Trips to her local Kroger afford Rebecca Deen, an associate professor of political science at the University of Texas at Arlington, the opportunity to be “professionally nosy” about the behavior of her fellow shoppers. On a recent grocery run, Deen contemplated why some people wore masks and others didn’t. 

Each person’s “decision calculus” likely involved not mere politics, she said, but partisanship, or a leaning toward a particular party’s principles. 

Health care has been part of political conversations for decades, but the pandemic has highlighted not only the need for health-related safety nets, she said, but the role politicians — like those on the county commissioners court — play in shaping them. 

And as primary elections approach for three of the five seats on Tarrant County’s commissioners court, Deen hopes people pay attention to how candidates could affect the direction of the county’s publicly funded hospital district: JPS Health Network

“With the nature of this particular virus, it kind of shakes the ground underneath us,” she said. “Things that we used to just count on, we can’t. It reinforces the importance of safety nets generally and JPS particularly.”

What is a hospital district?

A hospital district is a county government entity that levies taxes to provide medical care for residents who can’t afford it, Steve Montgomery, a member of the board of managers, said.

The relationship between the court and the hospital district

Each member of the commissioners court appoints two people to serve for at least two years on JPS Health Network’s 11-member board of managers, the governing body that creates the hospital’s budget, sets hospital policy and hires the hospital’s CEO. 

The turnover of three members of the court — the county judge and the commissioners for Precincts 2 and 4 — could be “hugely impactful,” said Steve Montgomery, a long-serving member of the board of managers. 

After the general election in November, the newly elected court officials will have the opportunity to either reappoint their predecessor’s selections for the board or hire someone new. Their selections will influence the hospital district’s infrastructure, leadership and programming moving forward. 

The $800 million bond package

In November 2018, voters approved an $800 million bond package to expand JPS Health Network. 

Progress for the project, which includes the construction of four medical homes and a behavioral and mental health hospital, was slowed by uncertainties over property tax legislation in 2019 and the pandemic, Tarrant County Judge Glen Whitley told the Fort Worth Report in November. 

The health network’s board of managers confers with the commissioners court regarding which plans to prioritize, Montgomery said. For example, the commissioners court will help determine the location of the first medical home, expected to be built this year. The court can use “soft power” to exert influence over these decisions, Montgomery said — like indicating their constituents’ priorities.

“But ultimately, if we thumb their nose at them, they could say, ‘Well, OK, thank you for your service,’” and appoint new members to the board, Montgomery said. Each board member gets a two-year term and then serves “at (the court’s) pleasure.” The current members of the board of managers have all surpassed their two-year terms, he said. 

Candidates for the county judge race differed on their priorities for the bond program. After speaking with local hospital CEOs and representatives from Parkland Health, Dallas County’s publicly funded hospital system, Republican candidate Betsy Price said she’d like to see “better service, quicker” from JPS Health Network. That could look like updating the network’s use of technology, including telemedicine, and expanding collaboration with partners throughout the county, she said. 

One of Price’s opponents, Republican candidate Tim O’Hare, said in a statement his focus for the bond program is fiscal responsibility. “I would place priority on providing quality health care rather than dropping $800 million dollars in cosmetic upgrades on a taxpayer-funded county hospital,” he wrote. “It’s been a wildly slow process, and any project that takes that much time is wasting money.”

A third Republican candidate, Byron Bradford, and Democratic candidate Marvin Sutton emphasized increasing access to JPS Health Network’s services. In a statement, Bradford said he’s keeping tabs on the projected growth of Texas’ population in the next 30 years, so “rectifying the shortages in primary care is crucial.” 

Sutton intends to focus on expanding access in underserved communities across the county — especially in Arlington. The pandemic underscored limitations in the health system’s current reach, he said. Republican candidate Robert Trevor Buker said he doesn’t support the bond package and prefers the hospital district focus on increasing efficiencies in their spending. 

Democratic candidate Deborah Peoples did not respond to the Fort Worth Report’s requests for comment. Peoples previously told the Report that voters repeatedly expressed concern over improving care at John Peter Smith Hospital. 

“They don’t always see the relationship between the county government and their lives, but when I talk to them about John Peter Smith, it resonates with them,” Peoples said. 

The Report was unable to find any contact information or website for Kristen Collins, a Republican candidate for county judge. 

