As Texas Blows

Your question has prompted me to do a little googling. Here is a bit of info.

The Texas Comptroller's office serves the state by collecting more than 60 separate taxes, fees and assessments, including local sales taxes collected on behalf of more than 1,400 cities, counties and other local governments around the state. State taxes and fees will generate an estimated $77.5 billion in the state's 2008-09 budget period.

http://www.window.state.tx.us/taxes/#TexasTaxes

Scroll down for a list of taxes and fees and links to each.

Thanks Ed.

Texas state highway fund is broke down on the side of the road
Texas soon will be shelling out more per year to pay back money it borrowed for road construction than it spends from its quickly vanishing pile of cash to build new highways.

Legislative leaders characterize the state's transportation funding as a crisis. Most Texans, they say, are unaware of its severity and must be educated before the state can find new ways to finance new roads.

The gasoline tax pays for road maintenance and construction but has not increased in 20 years. Gas tax revenue peaked in 2008 and likely will decline as vehicles become more fuel-efficient.

"It's not a crisis until everybody agrees that it's a crisis. Right now, people who don't understand it are saying, 'You're crying wolf,'" said House Transportation Committee Chairman Joe Pickett, D-El Paso. "Yes, it's a crisis."

Senate Transportation and Homeland Security Committee Chairman Tommy Williams, R-The Woodlands, agrees.

"The gravity of the situation is that in the absence of further action by the Legislature this session, we will literally be out of money for new construction in 2012 in the fastest-growing state in the country and in one of the largest states in the country," he said. "We need to begin to have a discussion about it."

Unfinished roads -- Roads to Nowhere? -- potholes, bridges broken down, then finally toll roads and Lexus lanes... but isn't this what a whole lotta Texans voted for in the last election?

What is everyone so upset about? Besides the ill eagles, as usual?

Remember: this is a financial issue mostly separated from the state's budget shortfall, which is also a crisis ... but not yet one of Rick Perry's emergencies, like voter ID, or sanctuary cities, or mandatory sonograms for women considering their reproductive options.


The transportation funding problem is separate from the state's projected $15 billion to $27 billion budget shortfall. The Texas Department of Transportation does not get any general revenue to build or maintain roads.

Legislative leaders generally agree that hiking the gasoline tax is not a viable option for several reasons, including the no-tax-increase pledge by Gov. Rick Perry and others. But Pickett wants that option on the table.

The proposed budget calls for the state to spend nearly $3 billion a year on road maintenance and nearly $800 million a year to repay debt. Less than $600 million, however, will be available per year for new road construction, which will not buy much pavement.

For example, the U.S. 290 corridor from Loop 610 to FM 2920 in Waller runs 38 miles and will cost $2.4 billion, according to TxDOT officials.

State lawmakers still have $3 billion left to authorize from a $5 billion road bond issue approved by Texas voters in 2007. Williams said he will push for that in the coming months.

The state began borrowing money in 2003 to pay for roads and now owes $11.9 billion. It will cost more than $21 billion to repay those bonds, Pickett said.

"We are trying to warn people," Pickett said, "Is this the way you really want to go? If you could get everybody around the table and put politics aside, common sense would say the conservative thing to do would be to limit borrowing capacity and put more cash in."

But hey, the Republicans elected in mass majorities just two months ago have a handle on it.


(Williams) agreed that the growing debt is a problem but said it is manageable given the size of the state, likening borrowing money for roads to buying a home with a 30-year mortgage.

A 30-year mortgage? Really, Tommy? In the current real estate market? You didn't sign us up for an ARM, did you?


Williams and Pickett agree that higher vehicle registration fees would help counter the immediate funding pressures. Current vehicle registration fees run about $60 a year in Texas.

Both said there's no benefit in assessing the state's long-term highway needs because that cost is so staggering that "you push the public away," as Pickett put it.

A report two years ago by the Texas Transportation Institute and others indicated the state's highway needs between now and 2030 would cost $488 billion.

Texans now pay 20 cents of state tax on every gallon of gasoline — a nickel of it goes to public education - which costs a person who drives 12,000 miles a year and averages 21 miles per gallon pays $7.14 a month. People who get better mileage spend less, Picket said.

A 5-cent hike in the state gas tax would raise about $575 million for roads and $190 million for schools.

"Is it OK to keep borrowing money, putting it on the credit card and paying high interest - or, should we raise the gas tax?" Pickett said.

