Naked City

Whenever David Hilgers talks to community groups about the need for a health care district, he begins by asking for a show of hands on three questions: How many believe our health care system is broken? How many know someone without health insurance? And how many have used Brackenridge Hospital?

Hilgers typically sees a lot of hands responding to each question. It was no different Monday night at a community forum sponsored by the Austin League of Women voters. Nearly everyone answered in the affirmative to the first question; more than half the crowd of about 100 said yes to the second; and almost half raised their hands for the Brackenridge question.

The points Hilgers is trying to make: Travis Co. is experiencing the same health care crisis as the rest of the country; a growing number of people are without health insurance; and, as the regional trauma center, the city-owned Brackenridge serves all of us -- not just poor people.

Hilgers serves on a steering committee that helped draft legislation for a city-county health care district, now known as House Bill 2327 (sponsored by Austin Rep. Elliott Naishtat, with a companion filed by Sen. Gonzalo Barrientos). Advocates of the proposal had hoped the bill would easily pass as a consent calendar item. But that requires backing from the entire local delegation, and two apparent holdouts -- Reps. Todd Baxter and Jack Stick -- are stalling the game plan. The two freshmen Republicans campaigned on anti-tax platforms, and thus far have not committed to supporting the bill. Stick has been quoted as saying he "hasn't seen evidence" to support the need for a district. Health care advocates express confidence that the bill will eventually pass but also note that state law allows the county to call an election for a district should the legislation fail.

The local health care crisis is going to require higher taxes with or without a health care district, Hilgers told the crowd. "Just because you don't have a health care district," he said, "doesn't mean the city and the county won't have to raise taxes to pay for those health care costs increasing." Ann Dunkelberg, a district steering committee member and an analyst with the Center for Public Policy Priorities, said that while other health care districts in Texas have tax rates of 18 to 25 cents per $100 property evaluation, the Travis Co. tax rate is, and would continue to be, lower than the state average. Currently, city residents pay 6 cents to cover public health care services, while county residents pay a penny. To kick-start a new district, Travis Co. residents would be asked to pay the same amount as city residents, adding another $5 million to the health care fund.

What can $5 million buy us? Not much, steering committee chair Clarke Heidrick acknowledged, but it's a start. "We could not sell [voters] right now on an immediate increase in taxes," he said. "But it would bring in some funding to create the right system."