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Central Health presents its budget, faces criticism over transparency

Wednesday, August 24, 2016 by Caleb Pritchard

The Travis County Commissioners Court heard details about Central Health’s proposed budget for 2017 on Tuesday during a lengthy hearing that also featured organized criticism of the county hospital district’s approach to transparency.

The court learned that the district is proposing a slightly lower tax rate – at 11.05 cents per $100 of property valuation – than the current rate. With expected increases in property values, that rate is estimated to lead to a $5.59 increase on the annual tax bill for a home worth $285,000.

The district’s staff pointed out that Central Health’s tax burden is lower than that of five other major hospital districts across Texas. They also said that through the power of federal matching money and private partnerships, each dollar of tax revenue the district collected in 2016 amounted to $3.59 in health care services provided.

However, those positive assessments were balanced on Tuesday by critical voices.

“In my experience, the governmental best practice – indeed, the best practice whether public or private – is to require contractors to itemize on their invoices the services and expenses they are providing,” attorney and activist Fred Lewis told the court. Lewis specifically targeted the $35 million Central Health pays annually to cover medical expenses for the region’s underinsured and uninsured through its partnership with Seton Healthcare Family and the University of Texas Dell Medical School.

That money is supposed to be earmarked for medical care for the region’s uninsured and underinsured residents. Voters approved the tax increase to cover the annual payments in 2012.

Lewis explained that he recently asked the Travis County Auditor’s Office for a detailed breakdown of how the money is being spent but was given documentation that painted only a broad picture.

“There are no performance metrics, there are no itemized lists of any services, there’s no financial accounting, there’s no audit. In fact, there are no numbers,” Lewis said.

Joining Lewis in his call for greater transparency were fellow attorney Bob Ozer, the League of United Latin American Citizens President Teresa Perez-Wiseley and Congregation Beth Israel Senior Rabbi Steven Folberg.

Central Health Board Member Cynthia Valadez agreed with their assessment and suggested that the budget could be presented with more specificity.

“We don’t get our budget in a line-item form,” Valadez told the court. “And I think that may be what creates some perception problems in the community. We get buckets. We get lump sums. We do not get line items.”

Central Health President and CEO Patricia Brown pushed back on Valadez’s diagnosis. Brown claimed that the budgets over which the board has final approval contain extensive details, except for the large sums the district sends to the state and federal governments. She explained that the opaque nature of those massive intergovernmental transfers is beyond Central Health’s control.

Backing up Brown was Board Member Clarke Heidrick, who has served since 2004. Heidrick said he’s satisfied with the level of detail in the budgets. He added, “If you get a budget that is too detailed, then you take away from the staff the flexibility to do what only they really know how to do to actually take care of the patients.”

Central Health will have two public hearings on its budget in late August and early September. The final draft will go before the district’s board of managers on Sept. 14 and will stand for final approval from the Commissioners Court on Sept. 20.

Photo by Larry D. Moore, CC BY-SA 4.0,

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