In neighboring Fort Bend County, residents aren’t so fortunate.
The county doesn’t have a hospital district, leaving uninsured and underinsured residents with less access to primary care physicians, specialists and other health care providers.
The diverging approaches reflect a statewide split in how Texas’ urban cores and fast-growing suburban communities have approached hospital districts, which are taxpayer-supported medical networks that largely serve residents in need.
While Texas’ largest counties operate sprawling hospital systems, spending billions of dollars on health care, several of their suburban counterparts haven’t embraced the approach as their populations have boomed. (Voters in each county must approve a hospital district.)
The lack of affordable medical options has become more acute as lower- and middle-income residents — many of whom have low-quality or no health insurance — increasingly flock to the suburbs for larger, more affordable houses.
A recent Kinder Institute for Urban Research survey of nearly 3,500 Fort Bend County residents showed 12% had no health insurance, one-quarter had at least some trouble accessing a primary care physician, and half struggled to find mental health or prenatal care.
“I think there’s a true unawareness that there are people in the county who could not afford health care, and oftentimes those people are not just folks who are the ultra-poor,” Fort Bend County Health and Human Services Director Letosha Lowe said.
The regional split
Texas voters established the option of hospital districts in the 1950s, seeking to create avenues for more local medical services and infrastructure.
Five large, urban counties — Harris, Dallas, Tarrant, Bexar and El Paso — quickly adopted hospital districts to take over operations of municipally run facilities. Travis County joined them in 2004, assuming control of a hospital run by the city of Austin. Together, the six counties, which have a combined population of 14 million, run sprawling health care networks funded in part by $3.4 billion in property taxes.
In the rest of Texas, however, hospital districts are scattershot.
About half of counties operate hospital districts of varying sizes, providing services ranging from hospital care to outpatient clinics to mental health support. They’re most popular in rural communities, where hospital district facilities often provide the only nearby critical care services, and least common in suburban and small metro areas.
In the Dallas-Fort Worth area, the two largest suburban counties — Collin and Denton, home to a combined 2.2 million residents — don’t have a hospital district. Neither does Austin’s biggest suburban county, Williamson, home to 700,000 people.
In the Houston region, Fort Bend and Galveston counties lack a hospital district, while Montgomery County has a relatively modest one. Brazoria County boasts two hospital districts, though they only cover a small share of the region.
The Fort Bend debate
A recent push to add a small hospital district in Fort Bend County laid bare the competing interests at play in Texas’ suburbs.
In late 2023, Fort Bend County Judge KP George backed the idea of a hospital district, saying “there are so many people living in our county, they need help.” The county has numerous privately owned hospitals, clinics and other medical facilities, though they often require insurance or offer fewer low-cost options than hospital districts.
IN 2024 - FORT BEND COUNTY @JudgeKPGeorge says it is time his fast-growing county looks at establishing its own county hospital district.
— Jason Whitely (@JasonWhitely) December 31, 2023
Will healthcare there look like Harris County's in Houston next door? #txlege @khou @wfaa
STORY: https://t.co/xQr55CshF4 pic.twitter.com/YdoOkJXxJs
Several months later, Fort Bend County administrators proposed creating a relatively small hospital district that would generate $12.5 million. A homeowner with a taxable value of $300,000 would pay $32 more in annual taxes.
Most of the money would be spent on expanding health care access for low-income residents and adding space for people experiencing a mental health crisis. County health administrators argued the hospital district would generate an estimated $100 million in savings for taxpayers, largely because residents would spend less time in expensive-to-run emergency rooms and jails.
Two of Fort Bend County’s five commissioners, however, balked at the proposed tax increase, arguing it would hurt their ability to attract big businesses that could lessen the tax burden on homeowners. Single-family and multifamily residential property owners account for 72% of the tax base in Fort Bend County, compared to 55% in Harris County.
“I’d like to see us build that industrial base first before we start taking on additional social programs, so that we can more easily afford (them) and we don’t put all of the tax on our residential property owners,” Commissioner Andy Meyers said at the time.
Fort Bend County leaders ultimately tabled the proposal. Three months later, voters across the county line approved a $2.5 billion bond for major upgrades to Harris Health System’s facilities.
Lowe, the county health and human services director, said she plans to continue discussions with commissioners about creating a hospital district, though there’s no timetable for potentially holding an election.
