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Nelson Wolff

We may soon need another legislative special election

In Bexar County.

Rep. Justin Rodriguez

State Rep. Justin Rodriguez is expected to fill the vacant Commissioners Court seat of political icon Paul Elizondo, a major local power broker and a veteran of the commission for more than 30 years who died last week.

Multiple sources said Wednesday that Bexar County Judge Nelson Wolff likely will appoint Rodriguez, who’s served in the Legislature since 2013.

Wolff declined to confirm that he plans to appoint Rodriguez, but he sketched out what he’s looking for in a successor, in deference to the death of his closest friend. Rodriguez declined to comment.

“I’ve had obviously a lot of time to think about this because Paul has had several challenges with his health,” Wolff said.

The county judge said he plans to appoint someone who has legislative experience and fiscal expertise and can help improve the county’s relationship with the city.

[…]

It’s unclear who might step in to run in a special election for Rodriguez’s seat, which would be called by Gov. Greg Abbott.

Rodriguez and a few other close allies of Elizondo have been seen as his potential successors. Among them: City Councilwoman Shirley Gonzales and former state Sen. Leticia Van de Putte, who’d known Elizondo for some four decades.

We should know pretty soon whether Rep. Rodriguez will be the choice to fill that County Commissioners seat. You may recall from when Jerry Eversole stepped down, it is the County Judge who names the successor, so whatever Judge Wolff decides is what will happen. The Rivard Report makes it sound like the choice is more up in the air, and includes Queta Rodriguez, a former employee of Precinct 2 who nearly ousted Elizondo in the 2018 primary, as a potential pick as well.

Rodriguez represents HD125 in Bexar County; he was elected in 2012 after Joaquin Castro decided to run for Congress. After a decade of turnover, he’s the second-most senior member of the Bexar delegation, after Rep. Roland Gutierrez. HD125 was solidly Democratic in 2016, as Hillary Clinton carried it 61-33, but it was closer in 2014 as Wendy Davis took it by a 56-43 margin. If he gets appointed and this becomes a race, I’d expect the Republicans to seriously challenge it. The Dems would be favored to hold it, but it would not be a slam dunk. Keep an eye on this.

Bexar County joins in on SB4 litigation

Add another to the list.

Bexar County has joined the fight against Senate Bill 4, the so-called “sanctuary cities” law.

In their biweekly meeting Tuesday, three commissioners and Judge Nelson Wolff voted to join the City of San Antonio in its lawsuit against the State of Texas in an effort to stop the controversial SB 4.

[…]

Judge Wolff said he received a text message from Commissioner Kevin Wolff (Pct. 3), who was visiting his daughter in China and missed Tuesday’s meeting, saying he did not support joining the lawsuit at this time. Kevin, the lone Republican on the Commissioner’s Court, did, however, support Bexar County’s resolution against SB 4 that commissioners signed in May.

At the beginning of the meeting, Edward Schweninger, Civil Division chief for the District Attorney’s office, said he would come back to commissioners within 30 days with an official recommendation from District Attorney Nico LaHood on whether to join the lawsuit. During that time period, LaHood and his office would do more research on the legal issues surrounding SB 4 and lawsuits contesting its constitutionality, Schweninger said.

But commissioners said the County needs to act now.

“I think we need to get on board and send a message,” said Commissioner Sergio “Chico” Rodriguez (Pct. 1).

See here for the background. Looks like Ken Paxton’s attempt to intimidate potential plaintiffs in anti-SB4 action hasn’t worked just yet. And yes, we’re still waiting for Houston to do something. One hopes that will sooner rather than later.

San Antonio wants a do-over on Uber and Lyft

Maybe the third time will be the charm.

Uber

Mayor Ivy Taylor said Friday that there’s a demand for transportation-network companies in San Antonio and signaled that she wants to work a new deal that would allow Uber and Lyft to restart operations here.

Taylor told the City Council during an all-day retreat that she has directed City Manager Sheryl Sculley to develop a plan for bringing the transportation-network companies, or TNCs, back to San Antonio while the council is on summer break next month. The council met for team-building Friday at Hardberger Park on the North Side.

“We’ve never wanted them to leave,” Taylor said in a Friday interview. “We’ve always wanted Uber and Lyft to be here.”

The ride-hailing firms, however, disagreed. After operating in San Antonio for about a year without regulation, the companies shuttered when the City Council approved policies that the companies found too onerous.

City officials thought they’d come to an agreement with the companies when they approved the updated ordinance, but unresolved concerns over how background checks on drivers would be conducted ultimately drove the companies out of town. The taxi industry lauded the council’s decision, saying “public safety” won the day.

[…]

Lyft

“I am directing the city manager to develop a framework for operating agreements which would allow for TNCs to return to San Antonio during a pilot period,” she said. “This framework will be brought to council for review the second week of August and action thereafter. I have asked Councilman (Roberto) Treviño to be the council representative during this process.

“It is important that we get this issue resolved soon, and I do not want the work to stop during the month of July. Safety will still be a top priority for all of us, and that won’t change.” she said.

Taylor said a data-driven discussion about the merits of the firms’ background checks had been missing from previous discussions. She said she wants to delve deeper into that.

Uber spokeswoman Debbee Hancock said Friday that company officials are looking forward to restarting discussions in San Antonio.

“We are heartened to hear that Mayor Taylor has made it a top priority to bring back ridesharing this summer,” she said. “And we are excited to continue working with the mayor and City Council to make this a reality.”

See here and here for some background. Bexar County Judge Nelson Wolff is a fan of Uber and Lyft, and the other cities in the county have explored having them operate in the non-SA parts of the county, so there was some pressure on Mayor Taylor beyond the tech/millennial community in town to revisit this. We’ll see what happens. The Rivard Report and the Current have more.

