Begin with the number, because the number is the whole story. Texas hospitals are losing an estimated $27 million a day.
On the first of September, the federal government withheld approval of roughly $10 billion owed to Texas hospitals for the coming year. The bulk of it comes from a program with a bureaucratic name — the Comprehensive Hospital Increase Reimbursement Program — that does a plain thing: It helps hospitals cover the gap between what Medicaid pays and what care actually costs. Local taxing districts collect billions from the hospitals themselves, and the federal government matches those dollars so a hospital is not punished for treating a patient whose coverage pays less than the care requires.
That match is what has been frozen. That’s $27 million a day, gone from the institutions that treat the poorest people in this state.
Eileen Monte
It is worth being fair about the dispute underneath. The disagreement is technical — it concerns how Texas taxes its hospitals to raise the state’s share of these funds. A reasonable person can believe the federal government has every right to examine that arrangement, and to be careful before releasing $10 billion. This is not a story with a cartoon villain, and I am not going to pretend it is.
But the state does not believe it is doing anything wrong. Gov. Greg Abbott has said so plainly — that there is nothing illegal in what Texas has done — and he is fighting publicly to recover the money. When the leader of the state stands up and says the funds are owed and lawful, you would expect the state’s chief lawyer to stand beside him. That is the part of this story that will not sit quietly for me.
Three years ago, a different administration threatened this very same money, from this very same program. Ken Paxton, the attorney general of Texas, did not wait. He sued the federal government to keep the funds, and he won, and he called it a major victory — a defeat of unlawful overreach. He was right to fight. Defending the state’s hospitals is precisely the work of that office. When the sword is coming and the people are about to be harmed, the one who sees it is supposed to sound the alarm.
This week the sword is the same. The program is the same. The harm is the same, only larger. And the man who sounded the alarm the last time has said nothing. His office has filed no suit and issued no statement. His campaign has offered no comment. There has been no trumpet at all.
“Paxton is weeks from an election, in a hard race for a seat in the United States Senate, and standing against the powerful of your own side is expensive.”
The law has not changed between then and now. What has changed is who sits in the seat that the alarm would trouble. Three years ago, the administration withholding the money belonged to the other party. Now it belongs to his own — and Paxton is weeks from an election, in a hard race for a seat in the United States Senate, and standing against the powerful of your own side is expensive.
I cannot see his heart and will not pretend to. But I can set the two moments side by side, and I can see that the one thing different about them is the cost to him of speaking.
I know something about that particular arithmetic — the kind that weighs what the truth will cost you against who else will pay if you keep quiet. I kept a silence like that once, for the better part of my life, and I learned that the bill for it is always real and almost never paid by the one who stays silent. That is the whole danger of a silence. It looks free to the person keeping it.
Here it is not free. It is itemized, at $27 million a day, and it will be paid in a rural county where a hospital cannot make its numbers work, in an emergency room that closes, in a child on Medicaid whose care never was a line in anyone’s campaign. The prophet Ezekiel wrote that a watchman who sees the sword coming and does not blow the trumpet is answerable for the people who were not warned — not because he swung the sword, but because he saw it, and stayed quiet and let the cost fall on those who never saw it coming.
I am not asking anyone to change a vote. I am asking us to notice what is easy to let pass — that a man can see the danger, and know exactly how to raise the alarm, and prove he knows by having done it before, and still choose the quiet because the quiet is safer for him. The hospitals cannot afford that quiet. Neither, in the end, can the people they were built to serve.
Eileen Monte is a transgender woman writing from Fort Worth, Texas. She seeks to take on the political machine working to legislate trans people out of public life and the inherited fear it runs on. She is not a historian or a member of the clergy. Just a person of deep thoughts, stubborn convictions, and five kids who keep her honest.
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