Higher fees, more debt, and/or raising taxes are the choices. And "let's have a discussion about it" is what's coming out of the mouths of Republicans in the state legislature. I think I hear a Teapot squealing.

The Republicans have been in charge of Texas for almost 20 years now and this state is in the worst shape it has ever been in its entire history. Prior to 1998 the Democrats had been in control for about a hundred years and not once during the entire time have the state's financial consequences been this dire. Not once.

Rick Perry (and David Dewhurst, and everybody running for Kay Bailey's chair too, for that matter) has gone from boasting about the strength of the Texas economy during the campaign season to blaming all our troubles on Washington -- that is, when he can bring himself to admit we have any troubles at all. It's the same con game as his public persona. It's the drugstore-cowboy equivalent of bragging about how brave you are because you shot a coyote, even though nobody actually saw you do it and there's no dead coyote to be found.

The fact is that Republicans rule, and Democrats govern. I realize this is difficult to understand, particularly if you have been drinking too much tea for the past year

From PDiddie's blog -

Bill White is ex mayor of Houston.

Bill White
"Please forward the posting below, and attachment, to friends wondering about why we have rolling blackouts in cold weather. Remember, the summer peak requires 15% more power than the coldest day this winter. I wonder how many people and businesses have had their hard drives fried., like we did at home, because power sent out when it was trying to reboot after the previous outage."

.Bill White
"Inadequate power supply has led to rolling blackouts. The deregulation bill killed Texas' historical authority to review the adequacy of power supply to meet peak demands and to require a reserve margin. Years ago, in the linked article, I explained why we needed to fix this. Rather than action we'll get a study and excuses: plants intended for use on the coldest day didn't work because it was cold???"

In the last post, Bill White referred to the following article, authored by him, in 2007:


Electricity deregulation has failed to lower utility bills, as was originally advertised. The Texas Legislature should immediately give our Public Utility Commission more power to protect Texas' economy and consumers. Without improved regulatory authority, we risk the type of instability that devastated California.

TXU's actions highlight the need for more accountability to independent, expert regulators. Texas' biggest utility raced to obtain permits for 11 coal-burning power plants, which would emit tons of mercury and other pollutants into Texas' air. After the company claimed "fast track" approval was needed to avoid blackouts, TXU changed its course, announcing sale of the firm to private investors, with large stock options given to the president.

Texans depend on reliable, affordable services such as water, transportation and electricity to plan budgets and create a strong and stable business climate. That is why Texans across the political spectrum supported public ownership or strict regulation of these services for a century.

With the benefit of hindsight, the basic factual assumptions behind deregulation have long proved to be wrong, as most industry experts at least privately acknowledge.

Firms, led by Enron, claimed deregulation would lower prices because: (1) new natural gas-fueled power plants could generate clean electricity at substantially lower costs than the average price of the older plants; and (2) consumers would shop around. Regulated utility monopolies feared and fought deregulation based in part on the same assumptions.

The 1999 deregulation legislation "split the baby," with old utilities getting paid extra by consumers for their older plants, and the PUC losing all authority over retail prices in January 2007.

However, since 1999 the economic reality changed completely. Higher costs for gas turbines and natural gas have made clean new power plants much more expensive to build and operate than the older plants. In addition, consumers — particularly lower-income families and seniors struggling to get by — have stuck with their old suppliers even at higher prices, partly because of fear of change. So, many who can least afford it now pay the most.

These changes altered completely the impact of deregulation. As any first-year economics student knows, market pricing will be lower than prices based on average costs when the cost of incremental supply is less than the average costs. In contrast, prices based on "what the market will bear" will be higher if the cost of the incremental supply is higher than the average historical cost of all supply.

Guess what's happening. As with the case of some of its accounting, Enron's idea sounded good, if it weren't for the reality.

Wall Street investors know how to profit from Texas' deregulation scheme. The largest plants serving the Houston region have already been both bought and sold twice, at enormous gain. Now, electricity consumers throughout the state have been forced to pay billions of dollars to the old utilities for those power plants based on the false assumption that deregulation would make them less valuable. (We have been fighting this absurd payment in court.) And consumers of municipally owned utilities in cities such as Austin and San Antonio, which were exempt from deregulation, get fairer and more accountable rates.