Moving on to the runoff for the SA Mayor’s race

This Express News story on the beginning of the Mayoral runoff in San Antonio between Leticia Van de Putte and Ivy Taylor gets to the question of what if anything the two runnersup and their supporters will do.

Leticia Van de Putte

Leticia Van de Putte

But all eyes were on the mayoral race, and the historic runoff with two women candidates. Van de Putte would be the first Latina elected to the mayor’s post, and Taylor the first African-American elected to the seat.

As Villarreal and Adkisson, the third- and fourth-place finishers, licked their wounds Sunday, questions remained about whether they would support either Van de Putte or Taylor.

Communications Director Greg Jefferson said Villarreal planned to meet with his supporters Monday to discuss the matter. Adkisson said after conceding the race that he wasn’t in a hurry to throw his support behind either candidate.

“I think we’ll take some time to chill,” Adkisson said.

Campaign consultant Colin Strother said there’s no way to predict what the former county commissioner would do.

“The guy has been through 50 forums with these ladies and he probably knows better where they stand on the issues than anyone else. At some point, I’m sure he’ll have meetings with them,” Strother said. “With Tommy, one thing I’ve learned is he’s an unconventional guy and he thinks unconventionally, so it’s hard to predict what he’s going to do. I don’t know what he’s going to do, and I don’t know that he knows what he’s going to do.”

Ultimately, support from Villarreal and Adkisson could play a pivotal role in the runoff election. St. Mary’s University political scientist Henry Flores said the contrast of support for the candidates is stark.

“If Leticia gets support from Adkisson, that would be some really important support from the South Side, and that’s a high turnout area. That’ll work to her advantage,” he said. “Ivy is tied to the evangelicals and the tea party, so her support is going to come out of (North Central and Northeast Side) Districts 9 and 10 and a little bit of 8.”

Randy Bear helpfully points out that all campaign acrimony aside, Van de Putte and Villarreal are much closer on the issues that Taylor and Villarreal. That’s not a guarantee of anything, but Van de Putte needs Villarreal voters, so I’m sure she’ll be working to get them, while Taylor will make her pitch to Republicans. Van de Putte did pick up County Judge Nelson Wolff’s endorsement, which is nice but I don’t know how many actual votes it moves. Early voting begins June 1, so there’s not a lot of time to get it done. This is going to be a fast and eventful ride.

UPDATE: And Taylor picks up the endorsement of Mike Villarreal’s campaign treasurer. I figure there will be a lot more of this going back and forth.

Uber and Lyft for the San Antonio suburbs

If the rules in the big city aren’t amenable, maybe the rules in the smaller nearby cities will be.

Lyft

San Antonio’s new rules for rideshare companies go into effect April 1 and controversy over the regulation of transportation network companies (TNCs) continues as Uber and Lyft prepare to leave San Antonio. Company representatives say the rules are too restrictive and burdensome to operate within city limits.

The mayors of Windcrest, Alamo Heights, Olmos Park and Hollywood Park, however, feel otherwise, and joined forces at a Wednesday press conference to express support for Uber to stay in the local service area and continue to operate in Bexar County suburban municipalities.

Windcrest City Council is to vote Wednesday evening on a resolution that would lead to an interim operating agreement with Uber, allowing that company to keep serving its city. Windcrest is home to a host of small and large businesses, including Rackspace‘s corporate headquarters at the former Windsor Park Mall, as well as a large number of retired military veterans.

Alamo Heights, Olmos Park and Terrell Hills city councils each will consider a similar resolution in April.

Uber

[…]

The big questions now is whether Uber drivers picking up a passenger in Windcrest or another Bexar County suburb can be allowed to drive San Antonio roads to deliver passengers to their destinations within San Antonio, such as the San Antonio International Airport.

“If it originates in Windcrest (or another permitted city), they can take the passenger anywhere, whether it’s Bexar County or Houston. That’s how I interpret the law. Then again that’s something for lawyers to squabble over,” Windcrest Mayor Alan Baxter said.

Olmos Park Mayor Kenneth Farrimond has talked with City Attorney Frank Garza and that their feeling is that even with these suburban agreements, Uber drivers and passengers will still be limited in what they can do in San Antonio city limits. Cooper questioned whether San Antonio law enforcement could enforce Uber drivers transporting suburban passengers in any way.

Sgt. Javier Salazar, spokesperson for the San Antonio Police Department, later said if and when Windcrest or another Bexar County suburb issues a driver’s permit, TNCs may use San Antonio streets only to drop off fares initiated in a city where the permit was issued.

So, if approved in Windcrest, you can call an Uber within its city limits and have it drop you off in San Antonio, but you’ll have to find another way back.

“If a pick-up begins in another city, other than a permitted city, they may not travel through San Antonio,” he added. Salazar said San Antonio’s ordinance can be enforced in a number of ways, including a sting operation or via routine traffic enforcement.

Interesting. I’m not sure how economically viable that will be – Alamo Heights, Olmos Park, Terrell Hills, Windcrest City, and Hollywood Park have a combined population of about 22,000, so the potential customer base they could offer is pretty small. That said, as the Express News story says, mayors of 25 out of 26 non-San Antonio towns in Bexar County attended a meeting called by County Judge Nelson Wolff (a suporter of ridesharing) to discuss this. If the rest of Bexar County is on board, that changes things, though it’s still complicated. Worth keeping an eye on, and Windcrest City Council did approve the resolution, with several others to follow soon. I wonder if Harris County and the other cities it has will make a pitch as well. The Current has more.

San Antonio may try again on vehicles for hire

Very interesting.

Lyft

Key players at City Hall are crafting an eleventh-hour amended ordinance to stop Uber from leaving San Antonio, 10 days after the rideshare company announced plans to end service here if one of the nation’s most restrictive ordinances goes into effect on March 1.

