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Cuts could put some health care providers out of charity business

Wednesday, April 23, 2003 by

Under the budget approved by the House of Representatives last week, Travis County medical providers would lose $71 million in federal and state funding for programs for the indigent, according to David Lurie, director of Austin/Travis County Health & Human Services. That plan would eliminate funding for approximately 6,100 children who are currently enrolled in the Children’s Health Insurance Program in Travis County. That’s about half of those participating, he said.

In addition, the House proposal would reduce funding for Medicaid, including the amounts paid to health care providers. Lurie said, “Some providers would choose to no longer provide care . . . and those (patients) would be shifted over to the clinics, potentially . . . so it has a really large impact. As there are cuts at the state level it spills down to the local level. We have to find ways to address those needs or limit the services.” Lurie provided written data showing that Williamson County would lose more than $19 million in funding for health care and Hays County would lose more than $8.6 million.

Lurie and Trish Young, director of the Primary Care Department for the city, delivered the bad news to the City Council Health Care Subcommittee yesterday. The figures apply to the 2004-2005 budget. Lurie said the Senate’s proposed budget, which has not yet been approved, does not contain the drastic cuts approved by the House. The Senate plan does prescribe some reductions, but would not cause children who currently have insurance to do without, he said. Lurie and Young urged Council Members Betty Dunkerley, Jackie Goodman, Danny Thomas and Raul Alvarez to speak to legislators about the negative impact the cuts would have on the public.

Dunkerley, who is chair of the subcommittee, said she is extremely worried about the situation. “I think it’s going to be a tremendous crisis in the community,” said Dunkerley, when she envisions the additional number of patients who will show up at city clinics for the indigent. She pointed out that Austin pays only six cents per dollar of indigent health care—where Dallas and Houston spend about 18-20 cents—“because we’ve got all of these other providers that are filling in the gaps. What are we going to do? We’ve got the Peveto Amendment that limits the amount we can even raise . . . The whole system falls apart.” The Peveto Amendment limits tax increases by allowing voters to roll back a tax rate increase above a certain amount.

Young said, “It’s kind of a shell game to say we’re saving taxes, because we’re not.” She said the burden was simply being shifted from the state to the cities and counties.”

City Manager Toby Futrell told In Fact Daily, “We all know what this means in a clinic system that is already maxed out: there will be even higher demand for services. Trish is running her clinics at 120 percent of capacity, meaning long waits . . . In the MAP (Medical Assistance Program) clinics it’s a five-hour wait to even get an eligibility worker to sign you up. Every action that the state is taking has a trickle-down effect. We’re doing what the airlines do and are overbooking. So on days when everybody does show up it can be an all-day affair to see the doctor. We’ve wrung every ounce of productivity out of our clinics,” she said.

Futrell said she was trying to write a budget for next year that would not lower funding for the clinics, but “will be more and more people who need the services and no money to bring them in.”

Dunkerley estimated that the city spends about $32 million per year on health care, including $7-7.5 million for the clinics.

All candidates say they would oppose proposal; Wynn cautious

Business owners in the Warehouse District vented their frustrations with city government at a candidates’ forum on Tuesday, expressing dissatisfaction with code inspectors, the city’s permitting process, road construction, parking and traffic. The restaurant and nightclub owners were particularly irate over the proposed no smoking rule considered at the May 8 City Council meeting, and extracted pledges from several candidates to work against the plan to eliminate smoking from bars and restaurants altogether.

Brad Meltzer, Marc Katz and Max Nofziger all stated that they were steadfastly opposed to the proposed changes in the ordinance. “I’m in the biz, guys,” Katz told the restaurant and bar owners. “I travel all over the country in this business. There isn’t a city in the country that didn’t suffer when they put in the smoking ban.”

Council Member Will Wynn, the only one who will actually have to vote on the proposed ban before he leaves his Place 5 seat, was less enthusiastic about making a blanket statement on the issue. “Personally, I’m very troubled with it,” Wynn said. “I’m troubled that at a time when our economy is as shaky as it is the city does anything that changes market dynamics.” The Council member indicated that he did understand the argument being presented by the no-smoking forces. “I can talk to you for hours about how, as city property taxpayers, we’re paying a disproportionate burden to fund health care in this community. And I do buy off on the public health argument on smoking,” he said. When pressed for a “yes or no” decision on the smoking ban proposal by a member of the audience, Wynn indicated he would likely be against it. However, he also said the issues of public health and equality could not be ignored. “If it’s a health issue in his restaurant, why isn’t it a health issue in his bar? It seems to me that even though we have this existing ordinance, it’s not equitable,” he said. “Some businesses have to deal with it and some don’t.”

