majority of that board of officials to call an election to determine whether the continuation or not of the hospital district. Those are the issues that have come up to this day that they would like for you to consider. If you want to go through them one at a time, I can answer any questions.
>> first of all, the elected, those are my concerns. I think that they should have enough accountability with that, which seems to me that they should be elected. Now, I guess my question is that -- there is under 286 ways that a person can be elected to a board. If that's the case, then -- it's not suggested, but to create another tier that you have board members appointed by the city and the county, and at this tier you have two elected officials from the city and also the county at this level to kind of oversee this and have the authority to override anything that they do that's not acceptable and then ask them to be able to have the limitations. My whole point is since you have the elected officials as board members and the whole -- I think in my mind it's the proper way to go. Now, I don't see any other way. There's a lot of educational things coming out. Tell me how many hospital districts in the state of Texas operate in the black right now. Right now I don't know if there are any. I think it needs to be put before the voters educationwise to let them know what's going on, the feasibility and what it's going to actually cost. I think that the city's ability, the feasibility -- it's a lot of education that need to be understood. And I understand this is going before the legislature.
>> let me walk through the process. First you need the enabling legislation that would authorize the creation process and the legislation is now following a model of a kind of morphing of 281 and 286, would be the process where an election would be called in Travis County, and the district could not be created until that election -- the result of that election were successful. So there would be that education process, and there were members of the taskforce, as I understand, that are working with that function of their committee. I've been on the legislation more, but their function is to be prepared for that education national process. But yes, all routes, whether it be 281, 286 or this hybrid that they're now on would still require an election of the populous before a district could be created.
>> so I guess my concern, though, is that what we're looking at now -- and I guess it's looking at maybe the enabling legislation that hopefully they're going to take up this time, I guess, as far as the board appointment is something that would be suggested to the legislature for them to consider. And that even in that format -- [ inaudible ] now, my whole point, exactly what I said, I think that in my mind I would say that we see whatever happens, whatever comes before the voters, I would feel more comfortable going to the voters than the persons elected. -- [one moment, please, for change in captioners]
>> and the residency --
>> non-elected officials and with the residency stipulation. Two of the counties being residents of the city of Austin.
>> and judge, by voting for this, it doesn't mean that everything is set in concrete.
>> not at all.
>> we are just moving the process ahead. I'm not for or against this. Just moving the process ahead.
>> I think we all make that same [multiple voices]
>> I will ask the attorney for a legal opinion on that statement. Because I think if we vote on this today, we are saying, look, state legislature here we are, this is the way we would like to see the am pointed board structured -- appointed board structured. Is that etched in stone.
>> this isn't a -- this is not a statutory position that you are in or statutory vote that's called for. What's happening is is -- there is some legislation. Anyone can get a sponsor and file as many pieces of legislation on this hospital district. But the task force that's moving forward is proposing to have filed in the legislature very soon some legislation that would call for this process for the hospital district. In it, they are proposing to put in 441, as we have just discussed, the court can frame it any way they would like it. If it's going to be an appointed board, this is what we would prefer, but reserving the rights, as it goes through the legislative process, to make its, you know, particularly well known and to work with the legislature on what it should ultimately be.
>> but as far as this particular issue is concerned, as far as what the commissioners court and also the city of Austin are going to do, for -- what I'm saying is that once we -- well, the month goes has already been made, this is the reporter for the task force to too it to the legislature --
>> all that happens is a bill gets filed, which is wide open for anything to happen from then to --
>> right. [multiple voices] but from here is where it starts.
>> that's true.
>> that's what I'm saying.
>> it's starting before this.
>> as far as this motion, the appointment of the board members from us, whatever we do here today, my position is still that I think that elected officials, if -- if the voters ever approve the district, I don't know if they will or not, nobody knows that right now. But my position is that these persons should be elected if they are going to have a possibility of --
>> commissioner --
>> why don't you make that in the form of a substitute motion.
>> I will.
>> then we can kind of see where --
>> did anybody second commissioner Sonleitner's motion.