The ordinance passed by Council in December, say supporters of Transportation Network Companies (TNCs) like Uber and Lyft, is so restrictive compared to other cities that it seemed designed to drive out any competitors using new technologies threatening the local taxi industry.

The working group is being led by Councilmember Roberto Treviño (D1), who represents the center city, and includes Jill DeYoung, Mayor Ivy Taylor’s chief of staff, Deputy City Manager Erik Walsh, and interim San Antonio Police Chief Anthony Treviño.

Councilmember Treviño confirmed the latest developments in an interview late Sunday after several sources shared details of the effort with the Rivard Report.

The group is drafting a less restrictive ordinance that could be presented to City Council for approval within weeks, and no later than March 5, Treviño said in an interview.

Uber

“I feel very positive that we are very close to a compromise agreement,” Treviño said. “We are really focusing on a policy that does not make us look like a city that stifles innovation at the same time we take care to assure the public’s safety.”

Treviño said he could not say if the proposed revisions would win the support of Mayor Ivy Taylor and others on the City Council who voted 7-2 in favor of the highly restrictive ordinance in December that prompted Uber representatives to announce they will end service in San Antonio.

[…]

Bexar County Judge Nelson Wolff, who served as San Antonio’s mayor from 1991-95, sent an open letter to Mayor Taylor one week ago on Feb. 9 that criticized the pending ordinance and how it would negatively portray San Antonio around the nation. Rideshare, he wrote, is an attractive and popular transportation option that reduces the incidence of drunk driving, and is especially appealing to skilled young professionals that cities everywhere are competing to retain and attract.

Mayoral candidate and longtime Southtown resident Mike Villarreal, who recently stepped down from his District 123 House seat in the Texas Legislature, is making rideshare a campaign issue. A campaign email blast on Sunday called on his supporters to sign a change.org petition launched by Lorenzo Gomez III, the director of the 80/20 Foundation and Geekdom, the downtown tech incubator and co-working space. Nearly 5,000 people had signed the petition by Sunday evening.

See here, here, and here for the background. There was also movement towards a lawsuit against the San Antonio ordinance, as the story notes. What would be proposed here is something more like the ordinances that other Texas cities have passed. Insurance requirements – the transportation network companies (TNCs) like Uber and Lyft were required to carry larger liability policies than cabdrivers were. As I understand it, the general public in San Antonio wanted to allow Uber and Lyft to operate, so this ordinance had generated some blowback. It will be interesting to see how the revised ordinance fares, especially now that Mayor Ivy Taylor has declared that she does in fact want to run for a full term. Taylor had supported the restrictive TNC ordinance, will likely be a point of attack against her by other candidates. How effective that may be I couldn’t say, but it does reinforce my belief that San Antonio should have tabled this effort until after the May election/June runoff. We’ll see if the issue still needs to be revisited under the newly-elected Mayor.

Tommy Adkisson joins SA Mayoral race

And then there were three major candidates.

Tommy Adkisson

Bexar County Precinct 4 Commissioner Tommy Adkisson became the latest candidate to enter the 2015 San Antonio mayor’s race Sunday as he announced his bid to lead the Alamo City.

[…]

His announcement touted that the city needs a “Stay-at-home” mayor to handle the resolution of the fire and police contract and appeared to single out City Manager Sheryl Sculley.

“We need to get back to the bargaining table and resolve, not leave the table until we reach a resolution,” he said.

“My fellow citizens, one thing should be clear: the city manager works for the mayor and council, not vice versa,” he said in a statement released Sunday night.

The statement in question is here, via his campaign Facebook page. Adkisson, like Mike Villarreal and Leticia Van de Putte, is a Democrat; he was a Bexar County Commissioner for four terms before making an unsuccessful challenge in the Democratic primary to County Judge Nelson Wolff this March. He was also in the Lege for two non-consecutive terms back in the 80s. His candidacy for Mayor had been rumored/known about for some time, so this is no surprise. Beyond that, I don’t know much about him, but his presence pretty much guarantees that there will be a runoff, and it adds a few extra dimensions to things. I’d be interested in hearing from my San Antonio readers what you think about this.

More MLB-to-San-Antonio rumors

Believe them at your peril.

Could the Oakland A’s find a home in San Antonio?

At least one Oakland elected official thinks so, but Bexar County Judge Nelson Wolff says San Antonio sports fans shouldn’t hold their breath.

“There’s nothing happening over here,” Wolff said.

“Our name’s been thrown out, but we went through that with the New Orleans Saints. I went through that with the Marlins. We didn’t spend a lot of local money but we spent a lot of time on it. You get these owners telling you one thing, and the baseball guys, administration, telling you something else. They’re going to have to be a hell of a lot more serious and a hell of a lot more coordinated to expect any of these communities to express any interest in it.”

However, Oakland City Councilman Larry Reid said he doesn’t believe the A’s are bluffing in their threat to leave the city if they don’t get a 10-year lease extension at the Coliseum.

Reid told San Francisco Chronicle blogger Phil Matier that San Antonio and Montreal are possible destinations should the A’s not get the deal they want.

“They have options,” Reid said, citing sources among the Coliseum Authority negotiators who have been working for 14 months to try to reach an A’s lease extension.

When asked if he thought the threat was real, Alameda County Board of Supervisors President Nate Miley said, “I’d put money on it.”