Texas must learn from California's mistakes. Consider what we found when I served on an expert commission that warned of the California power fiasco in 2001. Like Texas, California had previously regulated power prices based on the average cost on investments. This historical regulation also incentivized spare capacity and energy efficiency as insurance against blackouts or extraordinary spikes in the prices. But after deregulation in California, as now in Texas, no one had the authority and responsibility for ensuring that retailers secured enough supply in advance. So those outside California and the municipally owned utility in Los Angeles locked up the power in the region, and the state found itself more than 10 percent short going into the summer of 2001, and facing either massive blackouts or "take it or leave it" prices. The transmission companies went bankrupt and, to avoid blackouts, the state had to borrow tens of billions of dollars, destroying its credit for a generation.

Of course, we can't put the market back to where it was before 1999, where old power plants have been sold to new owners at higher costs, and competition can have some benefits. But our Legislature should give the Public Utility Commission the authority to:

•Determine the adequacy of base and peak power supplies that have been contractually obligated at predictable prices to those selling power to consumers, and provide regulatory incentives as needed to secure standby capacity to meet peak summer power requirements.
•If necessary, provide cost-based incentives to obtain clean power, an authority which was used successfully several years ago when Reliant and others invested heavily to reduce smog-related emissions from their facilities.
•Establish maximum levels of debt acceptable for transmission and distribution companies, those maintaining the wired "grid," so that they make needed investments to make power delivery efficient and reliable.
•Set rates for transmission and distribution to ensure adequate cash flows available to make needed investments, regardless of weather or the volume of power usage.
•In the absence of an adequate fund to ease the burden on low-income consumers, which was originally promised, establish regulations to ensure that retail rates actually paid by low-income consumers do not exceed the average rates paid by all others.
•Review and approve any corporate reorganizations, with rules to reduce long-term risks to public interests, such as avoiding excessive debt on retail or transmission providers or concentrating ownership of power supplies in too few hands. The rules need not dictate who owns utilities.
•Report back to the next Legislature on any other changes that should occur in the regulatory structure to allow Texas businesses and consumers to have affordable, clean, reliable power.
The Legislature can outline required objectives and give our independent regulators the responsibility to fine-tune, using its access to expert staff and procedures for open public hearings and appeals. The Legislature is in session. Utility rates are pressing Texas' families and businesses. California showed the risks. Our state must define the conditions for the TXU acquisition. The time to act is now

AUSTIN, Tex. — Gov. Rick Perry of Texas cannot be faulted for lack of optimism. Facing a two-year budget gap of at least $15 billion, Mr. Perry struck a defiant stance in his annual address to the Legislature, calling the state economy “the envy of the nation” and promising the budget would be balanced through spending cuts alone.


Jack Plunkett/Associated Press
Gov. Rick Perry of Texas on Tuesday delivered his State of the State address in the Capitol’s House chamber in Austin.
Times Topic: Texas“Now the mainstream media and big-government interest groups are doing their best to convince us that we’re facing a budget Armageddon,” he said. “Texans don’t believe it, and they shouldn’t, because it’s not true. Are we facing tough choices? Of course, but we can overcome them by setting priorities.”

To be sure, Texas fared better than many other states during the recent recession, but sales tax revenues were badly hurt as people curbed spending. The depth of the state’s revenue shortfall was also hidden because it employs a two-year budget cycle and had used billions in federal stimulus money to avoid cutbacks in 2010. Now the state finds itself in a budget crunch not unlike those in New York, California, New Jersey and Illinois.

Even if one does not account for the natural growth in school enrollment and Medicaid rolls, the state would need at least $15 billion of new revenues over the next two years just to keep spending flat.

To continue services at current levels and accommodate growth in the population, however, lawmakers in Austin would have to come up with $27 billion in new revenues.

Republicans, who control every statewide office as well as both houses of the Legislature, are beginning to confront what it means to close the budget gap solely with cutbacks. About 10,000 state employees are in danger of getting pink slips. House and Senate leaders have said they plan to cut aid to schools by $10 billion, a move that would force the layoffs of thousands of teachers and increase class sizes. Lawmakers are also contemplating slicing Medicaid payments to doctors and other providers by 10 percent.

At Statehouse hearings in recent days, advocates for schools, the poor, the disabled and the elderly laid out in detail how Texans would be hurt by cutbacks. They forecast a near future in which nursing homes and rural health clinics would have to close, schools would be consolidated and nursery schools shuttered.

