I spent an unreasonable amount of time this weekend reading Texas healthcare statutes because apparently this is who I am now.
And after digging into the proposed Hays County Hospital District, I came away with one question that Commissioners Court can actually begin answering right now:
What would it cost Hays County to help more people using the healthcare program we already have?
If you missed the full explainer, start there:
[READ: Does Hays County Need a Hospital District? We’re Asking the Wrong Question.]
Here’s the short version:
Hays County already operates a County Indigent Health Care Program under Chapter 61 of the Texas Health & Safety Code.
Its published income eligibility threshold is currently below 21% of the federal poverty level.
That is extraordinarily restrictive.
But that number is not handed down from God.
Texas law allows Commissioners Court to adopt less restrictive eligibility standards. The county can also appropriate more money to healthcare and has considerable authority under Chapter 61 to arrange healthcare for eligible residents.
Which brings us to something happening right now.
Hays County is writing its next budget.
The official FY2027 budget calendar shows Commissioners Court has been conducting its August budget workshops, with a public hearing on the proposed budget scheduled for Tuesday, August 25.
So let’s give them some homework.
Instead of arguing abstractly about whether Hays County needs a hospital district, I want Commissioners Court to tell us:
What would happen if we simply helped more people through the program we already have?
Run the numbers at 50% FPL.
Run them at 100%.
Run them at 138%.
Run them at 200%.
Tell us how many additional Hays County residents could qualify.
Tell us what it would cost.
Tell us what healthcare we could provide.
Then put those numbers next to the proposed hospital district and let us compare them.
Maybe expanding the county program is dramatically cheaper.
Maybe it isn’t.
Maybe a hospital district can leverage state and federal funding in ways that make it a much better investment.
Maybe we discover that a properly designed hospital district is exactly what Hays County needs.
I don’t know yet.
That’s the fucking point.
Before everybody picks a political team, make the government show us the options.
You can ask Commissioners Court yourself.
And you don’t have to take Tuesday off work and sit in Commissioners Court to do it.
Hays County allows residents who cannot attend to submit written public comment by email to the County Clerk at publiccomments@hayscountytx.gov. According to the county’s public-comment rules, emailed comments must be received by 11:59 p.m. the day before the meeting to be read aloud during Court.
Your submission needs to include your name, address and phone number, and you should identify whether it is general public comment or relates to a particular agenda item.
Hays County’s official public-comment instructions
Don’t know what to say? Steal this.
Change it. Shorten it. Make it nicer. Make it meaner. Add your own questions. Just make it yours.
Subject: Public Comment — Hays County Healthcare Funding & Eligibility
To: publiccomments@hayscountytx.gov
Name: [Your full name]
Address: [Your address]
Phone: [Your phone number]
General Public CommentCommissioners,
I am asking Commissioners Court to publicly evaluate expanding Hays County’s existing County Indigent Health Care Program as part of the current healthcare and budget discussion.
Before Hays County asks voters to create a hospital district with its own dedicated property-tax revenue, residents deserve a meaningful comparison of what the County can accomplish using the healthcare authority and funding structure it already has versus what would become possible through the proposed district.
Please ask County staff to run two sets of numbers.
First, estimate the additional annual cost, projected enrollment and services available if Hays County expanded eligibility for its existing program to:
50% FPL
100% FPL
138% FPL
200% FPLSecond, instead of starting with an eligibility threshold, start with the money:
Show us what an additional $4 million, $8 million and $12 million in County funding could buy under the County’s existing Chapter 61 authority.
For each funding level, tell residents approximately how many additional people could be served, what eligibility level could reasonably be supported, what services could be offered, what provider arrangements could be made and what state, federal or other outside funding could potentially be leveraged.
Then show us what the proposed two-cent hospital district buys.
Use the same measurements so residents can make an actual comparison: local public dollars required, projected enrollment, income eligibility, healthcare services, provider access, administrative costs, outside funding or matching funds, and any other material differences between the two structures.
I am not asking Commissioners Court to assume that one approach is better than the other. I am asking you to give the public enough information to determine that for ourselves.
Simply multiplying the County’s current healthcare spending by higher FPL percentages would not answer this question. The number of residents in each income bracket, expected enrollment, healthcare utilization and cost per patient will not necessarily increase proportionally. Those are precisely the numbers County staff should analyze.
If the proposed hospital district can provide substantially more healthcare per local tax dollar because of dedicated funding, federal matching opportunities, provider contracting or some other structural advantage, show us.
If expanding the existing County program can provide comparable access without creating another taxing entity, show us that too.
Hays County residents should not have to choose between competing political claims when the underlying question is measurable and the tools for the solution are already in your tool box.
Price both options. Measure what each one buys. Publish the comparison.
Thank you.
And Commissioners: this part is for you.
Criticizing Ruben Becerra’s hospital-district proposal is not a healthcare policy.
Neither is criticizing the commissioners who didn’t show up for his special meeting.
We have five elected officials on Commissioners Court.
Give us five ideas if you’ve got them.
Becerra has now put an approximately two-cent hospital-district funding roadmap on the table. Great. Keep developing it. Tell us what two cents actually buys.
And if the other commissioners think there’s a better way to improve healthcare access without creating another taxing entity, put that plan on the table too.
Price it.
Publish it.
Let us compare it.
You don’t have to agree about the solution.
But Hays County has tens of thousands of uninsured residents while its existing indigent healthcare program has an income threshold so low that many working people have essentially no chance of qualifying.
Surely five elected officials can give us more than one idea for fixing that.