The Austin Chronicle

Hospital District Campaign Ready to Roll

By Amy Smith, March 12, 2004, News

Just two days after the primaries and two months before the next election, public health care advocates will gather Thursday at Brackenridge Hospital to jump-start another campaign – this one to create a countywide hospital district. The taxing district plan will appear on the May 15 ballot along with races for Austin ISD and Austin Community College trustees and for the board of the Barton Springs/Edwards Aquifer Conservation District, along with a city proposition allowing Austin firefighters collective bargaining rights.

As it was with ACC's successful referendum last spring, the operative word here is "tax" – the necessary evil that would generate an extra $5 million to help shore up a local health system hobbled by skyrocketing insurance rates, overcrowded emergency rooms, and thousands of uninsured residents. That $5 million – to be generated by a tax hike for county residents outside the Austin city limits – is a fraction of what experts say is truly needed to stabilize the local public health system, but it's a start. Right now, county residents pay 1.3 cents (per $100 valuation) of their property taxes toward the public health care system, but Austin residents pay an additional 4.7 cents, via their city property taxes. The district plan calls for all county residents to pay the same rate that city residents pay now; that rate would be capped in the future at 25 cents per $100.

Since introducing the plan more than a year ago, proponents of the measure have switched from using their preferred name, "health care district," to the legal name, "hospital district," to correspond with the language in the state statute. But no matter what it's called, the very idea has stirred the anti-tax crowd into organizing under the name Save Our Taxpayers, which founder Don Zimmerman says is somewhat of a nod to the Save Our Springs Alliance. Taxpayers, he asserts, are as much in jeopardy as the Barton Springs salamander. That's where the similarities end.

Opponents of the district – including Travis Co. Commissioner Gerald Daugherty – cite a number of concerns with the proposal, beginning with the election date. Daugherty and others are dismayed that the ballot issue will go to voters in May rather than in November, when the turnout will be substantially higher. But Clarke Heidrick, who chairs a steering committee that is promoting the hospital district, says the more competitive races on the November ballot would drown the proposal out. Plus, he says, a November election would delay implementation of the district until fiscal year 2006.

The foes aren't buying those arguments. "I think these guys are deliberately pushing for a May election in anticipation of a low voter turnout," said Zimmerman, an IBM software engineer who calls himself a Ron Paul Republican, after the U.S. congressman who crusades against taxes in favor of free enterprise and personal liberties. "The lower the turnout," Zimmerman says, "the higher the special-interest vote."

Daugherty is also unhappy that some key provisions in the original bill taken to the Legislature last spring to create the district were eliminated in the last-minute maneuvering to pass the measure. One in particular would have allowed voters to decide either to continue or to dissolve the district after several years. Without that mechanism, he says, "it's just too damn difficult to change something that's already been created."

Daugherty suggests he won't be a leader of the opposition in this fight – unlike his role in shooting down Capital Metro's light rail plans in 2000. "I'm not overly happy about this [hospital district], but am I as crazy about it as I was about light rail? Probably not," he said. In place of taxes, Daugherty said, he'd prefer the city and county look elsewhere – anywhere – to try and drum up funding for health care and ultimately draw the line on what governing entities can and cannot afford. "Otherwise," he said, "we'll just tax ourselves into oblivion."

Proponents of the district argue that the proposal, with its 25-cent rate cap, offers a "tax-efficient" approach to tackling the problem. (Other Texas hospital districts can levy up to 75 cents.)

Heidrick also points out that the hospital district would not only help pay for health care for the indigent but also for those who are gainfully employed but can't afford insurance. In all, 25% of Travis Co. residents are uninsured. "That's a terrible number," Heidrick said. "That's telling you that there are people out there like you or me who can't afford to pay $7,500 a year for an insurance plan." Moreover, the district would also help Brackenridge Hospital continue serving as the regional trauma center for 11 counties, even though the city-owned facility is squeezed for space that won't become available until 2007, when the Children's Hospital moves to its new site at the old Robert Mueller Airport.

So far, the health district campaign has raised $300,000 toward its $500,000 goal. The measure has broad bipartisan support, including endorsements so far from the Travis Co. Medical Society, the Gray Panthers, and the Austin Council of PTAs, plus the backing of the two major private hospital chains – St. David's HealthCare Partnership and the Seton Healthcare Network – as well as a number of private corporations and banking concerns. By comparison, says Zimmerman of SOT, "We'll be lucky if we can raise $50,000."

The District Details


  • Right now in Travis Co., only 35% of the patients seen at local hospitals and physicians have private insurance; 40% are on Medicare and Medicaid, and the rest, 25% and growing, have no insurance at all.

  • The numbers are even worse for patients in local emergency rooms; at some local hospitals, 50% of all ER patients are uninsured or indigent.

  • Emergency room visits are growing at a rate of 8% a year. All area ERs, including the regional trauma center at Brackenridge, are facing a shortage of beds and treatment rooms. Travis Co. has no psychiatric emergency facilities.


  • Between their city and county property taxes, city of Austin residents pay 6 cents per $100 of assessed valuation for public health care.

  • Travis Co. residents outside the city limits pay 1.3 cents per $100.

  • Out-of-county residents pay no taxes to support emergency and trauma care provided at Brackenridge Hospital, which serves 11 Central Texas counties.

  • Under the proposed hospital district, all Travis Co. residents would pay the same 6-cent rate; that amount could be raised in the future, but would be capped at 25 cents.


  • Governed by a nine-member board appointed by the Austin City Council and the Travis Co. Commissioners Court.

  • The city and county health care budgets and funds would be merged into a single district budget.

  • Travis Co. commissioners would approve the district's budget and set its tax rate.

  • The district would own the city and county health clinics as well as Brackenridge and the new Austin Women's Hospital (leased and operated by Seton and the University of Texas Medical Branch, respectively).

    Source: Travis Co. Hospital District Steering Committee

    Aguments for and against the hospital district can be found online at and

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