Here’s the blog post on which this story is based. It mentions that Montreal is another possible relocation option for the A’s, and in doing so broke my brand-new Irony-O-Meter. I paid forty bucks for the damn thing, too – guess I better mail in that warranty form. Anyway, as noted before, San Antonio may be a viable landing place (or expanding place) for a MLB team someday, but that day is not today, and likely won’t be anytime soon. San Antonio and – I can’t say it with a straight face, so please pardon the guffaw – Montreal are much more useful to MLB right now as points of leverage in this sort of negotiation. If it ever gets more serious than that, I trust that grassroots folks like MLB in San Antonio will be a bit more chatty on social media about it than they are currently. Enjoy the All-Star break, y’all. There should be some real baseball news again soon.

Making San Antonio more musical

San Antonio is a little jealous of Austin, it seems.

Nelson Wolff

Tired of San Antonio playing second fiddle to Austin when it comes to a live music scene, Bexar County Judge Nelson Wolff on Friday laid out ambitious plans to change that.

Wolff said he’s ready to work with two top-notch promoters to raise San Antonio’s profile in the music world.

“I want to see Bexar County make its mark,” he said.

“Our best opportunity to rival Austin would be to stage a major music festival featuring the new sounds of music along the Mission Reach of the San Antonio River,” Wolff said.

[…]

Wolff debuted the proposal during the annual “Bexar Facts” state-of-the-county report to the North San Antonio Chamber of Commerce. He reported progress on transportation and flood-control projects and urban enhancements including the Tobin Center for the Performing Arts.

“But there is still a major piece missing in attracting the best and the brightest, and that is the lack of a first-class music scene,” Wolff said.

Despite having venues for major events at the AT&T Center, Freeman Coliseum and theaters, Wolff said, “we are on the losing end to Austin when it comes to attracting tour acts and festivals. Witness Paul McCartney’s sold-out show in Austin this week while he skipped San Antonio.”

Wolff said he’s encouraging two prominent promoters to bring more independent music to San Antonio.

I get why San Antonio feels overlooked. At least back when I was in college, it was fairly common for big music acts to skip San Antonio when they toured Texas – a typical visit would be Houston, Austin, and Dallas. I have several friends who drove to Houston in 1986 to see Pink Floyd at the Astrodome. I might suggest that San Antonio figure out a way to build up its local scene, especially at smaller venues, as a complimentary path to enhancing its appeal to traveling artists. Again, my only frame of reference is my college days in the 80s, but the North Mary’s Strip between Trinity and downtown seems like an obvious place to begin with that. The thing about Sixth Street in Austin is that you walk down it and you hear music coming out of one bar after another. There’s plenty of bars along the Strip, there just needs to be the music. A music festival along the lines of the Free Press Summer Fest would be a good idea as well, especially if the river can be used as a backdrop/venue. I’m not exactly sure what Bexar County Commissioners Court can do to abet either of these, but I wish them luck in their effort.

Counties may try to expand Medicaid on their own

The Washington Post reports on the efforts of county and hospital district officials in some of Texas’ largest counties to bypass Rick Perry’s refusal to expand Medicaid for Texas and seek approval to do it themselves for their own jurisdictions.

It's constitutional - deal with it

George Hernandez Jr., CEO of University Health System in San Antonio, came up with the idea of the alternative, county-run Medicaid expansion, and said he has been discussing it with other officials in his county, Bexar. “They are all willing,” he said. He added that he has also been talking up the proposal with officials in other big counties, such as those including Houston and Dallas, and is optimistic they’ll support the idea.

Robert Earley, CEO of JPS Health Network, the public hospital system serving Tarrant County, which includes the Fort Worth area, said he could see the idea catching on.

[…]

Under the federal health law, the Medicaid expansion would begin in 2014, and would cover people with incomes of up to 133 percent of the poverty level. The federal government would pay the entire bill for the first three years and 90 percent thereafter. If there were a county-backed expansion in Texas, the local hospital districts would tax residents to come up with the 10 percent state share. Texans living in counties that participated in the expansion would be eligible for Medicaid under the less restrictive rules, while those living in the rest of the state would not.

An official from the U.S. Department of Health and Human Services declined to comment on the idea, but said, “We look forward to continuing our dialogue with states . . . as we work to meet the law’s goals.”

Alan Weil, executive director of the National Academy for State Health Policy, said that the idea, despite its challenges, “is certainly not far-fetched.”

Weil noted that there is precedent for a federal waiver of this type: After California declined to take advantage of a provision in the health-care law that allows states to accelerate their Medicaid expansion, the leaders of several counties got permission from the Obama administration to do so on their own.

The Texas proposal, of course, represents more than a temporary bridge to statewide expansion; it could be a permanent arrangement.

“And federal authorities might feel differently about that,” Weil said. “But as a general proposition, could you have different counties with different eligibility standards? I think the answer would be yes.”

We first heard about this a few weeks ago, after the Perry announcement and the sheepish admission by outgoing HHSC Chair Tom Suehs that Medicaid expansion would not cost nearly as much as his agency had first claimed. It’s an interesting approach, one that I could see being allowed to happen, and I admire creativity and perseverance of the officials who are pursuing it, but let’s be clear that it’s at best a kludge designed to work around a bad decision. For one thing, it cannot possibly be more efficient to have up to 254 potentially different standards for eligibility in Texas than just one statewide standard. For another, while I expect that many counties would do this if they are permitted to do so, some others will choose instead to be free-riding parasites on their neighbors; this is another reason why a statewide solution is better. Given the choice between no Medicaid expansion and a patchwork of Medicaid expansion done by the counties, I’ll gladly take the latter – it’s way better than the status quo, and could easily wind up covering a significant portion of the large uninsured population in Texas, many of which are now served by these overburdened hospital districts. But again, it’s a patch that’s being applied to a strictly self-inflicted wound.

And this approach now has a champion in Congress.

Congressman Henry Cuellar is asking the U.S. Department of Health and Human Services if Texas counties can bypass their state government in order to expand Medicaid coverage.

