Bell County Commissioner Louie Minor talks about hospital district vote

Louie Minor, the outgoing Bell County commissioner for precinct 4, talks with Inside Killeen on the upcoming ballot vote on a hospital district as well as some of the issues with indigent healthcare in the county.

Transcript

SPEAKER_00 0:00

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SPEAKER_03 0:23

Welcome to the Inside Kaleen podcast brought to you by KDH News. My name is Kevin Limity. I'm one of the hosts for the podcast. And I'm joined today by Bell County Commissioner Louis Minor from Precinct 4. He covers much of like Kaleen and that area. How are you doing, sir?

SPEAKER_01 0:44

I'm doing well. Thanks for having me, Kevin.

SPEAKER_03 0:46

Yeah. So how have things been going? I mean, we want to talk a little bit about like Bell County indigent indigence indigent health district, which is a word that I can never, no matter how many times I say it, get it get it to come out of my mouth correctly. So maybe you could talk a little bit about that, but also a little bit about kind of stuff you're doing.

SPEAKER_01 1:08

Yeah, well, just what's been going on, you know, that it's budget season. So the county is going through that process. Uh, you know, we had to make a lot of hard decisions, and and what we're gonna be able to fund. I'm I'm I don't know if if you're aware of this or not, but you know, property values in the county for the first time have gone down and or or stagnant in some cases. Uh sales taxes are down. Yeah. So, you know, we're we were starting the budget with a $15 million deficit. So, you know, that we had to find where to trim. And I I think that we we came up with a good plan and where we can, you know, well, you know, we didn't approve a lot of things, that new request, and then we had to probably looks like we're gonna have to dig into our reserve fund. Uh and that and that's to stay at the no-new revenue rate. You know, even at the no new revenue rate, if people when when they look at their property taxes, it's gonna go up. Like the actual number is gonna go up, but that's the no-new revenue rate. So even at the no-new revenue rate, but just because property taxes are down, sales taxes are down, the tax rate will increase at the no-new revenue rate.

SPEAKER_03 2:22

Yeah, I mean, that sounds like something that's been happening like almost across the board.

SPEAKER_01 2:26

Yeah, it's gonna it's gonna affect every every taxing entity here in the county.

SPEAKER_03 2:30

Yeah, I mean, I I mean, what what do you attribute to that?

SPEAKER_01 2:35

Uh well, you know, I think that probably, you know, a couple of years ago, our property values skyrocketed. I mean, they really, really jumped up. That's good if you're selling your properties, but I think this is a market correction here locally where we saw you know a lot of home values. And it was across the board. It was, you know, residential, commercial, raw land, all those, you know, went down in value.

SPEAKER_03 3:03

Um, yeah, no, it's it's I mean, I think uh and you mentioned the deficit, and like I think Colleen's having the same problem, although maybe on a smaller scale. Uh it wasn't me, but there was a couple of my colleagues who went to the state of the region talk, which was given by Kaleen Mayor Joseph Solomon, but also given by uh the county judge. And I think that there was some kind of contrasting like experiences.

SPEAKER_01 3:34

Yeah, well, I mean, it's it's gonna affect you know services for for our residents. So I think Bell County runs lean uh as far as uh personnel, you know, for the size of county that we are.

SPEAKER_03 3:48

Yeah.

SPEAKER_01 3:48

Uh so already, you know, we're we're not our our people are not requesting, you know, bells and whistles. They're they're they're requesting needs to provide you know continued services for our growing counties, and they're not able to do that because you know, we don't have the tax rate to to fund those.

SPEAKER_03 4:08

Yeah, and that I think is a pretty good segue into talking about some of the issues that the county's been seeing in regards to health care. Uh can you talk about that a little bit?