But Mr. Perry, who has worked to raise his national profile as a fiscal conservative, vowed again in his speech not to raise taxes. He also said he would not tap into the state’s reserve fund of about $9.4 billion, fed with oil excise taxes, saying it would be irresponsible to use emergency funds on salaries and other recurring expenses.

Instead, the governor proposed consolidating several state agencies, like the Department of Agriculture and the Department of Rural Affairs. He also proposed temporarily doing away with others, among them the Historical Commission and the Commission on the Arts. It was time, he said, to reinvent the government.

“If ever there was a time to truly reform our approach to governance and streamline our organization, it is now,” he said.

Democrats said Mr. Perry and Republican legislative leaders, who have big majorities in both houses, are ignoring reality to curry favor with Tea Party conservatives. They point out that the governor regularly boasts about people moving to Texas but has not budgeted for the costs of rising school enrollment.

“It’s totally unrealistic,” said Representative Garnet F. Coleman, Democrat of Houston. “He runs around during the election saying we don’t have any problems, and he’s still saying we have no problems here. It’s clear he can’t add or subtract.”

Even members of the governor’s own party are saying privately that they would support dipping into the rainy-day funds to cushion the blow to schools and nursing homes.

Many lawmakers think Mr. Perry is more concerned about laying the groundwork for a run for national office than averting painful budget cuts. Though Mr. Perry has said repeatedly he is not interested in running for president, others see his themes of low taxes, limited services and tight regulation as a platform for a possible run in Republican primaries

Tue Feb 8, 2011.

By Jennifer Bell

With the threat of Medicaid cuts looming in the state budget, local nursing homes are concerned that changes in funding could cause them to close their doors.

At the Greater Tomball Area Chamber of Commerce's Government and Legislative Affairs Committee meeting Feb. 1, Tamika Simmons, community relations director at Park Manor nursing home, said that current budgets proposed by the Texas House of Representatives and Senate include a 10 percent reduction in Medicaid funding to doctors, nursing homes and hospitals.

Statewide this means a total budget cut of $1.4 billion for nursing homes, or 33 percent less than current funding. This percentage includes a shortfall where Medicaid was previously bolstered by stimulus funding.

It's a number that could mean less staff and less care, and a number that scares Nancy Wood, Park Manor's administrator.

"We're asked to reduce expenses and still provide services," said Wood. "There's a travesty being presented--we have to manage our state budget, but let's not do it on the backs of the elderly."

According to the Texas Healthcare Association, the average nursing facility serves 83 residents and 69 percent of these residents pay with Medicaid. As well, the average facility employs 114 staff members.

If Medicaid is cut, area administrators believe local jobs and economies will also be at risk.

"Every piece of the budget that's cut, somebody loses their job," said Gary DeJean, administrator at Tomball Nursing Center. "There are four major nursing homes here, and this would definitely hurt Tomball."

Medicaid is a state-administered program that was designed to help low-income individuals and families cover medical expenses, but the elderly, disabled and pregnant women may also be eligible, with income considered.

Individuals and families must apply for assistance, and if they qualify, payments go directly to healthcare providers.

In Texas last year, over 3 billion people were enrolled in Medicaid. At $8.3 billion a year, Medicaid is one of the biggest expenditures in the state, second only to education.

But in the minds of nursing home owners, the care of elderly is worth the money.

"The elderly have paid their dues, they deserve good care in their later years," said DeJean. A "2 to 3 percent cut, perhaps we would be able to absolve, but with a 33 percent cut, we wouldn't survive."

If Tomball facilities are forced to close, a bigger problem may present itself: displaced elderly patients who cannot care for themselves.

"I would say to legislators: look elsewhere, these individuals have no other mechanisms to survive, they don't have a choice to get a job," said Wood.

Nursing home administrators, along with health care lobby groups like Texas Healthcare Association, are pushing for state representatives to fight this legislation.

Park Manor is organizing a town hall meeting in Tomball to garner support from the public as well.

Tomball has "so many healthcare facilities, and they're a great economic source for the community," said Wood. "We buy in Tomball, and if that's taken away, we've taken away our economic strength."

Wow, that is ten times the population of the United States! No wonder they are in such trouble.

I think that's more of a notional number, like the number of registered voters in Cook County, Illinois.