>> yes, judge Biscoe.
>> well, I will make a substitute motion that the nine members four appointed by the -- by Travis County and four appointed by the city of Austin and one -- one that will be appointed by Travis County, these nine positions, I think that should be an elected position, not appointed. They should be voted on by the citizens of Travis County.
>> I will second it.
>> let me -- can I ask a question?
>> we need to have a full discussion of that motion, yeah.
>> okay. Well, I will -- full discussion, that's fine.
>> I think, commissioner, that I do understand your apprehension on this because I mean we have all witnessed things you know, gaining some momentum, before you know it something gets put in motion and you didn't really get to do what you wanted to do. I realize that that is your -- and I have a little bit of apprehension with that, too, because we have all, you know, witnessed those kind of things. But as I understand this, what this rule is, basically putting in motion the fact that we want a bill filed, given that we are all -- I think we are all in agreement that we do want to look at a hospital district if this community passes it. The specifics about it are something that we will all really be able to bring back because I share some of the same concerns that you do, commissioner Davis.
>> and I understand commissioner daugherty for that. But what I'm trying to say is that if the bill is filed, in other words, what we are doing is to be filed, under what we are doing in there, so -- so my whole disposition on that, if we -- whichever way this voting as far as the way the board members ought to be selected, is the [inaudible] and information that be used in the bill.
>> let me see if I can explain it this way, commissioners. There's not a requirement that a vote be taken. They can go -- they can go file this bill without any vote of this commissioners court. But of course it's all in the process of collaboration and trying to get as many sides, vision attributed to and respected. In moving forward they are more worried for the time. It's open to the commissioners court to decide as they will. They can say for right now for purposes of moving the bill forward, we don't object, four for one is one viable option. But we reserve the right as we go through and learn more about how this is going to be set up to say we prefer a different model. That's not to say it will change because by the time it gets to the legislature it's not in your hands. It's in the legislature's hands they will decide what the wisdom is. If you said no, if you take a vote that you support an election, there's not any requirement that they change that. If the city says one, you say the other, we are still back where we were. Just trying to reach some collaboration in time to get the bill moving forward.
>> see, my point is, what I'm hearing from folks in the community as far as taxes is concerned is too much taxes. They say we are here, we have looked at this process, we have looked at this situation, and here is another tax identity on top of Texas'. And of course I asked the question, what hospital district in the state of Texas are operating in the black right now. I don't have an answer to that right now.
>> I don't know.
>> right, but I do hear there are a lot of them operating in the red. And they do have taxing authority. Now, I don't know, there's a lot of education and discussings things, still haven't been said. So in my opinion I feel that we should go with -- if the voters want to go with the hospital district, let them also, let the legislature know that we are looking at persons to be serving on board as elected officials. Of course I'm quite sure that the board will have an executive manager. Executive director. A lot of other stuff. But --
>> to be fair, just, there was -- there's not been a vote to my knowledge, in at least my legislative committee, whatever the collaborative process and consensus reaches. What I can remember discussions coming from various parties that are -- that work with hospital districts around the state, I don't, but their concern warks of course, the people that they want to attract on board or, you know, health care professionals, business professionals. There was a concern, I think, voiced by these members that -- that -- that professional experience might be more difficult to obtain if -- if it can only be obtained through an election. That's the -- I'm not ratification that thought or -- I'm saying that just to report to you what I think some of the discussion, some of the mentality is behind what they are recommending. But I think either way the court goes will -- [inaudible] [multiple voices]
>> in terms of elected or not, I think if we look at what do other large urban counties do, it is an appointed board, not an elected board. Elections are not inexpensive. And this would be a county-wide election. It's, I think, the cost now is about $300,000 to do a county-wide election. That is one more expense that this district, if indeed it comes about, would have to bear. Would we then talk about these like are these county cash wide slots are are you talking single member districts. To me it's kind of like where we are with the r.m.a. For whatever reason, it turned out this way, the authority is being vested in counties to make their best decisions about the kinds of qualified professionals to sit on a very important board that will make fiduciary decisions and I certainly am looking for at least when this thing starts, I guess that's a question for you, david, is there a thing that this could be converted to an elected board at some point in the future? Because certainly I think getting it started up, I think the