There are opinions on both sides of any important matter but in my view a healthy community can best be measured by how well it provides access to care for the whole population, including the uninsured and indigent care patients.

In 1995, Ramiro Casso, M.D., and I incorporated the Community Health Management Corporation, better known has El Milagro Clinic in McAllen. This clinic has quietly operated for the past 20 years thanks to a dedicated board, committed staff and local physician providers that have made a profound difference to this community.

I chaired that board for 13 years and we quickly realized that it was an important component of the medical community from a public health standpoint as well as for early identification and treatment of chronic health issues and needed follow-up care from local emergency rooms.

I also realized first-hand how difficult it was to secure reliable financial support for such a community clinic population without insurance. I was constantly trying to determine how to meet the costs for a growing indigent care patient population.

When first establishing the clinic in 1995, and prior to securing grant funding, I secured our initial operational funds to pay staff and purchase supplies by establishing a personal line of credit with a local bank that was paid off over time.

This funding issue was and continues to be the major obstacle affecting the survival of these non-profit community clinics and their ability to grow and provide, though local physician providers, high quality medical care.

This is a major reason I support a health district and the commitments that have been made between our local hospitals, city and county government and the faith community, particularly the efforts of Carlos Cardenas, M.D., Judge Ramon Garcia, Edinburg Mayor Richard Garcia and Father Jerry Frank with Valley Interfaith working toward a formal commitment to provide a portion of the health district funding specifically to assist our local community clinics as a priority.

In that regard, Hidalgo County is the largest county in Texas without a health district. A health district provides the means through which a community can directly support the healthcare needs of the uninsured and keep pace with its growth.

In Hidalgo County, we are also unique in that we do not have a county hospital for treating the indigent population and depend on local private hospitals to provide these services primarily in the emergency rooms which is the most expensive form of health care.

Emergency rooms are not designed to provide routine care but in the absence of reliable funding for these public clinics this is often the only alternative – particularly for many working poor families. ERs are often faced with addressing long standing chronic healthcare needs that have gone unmanaged and which require a setting where better continuity of care is possible such as our local community clinics and Federally Qualified Health Clinics (FQHCs). Local private practice physicians from my direct experience over many years also routinely provide such healthcare services to the indigent population in their clinics as well, often without reimbursement.

Further, the Hidalgo County Indigent Care Program provides essential health services for this population, but is limited to a serve a population of approximately 7,000 patients as a percentage of the County budget which does not keep pace with the growing needs of this segment of the population, in my view.

This therefore requires looking for a longer term and permanent solution to this issue for the benefits it can provide to the communities served. In my opinion, it is best provided through a locally managed health district where the community can participate in the decision process.

Community clinics such as El Milagro and Hope that treat the uninsured and indigent can contribute substantially to improving local public health standards and provide a safety net for the large and growing indigent population. They can keep adults well and able to work and their children healthy and in school. The federal qualified health centers (FQHCs) such as Nuestra Clinical del Valle provide substantial healthcare services but also have funding limits annually.

However, with reliable funding, these FQHCs and community clinics can improve access to care with the potential to reduce health care costs through timely treatment and follow-up in concert with the broader medical community.

These community clinics can also potentially serve as medical education and training sites where our future doctors are directly exposed to the most pressing health needs of the indigent care population clinically. Here the clinical team can focus on curative care as well as preventive health and chronic disease management as well as health education. The future doctors training in local hospitals and public clinics here will learn their skills by exposure to the healthcare needs of the community served; and statistically are more likely to practice in the community where they are trained after their medical training is completed.

This improves access to care and has the potential to raise the public health standards of the entire community while addressing physician shortages and access to care issues in this rapidly growing area.

With the development of the UT Rio Grande Valley School of Medicine we have a great opportunity to not only train future doctors, and support research into endemic chronic diseases here but also a means to specifically address and support the needs of the uninsured and the large indigent population. In that regard, all medical schools require the support of the communities they serve through a health district in order to maximize the impact they can provide to the community.

Quality medical education and training programs are expensive but have substantial long term benefit to the communities they serve. In that sense, they become an important partner with the community, addressing health and research issues in tandem with local leadership; and that has been shown repeatedly on a national basis, to be the economic engine that profoundly improves not only the local healthcare standards and healthcare access issues, but also promotes strong industry related business development necessary to support the new UTRGTV Medical School while also directly impacting local job growth essential to this rapidly growing region.

In summary, these local challenges have solutions for the local indigent population, for local hospitals which absorb enormous uncompensated care costs now, as well as the medical education and training programs of the UTRGV Medical School necessary to insure the availability of physician providers to meet the growing needs of the population.

From my experience, that solution requires participation by the community served in the form of a health district managed locally to insure community input and to control costs. This is what is contained in Proposition 1 on the ballot this year and I encourage you to support this effort and do your part to help meet these challenges that impact us all. Thank you.