The writing is from a small town paper. The author never made the big time. The general thrust of the article legitemately gives plenty to consider.

Many "big time" writers do the same thing. Millions, billions, trillions, the bigger sounding the better.

None has been able to answer, "How many is a brazilian?"

- The Texas comptroller told the House Appropriations Committee on Thursday that she can't imagine solving the current budget crisis through cuts alone.

Susan Combs spoke at a hearing designed to be a reality check for conservatives who think the budget can be balanced by slashing state services. The current two-year budget cycle is $4.3 billion short and, under the Texas Constitution, that deficit must be made up by Aug. 31.

The state is also facing another projected $27 billion shortfall in the next two-year budget, but that was not the subject of Thursday's hearing.

Committee Chairman Jim Pitts, a Waxahachie Republican, asked Combs to testify after he introduced a bill to spend $4.3 billion from the state's Rainy Day Fund to cover the deficit. In opening Thursday's hearing, he tried to communicate the gravity of the problem, which left lawmakers silent and stone-faced.

"The budget adopted by the Legislature last session, and signed by the governor, exceeded the comptroller's measure of available revenue," Pitts said. "This committee, and this Legislature, has very limited options: the use of the Rainy Day Fund, further reductions ... or deferring payments into the next biennium."

While Combs never called on the committee to dip into the Rainy Day Fund, she presented a detailed history of how it had been used in the past and how spending it would not hurt the state's credit rating. She also examined the other options.

"I don't know how you can get to $4.3 billion in cuts," Combs said. She warned that even if the recession ends, that doesn't mean revenues will return to levels seen in 2005, when the Texas economy was booming.

When some lawmakers tried to compare the situation to 2003, the last time they tapped the Rainy Day Fund, the Democratic vice chair chastened them.

"I wish this was 2003. But if anyone tries to compare 2003 to what we are going through now, and saying they are similar, you are not facing reality," said state Rep. Sylvester, D-Houston. "This situation is far worse."

Combs acknowledged that the recession that began in 2007 was the worst since the Rainy Day Fund was created. But she warned that lawmakers should think about the next four years, not just the next two, when considering how much of the fund to spend or how to fix a business tax that has never raised as much money as expected.

She also pointed out that if lawmakers did not make funds available to cover the deficit, she is obligated under the state constitution to borrow money from the Rainy Day Fund to pay the state's bills.

Also Thursday: State Rep. Charlie Geren, R-Fort Worth, wants people willing to undergo background checks to get a fast pass into the state Capitol while carrying weapons.

Under current procedures, Texans with concealed handgun licenses can bypass metal detectors to enter the building. Lobbyists, journalists and other frequent visitors have signed up for gun permits in droves, just to get in quicker.

Geren’s bill, filed Thursday, would establish a “pass for expedited access” to people who undergo the same background checks and pay a fee, but without having to get a gun permit.

: 11:00 a.m. starting at 12th & Trinity
Rally: Noon-2:00 p.m. at State Capitol Bldg, 11th & CongressTexas students are tough, but they've never faced a crisis like this. In communities across the state, the same grim headlines repeat: campus closures, teacher layoffs, deep cuts to core academic programs.


There is help for Texas students - IF our leaders have the courage to use it - and you can make a difference.


On Saturday, March 12th, join thousands of Texans for a march and rally at the State Capitol to send a clear message to our leaders:


* Make education a top priority!


* Use the $9.3 billion Texas "Rainy Day" Fund to support schools.


* Sign the paperwork for $830 million in federal aid for teachers.


* Fix school funding laws to be fair to all districts and to our growing student population.


Plan now to be part of this historic event! Talk to your family, friends, students, co-workers, teachers, neighbors, business leaders, members of your faith community and more. Ask them to join you in Austin on March 12th to show our leaders what matters to Texas.


Together, we can make a difference. Please stand up for Texas schools on March 12th at the State Capitol. Our future depends on it!

Houston Chronicle:

All over the state, parents, teachers and business groups are righteously angry about the proposal to slash $11.6 billion from Texas' already anemic public-school budget — a plan that would gut pre-K, cause class sizes to skyrocket and eliminate as many as 100,000 school jobs.

But hey, Gov. Rick Perry said recently: That's not the state's problem.

Wednesday, when asked about the growing fury over the strangling of Texas schools, Perry blithely batted blame away from himself and his school-slashing allies at the statehouse and tried to dump it instead on local school boards, superintendents and principals.

