Indigent health care takes hit

The Cameron County Commissioners Court has reallocated more than $300,000 in tobacco settlement funds away from local indigent health care programs, disappointing advocates who rely on such funds to serve thousands of the county's uninsured and impoverished residents.

"We're not an unlimited well," said Cameron County Judge Carlos Cascos. "We have a lot of other needs to take care of."

In one of the poorest counties in the United States, the decision has created tension between politicians in the midst of a budgetary crisis and providers of basic health services.

"It's a slap in the face to people who have respect for the judicial system," said Paula Gomez, executive director of the Brownsville Community Health Center. "Politicians never have to see the faces of the people who get turned away from the services they need."

The tobacco industry in 1996 agreed to pay the state of Texas $15 billion to recover the tax dollars it had spent to treat tobacco-related illnesses. The interest generated from the endowment is now dispersed among counties and hospital districts - a potential boon for underfunded community health clinics.

Though no restrictions are placed on the county's distribution of tobacco settlement funds, the money is traditionally spent on indigent health care, thanks in part to incentives provided by the state.

"It's to the county's advantage to spend money on indigent care," said Emily Palmer, a spokeswoman for the Texas Department of State Health Services. "The more they spend on uncompensated care, the more they will receive (in tobacco settlement funds) the subsequent year."

But due to rising costs in the indigent defense fund, the construction of two new district courts and decreased revenue from the county's bridge system, Commissioner David Garza said the county was hard pressed to balance the budget without absorbing tobacco monies into its general fund.

Cameron County will spend approximately $3.29 million on indigent health care in the 2008-2009 fiscal year. Though an additional $300,000 would constitute only a marginal increase in the current allocation, some local health care advocates see the county's move as a betrayal.

"You owe an explanation to our 6,000 parishioners in Cameron County who signed petitions that the county dedicate its tobacco settlement funds for direct primary and specialty health care services to the poor," the Rev. Jerry Frank wrote in a letter to Cascos last week. Frank was the vice-chairman of the now-defunct Rio Grande Valley Health Services District, which was once charged with allocating settlement funds.

County officials are now trying to redirect $300,000 from the general fund to indigent health care programs - a daunting task, they admit, in such dire financial times.

"There's always been a caveat," Cascos said. "It's always been subject to budget restraints."

Cascos points to a new partnership with Valley Baptist Health System as a more efficient way to address indigent health care needs, even without the allocation of tobacco settlement funds. But others say the program marks only a halfhearted commitment to indigent care.

"More people qualify for these programs than ever before," Gomez said. "This is what the (tobacco) money is for."