Proposition 1 pros, cons explored

There were surprising revelations that emerged during the healthcare district debate hosted by Futuro McAllen last week. Among the surprises was proponent Ann Cass twice stating she agreed with her opponent, Eddie Cantu.

Proposition 1 is the issue on the Nov. 8 ballot that, if it passes would establish a new healthcare tax district in Hidalgo County with an initial property tax rate of eight cents per $100 valuation. The proposition is very similar to the one that was voted down by Hidalgo County voters two years ago. Immediately after it was defeated, Valley legislators, led by State Sen. Juan “Chuy” Hinojosa and State Rep. Bobby Guerra, drafted new legislation that would be more palatable with certain groups of voters.

The Futuro McAllen debate consisted of a panel of four spokespersons – two for Proposition 1, and two speaking against the issue. Representing those in favor of the proposition were Ann Cass, of Proyecto Azteca and Equal Voice Network, and Pharr Mayor Dr. Ambrosio Hernandez. Panelists representing the opposing view were attorney Mark Walker and Hidalgo County Pct. 2 Commissioner Eddie Cantu.  KURV radio’s Davis Rankin moderated the panel discussion held at the McAllen Convention Center.

In last Friday’s edition, the Progress Times reported on the presentation by Futuro McAllen’s David Girault of important background information about the proposition.

This article will address many of the arguments laid out by these panelists – both in favor of and in opposition to the proposed healthcare district.

The proponent panel members tried to frame the proposed healthcare district as a cure for the many problems with healthcare access in Hidalgo County.

In her introductory statement, which far exceeded two minutes, Ann Cass stated her concern that if the state of Texas does not come up with a plan to insure all people in the state, the Center for Medicaid and Medicare Services (CMS) may not extend the 1115 Medicaid waiver that helps provide funding for indigent care in Hidalgo County and across the state.

She also drew attention to a concern that the present system for providing healthcare access to the indigent and uninsured in the county focuses on primary care and, according to Cass, only provides hospitalization for emergency situations.

She cited as an example, a migrant worker with an abdominal hernia would not be considered an emergency case – until complications arising from the hernia became life threatening.

“So if you’re a migrant worker and you have an abdominal hernia, that’s not an emergency. If you have cancer, that’s not an emergency,” she said.

“We have a good medical system down here and lots of resources, but if you don’t have insurance, you’re not going to be able to access it,” she added.

Dr. Hernandez stated the healthcare district should cover every resident of Hidalgo County.

“The county could raise taxes and be done with it,” Hernandez said. He later added, “The health district should cover the entire population, from beginning to end.”

However, these statements drew criticism from Commissioner Cantu who said the county cannot possibly pay for the everyone’s healthcare.

“There are 130 healthcare districts in the state of Texas. If you follow the logic of [Hernandez] that means those healthcare districts are providing 100 percent care for all their citizens. That’s not happening… Those costs are exorbitant.”

Cantu also said, “Ann talks about people with cancer and needing something more than primary care. The fact is that Travis County is not providing secondary care. That’s an existing healthcare district that they (the proponents) keep mentioning as the healthcare district we should be like.  They’re not providing that kind of care because it’s expensive and at some point you have a limit. You can only do so much.”

A major point for the opponents was their objection to using tax dollars to subsidize the profits of for-profit hospitals. This concern arises from the fact that the hospitals have been the primary proponents of first, a hospital district as was rejected by the voters two years ago, and now a healthcare district, that would reimburse the hospitals for millions of dollars each year for uncompensated care (unpaid hospital bills).

Walker said the hospitals in Hidalgo County are presently making about $2 billion from net patient revenue.

“What if we instead take that extra $4 million [that the county now gives to the hospitals for uncompensated care] and we give it to the non-profit clinics like Nuestra, Hope, Milagro – who are doing a good job on the frontlines taking care of our poorer residents?” he posed.

A skeptical Walker also stated, “When you hear a governmental taxing entity tell you it wants to invest your tax money, grab your wallet. That only means that they have a scheme to tax you and give the money and profit to someone else.  And think big, political donors when you think about where your tax money is going to go.”

He illustrated his point of political payoffs with a deal the city of Edinburg did with DHR (Doctors Hospital at Renaissance) in 2014.
“The Edinburg city council gave DHR over $2 million of Edinburg taxpayer money to help DHR build a $14 million medical conference center – not a hospital, not a clinic, but a conference center, which is owned by DHR.  Like DHR needs the money!  Or the construction company that built it needs the money,” Walker stated.  

“DHR was already going to build that conference center.  Mayor Garcia’s constituents’ tax money built a building on private property for the profit of that private owner,” he added.  

“Is this how we want to invest our taxpayer money?  To benefit highly profitable hospitals, to benefit highly profitable political donors who have incredible amounts of political power and … virtually unlimited political funds?”

Dr. Hernandez and Commissioner Cantu clashed over whether the medical school should be funded through the proposed healthcare district.

“The medical school is not fully funded,” Hernandez said flatly, but did not elaborate.

 Cantu said funding for the medical school is already being provided through a MOU (Memorandum of Understanding) by the county and the cities, providing the $5 million per year requested by the school.

“We can and should fund the medical school without a tax,” Cantu said. 

Walker dismissed the idea that more funding is needed for the medical school, saying, “There’s 55 students right now in the medical school.  $30 million in operating costs isn’t enough?”