The Laredo Democrat says he supports giving counties the choice. He said he set up a teleconference call with HHS after reading an article in the Washington Post that said some of Texas’ largest counties want to make an end run around Gov. Rick Perry’s opposition to the expanded Medicaid program included in President Obama’s health-care law.

“I will be talking to HHS next week. I want to know if it is up to the Texas Legislature to decide if counties can do their own thing or whether it is something we can make happen at the federal level. I want to do all I can to give counties the choice,” Cuellar said, in an interview with the Guardian in Rio Grande City on Tuesday.

[…]

Cuellar recalled his time in the state legislature when he wanted to give Texas counties the opportunity to expand the Children’s Health Insurance Program. “We do not do as good a job with the CHIP program as other states do and I wanted to negotiate with HHS to give our counties the chance to expand it. I was opposed by the other states. They understood that if Texas sent CHIP money back, they could get some of it,” Cuellar said.

The Washington Post story focused on the larger Texas counties that have large public hospitals and hospital districts. Many border counties do not. Asked if border counties could bypass the state government in order to secure expanded Medicaid coverage under the ACA, Cuellar said he is going to ask HSS if such a maneuver is possible. “I want to see if the border counties can group together. I want to see if we can give them an option,” Cuellar said.

Again, given the constraints of Rick Perry’s obstinacy and antipathy towards non-rich people, that’s a great idea. Any opportunity to bypass the Lege should be grasped with both hands. Make that option available to any group of counties that don’t have a hospital district but want to do right by their taxpayers, too. If there’s any justice, Texas would achieve near-complete coverage by this method. It will probably take something like that to change the status quo. It’s still a stupid way to do business, but you gotta do what you gotta do.

There’s one remaining question that I have about all this, and that’s what Harris County intends to do. Bexar County has been the driving force behind this movement. Harris has the same need and a much bigger population, so its participation would be a big deal. I placed a call and was informed that Harris County Hospital District CEO David Lopez is “not granting interviews” on this topic at this time. Disappointing, but I suppose the politics of this are rather tricky for them, and they want to get as many ducks in a row as possible before deciding on a course of action. If you’re an officeholder in Harris County and you like the idea of providing coverage to the million or so uninsured residents of this county, I suggest you bring this up to Mr. Lopez at your next opportunity. You never know who else might be talking to him if you aren’t.

Medicaid expansion: Not as expensive as the state claimed it would be

Remember last year when the state Health and Human Services Commission claimed that Medicaid expansion would cost the state of Texas $27 billion over ten years, causing every Republican in the state to have a fainting spell and a hissy fit about how that would bankrupt us all? Turns out that estimate was a wee bit too high.

On the heels of Gov. Rick Perry’s declaration that Texas will not expand Medicaid because it is too costly, his health and human services commissioner said Thursday that fully implementing health care reform would cost the state about $11 billion less over 10 years than previously estimated.

Executive Commissioner Thomas Suehs told a Texas House subcommittee that the new estimate is between $15 billion and $16 billion in state costs over a decade, compared to the previous estimate of $26 billion to $27 billion.

The state would get an additional $100.1 billion in federal money over that time, according to the Texas Health and Human Services Commission – money that Suehs acknowledged would be attractive to local entities grappling with the cost of caring for the quarter of the state’s population that currently is uninsured.

“If I was a county hospital district, I would be knocking on your door saying we need to re-debate” Medicaid expansion, perhaps with a push for a local option, Suehs said. That idea, in which a local agency would deal directly with the federal government to expand Medicaid in its area, has been cited by Bexar County Judge Nelson Wolff.

I’ll get back to that “local option” in a minute, but for now take a look at the reasons why HHSC says they overshot the mark. The interesting thing is that in an ideal world that original HHSC esitmate would be closer to the mark because more people who would be eligible for Medicaid under the Affordable Care Act would be getting it in a more timely fashion. Of course, the dirty secret is that under those same assumptions Texas would be paying a lot more for Medicaid now. A lot of people who are eligible today for Medicaid don’t get it, in large part because of policy decisions made by Texas such as means testing and six month enrollment periods. The same is true for CHIP, whose enrollment levels have never returned to those before the 2003 cuts. Our stringent enrollment requirements and stingy benefits, both of which are big contributors to the large number of uninsured people in Texas, are matters of policy and priority, just as Medicaid expansion is. Rick Perry and legislative Republicans don’t want to spend any money on that. It’s just not something they care about. For all their carping and whining about the federal government making them do something about this, they themselves have never proposed a solution to deal with the problem. Well, they are proposing something now, but I’ll get to that in a minute as well.

What does that “local option” mean?

“It (the federal portion) is a huge amount of money. You just can’t leave that on the table, particularly when the burden falls on public hospitals that are funded by local taxpayers,” said Wolff. He is head of the commissioner’s court, which approves the budget for University Health System, a main provider of health care to low-income Bexar County residents.

Harris County Hospital District president and CEO David Lopez said he wants to talk with Perry’s office about possible funding alternatives.

The local option would have to be discussed by all the area’s health care providers, Lopez said.”It’s more than just a public hospital issue. All providers in our community are impacted by this, so they should all be part of the discussion.”

Sen. Leticia Van de Putte, D-San Antonio, said she does not think a local option is available in the law as written, but she is making inquiries about what is possible. “This is real money, and it means real health care for Texans,” she said.