SPEAKER_01 4:19

Yeah, so this November on the ballot, it will be proposition A. We will be voting, and by we, I mean Bell County, all Bell County residents, will be voting on a county hospital district. This is uh under authority, chapter 281 of the Texas Health and Safety Code that for counties over 190,000 in population to create a hospital district. Now, if you look at Texas, you know, there's 254 counties in the state of Texas. Large, almost, I think just about every large county, urban county has a hospital district. And a lot of smaller counties have hospital districts as well. But you know, definitely there's more counties that don't have them just because, you know, the number of counties that we have. The Texas Constitution and also Chapter 61 of the Health and Safety Code require counties to provide indigent health care here in the state of Texas. So that's not something that we can say no to. It's it's required by law, it's required by the Texas Constitution that we're going to take care of of the most needy in our community, you know, the people that don't have health care. Uh so this has nothing to do with if you have insurance, this is or or Medicare, Medicaid. If you're eligible for Medicaid or Medicare, the county helps you get that process uh and get qualified there. This is for that window of indigent that are underinsured, no insurance, and cannot qualify for Medicaid, Medicare. You know, it's the working poor because I I'm sure this is an issue. I mean, it's going to be an issue with everyone. You know, insurance is going up, regardless of the type of insurance, homeowners and insurance, auto insurance, health insurance is also going up. So for the for us and for government, for the county, it's it's going up. So these are issues that that you know we're struggling with on how to fund it, just because uh, you know, we can only increase taxes up to 3.5% above the no-new revenue rate before you have to go to the voters uh to get voter approval. So, you know, the hospital district I think is a way that we'll be able to provide that steady funding source and and get it separated from the county and having its own taxing authority, its own taxing entity. Uh, but that's going to allow us to do a couple of things uh as well. So what I kind of wanted to do is just to give an overview, I mean, a dollar-dollar, you know, of what the county is spending on indigent health care. Uh, so people have a good understanding of because it's complicated.

SPEAKER_03 7:14

Yeah, you know, it is complicated.

SPEAKER_01 7:16

It's complicated. There's a lot of laws involved, uh, it's a lot of tax dollars involved. So people need to understand what they're voting on and you know what is the problem that we're trying to fix by by bringing this to the voters. So the indigent health care budget right now for for this fiscal year, just the for staff, just for staff, it's $789,000. Bell County, we give the Killeen Community Clinic and the Temple Community Clinic, we give them both $525,000 each to help us care for indigent uh services here in the county. And then our the the biggest contributor for indigent health care is our jail. Everyone in jail is considered indigent by law. So we have to provide them medical services while they're in our custody and care. So our average daily population here lately has been anywhere from 1,130 to 1200 population. So every day, you know, that influx, we're we're providing medical coverage, we're providing medication to all those uh inmates. If someone has an issue where we can't handle it inside the jail, we got to send them to, you know, Scott and White or one of the other hospitals to be able to provide whatever we can't perform there in the jail. And we got to pay for it. You know, the the citizens have to pay for that. So uh that cost is $11 million, you know, over a million million dollars just this fiscal year. So, and then what we have left over is about $2 million and $2.5 million. And what that money is used for is, you know, say you go to the community clinic and you have hypertension, you have, you know, some regular routine stuff, but then you got to go see a specialist for something, the the clinic will send you a referral to one of the local hospitals for a specialty, and then that remaining $2 million will be able to cover that specialty care. Now, we pay Medicare rates, so that's that's what the hospitals are getting, at least from the county, of what we pay. So that's the county budget of what we spend. Now, if you add all that together, it's gonna be about a little over $15 million that the county spends per year in indigent health care. So if you not a small number. No, it's not a small number, but if you equate that to a tax rate, you know, what would that $15 million look at a tax rate? One penny on the county side, uh, one penny levied is about three and a half million dollars in taxes. So you're looking at fifteen million dollars, you know, you're looking close to you know four to five cents that we're required to by law to spend on on our indigent health care. So just think have that number in the back of your head, you know, the four to five cent tax rate. Other things that affect indigent health in the county we have what's called LPPF. I think y'all have done a story on this before. Yeah. Local local provider participation fund. That that's you know, people don't understand what that is. What it's a tax on health care is what it doesn't use the word tax. It says it's a mandatory payment. So you want to call it a tax or you want to call it a mandatory payment. Either way, Bell County, here in Bell County, we tax all health care six percent. Last year, the county received over a hundred and six million dollars in LPPF funds from the hospitals because we tax them the mandatory payment. Now, the the hospitals they ask us to do that. They come to us every year, we have to do it every year, and they say, please tax us six percent. You know, give us the LPPF. Because what they're able to do, since Texas is a red state, you know, Texas did not expand Medicaid, Medicare under, you know, the Obamacare Affordable Care Act, Texas did not expand it. A bunch of other red states didn't do it either. So LPPF is kind of a workaround where they could draw some federal funds down that they're not able to now. So we send up $106 million and we get back one and a half times our money back. So, you know, do the math. That's how much money is coming back from the federal government with LPPF dollars, the $106 million uh that we levied. Now the hospitals pay for it. I I don't think you'll see, you know, if you look at your your bill that you get from you know Scott and White or Advent or whoever, you won't see a tax on their, you know, county tax, or I don't think you'll even see LPPF or anything like that. The hospitals, they they pay for it, they'll cover that cost. But where do the hospitals get their money from? You know, it doesn't grow on trees. They get it from premiums, they get it from insurance, they get it from care. But what is LPPF supposed to do? It's supposed to offset what's called uncompensated care. So if you go to the hospital and you don't have insurance, that's called uncompensated care. They give us a report of you know how much uncompensated care we have in the county. And to me, that is the true need of indigent health care in our county total. Last year, our report was over $200 million in uncompensated care here in the county. So, what would that look like at tax rate? You know, it'd probably look like what the county is now, you know, about 30 cents. Now, no one is proposing that, but I'm just telling you, that's the true cost of uncompensated care in Bell County, plus plus the $15 million that we're spending. So though those, I mean, you know, these are big numbers for healthcare. There's these are big numbers for our residents. You know, people are paying for it one way or the other, whether it's it's through their insurance premiums or tax, you know, being taxed by the county. So what what benefit would we get by creating a hospital district? The the number one thing that we'll be able to do is tap into the LPPF money. Right now, that $15 million that Bell County levies and we spend on indigent health care, we're not able to send that money up to the federal government and get one and a half times our money back like the hospitals can. So at a very minimum, we will be able to tap into that LPPF bucket. And the the the hospitals, they have a limit. They can only send up six percent uh rate up for LPPF. But hospital districts have no limit on how much money they send up to get one and a half times money back. So though there'll be a benefit there. We'll be able to draw more money down, and for the same tax dollars, we'll be able to to you know multiply uh our our services that that we'll be able to provide. But I think uh another thing that that people have to think about is uh Bell County public health. Now it says Bell County, but it's not a Bell County entity in itself. It's a quasi-government agency where a lot of organizations and a lot of other cities pay into it to keep it going. Like the county's contribution is $169,000 a year to the Bell County public health. Bell County Public Health has been challenged in a lot of ways, to say the least. Financial challenges. And I mean, it I'll be honest with you, I don't know the future of Bell County Public Health. The hospital district would be able to cover those those duties. So that's something that that we could look at too.

SPEAKER_03 15:59

Yeah, the Bell County Public Health has gone through a lot of tur, I would say turmoil in like the past like few years.

SPEAKER_01 16:10

Yeah. Other challenges that we're looking at in the county is you know, we don't have rural ambulance service. We we do have a contract with a a provider. They have one ambulance that provides coverage for the east side of the county. Now it's it they don't charge us anything because I guess they they make their money on the insurance side, and there's nothing on the west side. On the west side of the county, we've been dependent on the city of Killeen to go out and provide services for us. Yeah. City of Kleene said they're not gonna do that anymore. They're gonna start charging the county as they should, as they should. So, you know, they estimated if you all the runs that the city of Killeen did last year in in the west side of the county, it would be well over a million dollars for for those runs. So we we have a contract that I believe is going to be coming up for the same company to provide ambulance service for the west side of the county for free, but it's only for you know 12 hours a day. Yeah. To me, that's not coverage. We need 24-hour service for for our residents, and and and it's our responsibility to do that. Yeah, a hospital district could cover that that service.

SPEAKER_03 17:28

Yeah. Slightly off topic, but I remember like a while ago, me and you went out to to that, what was the name of it? But it was just outside of the city of Kaleen and Chumbo Ranch. That's it. Yeah. We went out there and we actually have me to remember since she also was out there. That's our producer. Yeah. Um, but anyways, we went out there and we one of the big concerns about it was that even though like police was right next door and ambulance was right next door, they could not actually like get to those people because they technically were not part of the city.

SPEAKER_01 18:10

Right.

SPEAKER_03 18:10

And you know, the city is supposed to have like I mean, from what I've been told by uh city officials, and obviously they're they might be a little bit biased here, but from what I've been told, like it's some of the best like ambulance service that you can get pretty much anywhere.

SPEAKER_01 18:26

Definitely better than what the county has now, which is nothing.

SPEAKER_03 18:30

Right. I mean, yeah, but I mean, I guess like I get but but but do you think that this is sort of like kind of like thinking along similar lines like as as to the issues that were happening at turnbox except on a larger scale?

SPEAKER_02 18:46

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SPEAKER_01 19:54

Right. I mean, it it's our responsibility. At the end of the day, it's the county's responsibility, and and we've been dependent on the city of Kaleen to cover it, and Killeen taxpayers to cover a county responsibility. So I think we we need to end that. And you know, it it's the cost of of you know doing good being government. And you know, we've like I said, we put push it off as much as possible. The hospital district can cover that service as well. Uh so these are all things the hospital district would cover the the jail medical too. So imagine what we spend now is almost five cents of the county tax rate. That five cents would go to the hospital district. So lowering your current county tax rate and putting that in the new uh hospital district. So the uh uh the proposition A, which is gonna be on the ballot, the the the law dictates what the ballot language will be. So the the ballot language is gonna be the creation of a hospital district and the levy of a tax not to exceed 75 cents on each $100 of the taxable value of property taxable by the district. So some people have been fear-mongering the community saying we're gonna go and and the hospital district is gonna, you know, tax you 75 cents per $100 valuation and be the highest tax rate in the county. Uh that's not true. That's not true. The law states what the ballot language is gonna be. The law tells us that uh a hospital district cannot go over 75 cents. So that's what that is telling you. So if you equate to what we're paying now and we did nothing further, that would be just a about a five cent tax rate. So, you know, that that's what people needed. It's gonna be closer to five cents than 75 at the end. the day.

SPEAKER_03 22:00

Yeah.

SPEAKER_01 22:01

So all the misinformation that's out there about a hospital district, that's just not true. And the citizens need to know what what they're going to be voting on.

SPEAKER_03 22:09

Yeah. On the com commissioners court, your colleagues on there, do they like do are they more or less opposed to it?

SPEAKER_01 22:18

I I mean I don't I don't want to speak for for all the commissioners. They're there's you know they're skeptical. And you know I we could have done it two ways calling for this vote. The commissioner's court on its own action could have called for the election for creating a hospital district or it could have been brought by a petition of at least 100 people property taxpayers registered voters in the county. I brought I initially brought it up for us to vote on it as the commissioner's court to for us to call for the vote. They voted that down and then I brought the petition with you know a minimum of 100 people that signed it. I got way more than 100 people that signed it. But that's what's forcing the election is that petition of citizens that think that we need more health care in our county. And this is not going to be you know the hospital district in competition with our local hospitals we're not in competition with them now. This is going to be a I'll use an army term a combat multiplier for us to address the real indigent healthcare need in our community. So you know another issue that that is all wrapped up into this is uh the the one big beautiful bill that was passed. That that cut a lot of affordable health care subsidies so just right now here in Bell County as of 2022 yeah as of 2022 that was the last numbers I could find we had over 12,000 people in Bell County enrolled in ACA program. The one big beautiful bill is projected to cut about 13% of that. So that's going to be about 16 1500 people that are going to be uninsured in Bell County from you know that previous year. That's going to be adding to our indigent health care. So we built a bigger jail. Our jail could hold almost 1900 people I I told you that there's you know 1100 1200 people in in the jail now as that jail gets more populated it's going to cost the county money to provide health care for those for those individuals way more than what we're we're charging now. So I'm a big critic of our jail expansion I think the county wasted $100 million. It's going to be $130 million total but a hundred million of that was COVID money that we got. They put it all in the jail didn't even try any other mechanisms for reducing jail population. But the they're running around telling everyone and by they I mean my colleagues that you know we have the seventh largest you know jail in the state like that's something to brag about what we don't have is the seventh largest tax property values in the state. So right there already you know our tax rate does not justify having the seventh largest jail in the state so our county taxpayers are going to have to make up that difference to keeping that thing functional.