"The lieutenant governor, the speaker and their colleagues aren't going to hire or fire one teacher, best I can tell," said the governor. "That is a local decision that will be made at the local districts."

But to state the obvious: It's the state, not those school boards, that controls the state education budget. And it's state government, not those school boards, that could mitigate the pain by tapping Texas' rainy day fund. But so far, Perry has exerted far more effort to protect our state's emergency stash than to protect our state's schools.

The governor suggests that school boards can cope and suggests that they focus on trimming "non-teaching staff." But as Chronicle reporters Peggy Fikac and Gary Scharrer recently calculated, according to the state's own figures, even draconian cutbacks in those areas would be only a start:

"Texas could fire every school superintendent, all principals and assistant principals, every school counselor, every librarian, every school nurse, all cafeteria workers, custodians and bus drivers - all 329,574 nonteacher jobs - and still not save the $11.6 billion in public education cuts."

If the Perry-backed cuts go through, Texas school districts will have no choice but mass layoffs of teachers - in addition to making deep cuts in supposed luxuries such as cleaning supplies, security and building maintenance. The schools aren't being forced to cut fat. They're being forced to cut muscle, bone and vital organs.

Perry, though, floats above that pain. To his magical way of thinking, the credit for budget-cutting belongs to him and his allies, while somebody else has to deal with the damage those cuts will inflict.

Those somebodies, of course, aren't just local school boards. They're Texas' school kids - and anyone who lives in this state after that

AUSTIN, Texas -- Democratic lawmakers denounced the latest
version of the state budget on Wednesday, saying it would close 50
percent of the state's nursing homes and leave 43,700 elderly and
disabled people without a facility to live in.

Lawmakers have been struggling to find a solution to the $27
billion revenue shortfall facing the state. Republicans have
pledged to cut state spending and not raise revenues.

A proposal working its way through the House Appropriations
committee this week would cut state Medicaid spending by 33
percent. The elderly and disabled take up 59 percent of Medicaid
spending in Texas and much of it goes to nursing homes. Other
Medicaid programs that help the elderly stay at home would be cut
40 percent.

State Rep. Dawnna Dukes, an Austin Democrat serving on the
committee, said the draft budget would only provide nursing homes
with 67 percent of what it actually costs to house, feed and treat
the elderly and disabled. Many facilities use profits from other
patients to offset losses on Medicaid patients, but many will not
be able to stay in business if reimbursements are cut any further.

The Texas Health Care Association used data from the Texas
Health and Human Services Commission to forecast what the budget
cuts mean for nursing homes statewide. In addition to the elderly
and disabled who would lose their facilities, the group calculated
that nursing homes would lay-off 60,000 workers.

"These are business, many of them small businesses, that
provide vital skilled nursing and medical care to Texans who are in
grave need and unable to care for themselves," Dukes said. "We
will be putting hundreds of nursing facilities out of business and
forcing them to close their doors and leaving those they serve with
nowhere to turn."

"We are making life and death decisions in many cases," Dukes
added.

Republican leaders have repeatedly said that the state is broke
and that difficult budget cuts are necessary. Others have cautioned
that the final budget will be different from the draft budget.
Democrats said if Republicans are planning any major changes from
the current draft, they should bring those proposals forward now
rather than wait and make backroom deals later in the session.

"If there is going to be additional funding, bring it to us now
so that we can discuss and debate the priorities of everyone in the
Legislature," Dukes said.

Democrats make up less than a third of the Texas House. They
urged Texans to call their legislators to protest the cuts.

The Harris County Hospital District has begun turning away uninsured patients from other counties who show up in its facilities and do not need urgent care, unless they pay cash up front.

The policy is one of several strategies the district is pursuing to prevent "cataclysmic" effects on patients as the state considers cuts that could take nearly 10 percent of the district's budget, president and CEO David Lopez said.

If a patient enters a hospital or clinic with a medical emergency, federal law mandates treatment. Many people, however, visit emergency rooms with routine illnesses, said Dr. Shkelzen Hoxhaj, chief of emergency medicine at Ben Taub General Hospital, the district's flagship facility.

It cost the hospital district about $3.9 million to treat uninsured, out-of-county, non-emergency patients during the fiscal year that ended Feb. 28, said district chief financial officer Mike Norby. About $200,000 of that will be collected, he said.