I’ll have to do some research, because this is the first I’ve heard of this, but I gather that a “local option” means that local entities such as counties or hospital districts would apply to the federal government for some amount of money to cover the needs that the state has abdicated by opting out of Medicaid expansion. I have no idea how this would work, whether we’re talking about a restoration of funds to covered uninsured patients who show up at emergency rooms – which, you will recall, is the most expensive and least efficient way to deliver health care – or if these local entities would somehow be administering their own mini-Medicaid programs, or something else entirely. How this is a better idea and a less burdensome regulatory context than simply expanding Medicaid is a question I can’t answer. (The same could be said about having fifty individual statewide Medicaid programs instead of one federal program, but that’s beyond the scope of this discussion.) Whatever this is, I’d call it better than nothing, which is what the state wants to do right now, but in the absence of any details I can’t say how much better than nothing it is.

On the matter of funding to cover uninsured patients, some hospitals are in for more hurt than others if nothing happens.

Bruce Siegel is the chief executive of the National Association of Public Hospitals, which represents the nation’s safety-net hospitals. His members include more than 60 hospital systems, largely in urban areas. As public institutions, they tend to see a greater share of Medicaid and uninsured patients, and also provide more medical services that ultimately do not prove profitable.

That all made the Supreme Court ruling of the Medicaid expansion as optional a huge deal for Siegel and his members. “It’s a pretty grim menu of choices,” he says. We spoke Thursday afternoon about why he’s taking governors’ threats to opt-out seriously, what that would mean for public hospitals and how his group will push the White House for a fix.

[…]

SK: I was writing about DSH payments last week and I was hoping you could explain why they’re so important. They amounted to $11.5 billion last year, which isn’t nothing, but is a pretty small part of Medicaid’s $393 billion budget.

BS: It’s important to keep in mind these payments don’t go to every hospital. They are designed to target those who serve lots of uninsured people. So DSH payments are very important for public hospitals in places like Mississippi, Alabama and Texas, really a lot of Southern states. They’re not going to most hospitals. They’re targeted to a very specific purpose.

SK: Let’s say a big state like Texas, which got nearly $1 billion in DSH payments last year, doesn’t participate. Game out what happens to the public hospitals in that state.

BS: The average American hospital has an operating margin of 7 percent. The average among our members is 2 percent.

We project that if you took away DSH, the margin drops to negative 6 percent. If that happens, you can’t keep up a negative 6 percent margin for more than short time. After a year or two, you have to think about what happens next. You’re having to think about what you shut down after a year or so.

We think there are essentially three options. One is you start cutting back on services. You start figuring out what isn’t bringing in much revenue. And that could be things like community clinics or trauma services. You make some hard decisions.

You may be forced to go to local taxpayers. You find yourself basically putting this in the lap of taxpayers and tacking on the bill for your uninsured to their bills.

In the worst circumstance, you simply decide you can’t go on in that situation and close your doors. It’s a pretty grim menu of choices.

SK: How do you fight this at the state level?

BS: We’re working in state capitals, trying to give our members facts to work with about what this does and doesn’t mean, so they can have an intelligent discussion. There are different strategies for each state. We’re raising awareness that you can’t have it both ways. You can’t say no to the coverage program and cut the DSH program in half, and have this work. We need to get to a consensus that is a huge problem.

Again, the point is to reduce the number of people who rely on emergency rooms – the most expensive and least efficient way to deliver health care – by getting people onto insurance so that they can have access to non-emergency health services. Maybe expanding Medicaid isn’t the best way to do that, but any program to expand health care access is going to involve some up front cost. Some part of that is mitigated by reducing costs elsewhere such as this, which is why the Affordable Care Act cut the subsidy for uninsured patient care to hospitals. Without the expansion of Medicaid, however, you get the worst of all worlds. What does the state’s Republican leadership plan to do about this? Going by the rhetoric of retiring Medicaid director Billy Millwee, speaking to a bunch of zealots at the TPPF, it’s mostly slogans.

Despite Perry’s announcement that Texas will not expand Medicaid, the state will likely see a jump in those enrolling in the current program, Millwee said. Because the individual mandate — which requires all citizens to purchase health insurance — was ruled constitutional, those who were “eligible but not enrolled” in Medicaid will now join the program, he said.

“Medicaid is crowding out other programs,” Millwee said. “In my mind, it is starting to enable poverty.”

Millwee called the current Medicaid system “antiquated” and suggested the state instead receive block grants — federal funds with relatively few restrictions — to expand its health care system.

Expanding Medicaid would “add a lot of people” to the program without increasing their actual access to coverage, Millwee said, because of the scarcity of doctors accepting new Medicaid patients.

Last year 31 percent of doctors accepted Medicaid patients, The Texas Tribune reported earlier this week. Millwee attributed this number to the complexity of Medicaid, saying doctors are not paid as well under the current system as they could be under a block grant system.

That remark about poverty is the sort of thing that could only be said by someone who doesn’t worry about where his next meal is coming from to a bunch of people who think poor people have no one to blame but themselves for their situation. I’m sure they all congratulate themselves for their rectitude every Sunday at church. Having said that, there is some truth to what Millwee says, in the sense that as people move up the income ladder from the very bottom to a step or two above the very bottom, they suffer the equivalent of extremely steep marginal tax rates as they lose eligibility for various programs, including Medicaid. There’s no reason why Congress and the State Lege can’t address this in a fashion that makes more sense, but what with all the wailing and gnashing of teeth by the TPPF types about millionaires paying slightly higher marginal tax rates, which as we know will cause them to stop creating jobs, that seems to get lost in the shuffle.

