You are here: Home >> Leander-Cedar Park >> Local News >> Health care in a growing county

Health care in a growing county

Attention: open in a new window.

Written by Kara Vaught Friday, 18 July 2008

Property taxes an option to fund care for indigent, needy residents

In 2004, Travis County voters approved the creation of a taxing authority known as a hospital district to provide health services to uninsured and underinsured residents.

By a quirk of semantics, it was later named the Travis County Healthcare District.

At the time, the creation of a hospital district that would serve multiple Central Texas counties was considered, but the single-county strategy prevailed. Some involved in that effort now work in Williamson County healthcare settings, and the idea of a hospital district here is being informally discussed.

What is a hospital district?

As defined by Chapter 281 of the Texas Health and Safety Code, a hospital district is an entity with the ability to levy property taxes to establish a hospital or hospital system to furnish medical aid and hospital care to indigent and needy persons residing in the district.

The law obligates such facilities to serve people at or below 21 percent of the Federal Poverty Level, a ridiculously low standard, said Christie Garbe, chief communications officer of the Travis County Healthcare District. TCHD chooses to provide varying levels of services to residents making up to 200 percent of the poverty level.

The most recent United States Census Bureau poverty statistics for Williamson County indicate that 19,663 residents — 6 percent of the county — were living in poverty in 2005. For that year, the poverty threshold for a family of two parents and two children was $21,027. For a single person younger than 65, the level was $13,884, and for a single person older than 65, the level was $12,533.

Williamson County fares better than the state average of residents living in poverty, which was 17.5 percent in 2005, according to the census bureau, and better than Travis County’s 15.5 percent.

Too wealthy to worry

Williamson County’s relative affluence combined with the area’s strong conservative foundation would make creating a hospital district here a hard sell, said Mark Hazelwood, president and CEO of Seton Medical Center Williamson.

He was involved in advocacy and communication efforts for Travis County’s hospital district before voters approved it.

“Up here, one of the big challenges we have is for people to appreciate that this is an issue we need to start working on,” Hazelwood said. “There’s an assumption that all these new hospitals will take care of the problem, and, in fact, they probably will help alleviate the problem in the near term, but in the long term, this is going to be a real issue.”

Ernie Bovio, CEO of Scott & White University Medical Campus Hospital, said that while a hospital district could be part of the solution to what is going to become a growing concern for the county, the current demographic is such that the concept is not on the public’s radar. Quote from Mark Hazelwood

Bootstraps, not taxes

If it was on the radar, Hazelwood said, residents would likely not take to the idea of creating another taxing authority.

“It’s going to get them into discussions of, ‘Why should I have to pay for somebody else?’ although there’s a lot of people up here who are very generous, and this is a very faith-oriented area. This area is viewed as so fiscally conservative, but faith-based people give [charitably], on average, more than non-faith-based people.”

Another thing that may sour voters on paying a tax to fund indigent health care is that in Texas, 80 percent of uninsured people have jobs, and of that number, 80 percent have insurance available to them that they choose not to take, Hazelwood said.

“That doesn’t square very well with people who think philosophically that you need to be more self-reliant and step up and be more accountable for taking care of yourself.”

In 2005, the Texas Data Center estimated 59,020 — 17.7 percent — of Williamson County residents were uninsured.

The bottom line, Bovio said, is that taxpayers are already funding indigent care through their insurance premiums.

“Would [a hospital district] benefit the hospital? Yes, ultimately I think it would help close the gap that exists. Specialty care and hospital care is not funded through federally qualified health centers,” Bovio said.

What are FQHCs?

In 2004, the Lone Star Circle of Care applied for and was granted federally qualified health center, or FQHC, status to serve Williamson County, which at the time was designated as a medically underserved area. Once granted, an organization retains its status as an FQHC regardless of changes in the number of healthcare providers.

LSCC provides primary care as well as dental, psychiatric and women’s services through its clinics, which are located on the eastern side of the county. Through its designation as an FQHC, Lone Star receives a higher reimbursement rate from the government for the Medicare and Medicaid patients it serves than a hospital or physician lacking the designation. In return, an FQHC agrees to focus its efforts on serving the under- and uninsured population.

Pete Perialas, who was involved in the marketing of Travis County’s hospital district, is now CEO of Lone Star. He said his organization would be an ideal implementer of a Williamson County hospital district.

“We would be the core provider of primary care services. We would not just have 9-to-5 clinics. We would have clinics open seven days a week for 12 to 14 hours a day so that people who needed [basic care] would have some place to go other than the emergency room.”

Competitive care?

With five hospitals now located in Williamson County, it is possible those healthcare providers might see a hospital district as extra competition, Perialas said.

“Though it’s not optimal to have someone in your ER who just needs [basic care], hospitals have sort of evolved this dysfunctional economic model that accounts for that. They will need to know that a hospital district is permanent before they will let go of that model. The only thing worse than having someone come into the ER that only needs hydration is having nobody come in.”

The reality of the hospital industry, said Alfred Knight, president and CEO of Scott & White Hospital System, is that it takes between three and five years for a new hospital to become profitable. Three of the five hospitals in Williamson County are less than three years old.

“The bottom line,” said Dr. David Klein, CEO of Cedar Park Regional Medical Center, “is that we would be for anything that improves the health of the community.”

Williamson County and Cities Health District

Williamson County has an existing health district. Though the name is similar to Travis County’s Healthcare District, the function is different. First organized as the Williamson County Health Department in 1943, it was reformatted into its current state as a health district in 1989.

A health district is a government entity funded by member cities, Texas Department of State Health Services contracts, client fees, Medicaid and Children’s Health Insurance Program reimbursement, grants, contracts and contributions.

Member cities include Cedar Park, Georgetown, Round Rock and Taylor. Though Leander is not a member city, it does contribute some funds.

The focus of a health district is on the health of the community at large more than on individuals, said Dr. James Morgan, director of Williamson County’s health district.

“WCCHD focuses on population health, and it is our goal to support community providers in being able to meet the demand for personal medical care services. We serve in a very limited ‘safety net’ role in providing health care for individuals,” Morgan said.

In the past, health districts played a larger healthcare safety net role, but now those services are provided by federally qualified health centers and hospital districts.

“We try not to duplicate any services in the community that have a funding source,” Morgan said. “The main area where you could look at and say there is duplication is immunizations.”

WCCHD continues to provide immunizations because some physicians are wary of stocking expensive vaccines, choosing instead to refer patients to the health district.

“Our part in the ‘big picture’ is to assist the county in providing support and help to people in need of medical care services, to monitor the collective health of the communities we serve, to provide information on health to communities and individuals and to assist the county and cities in assuring conditions under which people can live safe and healthy lives,” Morgan said.

In addition to health services, the WCCHD provides: