Opinion: When it comes to health care in Austin, there can be no justice without accountability: It’s time the Travis County Commissioners Court ordered an independent performance review of Central Health – Columns
While Central Health, our county division that provides public health care to the poor, recently broke ground on replacing two clinics in eastern Travis County, Austin residents might want to give a round of applause. Health Equity First, the collaboration of local LULAC and NAACP, has released a worrying new report that details eight key Central Health red flags that point to serious financial and operational mismanagement. The report (available at healthequityfirst.com/red-flag-report) questions whether Central Health is serving either the poor or the taxpayers well.
This issue will come to a head over the next few weeks as we ask district commissioners to order an independent, comprehensive performance review of Central Health. The district commissioners have the financial oversight authority over Central Health, and the community needs independent, complete answers to these serious problems.
Central Health’s budgets are so misleading they seem wrong. For example, it was recently stated that “Ninety-seven percent ($491 million) of Central Health’s fiscal 2022 budget of $506 million is dedicated to low-income healthcare.” In reality, only 20% of Central Health’s budget accounts for actual health services. The alleged $491 million in “health care” includes expenses such as travel, printing and copying, phones, utilities, insurance, marketing, community relations, legal and other administrative costs not typically considered health care.
His budget also shows that $298 million of his alleged $491 million in “health care” is actually just sitting in a reserve account for unexplained future contingencies. These reserves have grown from $36 million to $298 million over the past five years and now account for 59% of the budget. Reserves held in a bank account for contingencies and miscellaneous administrative expenses should not be publicly presented as health care for the poor.
In addition to questionable budgets, a performance audit is critical to restoring community confidence in Central Health. When voters approved a tax hike for Central Health in 2012, its leaders repeatedly pledged that “…a certain amount of the estimated $54 million a year in new tax revenue—$35 million—would be permanently earmarked for services to patients in need of the.” faculty and medical school residents who are MDs,” as reported by Austin American statesman on Oct. 14, 2012. Similar promises were made in other articles in statesman, The Austin Chronicleand KUT.
Central Health broke its word. County taxpayers have paid the medical school $280 million to date, but there is no documentation to show that those funds have been used to deliver medical care to the poor. For years, the community has repeatedly asked about the number of patients treated and the care provided. Nada.
Central Health is quick to argue that a performance audit isn’t necessary as it is audited financially every year, but this is misleading. Financial audits do not examine whether Central Health miscategorizes budget items or spends taxpayers’ money inefficiently, ineffectively, or outside of its responsibilities. As for the planned 2023 audit, which Central Health claims to be assessing its performance, it should be noted that Central Health undermined the integrity of the last performance audit, conducted in 2017, by insisting on controlling the audit. This effectively prevented the public from receiving independent, trustworthy analysis. The main question the community wanted answered in 2017 was cleverly sidestepped by its rigged audit: How much of its then $105 million fund for medical school went to health care for the poor?
Frankly, Central Health can’t be trusted to self-assess. Our district commissioners should now order a comprehensive, independent performance audit. We deserve reliable answers to two basic questions: How much health care did the poor get from medical school for $280 million? Is Central Health spending tax dollars on the poor effectively, fairly and in accordance with its mission? That shouldn’t be too much to ask.
Nelson Linder is President of NAACP Austin and Frank Ortega is Director of Texas LULAC District VII. Their organizations recently collaborated to create the Health Equity First project. The project aims to raise awareness of the need to increase transparency and accountability of Texas public hospital districts like Central Health so they can better serve the health needs of the poor.