The Louie Minor Show
Texas politics from Killeen to Belton to Austin and beyond. Join the conservation with Bell County Commissioner Pct 4 Louie Minor as we dive deep into local government. Interviews with community leaders and the public.
The Louie Minor Show
Building a Better Bell County Healthcare System
In this revealing episode, I share my vision for transforming healthcare delivery in Bell County through the creation of a dedicated hospital district. After six months of research, visiting successful models across Texas, and analyzing our current system's limitations, I'm convinced this approach offers the best path forward for our growing community.
Bell County currently allocates 8% of our general revenue budget (approximately $10 million annually) to indigent healthcare services, split between jail healthcare and community programs. But as our population grows and federal cuts to Medicaid, SNAP, and the Local Provider Participation Fund loom, this system faces mounting pressure. The stark reality: without structural change, our most vulnerable residents will suffer as existing resources stretch thinner.
The hospital district model—already proven successful in Texas's largest counties—would consolidate indigent healthcare funding, public health responsibilities, and jail healthcare under one specialized entity. This would address troubling disparities in service levels between eastern and western Bell County while creating a focused, efficient approach to community healthcare needs.
What makes this proposal particularly practical is that Bell County residents already pay for indigent healthcare through county taxes. Creating a hospital district would transfer those existing funds to the new entity, ideally with a corresponding reduction in the county tax rate. The district would have dedicated healthcare professionals managing these critical services rather than competing with roads, law enforcement, and other county priorities.
My commitment is bringing this proposal to voters in November 2026. When democracy and healthcare access are on the line, we must choose to fight rather than surrender. Join me in exploring how a Bell County Hospital District could strengthen our community's health safety net for generations to come.
Welcome. You're listening to the Louie Minor Show. I'm your host, bell County. Commissioner Louie Minor, today is March 29, 2025. We are back. Had a lot of stuff been going on that I want to catch you up on. Then I want to talk to you about some priorities for 2026. You up on and then I want to talk to you about some priorities for 2026. There's no commissioner's court meeting on Monday because it's the fifth Monday of the month. So the next commissioner's court will be April 7th and I'm sure it'll be a lot on the agenda to cover, so I'll be anxious to talk about that once it comes out. But so let's talk about what's going on.
Commissioner Louie Minor:This weekend Down in Austin they're having an SDEC meeting that's the executive committee for the Democratic Party, and because of Chair Hinojosa stepping down and resigning, we're going to be getting a new state party chair. For the first time in 20, I'm sorry, 13 years Since I've been involved with the Democratic Party, chairman Hinojosa is the only chair. Party chairman hinojosa is the only chair that I've known. So I yeah, I don't know who came before, but we will know who's going to come after after. There's three people top contenders at least that are vying for it and we'll play a clip here in a minute from the Texas Tribune where they're talking about that. But so that that's just to cover the chairmanship until the state convention in 2026. And that's when we'll pick the state chair. This is only to fill a unexpired term because of the resignation, so that's going on. Tomorrow Also, I'll be going to Houston to a Victory Fund champagne brunch. I've always been invited since being elected and so this will be my third year going down to Houston and participating in that. It's a good group, good organization. Victory Fund trains and supports many LGBT candidates across the country and Texas, so I'm happy to be a part of Victory and excited for the Champagne Brunch this coming weekend.
Commissioner Louie Minor:The next thing that I want to talk about is last weekend, the Texas Democratic Party and the Texas AFL-CIO in Killeen. We're in Killeen for a workers' town hall and it was a really great opportunity for people to come and speak and vent. They invited three congressmen Carter, pfluger and Williams. Obviously, none of them showed up to answer to all these federal employees that have been terminated or now they have to do five things email and send it in. Five things you've done this week and it's scary if you know you've put all your time into working and now working for the federal government because of the security and you're giving back to the country. A lot of them are veterans, but they're on the chopping block and they're under attack by this administration.