Candidates fielded several questions from the audience, including one from Bob Woody of the East 6th Street Community Association. Woody, owner of the Pecan Street Café, asked candidates to find a new location for the future Homeless Resource Center to be located with the Salvation Army on 7th Street, near the 6th Street entertainment district. “At 7th and Neches we’re developing the largest constellation of homeless that you can imagine,” Woody said. “What kind of disservice is this to the tourism that we’re hoping to bring?” Woody also pointed to new hotel construction in the area as another reason to move the homeless shelter and service center, while hinting that other areas might be even less willing or able to withstand the loss of business that could result from a large homeless population. “6th Street can take any trash you throw at it. We’re strong,” he said.

All four mayoral candidates agreed that locating the homeless shelter near the entertainment district would be bad for businesses and bad for the people it would be serving. “To have our homeless center and social service center blocks from our convention center and our tourism and hospitality industry, that’s not a good mix,” said Nofziger. “The next Council needs to think about where we’re going to put those homeless facilities.” Wynn pointed out that he had voted against the 7th Street location, but disagreed with a suggestion from Woody that it be located in East Austin at a state facility off Decker Lane. While Woody said the location near MLK would provide a campus setting away from the temptations of drugs and alcohol, Wynn said finding a remote location would not be so easy. “So where do you put it? I’m sorry, to stand up and say, ‘Let’s go put it in East Austin,’ sends a poor message,” Wynn said. “The trouble is: where do you find the campus setting?”

The meeting also included City Council candidates Brewster McCracken, Steve Adams and Wes Benedict. All came out against expanding the city’s no smoking ordinance. Benedict’s and Adams’ stances on less government regulation also received a warm response from the crowd. McCracken is running for Place 5, which Wynn is vacating. Adams is running for Place 2 against incumbent Council Member Raul Alvarez and Benedict is running for Place 6, currently held by Council Member Danny Thomas, who is seeking re-election.

Candidate asks current Council to give up salaries also

Mayoral Candidate Marc Katz produced his own “no new taxes” pledge on Tuesday, along with a promise to forgo his Mayoral salary while the city runs a budget deficit. Katz offered a signed “contract” promising not to raise taxes to reporters and called on other Council members and candidates to make the same pledge.

Katz is not the first candidate to promise not to raise taxes. Businessman Brad Meltzer has made a similar pledge. But Katz said his “contract”, was superior. “I will not vote for a tax increase as my tenure as Mayor,” he said. “If I vote for a tax increase I will resign.”

Katz is also offering to cut the Mayor’s salary down to $1 per year while the city runs a budget deficit. And he also called on the current members of the Council to do the same. “When the city is out of deficit, I will then give my salary to three major non-profits,” he said. “What I want immediately is for them to stop taking their salary. They’re part of the problem. I don’t think they should get paid.” That might prove to be difficult for some Council members who have no outside business interests, such as Katz, who said he did not know the exact amount paid to the Mayor each year. “I’m not sure…I believe $45,000, but I’m not exactly positive,” he said. The Mayor’s salary was set at $53,000 in 2000 and the Mayor also receives a car allowance.

Regardless of the Mayor’s pay, Katz said cutting salaries would have a significant impact on the overall projected budget deficit. “We need to cut it from the top….I know $100,000 administrators that I’m not quite sure they know what they’re administering. We’re going to go to the top and find out who’s not doing their job…I’d like to see a list from the city of people who make $100,000 or more. I can’t get that either,” Katz said, stating that he had encountered difficulty obtaining basic financial information about city operations. “I don’t know where you would even go for this stuff.” Katz said he had not filed any official requests with the city through the Open Records Act . “No, I haven’t. We shouldn’t have to do that. It should be available to us,” Katz said.

Katz talks about layoff memo Futrell says does not exist

After postponing a planned news conference last week to discuss the possibility of “massive layoffs” of city workers, Katz has brought the issue up on the campaign trail. He is hinting that he has information that city management plans to begin the layoffs in June, after the May 3rd election. While not producing the actual memo outlining the plan, Katz referred to it when he asked Council Member Will Wynn about it during the South Austin Culture Club luncheon on Tuesday. “For the 10th time,” Katz said to his fellow candidate, “I would like to ask you: are you aware of a memo that says after the election there will be massive city layoffs?” The Katz campaign has not offered the document up for public inspection, and a top city official says no such document exists. As for the idea that there will be “massive layoffs” during the current fiscal year, City Manager Toby Futrell says “That is categorically not true. I had them pull every budget document they have written since November. We write estimates and budget forecast memos…I think everybody understands.” She added that eliminating positions was not out of the question in the next budget cycle. “It’s no secret, we will have service cuts,” she said, noting that 80 percent of the budget is salaries. “But nowhere have we said ‘massive layoffs.’ I would never use that phrase. We’re having a very open and honest dialogue with our employees . . . There’s no plan for any kind of layoff scenario before we lay the budget in front of Council on last day of July.”