Then there’s the talk of block grants, for which five GOP legislators shilled on the Chron’s op-ed pages on Saturday. This is a GOP wish list item, and the SCOTUS ruling that invalidates the ACA provision penalizing states for rejecting Medicaid expansion has given them fresh hope of getting it. The thing to remember is that a block grant is a single lump sum of money, with the lure for states being that it has few restrictions on how it can be spent. But the thing about a block grant is that if you run out, either because the amount you were given was insufficient to meet your need or because you spent it foolishly, that’s all there is. If you’ve been paying any attention to the budget ideas of the Congressional GOP – the Ryan plan, in particular – you know that the strategy for controlling future costs is to ensure that block grants remain static or grow at a fixed rate that’s sure to be less than the rate of growth of the actual expenses. To be blunt, this is all about controlling expenses by cutting them. How it would expand coverage, as Millwee claims, is not explained, but look at it this way: You would be putting your faith in the people who have kept Texas at the bottom of the national list for health care access to do something about it once we’ve given them what they want. If that sounds like a winning scenario to you, I’ve got some beachfront property in Midland you might be interested in.

Finally, as far as the lack of doctors is concerned – what, you mean tort “reform” hasn’t solved all of our problems yet? – who says we have to have doctors accepting Medicaid? Why not seek out ways to encourage more nurse practitioners to do the kind of checkup and maintenance work they’re perfectly capable of doing? Maybe there are some burdensome regulations holding them back that the Lege could address. All I know is that going on a dozen years of Republican control of state government we’re no closer to solving this problem on our own, and we’re resisting a comprehensive solution that’s been presented to us. It’s all a matter of priorities.

Meet the new rail debate, same as the old rail debate

I feel like I’ve heard all this before.

Opponents of the planned downtown streetcar system said Tuesday that county officials broke a promise with voters when they agreed to use advanced transportation district funds to help fund the project.

The group contends that multiple pieces of campaign literature used to promote the ATD tax in 2004 explicitly stated the money would not go toward light rail or toll roads.

A streetcar, they said, is light rail by another name.

“I think the average person would say this is light rail,” said Jeff Judson, an Olmos Park city councilman, senior fellow with the Heartland Institute and former president of the Texas Public Policy Network, a conservative think tank that played a large role in the defeat of a 2000 tax increase that would have funded a 53-mile light rail system here.

[…]

A 2004 VIA campaign brochure, labeled “Keep San Antonio in Motion!” explained why voters should approve a ¼-cent sales tax increase to fund creation of the ATD, which would pay for transportation projects for VIA, the city and the Texas Department of Transportation.

It also included a note, in bold, italic type that “these funds would not be used for light rail or for projects on toll roads.”

The actual ballot included no reference to light rail or anything that would preclude the money from being applied to rail.

Michael Dennis, a retired lawyer working with the anti-streetcar coalition, said the brochure qualifies as part of a “contract with the voters” doctrine, which includes whatever voters think they are approving even if it wasn’t on the ballot itself.

“That is a binding contract that can be enforced,” Dennis said.

So an anti-rail group is claiming that a referendum didn’t say what it said but did say what they say it said. Yep, I was right, I have heard this before. That means the next step will be to demand a re-vote, and another re-vote after that if the result is unfavorable. My advice to Nelson Wolff and the folks at VIA is to stock up on the ibuprofin. You’re going to need it.

No MLB or NFL for SA any time soon

San Antonio is many things, but a Major League Baseball or NFL city is isn’t, and won’t be any time soon.

Those are the findings of California-based Premier Partnerships, which recently submitted the results of a six-month feasibility study commissioned by Bexar County and San Antonio to determine the viability of professional sports in the area.

The company, which describes itself as a sales and marketing firm that focuses on “revenue optimization” of sports initiatives, found that San Antonio, while hungry to pursue heavyweight leagues, is lacking in corporate sponsorship dollars and infrastructure.

The $50,000 report, which runs more than 250 pages, concludes the city “should continue to build its sports landscape and take a ‘wait and see’ approach with larger professional leagues.”

[…]

The study shows San Antonio lags behind major sports markets in critical areas.

For example, it found the average NFL host metropolitan area includes 18 Fortune 500 companies, ranks 18th as a media market and has a $53,800 median household income. The San Antonio region, in comparison, has six Fortune 500 companies, ranks 37th as a media market and has a $48,000 median income.

Major League Baseball host areas average 17 Fortune 500 companies, average 13th as a media market and have a $71,800 median household income.

“Clearly, the matrix of this (study) shows that it would be difficult to get it,” said County Judge Nelson Wolff, a longtime proponent of luring big-league baseball to San Antonio. “Instead of us talking about getting something in Major League Baseball or the NFL, it makes more sense to look into the future a little more. In 10 or 20 years, what might be available then?”

Fortune 500 companies are useful for buying up luxury suites, which is where the real money comes from, but the overall population is important, too. As we’ve seen before, even as the city of San Antonio has grown, the San Antonio MSA – excuse me, the San Antonio-New Braunfels MSA – still lags behind most of the existing ones with MLB and/or NFL teams. As a media market, San Antonio is only #31; Dallas is #5, and Houston is #6, and most other major league cities are in bigger markets. Put it all together, and I think Judge Wolff has the right idea.

San Antonio and New Braunfels

The San Antonio metro area has grown again.

New Braunfels, the second-largest city in South Central Texas, now is part of the newly expanded and renamed San Antonio-New Braunfels Metropolitan Statistical Area, which has grown from four to eight counties.

Defined by the federal government as a geographic region that shares social and economic ties, an MSA is designated by the Office of Management and Budget and used by the Census Bureau to collect data.

The changes have sparked applause in Comal County, where German settlers founded New Braunfels in 1845 and where many San Antonio commuters live.

Whether it’s entirely good for New Braunfels, however, “depends on who you ask,” said Mayor Bruce Boyer. “There’s certainly some pride in it, but we want to preserve our culture and heritage.”

More on the newly-named MSA is here. The change is mostly about regional planning, which is more of an issue now as development on each end of I-35 between the two cities creeps closer and closer together. I don’t know if they need to be thinking about regional transit – I have no idea how many people live in NB and commute to SA, and the story says that this is about more than that anyway – but if that Lone Star Rail line ever gets built, it would be nice for the two cities to coordinate their efforts.