Commissioner Louie Minor:And so we were able to gather and I was surprised how many people showed up. I think probably around 150 to 200 people showed up, and that was simultaneously while there was another event going on in Belton for Indivisible put it on or Indivisible put it on, but it was for another town hall, for John Carter, because John Carter hasn't held one in forever, and 100 people plus showed up to that one in Belton. So I think that will show you the motivation and the anger of the people here in Bell County and why it's important to hold these things. Just yesterday, beto O'Rourke and Governor Walz did one in Fort Bend County. They said thousands of people showed up to that On a wet, rainy night, thursday night. So there's definitely a lot of anxiety, a lot of energy out there and people are ready to do something and I don't blame them.
Commissioner Louie Minor:Cuts, cuts, cuts. You see cuts happening everywhere and it's going to affect it's already affecting Infrastructure projects. It's going to affect Our most vulnerable people Through Medicaid cuts, through SNAP cuts, and that's going to fall on local jurisdictions, local taxing authorities, the counties, the cities to meet that need, because those people are going to be here in our community and they're going to need help and we got to be there to help them because that's the right thing to do. So, anyways, let's get back to the workers town hall. What I want to play for you is the vice president for AFGE District 8, ms Cheryl Aliano. She lives here in Harker Heights, bell County resident, and she gave a great speech, so let me pull that up for you so you can hear part of it. So, with that said, I want to introduce the Regional Vice President or Vice President of AFGE, ms Cheryl Eliano.
Cheryl Eliano:Thank you, Thank you and good afternoon, good afternoon. Good afternoon, good afternoon. I am Cheryl L Hano. I am National Vice President of the US.
Cheryl Eliano:I need to turn up the volume. We have a couple of people up here that are going to speak to you, that are directly impacted by what is happening to our federal workers and all of you sitting here who don't know.
Cheryl Eliano:Federal workers are under attack today, but when we are under attack, we know how to fight back. So thank you for the invitation on today.
Cheryl Eliano:And someone asked well, this is going to be like those town halls you see on TV.
Cheryl Eliano:That's not the plan, that's for sure. It's all about having a conversation and giving out information, isn't that right? So, sisters and brothers and community members, we're here to send a message, even though they're not here we're going to send a message, even though they're not here.
Cheryl Eliano:We're gonna send them a message anyhow, a loud and clear message to our representatives and on Capitol Hill, especially the representatives Carter, williams and Flewer, and that message is this save the civil service and to save the country. I want you to know that, all of you sitting here, it may not, you may not feel it right now that it's impacting you, but I'm going to tell you, like Dr King said, we may have all came in on different ships, but we're in the same boat now, and so, as you all know, we have a pro-apartheid South African billionaire determined to do to the United States what he did to Twitter turning it into an X-rated obscenity. Only in America can you be called a business genius when you just borrowed and spent $44 billion and lost 8% of it. Trust me, he's no genius. And we are threatened. And we are threatened by a president who thinks he's a king but I only know one king. I only know one king, and that's him Jesus Amen. Also thinks he's aster or a boss or something, but he violates the law and the Constitution without a thought. We ask you all to stand up to support and defend the civil service and the country on. Today, use your voice to stop this president from canceling programs you've authorized and funding you've approved. We have to demand the executive branch uphold every collective bargaining agreement in force, every single one of them. Members of Congress must support and defend the people they represent, support and defend their rights and freedoms, their health and well-being, their safety and security. And please remember this nobody nobody voted for Elon Musk. Nobody voted for this president.
Cheryl Eliano:Americans didn't vote to sabotage our veterans by cutting VA staff. In firing more than 80,000 workers, a third of whom are veterans themselves, will destroy the VA's ability to fulfill the PAC Act's promises to veterans who either died or became ill as a result of exposure to burn pits, agent Orange and other types of subsets. Most of these employees were hired explicitly to provide the benefits provided in the PAC Act. The VA has been severely understaffed for many years, resulting in long wait times for veterans in need, but they've landed the employees that are working here every day. The Dodge plunder of career VA employees, adding to the illegal mass firings of thousands of probationary employees, can only make matters worse. They didn't vote to make air travel dangerous again, cutting TSA and air traffic control staffers, taking away the collective bargaining rights of those same TSA officers. We do have a TSA spokesperson for today from Alkaline Airport. Let's give her a hand. The ALTD will not test until basic dignity and rights of workers at TSA are acknowledged by the government once again and rights of workers at TSA are acknowledged by the government once again.