city and the county would want to know that the people who -- who are having this power vested in them are people that would be -- I will use the word hand picked as being absolutely qualified professionals for this particular thing. I know that on the school board, good god, we have to beg people for one of the most important jobs that we have got in this community, we have to beg people to run for school board. It is a very expensive matter for somebody to run in a school district, which is actually not even close to the size. And I think they are lucky to get a 5% voter turnout. I know that in terms of looking at some of the transit boards, denver had this experience when they thought about appointed versus elected, when they went to elected a lot of seats were filled by unit representatives because they had a vested interest on wanting to get on that metro board. That wasn't necessarily good for the board, they were also struggling with issues such as single member districts and trying to get people to even care about running for something that important. We certainly, right now, appoint people, maybe related to the emergency service districts, again people that we try to vet as being people that will have the good sense about taxing people. I know there is a limit as to how much they can tax that's set under the health and safety code at 10 cents. They can't go over 10 cents, but that is not a small amount of mope and there's legislation -- of money and there's legislation being talked about to up that to 20 cents, which almost gets you into the category of where they are talking about this hospital district. I personally think that there is a lot more to say about this being at least at the beginning an appointed board so that the city and county could have a certain measure of control that qualified professionals have been recruited to be on this board of utmost importance. I will go where david went before. This is just us trying to winnow down the number of issues that are still out there. Not by any means the signing off of anything related to this process. Just trying to narrow down what else we need to accomplish. And when we finish off this piece, I do have a couple of comments related to the e.m.s. Question that was raised.
>> well, then I withdraw my second. To the substitute motion.
>> this can be a full-time job here if you do it right. The other thing I think it would be good for people with a little bit more health care background, willing to serve --
>> oh, yeah.
>> without compensation. The other thing is I'm sitting here thinking, I don't know what recommendation would come from the committee, seems to had he that it's 50/50 that the recommendation would be that it's -- that the hospital district is not necessarily better than other places, so we ought not to go there.
>> right.
>> right now the law is that you indicate the maximum tax rate, which is 75 cents, right.
>> that's right. .> That's higher than travis higher the city of Austin's.
>> yeah.
>> if the law requires you to put that in there, it's going to frighten off a whole lot more people than it's going to attract. The other thing is I do agree with the sentiment that the average resident is not -- does not favorably view another taxing entity and so I think that this is an uphill battle at the same time. Nobody is suggesting that our health care system now is in good shape. Everything thinks that they could do a whole lot better. It could be that we do a whole lot better with the hospital district. It could be that we won't. The committees if not a hospital district what else that may be better than what we have in place right now. It would be good for us to have those recommendations. What I like about the effort is that we do have 50 or 60 people with good minds and interest in this area who are diligent my working -- dill gently working, I don't know that we've had that before in this community on this subject. That's the good news. The other thing is probably we could come up with as many advantages and elected officials serving as non-elected officials. But I think in terms of just time, non-elected and expertise, non-elected, but -- [inaudible] it. Anyway, with the seconded substitute.
>> I withdraw that.
>> the substitute motion dies for a lack of a second. The original motion is for non-elected officials to do the 441 with the stipulation that on the Travis County four, two would reside in the city of Austin.
>> yes, sir.
>> any more discussion of that motion?
>> yes. I would just like to say that I guess it could still work the same way. That the non-appointed positions could also maybe be converted later into an elected position, but I guess that also the trend could also be reversed of that. I guess, you know, I really don't understand -- I guess the -- the aspects of -- of the -- especially when you come to the taxing situation. I just really am going to continue to stand firm on -- on persons that's good to be able toable to the -- to be accountable to the persons here in Travis County. And of course there would be -- there would be a lot of other things that I'm discussing, we are talking about a 13 county area that we will be working at as far as a lot of medical services coming into Travis County. So, know, a lot of things have been fleshed out, who is going to pay in the cost sharing, is Travis County going to have to solve everything for everybody all in the whole region or the share of costs will be demonstrated. It just a lot of unanswered questions. I know we are trying to move things along. However, for the sake of having persons elected instead of appointed, I'm going to have to just -- commissioner Gomez you withdrew your second on my substitute.
