The Legislature and Rural Health Care

To the Editor:

The “Regular Session” of the Texas Legislature ended on June 2nd. Over 8,700 bills were filed by Texas House and Senate members. Probably around 1,200 passed by both the House and Senate will become law. The big ones were school vouchers (cost: $1 billion), public school finance (cost: $8.5 billion) and state water supply funding (cost: $ 1 billion). Others got a lot of air time (and used up legislators’ time) but don’t cost much.

The Legislature increased the 2026/2027 State Budget to $338 billion. The 2024/2025 State Budget is $322 billion. Most of the State’s money comes from sales taxes. The State gets 6.25 percent sales tax on all retail sales. Local taxing jurisdictions (cities, counties, special purpose districts) can each impose up to 2 percent more. Almost everybody pays sales taxes. An exception is purchases made for agriculture use (“ag exemption”).

So what new laws will improve rural healthcare with all this money? House Bill 18 (HB 18) will become law. Filed by State Rep. Gary Van-Deaver of New Boston (in East Texas), it is entitled the Rural Health Stabilization and Innovation Act. The Legislature’s bipartisan House Research Organization says HB 18 would “establish or make changes to several offices [state agencies], programs, and services that administer or provide healthcare services to rural counties of the state.”

HB 18 might also make grant money available to rural hospitals for limited purposes and time periods. It would not provide statewide funding for rural hospitals or healthcare. Rep. VanDeaver told the Texas Tribune (4/23/25) that over the next two years, HB 18 could cost the State about $49 million for administrative overhead and possibly another $100 million for grants to rural hospitals.

Last October, the County Judges and Commissioners Association of Texas and its member counties (including Fayette County) adopted a resolution to support “the passage of legislation to provide statewide funding to support and enhance rural EMS for all Texans.” It did not adopt a comparable resolution that would support legislation for statewide funding for rural hospitals or healthcare generally. The Texas Hospital Association says Texas has 147 rural hospitals serving 4.65 million people (15% of Texas’ population), including 586,000 rural Texans without any health insurance. Since 2005, more than 20 Texas rural hospitals have closed.

HB 18 was passed by the House and by the Senate on May 25th. On April 25th, another rural Texas hospital closed – Mid Coast Medical Center in Trinity County (in East Texas). Trinity County (pop. 13, 602) has a hospital district that contracted with Mid Coast Health System, a non-profit corporation, to provide hospital services to the county. Mid Coast also operates hospitals in Bellville, Crockett, El Campo, Llano and Palacios.

The Mid Coast CEO told the Trinity County News-Standard, the local newspaper, that the closure was due to “delays in establishing Medicare and Medicaid billing and contracts with commercial health insurers, lower-thanexpected revenue from collections owed on patient co-pays, increasing accounts payable for supplies and services, and insufficient local tax revenue to cover operational shortfalls.”

Mid Coast’s CEO also said that if Mid Coast - Trinity had been able to receive a “Rural Emergency Hospital” (REH) designation, “it would thrive and continue to meet the community’s emergency and outpatient healthcare needs.” St. Mark’s in La Grange had obtained REH designation (emergency room and outpatient services only) but still carried too much mortgage debt on its building to make its payments and closed as a result. HB 18 is too late for rural hospitals like St. Mark’s and Mid Coast - Trinity.

It seems there is pitiful little else that the Legislature has done this session to improve availability of rural healthcare. FCR reported on March 18th that the Fayette County Commissioners Court had adopted a resolution supporting passage of Senate Bill 1377 that would give 106 “rural counties” (populations of 10,000 up to 68,750) a one-time $350,000 grant to buy an EMS vehicle. Counties with a population of less than 10,000 (about 92) could get $500,000 each. Total cost about $83 million. SB 1377’s “companion (identical) bill” in the House, HB 3000 (filed by Rep. Ken King of Canadian,) has passed both the House and Senate and will become law.

Billionaires, PACs and big business pay for lobbyists and media campaigns and finance politicians’ election campaigns to buy the laws that they want. Big city legislators don’t understand or care what rural residents need.

Rural residents and local elected officials ought to be about fed up with getting scraps from the Legislature. Until they demand State elected officials and Legislators stop all the political maneuvering and partisan politics and focus on and start treating rural healthcare for what it is - a public health and welfare crisis - nothing much will happen. Rural folks will go on paying state sales and property taxes and rural healthcare will continue to be inadequate, rural people’s health will be at risk and the quality of life and economies in rural communities will decline. It’s Sad.

Russell Friemel Fort Worth & Ellinger