Cheryl Eliano:They didn't vote to put contaminated meat on supermarket shelves by firing inspectors. They didn't vote to get cancer from dirty air and water because EPA workers were all kicked to the curb. They didn't vote to fire the labor department staff who keep workplaces safe and make sure employers pay their workers. They didn't vote to put our war fighters at the mercy of contractors after they fired the OD civilians. They didn't vote for the dismantling of the Department of Education. Over 60 percent of Americans oppose this idea. The Department of Education plays a crucial role supporting our students and their families at schools and universities in every community across the nation, and President Trump's directive to eliminate this small but mighty agency would destroy our education system and devastate generations of students.
Cheryl Eliano:We have a spokesperson also from the Department of Education. This executive order is nothing more than an illegal overreach and executive power designed to unemployed dedicated civil servants and disseminate those critical services they provide to millions of Americans across this country, and they sure as heck didn't go to quote traumatize America's patriotic and heroic federal employees, 30% of whom are veterans. How many of y'all said y'all veterans out there, who is one less paid and more free than we ever get in the private sector, in order to uphold the Constitution and serve the American people? So to our Republican representatives we invited you here. We are asking you to uphold your oath of office. They're not here, but they're going to get this message. Don't put your conscience in a blind truss or check your spine at the door. Don't aid and abate a lawless, corrupt administration held bent on destroying government's ability to serve the people To our.
Cheryl Eliano:Democratic members of Congress here in the great state of Texas, use every tool in your toolbox to put sand in the gears of Musk and Trump's assault on America. When the debt ceiling needs to be raised, tell them you'll be glad to help them if, and only if, the Trump administration stops breaking the law. That means upholding all collective bargaining agreements, spending every dollar Congress appropriates, stopping all firings, protecting the civil service system and getting Elon Musk's ruby paws out of our debt. Use the power of the purse. Number one defund Dodge Gold, whatever you want. Number two defund the fat federal contract that fund Musk Empire. Number three defund this administration's union busting and put our people back to work for America. We're asking them to have courage. This is what they need. Courage is what the moment calls for.
Cheryl Eliano:How many of you know it takes courage on today? Because, even without speaking against this administration, they're ready to come against you just for speaking against what they're doing. But they might as well bring it on because we may. So, sisters and brothers, let's stand together in solidarity with everything on the line. Let's speak out. Let's speak out together, march together, fight together, rise up together Together. Let's get out there and tell our elected officials to stop the attempt of this coup. This is an assault on our democracy, right now, at this pivotal moment, before it's too late. It's now or never, and let's make sure we can tell our grandchildren that when democracy was on the line, we answered the call. So I want you to know when we fight, we what.
Cheryl Eliano:We win.
Cheryl Eliano:When we fight we what we win when we fight we what we win. Now, let's get out there and let's kick some butt. Give him a hand Now.
Cheryl Eliano:I know that was just a little bit hard to hear, you know you probably had to be in a quiet place and turn your volume up, but it was definitely worth listening to. Ms Eliano is a great speaker, very passionate about workers' rights for federal employees, and I don't blame her. I mean, she's been doing it for a long time. And this money, these positions, these agencies were created by Congress. They are funded and I just don't see why members of Congress are just ceding their power to the president and not even challenging anything, just letting it go. And so it's definitely scary times with what is getting by. But you know, beto said something in his town hall yesterday that that resonated with me, and what he said is you know, we're either going to fight or we're going to surrender, and I'm going to fight. When democracy is on the line, you either fight or you surrender. Which one are you going to choose? I know I've already chosen I'm going to fight. So, with that said, I want to touch on a subject that it's something I've been working on for several months doing research, talking to people, going out in the community, visiting other areas to see where they're being successful, where they're not being successful, and especially now, with everything going on in the federal government proposed cuts to Medicaid that's going to hurt. It's going to hurt our most vulnerable populations, and so let's go through a whole history of what I'm talking about. So you clearly understand the options. You clearly understand the options and, like I said, this is just going to be the first episode where I talk about this. There are definitely going to be more opportunities for discussion, but this is going to set the foundation. So you know what the county is doing in the past, what we've been doing, and then the possibilities of the future. So let's go down this long but beneficial road and let's start with our budget.