Earth Day 2003 . . . Land Commissioner Jerry Patterson and members of the Lone Star Sierra Club found something they could agree upon yesterday, as they jointly advocated increased use of renewable resources, such as wind, to generate electricity. Sierra Club spokesman Fred Richardson said Patterson “is showing vision and leadership in his efforts to promote Texas wind power. We still want to convince him that drilling for gas on Padre Island National Seashore is a bad idea, but we strongly support his efforts to promote wind energy. Developing clean sources of energy is one of the most important environmental issues of all, and it will be good for the Texas economy.” Mayor Gus

Garcia, LCRA General Manager Joe Beal and members of the Sustainable Energy Network also attended the Earth Day press conference . . . Voters have noticed . . . More than 1300 people in Austin took advantage of the Early Voting locations yesterday to cast their ballots for Mayor and City Council, as well as register an opinion on Austin Community College issues. That brings the total to 7,050, or about 1.27 percent of those registered . . . Work session today . . . The Council will hear a briefing on economic development projects using the new model of performance-based investments. They will also hear a proposal for The Domain. The meeting begins at 10am in the 3rd floor Conference Room of One Texas Center . . . One a day? . . . Mayoral candidate Marc Katz will be holding another press conference at 3:15pm today in front of his deli at 6th and Rio Grande. He says he will discuss Waller Creek and Capital Metro issues . . . ARC to honor Madla . . . The Association of Retarded Citizens (ARC) of Texas will host its 2003 Leadership Award Reception honoring Senator Frank Madla at 7pm today at the Austin Club, 110 East 9th Street. Master of Ceremonies will be former Texas Speaker of the House Gib Lewis . Madla is being honored for his service to the disability community in both the House and the Senate . . . Hands on a Hard Salami . . . Meals on Wheels and More is sponsoring a contest fundraiser based in the style of the documentary “Hands on a Hard Body.” The contestant who can keep his or her hand on a salami the longest will win a weekend for two aboard a luxury yacht in Florida, as well as air fare. The public is invited to watch, pledge on behalf of contestants, make contributions and volunteer to help deliver meals to the homebound elderly and disabled. The fun begins at 3:30pm Thursday at Katz’s Deli on 6th Street. Admission is free . . . Adam Smith clarifies . . . Adam Smith, aide to Mayor Gus Garcia, had a bone to pick with In Fact Daily about Tuesday’s story concerning the lawsuit over no-smoking ordinances. He wrote: “1. Both the current and proposed ordinances provide exceptions. Austin's current ordinance provides 18 exceptions, the proposed ordinance, 5. The proposed ordinance allows exceptions for private residences, retail tobacco stores, (a) hotel or motel room designated as a smoking room, a private or semi-private room in a nursing home or long-term care facility and an outdoor area of a workplace that is not in an area described in another section of the proposed ordinance. The proposed ordinance does not allow exceptions for bars, billiard halls and bingo halls. 2. To clarify, when I said the Mayor “might go along with an exception if another member of the Council proposed it,” I, at that point in the interview, was talking specifically about bingo halls. I went on to elaborate that he would not consider a carte blanche exception for bingo halls. At a minimum, any proposed exception for bingo halls would have to be no less restrictive than what is required under the current ordinance for the Mayor to seriously consider. Under the current ordinance, an exception is given to bingo halls if a separate enclosed nonsmoking area with a separate HVAC system is provided (or) the smoking area has a separate HVAC system and air filtering equipment and no one under 18 is admitted. The Mayor is bringing forward his ideal ordinance, which is based on input gathered from business representatives, advocacy groups and smoke-free ordinances from El Paso and the Americans for Nonsmokers' Rights. While he would like to see the ordinance approved with little to no changes, he realizes that compromise may have to be made to address other Council members' concerns. It goes without saying that the Mayor is just one of seven members on Council and passage of the proposed ordinance or any revisions to it requires approval from a majority of Council. The Mayor’s primary concerns are to protect the health of employees in the workplace and to ensure that nonsmokers (which account for approximately 80% of Austinites) are able to patronize and enjoy the same public places as smokers do, whether it be a restaurant, bar or billiard hall, without having to put their health at risk due to the harmful effects of secondhand smoke. Any revisions to the proposed ordinance that weaken this premise will require serious consideration by the Mayor.

© 2003 In Fact News, Inc. All rights reserved.

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