McALLEN, RGV – State Sen. Juan “Chuy” Hinojosa, who was born and raised in Mission, is an old friend of Mayor Norberto “Beto” Salinas, campaigning with him decades ago for better working conditions for the farm workers of the Rio Grande Valley.
On the issue of a hospital district for Hidalgo County, however, they do not see eye to eye. While Salinas has said he will lead the opposition to the project, Hinojosa is one of its biggest supporters and passed legislation last year to improve the chances of such an institution being formed.
In a lengthy interview with the Guardian, Salinas claimed a new hospital district in Hidalgo County would, within three or four years of its existence, set a tax rate at the maximum allowed under the Texas Constitution, namely 75 cents per $100 property valuation. (Click here to read Salinas’ viewpoint.)
Hinojosa said that is not true.
“Mayor Salinas is a good friend but he has got his facts wrong on this issue. No tax rate has been set, no board of directors has been appointed. This is pure speculation on his part,” Hinojosa said.
Hinojosa said the way the tax rate is handled involves a memorandum of understanding with the various hospitals in Hidalgo County. “The county has oversight over the budget of the hospital district so that there are discussions and negotiations between and among the public officials and those who are appointed to the hospital district. In addition to that the public officials can have a veto power over any recommended tax rate. Those are the realities and the facts of the situation.”
Hinojosa pointed out that other hospital districts around the state have much lower tax rates than the 75 cents Salinas is claiming Hidalgo County’s will have. Travis County’s is set at 12.9 cents per $100 property valuation. Nueces County’s is set at 14.1 cents, and El Paso County’s is set at 19 cents. The highest tax rate for a hospital district in Texas, say Hinojosa’s staff, is the 32 cents charges by a county in the Dallas Metroplex. That is obviously a lot lower than 75 cents.
In an exclusive interview with the Guardian, Hinojosa laid out the reasons for supporting a hospital district in Hidalgo County. He said it was integral to the success of the planned UTRGV medical school because it will help fund it.
“The reality is that a medical school is very much needed here in the Rio Grande Valley, for several reasons. No. 1, it will provide extra access to healthcare, where we have over 40 percent of the population here uninsured. No. 2, it will bring in more doctors; we have a shortage of doctors here. No. 3, it will also create more jobs because it will bring in health-related businesses. No. 4, it will expand the economy,” Hinojosa said.
Hinojosa said that no medical school in the State of Texas that can survive without a hospital district. “If you look at what a medical school will bring for us here in the Valley besides greater access to health care, all we have to do is look and compare with what happened in San Antonio with the health science center they have. Where it was built, in the northwest of San Antonio, there was only farms, farmlands, a rural area. Now it is a multi-billion dollar complex that has created thousands of jobs. It has attracted hundreds of thousands of research money, and, at the same time created greater access to healthcare. This is why I say this is a win-win situation for us.”
Another important point to make, Hinojosa said, is that creating a hospital district relieves a burden placed on Hidalgo County Commissioners Court. “Right now Hidalgo County is required to pay eight percent of its county budget on indigent healthcare. That is worth $12 million. With the hospital district and the medical school the county will not have to pay that $12 million. Right there, there is a saving of $12 million.”
Asked if it were a given that Hidalgo County Commissioners Court would reduce taxes by eight percent if it did not have to pay for indigent healthcare, Hinojosa said: “Hidalgo County can reduce their tax rate. That is correct. But, keep in mind the cost of taking care of the indigent will not go away. It will still be there. It will be paid by the county or paid through higher premiums by those of us who pay insurance.”
Another claim made by Mayor Salinas involved residents from Reynosa coming over to receive emergency room treatment. Salinas said if the hospital district is established, local hospitals will know they can bill the district for all the uncompensated care they provide. For this reason they will take on more uncompensated care, which will be a big incentive for the people of Reynosa to come over and receive treatment.
Hinojosa responded by saying a hospital district will provide better control over who is eligible and who is not. He said it will “sift out” who is eligible.
“I think Mayor Beto Salinas is misinformed about that. In terms of Mexican nationals coming over here for healthcare, it is already happening. They have tried to tighten up the criteria and eligibility requirements. That can be done through a hospital district. As a matter of fact, through a hospital district we can probably have more restrictions than we do now to make sure that the bulk of the healthcare goes to legal residents. The hospitals will not be setting the rates. Those rates will be set by the hospital board members and the elected public officials with the county. There will be restrictions on it. It will not be, bill us for all the patients we accept. That is not the way it works.”
Asked to respond to a claim by Mayor Salinas that a Hidalgo County Hospital District would raise about $300 million a year, Hinojosa said: “He is so off base. That is not true. It is absolutely not true. No tax rate has been set. He is picking a number out of the air.”
Another advantage of setting up a hospital district, Hinojosa said, is it will allow Hidalgo Country to draw down more federal dollars for healthcare than it would otherwise be able to.
“Without the hospital district we will not be able to draw down federal matching funds. The 1115 Waiver that we have in place right now, the provider fund, we get two to one. But, we have to keep in mind that that is going away. The hospital districts that are in place right now, they used to use part of their tax money funds and share it with other counties that had no hospital districts so that we could draw down funds. We would give it back to them, but would keep the federal funds. Those hospital districts no longer want to do that. They want to use the Waiver to keep all the money. For Hidalgo, without legislation I passed last session, creating the 1115 Waiver provider fund, the whole burden is going to be on the local taxpayers, without a hospital district,” Hinojosa said.
Hinojosa also said that Mission Hospital could “quite possibly close” if a hospital district is not formed.
Asked if he was going to tweak his bill on the hospital district next session, Hinojosa said: “There are some areas of the legislation where we need clarification. People are asking questions and we have to give the proper comfort. We have the MOU out of Bexar County. We have talked to the hospital districts, we have done the research. Most of the issues can be addressed through Memorandums of Understanding that are pretty routine. In terms of the legislation, there may be areas that need clarification but that will be done next session. It takes a while to set up a hospital district. It takes several years. So we have plenty of time to address that.”
Hinojosa concluded the interview by suggesting Mayor Salinas is struggling to understand how a hospital district would work.
“Beto cannot comprehend it. He has a very simplistic view that does not do justice to what we are facing. Healthcare is a very complicated issue. You have got the federal government involved. You have got the 1115 Waiver. You have got Upper Payment Limits. You have got Medicaid and Medicare. You have got a hospital district providing a matching fund. It is not a simple black and white as he paints it. The $1 million that Mission is putting up (for the medical school), we cannot leverage it. With the hospital district we can leverage it up to $3 million. That is just the way the federal government reimburses us.”