Cheryl Eliano:Actually, before we start with the budget, let's look at some laws that apply. There's two things that apply for the indigent health care for a county. We have the Texas Constitution that requires it, and then the Health and Safety Code, chapter 61, it really goes into the operations and the program benefits and services of a county indigent health care program laws that are governing the county health care program. So, according to the statute, 8% of the total budget for the county the general revenue budget, is dedicated, required, mandated by law to serve the indigent population of the county hospital or a county hospital district. Then those requirements go to those entities. But in Bell County we do not have a public hospital or a county hospital district, so that is the county's responsibility to administer that indigent health care program.
Cheryl Eliano:So if we look, there's a couple of things that the county does. So we have the local provider participation fund. That is a tax that the county is authorized to levy against health care, all health care in the county. So we do that. You don't see it on your bill. But the county levies a tax, a 6% tax, on all health care in the county and what that's supposed to do is authorizes the county is like a pass-through. And that tax that we give to the healthcare, to the hospitals, that comes to the county, the county sends it up to the federal government and we get reimbursed and it doubles, triples some of the money that comes in, doubles, triples some of the money that comes in and that's to help offset Medicaid, medicare expansion, that Texas did not do so and that LPPF they call it. That's actually on the chopping block.
Cheryl Eliano:With this administration. They're looking at cutting that. So if they cut that, bell County last year got over $180 million reimbursed to the county, given to the local hospitals to help offset the cost of what's called uncompensated care. So if you go to a hospital they cannot deny you care, but we don't want people going to emergency room for care because that's the most expensive type of care. But anyways, that money helps offset that uncompensated care. So if someone goes there don't have any insurance. That's how they supposed to get some of that money back. It doesn't make them whole, but that's how it was supposed to get some of that money back is through the LP, lppf, um tax and um. That with the current administration that's on the chopping block.
Cheryl Eliano:Uh, also, they're going to be reducing Medicaid. Those funds help our most vulnerable people get health care and if they reduce Medicaid and the LPPF, that's only going to strain services to the county because we're required to by law to take care of indigent health care, the indigent in our county. So LPPF, indigent health care, 8% of the county budget. Right, you're following me. And so what does the county do with that money? Now we'll kind of go into the budget a little bit.
Cheryl Eliano:This year's budget for 2025, fy24-25,. Let me go to the page One. Second, one second. I believe it's going to be around. Yeah, there we go $160 million for total general fund revenue for Bell County. So the county gets around $10 million roughly to do our indigent healthcare program.
Cheryl Eliano:So what does the county do with that money? Well, everyone in the jail and typically our jail population runs around 1,150 somewhere in there daily population, everyone in jail by law is considered indigent, so all the health care in the jail is covered by the health care program, the indigent health care program. So just right, there alone and it takes half of that $8 million, $9 million. That's going to change a little bit because we didn't budget for that. So we had, I think, $3 to $4 million budgeted for our health care program in the Bell County jail. Our contractor that we had quit canceled the contract last year because they said that they can no longer give us health care at the contracted price. So they canceled the contract. So we had to go out to bid. The bid that we received was double that, almost $10 million. So we're going to have to already raise taxes just to cover that additional expense for our health care that we didn't budget for. So half the money is already gone to the jail to cover those medical services in the jail.
Cheryl Eliano:The other portion of the money what is remaining is what is spent in the community portion of the money. What is remaining is what is spent in the community. So right now we have an indigent health care I guess administration where our director manages all the claims coming in, onboarding people. There's requirements that you have to do to be a recipient of indigent health care services. So there are certain thresholds that you have to meet. Outside of that there is optional care, but I think the county has moved away for any optional care. So there's basic services that the county is required to provide and outside of that, nothing else. Unless we want to, unless we're going to pay for it, the state is not going to reimburse anything, is not going to reimburse anything and the bylaw in Chapter 61 of the Health Code gives us that roughly $30,000 per qualified indigent person. That is in the program. So $30,000 a person has to spend for their health care in a year. That's medications, that is appointments, preventative care.