No matter what strategies are developed, [Bexar County Judge Nelson] Wolff predicted that the two biggest cities in the revised MSA will grow closer.

“Twenty-five, maybe 50 years from now we won’t be able to tell where our city ends and where theirs begins,” he said.

Yes, just like Katy and Sugar Land and eventually the Woodlands with Houston. Which may be a blessing or a curse, depending on how you look at it. But pretending it’s not going to happen won’t change anything.

San Antonio to seek federal funds for streetcar system

Another step forward for San Antonio’s quest to lose its title as the most populous city in America without rail transit.

VIA Metropolitan Transit’s trustees on Tuesday approved the routes for a streetcar system and directed agency staff to seek a $25 million grant to help fund an initial segment.

VIA plans to submit an application to the Federal Transit Administration by Feb. 8 seeking the funding for a 2.2-mile, north-south route that largely would run along Broadway and South Alamo Street, from Josephine Street to South St. Mary’s Street. Officials currently expect that segment to cost roughly $90 million.

The board also approved an east-west route that ultimately could connect the AT&T Center to Our Lady of the Lake University, traversing downtown along East Nueva.

Mayor Julián Castro and County Judge Nelson Wolff told the VIA board that the city and county are ready to be full partners in the development of the system and committed to help bridge a funding gap. The grant would require at least 20 percent in local matching funds.

Previous blogging here and here; my thanks to commenter UrbanInfill in the latter post for pointing this out to me. It’s worth noting that a logical future extension of any San Antonio light rail system – these lines are currently envisioned as streetcars, with the plan that they would be converted if ridership supported it – would be to the airport, which is not too far north of downtown at US281 and Loop 410. But a Broadway route isn’t really suitable for that, so some other option would be needed. A commenter on the news story suggested San Pedro as an alternative to Broadway; if nothing else, I think you could make an airport connection work from such a line. Just a thought. Also, it’s nice to see city and county governments working together on a project like this as Castro and Wolff appear to be doing. I wonder what their secret is.

Streetcars in San Antonio

San Antonio is looking to Portland for inspiration as it contemplates a streetcar system.

In the 1990s, driven by a plan to infuse the inner city with new residents, transit advocates drew up plans to link several districts by streetcar and encourage dense, walkable, mixed-use development designed around the rail line.

As it turns out, the little streetcar line — four miles from end to end — is an economic powerhouse, according to Portland officials. They say some $3.5 billion has been invested within two blocks of the streetcar line’s footprint. More than 10,000 new housing units and 5.4 million square feet of office space have been built in the same area.

San Antonio officials are looking to replicate that.

Henry Muñoz, VIA Metropolitan Transit’s board chairman, said he expects the agency to break ground in two or three years and will announce in the next month a citizens advisory committee to help guide the creation of a starter streetcar system.

“It’s something that could have potentially enormous impact on the city center of San Antonio,” he said.

[…]

While the idea of streetcars in San Antonio is in its infancy, Muñoz envisions lines running both north-south and east-west, connecting some of the city’s great cultural centers, sports facilities and public institutions. From Mission San José, a line could run north, to the southern border of Alamo Heights. And a perpendicular line could run from the AT&T Center on the East Side to Our Lady of the Lake University on the West Side.

Muñoz said he’s uncertain how much could be built initially because of the expense.

During conversations in Portland, San Antonio leaders rattled off a number of key sites that potentially could be accessed by a streetcar system: Southtown, HemisFair Park, the Convention Center, the River Walk, the Alamo, Municipal Auditorium, Market Square, Museo Alameda del Smithsonian, several college campuses, the Witte Museum, the San Antonio Museum of Art, the Alamodome and even Fort Sam Houston.

Any site accessible by streetcar would stand to benefit from the line, including the Museo Alameda, for which Muñoz was a driving force, and the Pearl Brewery, whose owner had representatives on the Portland trip.

In a joint effort between VIA and the Downtown Alliance, the Inner-City Rail Circulator Study is under way as well.

The feasibility study, due to be released this fall, will help determine whether San Antonio can support a system, how much it would cost and where it would be aligned. But it’s clear that local officials aren’t waiting for the results to move forward on planning.

There used to be a streetcar system in the early part of last century that ran up Broadway to Alamo Heights, past where Brackenridge Park now is. In addition to being historically true, it just makes sense. I hope they dare to think big about this. Which means thinking about more than just streetcars.

It’s clear there’s been a shift in thinking among local leaders, who in the past have advocated for light rail. They say a streetcar system, which is smaller in scale and cost, could prove to be a gateway to larger projects for San Antonio.

A starter system would allow people to “kick the tires” and get used to rail, which could lead to support for larger light rail and commuter lines that move more people longer distances.

[…]

For now, San Antonio will remain the largest city in the country without rail. The notion makes Muñoz cringe, but he sees San Antonio at a crossroads.

“People recognize that we’re at a critical juncture for our city’s future,” he said. “We have to provide them with an environment that helps them shift their thinking. That’s the moment we’re living in today.”

Taking this approach, and focusing on the area in and around downtown seems like a good idea for starters, though if the hope is to eventually incorporate light rail, I hope they leave themselves room for dedicated right of way. Part of the problem now, as the story notes, is that San Antonio isn’t very dense, and it has been resistant to density, though new Mayor Julian Castro is a fan. Maybe they can use this process to help them do mixed-use and transit-oriented development in a way that Houston still hasn’t quite figured out. I wish them luck in getting it done.

On a related note, I see that Dallas may be catching streetcar fever as well. Dallas of course already has a successful rail system in place, so this would be an extension of that. They may have an easier time getting it off the ground as a result.