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DALLAS (CBSDFW.COM) – Dallas County’s healthcare safety net is now looking to make up a roughly $100 million budget shortfall—while some local leaders blame Texas politics for a stalemate that leaves both poor patients and taxpayers on the hook.

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“Texas is leaving $100 million on the table every month,” says Dallas County Commissioner John Wiley Price, “and in the final analysis, it’s shifting to the local governments.”

Just ask anyone about taxes and the response is no surprise: “they need to be lowered!” insisted an indignant Janice Fowler of Dallas. And yet, Fowler admits that she never considered the pocketbook cost of Texas politics: in particular, the state’s refusal to expand the Medicaid program.

“So those Texas monies that go to Washington are spread across those 30 states that have expanded Medicare,” says SMU Political Science Professor Cal Jillson, “and we’re down here wondering how to take care of Parkland hospital.”

According to Professor Jillson, Texas could lose as much as $100 billion over 10 years that could be used to expand coverage to the poor.

“There’s money that Texans send to Washington that Washington is offering to send back and we’re saying ‘no thanks because we don’t trust you long term’. That’s a real cost to Texans.”

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Ultimately, Dallas County Commissioners control Parkland’s purse strings—and they have directed leaders to consider service cuts if necessary.

“I read all the numbers,” says Commissioner Price. “But, at the end of the day, you can’t provide services for everything. At some point in time, you’ve got to make some decisions.”

Commissioner Mike Cantrell has expressed concern about rising tax bills. “The business model that we have ought to correspond to what we can afford, not to what we want to afford.”

Meanwhile, patients are flocking to the new Parkland and 75 percent of them are on Medicaid, which means the hospital is not reimbursed the full cost of their care.

“When you’re seeing reductions in the program that covers 75 percent of your business, it’s going to be a tough budget year,” said Parkland CEO Fred Cerise while discussing the hospital’s budget with County Commissioners. However, he says service cuts will be a last resort.

Janice Fowler laments the money left on the table. “Maybe we need some new lawmakers.”

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