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Hospital managers have little to spare

Thursday, September 2, 2004 by

Hardest decisions likely to involve final $5 million

If last night's budget hearing was any indication of what's ahead for the Travis County Hospital District Board of Managers, then it's clear the board's toughest choices are going to come when it has to decide how to spend the last $5 million in the budget.

Much of the district's budget is already nailed down, from the contracts with the City of Austin, Seton and the University of Texas Medical Branch to the money set aside to hire a handful of staff for the first year of operation. Even the money proposed for hefty legal budget for the next 16 months appears to have the board's general support.

The $84.9 million budget does signify some decisions already made by the board. For starters, the Rural Medical Assistance Program and Medical Assistance Program will be merged, but county enrollees will continue to receive their current, higher, level of benefits. For now, the city will continue to operate both city and county clinics, but the city is expected to eventually hand over those operations to the hospital district and its staff. And the budget does not contain reserve funds, an issue that remains unresolved at this time, although county commissioners expressed a strong intent this week to come up with the $2.5 million requested by President Clarke Heidrick and the board.

What's left to decide is how to spend the $5 million set-aside for enhanced services. Last night, the board heard from a number of people who asked them to consider additional services, especially for mental health care.

Clearly, the choices will be tough. The city's Federally Qualified Health Clinics are over capacity. The same is true for the People's Community Clinic and El Buen Samaritano, non-profit clinics that hold contracts with the city and county.

David Evans, executive director of Travis County Mental Health/Mental Retardation, told the board that the county lacked publicly funded residential detoxification beds. Bob Gaines of the Austin Interfaith Alliance spoke of churches with members enrolled in MAP who must use the emergency room because they have been turned away from city and county clinics. And People's Community Clinic Executive Director Regina Rogoff spoke to the long-time wish to add portability to the Medical Assistance Program to expand access points.

Jack Gray, who served on the hospital district steering committee, was the one who pointed out expenditures must stop somewhere. While the board offered few comments during the hearing, Gray had no problem saying what many may eventually think: The board of managers must decide what it intends to fund and what it won't fund, and that means some in Travis County will go without health care.

One of four people in Travis County is without health insurance, Gray told the board. The hospital district will operate on a budget of $90 million. Statistics show that it would cost almost $500 million a year to provide even nominal health care for the uninsured.

"Your budget, while significant at nearly $90 million, is a drop in the bucket in regards to the overall problem. You have no hope to come up with all that money," Gray told the board of managers. "That's why we must recognize that we are rationing health care, not by this board but by this community. You have to decide how much provision of health care you will offer at what cost."

Even something as worthy as portable MAP coverage would come at a tremendous cost, Gray warned the board. Portability is a vital and relevant issue, but the implications are extreme when it comes to the budget, he said. It would create, in essence, universal health, a concept good in theory but one the current Travis County Hospital District cannot afford.

"You need to decide how to provide at what cost, before we go off and make wide-ranging decisions that could have an impact on this budget," Gray said. "A well-organized community activist in this city, qualifying people under the current standings, could easily break your budget in a very short amount of time."

No one on the board has suggested significant new expenditures for the hospital district yet, but in case they did, Don Zimmerman and Joe Davis-Fleming were on hand to warn them the community was watching. Long-time hospital district opponent Zimmerman urged the board to keep property taxes at a level rate. And Davis-Fleming, a long-time hospital district supporter, expressed his continued support for the district but told the board his Lakeway neighbors already were grumbling that the district was going to cost more than originally promised. Fleming urged the board of managers to negotiate with the city to restore at least some of the $33 million it had transferred to the General Fund.

Commissioner Karen Sonleitner, speaking only on her own behalf, said she would not mention the "R" word, but then strongly encouraged the Board of Managers to establish a significant reserve fund, especially with the district's reliance on a single type of tax instead of a mix of taxes. She also warned the board to expect the state to take a strong hand in trying to divert disproportionate share funds to state, rather than local, efforts.

Sonleitner added that most of the county's mid-year budget adjustments had come from increases in state-mandated services to indigent residents, whether it was indigent health care or indigent attorney fees. Just this week, county commissioners approved an additional $153,000 for indigent health services based on higher-than-expected use of services.

The board of managers votes on its budget on Sept. 8. That will be followed by a presentation at Commissioners Court on Sept. 14. County Commissioners approve the budget and set the hospital district tax rate. In its initial year, the hospital district's budget must represent a balance of the current revenue from city and county services.

That means that 6.35 cents will drop from the city tax rate and 1.44 cents from the county tax rate, creating a Travis County Hospital District tax rate of 7.79 cents per hundred-dollar valuation.

McCracken ready to amend toll road plan

Council Member Brewster McCracken said late yesterday that he is hoping to spearhead a change to the $2.2 billion toll road plan approved by CAMPO last month. He said, "We should not charge people to drive on roads that have already been paid for," including a portion of US 183 in Northeast Austin, Highway 71 in Southeast Austin and MoPac in Southwest Austin.

McCracken, Mayor Will Wynn and Council Member Danny Thomas have been the subject of a recall effort since voting for the plan in July. While that effort is unlikely to be successful, it has been a continuing reminder of the depth of opposition to the toll road plan. Today’s Austin Chronicle will feature a full-page ad entitled "An Open Letter Calling for Reconsideration of the July Toll Road Vote at CAMPO," signed by more than 75 community, environmental and neighborhood activists and a number of organizations.

The letter says, "We believe the toll road plan you voted for in July is one of the most damaging public decisions for our area in decades." It goes on to list reasons why the signers oppose the plan and asks the public officials who voted for it to "take this opportunity to create a transportation system that solves our problems, instead of making them worse." The ad concludes with a disclaimer that states, "This is not the recall effort."