Which commissioner appointed which board member?  

County Judge Glen Whitley: Charles Powell, Steve Montgomery

Roy Charles Brooks, Commissioner Precinct 1: Ralph Waldo Emerson, Jr., Dorothy DeBose

Devan Allen, Commissioner Precinct 2: D.T. Nguyen, Amanda Arizola

Gary Fickes, Commissioner Precinct 3: Roger Fisher, Trent Petty

J.D. Johnson, Commissioner Precinct 4: Dr. Charles Webber, Zim Zimmerman

At-large: Dr. Steven Simmons

The selection of JPS Health Network leadership

Not long after longtime CEO and President Robert Earley announced his retirement from the health network in November, the board of managers appointed chief operating officer Dr. Karen Duncan to take the helm. 

Her appointment is temporary, however. She’ll serve for up to two years, Montgomery said, as the board of managers conducts a nationwide search for a long-term replacement. 

Although it is the board of managers’ responsibility to hire the CEO, members of the commissioners court may become part of the search committee, Montgomery told the Fort Worth Report in November. The commissioners will also have the opportunity to reappoint current members on the board of managers or select new members.

Candidates for the two open commissioner positions differed on how they plan to approach their appointments. Ruby Faye Woolridge, one of two Democratic candidates for the Precinct 2 seat, said she’d like to see a “rank and file” citizen on the board to represent the perspective of people “who are dealing with health care on a regular basis.” She’s also hopeful to include someone who understands the needs of people with disabilities. 

An appointment like this would be allowed; the only criteria for appointees is that they must be Tarrant County residents at the time of their appointment, Montgomery said. 

Andy Nguyen, the presumptive Republican nominee for Precinct 2 commissioner, said he’d like to prioritize people with experience in the health care industry who don’t intend to “play politics.” Similarly, Manny Ramirez, a Republican candidate for the Precinct 4 seat, said an appointee’s professional qualifications must include experience in health care and management. Joe D. “Jody” Johnson, another Republican candidate for Precinct 4, was even more specific: “I will not rule out the possibility of appointing an active or retired police officer to the JPS Board,” he wrote in a statement. 

The candidates also differed on the importance of hiring a local leader to take Duncan’s place. Nguyen emphasized the need for nationwide search to identify a candidate who’s not only studied in the health care industry but adept at cultivating relationships. Cedric Kanyinda, the only Democratic candidate for the precinct 4 seat, said his priority is hiring people “who come from the community.” Transplants don’t have the same level of investment, he said. 

The direction of JPS Connection

The health network’s board of managers can approve hospital policy with a majority vote at any of its monthly meetings, Montgomery said. 

For example, the network has declined for years to allow undocumented immigrants into JPS Connection, its charitable care program. The longstanding policy has provoked ample discussion by the system’s board of managers, as well as national news coverage. 

Candidates disagreed predominantly along party lines about their take on the policy. 

Larry Dale Carpenter, Jr., a Republican candidate for Precinct 4, said in a statement that he intends to keep the policy in place. Furthermore, he’d like to restrict undocumented immigrants from using “all facilities at JPS unless they’re fully funding the treatment themselves.” 

Alisa Simmons, a Democratic candidate for Precinct 2, disagreed. The current policy “leaves the entire population at risk,” she said in a statement. “Withholding health care to fellow citizens, even those undocumented, is inhumane and irresponsible in that it impacts more than just the person who is ill.”

Considering who gets access to health care — and who pays for that access — is central to the politicization of health care, said Deen, of UT-Arlington. 

“You have this fight over, is health care a right? And if it’s a right, that means the government has the responsibility to make sure everybody has equal access to it,” she said. “If it’s not a right, then what does that mean? Who gets to have it? Who has to pay for it? That is naturally political. We’re talking about people’s health and we’re talking about money.”

Alexis Allison is the health reporter at the Fort Worth Report. Her position is supported by a grant from Texas Health Resources. Contact her by email or via Twitter. At the Fort Worth Report, news decisions are made independently of our board members and financial supporters. Read more about our editorial independence policy here

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Alexis AllisonHealth Reporter

Alexis Allison covers health for the Fort Worth Report. When she can, she'll slip in an illustration or two. Allison is a former high school English teacher and hopes her journalism is likewise educational....

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