Cheryl Eliano:So just to give you an idea, what does the county do with that other portion of the money, the other half that is for the community. So we have two health care clinics, two clinics the Greater Killeen Community Clinic and the Temple Community Clinic. Those two clinics are, I believe, non-profits. They operate on their own. They've been in existence for quite some time both of them, and so the county partnered up with those two community clinics and we give both clinics the same amount of money. The same amount of money. We give them $500,000 each to help administer health care services for the county, indigent health care services. They're able to do it a little bit cheaper and it's been a good program. I think it's been doing it for about five years now. So it's been a good program. I think we've been doing it for about five years now. So it's been a good program for the clinics and for the county because we're able to see more people.
Cheryl Eliano:The rest of that money that is left over and I believe it's like $2 million that's for claims. So if there are, say, you go to the Killeen Community Clinic and you need a specialty, well, obviously they don't have any specialties at the community clinic, so you've got to get referred to one of the local hospitals. All these hospitals are for-profit but they're private hospitals. All these hospitals are for-profit but they're private hospitals. They're not any type of public hospital. So we have Baylor Scott White, we have Seton Ascension, then we also have the VA, we have Metro not Metroplex Darnell. So we have a lot of hospitals here locally and that's where some of that LPPF comes in.
Cheryl Eliano:The uncompensated care comes in, and so what? What I'm seeing is that our need is starting to grow, continues to grow. The county is getting larger. Our budget is capped. Each year we can only go 3.5% above what we taxed the previous year. That's our cap above the no new revenue rate is what they call it. So the no new revenue rate is the same amount of money that you got last year, whatever that tax rate would be. So obviously, as your county grows and develops and gets subdivided, but still keep the same revenue because you have more developed property coming on board. So that's the no new revenue rate.
Cheryl Eliano:We can only go three and a half percent above the no new revenue rate before we have to do what's called the voter approved rate. So anything above the no new revenue rate, the three and a half percent above the no new revenue rate, we have to take it to the voters. And you know, obviously it's going to have to be something compelling. Obviously it's going to have to be something compelling. I don't think voters are going to approve. Hey, we need more jailers, we need more road money maybe, but we haven't done it here. I think the last one that I'm aware of that went above the no new revenue rate, over the voter approved rate, and went to the voters was Harris County and the voters actually approved that. So, and there may be other counties that have done that, I just hadn't seen it in the news. But that's an option for us if that's what we want to do. But I do know that I don't think there's any appetite on the commissioners court to gamble on the voters on raising taxes because people don't like to increase property taxes. So what would happen is, if it does not get approved, a voter-approved tax rate, then you're stuck at the no new revenue rate. So that's kind of the catch that we're in with increased demand for indigent health services, with increased demand for indigent health services. But there's another option and that's what I've been working on probably the last six months, talking with other agencies, other counties on how they do it. I'm still doing my research, but I think we have an option here that we could choose from.
Cheryl Eliano:In Bell County, if you remember, I was talking about County Hospital District and I think that's going to be our answer I do see some disparity of services across the county, from the east side of the county to the types of services available on the west side of the county, and that's an issue. That's an issue. The level of service is not the same. The cooperation is not the same. Hopefully we can address some of those issues, but, as of right now, it is an issue that I see Access to care, the same level of care to our citizens. It needs to be standard. The type of care that you get and support you get on one side of the county should be the same that you get on the other side of the county, and that's what I'm going to strive for and I think that's what this proposal that I'm going to be bringing up would do.
Cheryl Eliano:So what I'm talking about is a county hospital district. A hospital district is a taxing entity but, as I mentioned already, you're already getting taxed entity. But, as I mentioned already, you're already getting taxed. 8% of our general revenue, which is taxes is for indigent health care. So that would get cut off from the county and go to a new hospital district Any type of public health.
Cheryl Eliano:Bell County has a public hospital district. Any type of public health. Bell County has a public health district. That would go to the hospital district as well. Then the jail contract, the jail health care, that would go. Those three things would all go under this umbrella of a hospital district. They also could do ambulance service. As of right now in the west side of the county there's a lack of ambulance service. We have to get ambulance service from Nolanville and that's only if it's available and that could be 30 to 40 minutes away for the Turnbow Ranch area, because City of Killeen said they're not going to go out and service Turnbow Ranch. So we have this county hospital district proposal.