Cass surprised the audience when she said she agreed with Commissioner Cantu who said, “No doubt the clinics could use more money to help the poor and the working class. But they need to create a purpose and need (plan) too. They need to show us what the money is going to be used for. They can’t just ask for 20 percent.”

And later, Cass again agreed with the commissioner, stating, “I do agree with the commissioner that there should have been more of a process before. There should have been a plan. We went to the county judge’s office three years ago and presented our concerns. We were not included in the last writing of the legislation. Right now, how do you know how much of the [hospitals’] costs are being paid by our tax money?  How do you know what the actual costs are?

“I have a friend who had a heart test done. They asked, ‘Do you have insurance.’ He said, ‘Yes.’ They said, ‘Well it’s going to cost you $6,800.’

“He has a $10,000 insurance deductible. … So he said, ‘Let’s start all over again. I don’t have any health insurance.’ You know what, the cost would be $582,” Cass said.

“What is the cost of our medical care? We really don’t know,” she stated.

She also drew attention to a concern that the present system for providing healthcare access to the indigent and uninsured in the county focuses on primary care and, according to Cass, only provides hospitalization for emergency situations.

She cited as an example, a migrant worker with an abdominal hernia would not be considered an emergency case – until complications arising from the hernia became life threatening.

“So if you’re a migrant worker and you have an abdominal hernia, that’s not an emergency. If you have cancer, that’s not an emergency,” she said.

“We have a good medical system down here and lots of resources, but if you don’t have insurance, you’re not going to be able to access it,” she added.

Dr. Hernandez stated the healthcare district should cover every resident of Hidalgo County.

“The county could raise taxes and be done with it,” Hernandez said. He later added, “The health district should cover the entire population, from beginning to end.”

However, these statements drew criticism from Commissioner Cantu who said the county cannot possibly pay for the everyone’s healthcare.

“There are 130 healthcare districts in the state of Texas. If you follow the logic of [Hernandez] that means those healthcare districts are providing 100 percent care for all their citizens. That’s not happening… Those costs are exorbitant.”

Cantu also said, “Ann talks about people with cancer and needing something more than primary care. The fact is that Travis County is not providing secondary care. That’s an existing healthcare district that they (the proponents) keep mentioning as the healthcare district we should be like.  They’re not providing that kind of care because it’s expensive and at some point you have a limit. You can only do so much.”

A major point for the opponents was their objection to using tax dollars to subsidize the profits of for-profit hospitals. This concern arises from the fact that the hospitals have been the primary proponents of first, a hospital district as was rejected by the voters two years ago, and now a healthcare district, that would reimburse the hospitals for millions of dollars each year for uncompensated care (unpaid hospital bills).

Walker said the hospitals in Hidalgo County are presently making about $2 billion from net patient revenue.

“What if we instead take that extra $4 million [that the county now gives to the hospitals for uncompensated care] and we give it to the non-profit clinics like Nuestra, Hope, Milagro – who are doing a good job on the frontlines taking care of our poorer residents?” he posed.

A skeptical Walker also stated, “When you hear a governmental taxing entity tell you it wants to invest your tax money, grab your wallet. That only means that they have a scheme to tax you and give the money and profit to someone else.  And think big, political donors when you think about where your tax money is going to go.”

He illustrated his point of political payoffs with a deal the city of Edinburg did with DHR (Doctors Hospital at Renaissance) in 2014.

“The Edinburg city council gave DHR over $2 million of Edinburg taxpayer money to help DHR build a $14 million medical conference center – not a hospital, not a clinic, but a conference center, which is owned by DHR.  Like DHR needs the money!  Or the construction company that built it needs the money,” Walker stated.  

“DHR was already going to build that conference center.  Mayor Garcia’s constituents’ tax money built a building on private property for the profit of that private owner,” he added.  

“Is this how we want to invest our taxpayer money?  To benefit highly profitable hospitals, to benefit highly profitable political donors who have incredible amounts of political power and … virtually unlimited political funds?”

Dr. Hernandez and Commissioner Cantu clashed over whether the medical school should be funded through the proposed healthcare district.

“The medical school is not fully funded,” Hernandez said flatly, but did not elaborate.

Cantu said funding for the medical school is already being provided through a MOU (Memorandum of Understanding) by the county and the cities, providing the $5 million per year requested by the school.

“We can and should fund the medical school without a tax,” Cantu said. 

Walker dismissed the idea that more funding is needed for the medical school, saying, “There’s 55 students right now in the medical school.  $30 million in operating costs isn’t enough?”

Cass surprised the audience when she said she agreed with Commissioner Cantu who said, “No doubt the clinics could use more money to help the poor and the working class. But they need to create a purpose and need (plan) too. They need to show us what the money is going to be used for. They can’t just ask for 20 percent.”

And later, Cass again agreed with the commissioner, stating, “I do agree with the commissioner that there should have been more of a process before. There should have been a plan. We went to the county judge’s office three years ago and presented our concerns. We were not included in the last writing of the legislation. Right now, how do you know how much of the [hospitals’] costs are being paid by our tax money?  How do you know what the actual costs are?

“I have a friend who had a heart test done. They asked, ‘Do you have insurance.’ He said, ‘Yes.’ They said, ‘Well it’s going to cost you $6,800.’

“He has a $10,000 insurance deductible. … So he said, ‘Let’s start all over again. I don’t have any health insurance.’ You know what, the cost would be $582,” Cass said.

“What is the cost of our medical care? We really don’t know,” she stated.

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