Last week, Central Health, Travis County’s hospital district, presented its Fiscal Year 2024 budget to the Travis County Commissioners Court. Under the proposed budget, the health care district would spend $744 million in total, “an increase from 2023’s $628.5 million.” That’s nearly a 20% increase year-over-year. To support all the new spending, it’s seeking a big tax increase.

In fact, Central Health wants the commissioners court to approve a 13.3% tax increase on homeowners. For the average homesteader, its annual burden would grow from $422.29 to $478.57. This increased burden results from the imposition of a higher tax rate, moving from $0.098684 per $100 to $0.100692 per $100. The combination of higher rates and rising values means much higher taxes for all.


Central Health’s tax hike is especially hard to swallow given that the cost of living is already high in Austin, with a March 2023 report showing Austin housing prices being 18% higher than the national average.

Now, you may find yourself asking: Why would Central Health want to add to the affordability crisis?

Well, the answer appears to have to do with equity.

Central Health is beginning to roll out its “health equity plan” to “close the gap in services for minorities and people at or below the 200% poverty line,” Central Health CEO Mike Geeslin explained. But many, including Travis County commissioners, don’t seem persuaded that Central Health is headed in the right direction.

At last week’s public hearing, Travis County Judge Andy Brown responded to Central Health’s managers’ request for more tax money by saying: “I think right now it’s not going well for you.” Other commissioners appeared to echo the sentiment and refused to adopt the tax rate and budget, instead pushing the decision to Tuesday, Sept. 26.

Part of the concern expressed was the fact that Central Health has $455.3 million in reserve and it isn’t spending money on health care delivery services. The Austin American-Statesman noted as much, saying: “Last year, it budgeted $491.4 million in health care delivery and spent only $147.4 million. In this year’s budget, it has $606.3 million for health care delivery but expects to spend $222.8 million.

Which left Travis County commissioners—and everyone else—wondering why Central Health needs such a huge tax increase?