Cheryl Eliano:There are three ways that we can and by we I mean us can create a hospital district in Bell County. The first way is Chapter 281 of the Health and Safety Code, that is, hospital districts in counties of at least 190,000 people. Hospital districts in counties of at least 190,000 people, obviously Bell County. We're nearing 400,000, and we would qualify under that section of the hospital district. It's going to require a vote. So the commissioner's court can either call for an election or a petition can be given to the commissioner's court can either call for an election or a petition can be given to the commissioner's court for the calling of a vote for a hospital district. This method would create a hospital district taxing authority and the board, the hospital manager, district board members would be appointed by the Bell County Commissioner's Court. A lot of the larger counties operate in this model Travis County, they have Central Health. Harris County, they have Central Health. Harris County, they have Harris Health. Dallas County, they have Parkland Hospital, that's their health district. Bexar County, they have University Health. So all those large hospitals operate. Hospital districts operate in this manner.
Cheryl Eliano:There's another way. We have Chapter 283 Hospital District and that's where it's still an election is called, but the board, the district, is the commissioner's court, the officers are the county's three and a half percent cap, if you kind of understand what I'm talking about. That way, like I said, it's it still calls for an election and the commissioner's court would, would call for for that. I don't know if there's a petition for this model. I don't think so. I think this is just that the commissioner's court um would call for it, yeah or no, it says, or presentation of a petition creation. Okay. So in this model it could be done the same way, either by petition or by the commissioner's calling the other way.
Cheryl Eliano:The third and final way chapter two, 86 of the health and safety code, and this is uh titled hospital districts created by voter approval. So in this model, uh, and and it is out in some other counties, uh, midland County for one of them uh, for instance, they have a hospital district and all their board members are elected, so they would be elected. This one has a little bit higher threshold, so the commissioner's court can call for the vote, call for an election, or a petition could come in with 3% of the total registered voters in the proposed district. So, for instance, in Bell County that would probably be about 7,000 signatures and then we would have to call for an election. Doing it this way, they would be elected during the same time that you do elections for city council and school board races. So those are our three options to create a hospital district.
Cheryl Eliano:Let's keep in mind the hospital district will be a taxing authority. You are already getting taxed for indigent health care, so it's not like it's going to be additional money out of your pocket. It could. I'm not going to lie and tell you that it wouldn't. And what I mean by that is so if the county is already taxing you 8% and a hospital district is created, that 8% goes to and by 8% I mean the dollars, the actual dollars that were levied would go to the hospital district. The county's tax rate is still the same, so you would expect for the county to lower its tax rate accordingly 8%. So that is just something that you're going to have to be mindful of to the elected officials, to let them know that, hey, if we support a hospital district, then we expect our county tax rate to be lowered, and that's something I would support.
Cheryl Eliano:Are there a lot of needs out there? Yeah, there are a lot of needs out there. Are there a lot of needs out there? Yeah, there are a lot of needs out there. But we need especially with our cuts that are coming to Medicaid, our cuts that are already happening to SNAP, to VA there's going to be a lot of need and the LPPF getting cut we're going to have to step up and be able to take care of ourselves, and I think this is a good answer. It's a good start.
Cheryl Eliano:Like I said, there's a lot of hospital districts out there. This would not be a new or novel approach to helping out the needy. Our largest counties in the state of Texas has a hospital district. Our smallest counties in the state have a hospital district, and now it's time for Bell County and its residents to have a hospital district. And now it's time for Bell County and its residents to have a hospital district to take care of our most vulnerable population. So that is what I plan to bring to the voters in November of 2026.
Cheryl Eliano:A hospital district, and it's going to be up to the voters to decide if that's something that they care about. Is that something that they can support? They're supporting it now with their taxes, with their taxes, and I think that the people of Bell County will step up to the plate. I think they will vote for a hospital district and I'm looking forward to going out and telling people the benefits of the district and what we have now and how it will improve lives, save lives and save money during the process. So, anyways, I got to pack, get ready to go, enjoy your day and we will talk to you next week. We'll be you next time.