>> yes, sir.
>> okay. So --
>> any more discussion? All in favor of the motion? Show commissioners Sonleitner, Gomez, daugherty and yours truly voting in favor. Voting against --
>> I'm not voting against. I'm abstaining I guess for the sake of having to ensure that the elected officials I think should be in this position of an appointed officials. Because of their responsibility. I think to the to the taxpayers out there. If these folks is going to levee taxes, I think the position would be an elected position, I'm abstaining based on that.
>> commissioner, I will stand pat with you. Once it gets time to discuss that. I think that is a good thing to write up. It's certainly worth the talk. So I understand, you know, where your feelings are coming from on that.
>> as I do. As well.
>> yeah. Again, we are just trying to narrow some of these topics, it may be by the time we finish with everything that gets brought forward, all of us may be going this isn't working for us, but again we are trying to narrow things and move forward.
>> I suggest that we -- that our response to the star flight matter be that at the appropriate time we will let them know. Seems to me if the appropriate time would be when we look at all of the other assets that ought to be transferred to the hospital district if one is about to be created. On the super board, if that is supposed to go into the legislation, we can have it on the agenda next week.
>> okay.
>> have we had a chance to think about it? Short paragraph that indicates exactly what it is they are recommending.
>> I will work on that.
>> and why.
>> actually I just got that at noon today. I will work on that. Let me add, though, it was the clinics as well. If I understand the current legislation, the clinics, north star flight are in the clinics are -- it's permissive if the county agrees, the clinics can go in. I think star flight is not in whatsoever. That would be the issue one whether you put star flight in permissive, then still takes that vote later as you were talking judge, when we talk about what assets go in, if you move even further over decide now if something goes in fully.
>> again, just to be thinking about for next week, about -- about the star flight piece. Right now, Austin Travis County e.m.s. Is a combined system and it's working and star flight is already being taxed on a county-wide basis, you all. There's nothing broke here. Aim afraid some of the folks that are trying to have star flight brought into us, it's brought -- they are hoping to use that as a weapon to beat other counties over the head, come into the hospital district or we are going to take star flight away from you. Some of those folks are not truly aware of what is the taxing capability around some of those surrounding counties. Yeah, there are 13 surrounding counties, but the number of people getting access to star flight and who really have money to bring to the table, Travis County is 812,000 people. Next largest is Williamson county at 250. The next largest county in this region is hays county, they only have 98,000 people. Next is bastrop, they are at about 50, 58,000 people. And dear little caldwell is at 38,000 people. Round Rock today is bigger than all of caldwell county. So there's not that much taxable value out there. They are also not super overreaching in terms of the amount of service and as we already know about star flight, they are some limits related to medicaid and medicare about what are the maximum dollars that we can recover anyway from a lot of those flights. Second thing is related to the county clinics. I think we already went through a long, painful process related to the county clinics. It may not be that the interests of city of Austin and Travis County are one in the same related to the clinics. When we went through this before, their way of dealing with the combined county, it's gee it is not cost effective to have the Travis County clinics. They are the ones that ought to be eliminated which totally abdicated the responsibilities of Travis County to deal with those areas out there. I personally think that the responsibility related to the city and county clinics ought to be left to those individual governing entities to figure out what is best for their constituencies and their mandated duties under the local government code. Again we are also talking about some very innovative things with the [inaudible] administration, I certainly don't want the hospital district to preclude what may be a very innovative way for us to resolve Travis County's very specific issues related to the county clinics. Which may or may not be the same as the city of Austin in relation to their clinics. I want to respect the fact that they need to do what they need to do. I would hope that we need to do what we need to do.
Last Modified: Wednesday, April 2, 2003 10:25 AM