SPEAKER_03 25:55

Yeah and another thing that you mentioned is that the the people at the jail the prisoners they are automatically getting indigeno healthcare do you think that that also kind of like takes away from like from the the rest of the population in terms of like finance?

SPEAKER_01 26:14

It does but we we have no other choice. Yeah yeah we it it's our responsibility to keep people safe and secure while they're in our custody. Yeah so until they either get out of jail or go to state prison whatever that whatever the outcome is you know we got to make sure that they're safe and healthy in the Bell County jail.

SPEAKER_03 26:40

Yeah no that that does make a lot of sense you know I know like from from dealing with you over the past few years that you've that this is a issue that is very very very important to you and I was just wondering if you could could tell me like like like why this is such a focus of yours.

SPEAKER_01 26:57

Because there's a need. There's a need. I mean have you been on the you know out in the streets and you know our homeless population our seniors are our working families here that you know they can't afford it. I I believe the Killeen Community Clinic they put a a dental every year they have a dental clinic free dental and you should see the lines of the people coming for free dental you know to get get a cavity filled or get a tooth extraction and and it's you know people are hurting. So this it's government's responsibility to make sure that you know we are caring for our our most vulnerable populations and that's that's what the constitution says uh that's what the law says and that's that's what you know we need to do yeah no that does make complete sense to me and so the hospital district uh proper is going to be in November.

SPEAKER_03 28:01

Right right and there's also a lot of stuff going on in that that particular election that that I think is going to be noteworthy.

SPEAKER_01 28:11

You know a lot of questions too that I get about the hospital district is where where is it going to be built? Yeah where where's the hospital going to be built you know those decisions have not been made you it it could be a brick and mortar hospital absolutely but it could not you know it it if there's all kinds of different models in in in the state right now initially whenever I started looking into this I was looking into the model like Travis County has they had their their hospital district is called Central Health where they're just a funding mechanism and they have a partnership with Seton and Seton cares for all of their indigent population. But I I heard after speaking to some of the other hospital districts in in the state that it would be beneficial to have your own brick and mortar hospital because you get more federal dollars you know by having that I I like what Bear County does down in San Antonio. Theirs is called University Health. They partner with the college there and they have like a teaching hospital. So you know we have a lot of nursing programs here in in in the county uh so maybe that would be a thing that we could partner with you know one of the local colleges and and have that embedded you know in into the hospital district. But the the great thing about this is that the hospital district will be whatever we want it to be. Whatever the citizens determine is the priority then that's what the hospital district is going to be. So if it gets created in November uh the Bell County Commissioner's court is going to have to appoint a board of managers. It'll either be a five member board or a seven member board but then you know after that that board they'll serve two year terms and that board will be setting the tax rate setting all the priorities for the for the hospital district you know if if if we create if this is voted on and created in November this is going to be the first hospital district created in the state since 2002. So the the last one was central health down in Travis County.

SPEAKER_03 30:28

So you know this this is a need for the county we're we're losing money or federal dollars that we could be working on you know drawing back down here in the county uh so to me I think it's a win-win for the county taxpayer and for our indigent healthcare program to to get this approved well I do really appreciate you come on and talking about this and just just so people know you lost the primary against Ernest Wilkerson so there will be a new precinct for commissioner come November I just was wondering it it would either be him or his his opponent his Republican opponent Curtis Emmons and I was just kind of wondering if maybe you could tell me like if what your plans for the for the future may be uh from here.

SPEAKER_01 31:22

Well it the the switchover would be in January yeah that's true that that is technically correct yeah so I I'm you got to put up with me until December December 31st but I will continue you know to serve the community in other way shape or form I I love local government I love Kaleen I love Bell County my home is here my family's here my friends are here so I mean I you know I served on P and Z for many years and you know I have a vested interest uh just like everyone else that's listening that you know we want Kaleen we want Bell County to to continue to grow to continue to be prosperous and and have all the resources that that our grandchildren are going to be able to throw uh thrive here locally all right well Commissioner Minor I really appreciate you coming on once more and I'm sure we'll be seeing each other yes remember remember this November vote yes on prop A save lives save money okay thank you so much Commissioner Minor this has been the Insight Clean podcast brought to you by KDH News I'm Kevin Limity Hamida Botway is the producer and we'll see you next time take care