Hospital District Births a Budget

The Travis Co. Hospital District Board of Managers' crash course in budget-making moved into the homestretch this week with Wednesday night's public hearing on the estimated $75 million health care package. The board will give the budget a final once-over on Sept. 8 before sending it to the county commissioners for formal approval on Sept. 14. Public testimony began after the Chronicle went to press, but board chair Clarke Heidrick said he anticipated hearing from both pro-hospital district forces and skeptics who remain wary of a tax-financed health care system.

As of Monday night, board members were still deliberating some of the line items in the draft budget prepared by interim administrator Jim Collins. The proposed $225,000 salary for a permanent administrator took up much of the discussion, but for good reason. Setting the salary too low could generate only a small pool of candidates, without the skill sets necessary to run a startup hospital district, board members believe. Clearly, the job will require a good deal of political savvy and skin thick enough to weather the inevitable slings and arrows. "We're going to need a person of vision, someone who's a change-agent, and a leader who can work in a public environment," Heidrick said. "That's a rare bird."

Too high a salary, on the other hand, could deprive funding in other areas and invite criticism from tax watchdogs. In most major metropolitan areas of Texas, hospital district administrators are the highest paid public officials in the community. But this is Austin, some board members reasoned, and the city itself is often the draw for stellar candidates.

Elsewhere, the budget earmarks $5 million for enhancement of services and takes an ambitious shot at gradually establishing a $15 million reserve fund. That figure is based on the assumption that the board can squeeze more money out of both the city and county, with some gentle arm-twisting. So far the city has kicked in $3 million toward a reserve, and the county has contributed $942,233. City and county officials hold two different views on the required size of reserve funds, which explains the board's initial uncertainty on how much it should tuck away. The county favors a larger stash of funds to cover the unexpected, while the city, drawing on years of experience shouldering health care costs, typically sets its reserve sights at a lower range.

In any case, the board anticipates more money from both sides, which could lead to a paring down of the $200,000 currently budgeted for a forensic audit of the city and county health care records transferred to the district. Looking for other potential trims, vice chair Carl Richie suggested enlisting outside sources to help pay for a legislative mandate to conduct a study on Central Texas health care needs. Rep. Jack Stick, R-Austin, pushed to have the study included in the hospital district legislation, but offered no direction on funding for what is presumed to be a guide for establishing a regional medical school. Richie said the board would likely find a willing funding partner in the UT Medical Branch at Galveston, which runs the publicly owned Women's Hospital and is mulling various options for expanding its educational presence in Austin.