McCracken said he had heard about the ad but neither the ad nor the recall movement was the impetus for his decision. He also said it doesn’t matter to him how the change happens. "We’ve been working with the RMA ( Central Texas Regional Mobility Authority)," to arrive at a solution, he said. "We need to fix the problem. I’m not locked in on how we fix the problem—just so long as we fix it." He said that the Mayor does not share his opinion, adding that in January he had opposed tolling a portion of US 183 close to McNeil Road in far North Austin.

McCracken said he still believes that most of the plan will be good for the city. "This is not a reconsideration of the plan. It’s an amendment," he said. He stressed that CAMPO had to act quickly to approve the initial plan. "And if we had turned down the plan we would have lost $561 million" to Dallas, he concluded.

Sixteen members of CAMPO voted in favor of the plan, while seven opposed it. It is not clear whether McCracken has the support of any of those who supported the plan in July, but he will have no trouble finding a second if he makes a motion to amend the plan this month. Whether a majority can be convinced to take out a major portion of the plan’s initial funds is quite another matter. But McCracken’s change of heart means that he, at least, has felt the heat. He said he had discussed the ramifications of the toll plan with people throughout the community and come to the conclusion that opposition to tolling existing roads has grown, not lessened, since CAMPO approved the plan.

Development review to gain 10 new employees

Another 51 will transfer from other departments but do similar work

The Watershed Protection and Development Review Department ( WPDR) will gain 61 new employees over the next year as part of the reorganization of city departments and the implementation of the “One Stop Shop” development review process. Dozens of employees currently in the Public Works and Transportation, Planning and Sustainability Departments will wind up under the umbrella of WPDR as their different functions are consolidated in one location.

The city is in the third year of its effort to streamline the development review process. “Staff from 13 different departments in 12 buildings will be housed under one service location at One Texas Center,” WPDR Director Joe Pantalion recently told the City Council. “The process redesign team from Austin Energy has simplified and consolidated 57 city regulatory processes into 21, based largely on suggestions from staff and customer interviews.” Physical renovations to several floors of the building are already underway.

The proposed budget for FY 2004-05 calls for $11,452,553 for the “One Stop Shop” from the city’s General Fund. But most of the department’s overall budget of approximately $55 million will come from drainage fees. Commercial drainage fees will be going up by about 22 percent, resulting in a revenue increase of $5.5 million. Residential drainage fees will also be going up by 7percent.

Over the past year, the department has reduced the wait time for customers at the Development Assistance Center. The average time for a completeness check has dropped from more than 24 days to 15 days, while the percentage of zoning cases given their initial review on time has gone up from 73percent to 79percent, Pantalion said.

Although most of the new employees for WPDR will be transferring in from other city departments, the proposed budget does include ten brand new full time positions to keep up with the growing workload. “The budget cuts this past year went pretty deep in development review,” Pantalion said. Six of the new positions will be devoted to staffing the “One Stop Shop.”

Parking contract problem resolved . . . Jill Maness, who is in charge of the city’s Building Services Office, reported yesterday that a proposed contract with AMPCO would be a stand-alone agreement to operate the new City Hall parking garage, and would not cover parking under I-35 or at One Texas Center. The Council delayed consideration of the contract last week after hearing complaints about the I-35 lot in particular. Mayor Pro Tem Jackie Goodman also indicated that she was uncomfortable with a plan to charge for parking on the surface lot at One Texas Center. Maness told In Fact Daily that the new garage contains approximately 729 spaces, of which 300 city employees will likely take. She said the city will begin negotiating with AMPCO as soon as Council approves it. “I hope to have the agreement worked out within a month because we really want to time the official opening of the garage with the date we expect the City Hall to get a temporary certificate of occupancy,“ expected to be around November 5, she said. The item is on the Council agenda for this morning . . . Also on the agenda . . . The Council will hear a briefing on the budget for Austin Energy, the Water and Wastewater Utility and the Solid Waste Services Department at 2pm and hold a hearing on the water and wastewater budget at 6pm . . .There are a number of other thorny issues, including the Walgreen’s/ Maria’s on South Lamar and a final consideration of the Central Austin combined neighborhood plan and University Neighborhood Overlay . . . Another one of the major items on today’s Council agenda is the presentation of a 10-year plan to end chronic homelessness. The Council’s Healthcare Subcommittee reviewed the proposal on August 24, sending it on to the full Council with a positive recommendation. A report compiled by the city’s Homeless Task Force estimates there are 587 people in Austin who fit the definition of chronically homeless. While that group represents only a small portion of the city’s homeless population, they take up a much larger portion of the city’s resources devoted to helping the homeless . . . Pennington appointed . . . County Commissioners have named Gloria Mata Pennington to the county's Mental Health/Mental Retardation board. Pennington replaces Rosie Mendoza, who was recently named to the Travis County Hospital District Board of Managers . . . Democrats to party . . . While Republicans watch President Bush’s acceptance speech, Travis County Democrats have a chance to celebrate what Democratic County Chair Chris Elliott has dubbed the "end of an error." In past years, the party has kicked off the fall campaign with a single event, but this year precinct chairs will be inviting their friends and neighbors to a house party. Elliott says more than 50 will be beginning around 7pm tonight. For more information, call the party at 477-7500 or visit the web site http://www.austinforchange.com . . . BTW . . . The Associated Press reported last night that Ralph Nader has been denied a spot on the November ballot in Texas, so Democrats do have something concrete to celebrate.

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