In a $1.06 billion budget, the loss is a fraction of 1 percent. No savings is too small when state cuts could cost the district as much as $110 million, Norby said.

"We need to just hold the line and say, 'Folks, we need cash up front.' It's the principle of the thing," Lopez said. "We knew we were going to have to start doing things differently. This is not going to solve our problem, but there's no one single strategy to addressing our loss of revenue."

Changes can add up
Other changes the district hopes will cut costs or raise revenue include:

Escorting patients discharged from Ben Taub to the cashier, rather than allowing them to find their way out. Collecting a down payment or co-pay on the spot is more efficient than seeking payment after the fact, Norby said, and could generate several million dollars in added revenue.

"They'd go out the ambulance entrance, they'd go out the other hallway to the main entrance," Hoxhaj said. "There was no control."

Encouraging district employees to seek health care within the district, ensuring a larger base of insured patients. This policy has just begun; Aetna, the district's health plan administrator, did not include district facilities in its network until last fall, Norby said.

Seeking comprehensive "coding," the process that tells Medicaid how to reimburse the hospital for treating a patient's ailments. Doctors often code the acute symptoms being treated, Norby said, and leave off chronic conditions that may be driving those symptoms. Recording all causes could result in higher reimbursements, he said.

Converting to electronic medical records. Completed four months ago, the transition is expected to save money by reducing repeat tests, Hoxhaj said.

Norby said the move also will increase Medicaid reimbursement. Some bills went unreimbursed, he said, because doctors did not sign the necessary forms; the electronic system solves that problem.

Making 90-day prescriptions available. The idea is to reduce emergency room visits by patients seeking renewals every 30 days, Hoxhaj said. It also is expected to reduce the likelihood of those patients visiting the ER to address a crisis caused by a lack of medication. The program started this month.

'Thoughtful' approach
All visitors to the district's emergency rooms are screened to determine a diagnosis. If that exam shows no urgent need, a financial counselor asks uninsured patients who do not live in Harris County to pay the full cost of the treatment up front, or a 50 percent down payment for expensive procedures, Norby said. The same goes for visits to district clinics.

If a payment plan cannot be negotiated, the patients are provided a listing of health care providers in their own counties.

The district accepts many items — from recent utility bills, credit card statements or lease agreements, to car insurance documents or post office records — as proof of Harris County residency. Only county residency is relevant to the policy change, not whether a patient has legal residency in the United States, district spokesman Bryan McLeod said.

"There's always a concern about putting finances potentially before patient care, but I think it's done in a thoughtful manner in that we do have a screening exam done before that decision is made," Hoxhaj said. "That sits well, I think, with our medical staff. I think they understand we don't have unlimited resources."

Steve Radack, a county commissioner and longtime critic of the district, said it should seek bids from private providers who may be able to perform procedures cheaper than the district but said he supports the penny-pinching efforts.

"As far as I'm concerned, it's their job to provide health care to qualified individuals at the least cost to the Harris County taxpayers," Radack said. "Hopefully, they'll start taking care of the business end of the Harris County Hospital District and start running more efficiently, more professionally."

Different in Dallas
Parkland Health & Hospital System, the Dallas public health district, does not screen patients to determine whether their needs are urgent, according to spokeswoman Candace White.

"We don't screen them out — we see them," White said. "Then, with follow-up care, that's when they go through the process with patient financial services."

As the uninsured are discharged, she said, they are asked to contribute toward the cost of their care.

Perry agrees to rainy-day fund spending (UPDATE)
Gov. Rick Perry publicly endorsed spending up to $3.2 billion from the rainy-day fund to help meet a deficit in the current fiscal year, issuing a statement that the House's budget chief said was politically necessary before the House Appropriations Committee took a vote.

Comptroller Susan Combs in January had announced a $4.3 billion deficit in the current fiscal year as part of her revenue estimate. It's part of a shortfall through the next two years estimated at $15 billion to more than $27 billion, with the larger number representing the amount needed to continue the current level of services through the next two years.

That deficit fell to $4 billion when Combs revealed Monday that stronger-than-expected sales tax revenues had yielded an extra $300 million. Lawmakers also plan to implement a net $800 million in cuts offered by state agencies at the direction of Perry, Lt. Gov. David Dewhurst and Speaker Joe Straus.

Perry has been back and forth over using the rainy-day fund, as more Republicans have suggest part of it should be spent to help close the immediate deficit.

Spending money from the rainy-day fund this fiscal year requires a three-fifths legislative vote. Tapping it again for the next two years would require a two-thirds legislative vote.

Perry started out before the session by saying he was against using the fund, then called its use premature since he wanted to be sure all possible cuts had been made first. Appropriations Committee Chairman Jim Pitts, R-Waxahachie, last week said budget-writers' job hadn't been eased by the governor suggesting there were more cuts at which budget-writers hadn't looked.

A top Perry aide testified in Appropriations last week that Perry hadn't "drawn a line in the sand" against using the savings account.

Perry aides refused a second invitation to appear before Appropriations on Monday, but Perry participated in a telephone town-hall meeting with the limited-government group Empower Texans in which he called use of the fund a last resort but added, "If there are some dollars in the rainy-day fund that are required to balance the budget, at the end of the day, we're going to have a balanced budget."

Perry emphasized today that he wouldn't support using more of the fund to help meet the rest of the shortfall through the next two years. Even with spending part of the money, the proposed upcoming budget will include massive cuts, Pitts said.

Pitts said before Perry released today's statement, "I've got people on the Appropriations Committee that need some protection, and I'm not going to let them vote without some protection. And that protection is the governor saying it's okay ... Those people are going to take that hard vote but they would like to have that protection."

UPDATE: The House Appropriations Committee approved House Bill 275 to spend $3.1 billion from the rainy-day fund wth a vote of 27-0. It approved HB4 to implement cuts offered by state agencies and higher education institutions by a vote of 18-9.
Full statement from the Governor's office on the other side of the jump.

Here's the statement issued by Perry's office:

AUSTIN - Gov. Rick Perry, Speaker Joe Straus and Comptroller Susan Combs today announced the decision to close out the Fiscal Year 2011 budget gap by implementing $800 million in cuts, using $300 million from increased sales tax collections over the last few months, and using a one-time draw not to exceed $3.2 billion from the state's Economic Stabilization Fund, also known as the Rainy Day Fund.

"We have worked closely with state leaders and lawmakers to balance the current budget, which includes using a one-time amount from the Economic Stabilization Fund to help our budget deal with the impact of the national recession," Gov. Perry said. "As we craft the next two-year budget, Texas leaders will continue to focus on a more efficient, fiscally responsible government, essential state services, and private sector job creation. I remain steadfastly committed to protecting the remaining balance of the Rainy Day Fund, and will not sign a 2012-2013 state budget that uses the Rainy Day Fund."


"For more than a year, leaders in the Texas House and I have been working with Governor Perry and Lt. Governor Dewhurst to cut state spending by nearly $1.7 billion as our revenue fell during the national recession," Speaker Straus said. "Now that most agencies have made substantial cuts from their current budgets, using part of the Rainy Day Fund to pay for the rest of our bills - even as we continue to look for more savings - is the conservative and fiscally responsible way to meet our constitutional duty to balance the budget. The Rainy Day Fund was created to help manage just such unexpected declines in state revenue. We will do so while preserving more than $6 billion in the fund to cover unexpected emergencies in the future."


"I look forward to working with the members, Gov. Perry and Lt. Gov. Dewhurst to preserve the remainder of the Rainy Day Fund," Speaker Straus said.


"I commend legislative leadership and lawmakers for their work to close the current year budget gap and do what is right for Texans," said Comptroller Combs. "Sales tax revenue has done well in recent months because of increased business and consumer activity, which will help close the 2011 deficit. And as I mentioned in recent testimony, it is also important to keep the state's future budget needs in mind in our decision making of today."


By resolving this biennium's shortfall, Texas leaders can now focus their future efforts on completing the 2012-2013 biennial budget without raising taxes.

A unified board insists that lawmakers spend $500 million on textbooks and instructional material for biology, chemistry and physics in high school, and for English language arts and reading in lower grades, Bradley said.

"This is non-negotiable," he said.

Some legislative leaders, however, question the wisdom of buying new textbooks when schools face up to $11 billion in budget cuts.

"Right now it doesn't make a lot of sense to spend money on textbooks and then fire the teachers who would be using the textbooks," said Rep. Scott Hochberg, D-Houston, vice chair of the House Public Education Committee and school finance expert on the Appropriations Committee.