Hatching A Plan: One of Hospitals’ Own Running for Texas House

Llano hospital administrator Hatch Smith puts health care infrastructure, rural access in the spotlight as he pursues a seat in Austin.


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As Texas’ 2024 primary election approaches, Hatch Smith (R-Llano) is standing tall on hospital issues and trying to add a unique voice to the conversation in Austin.

A champion for hospitals and a candidate for State District 53 in the Texas House of Representatives, Smith is a graduate of the Texas Hospital Association’s THA Leadership Fellows class of 2023 and chief administrative officer for MidCoast Medical Center – Central in Llano. He also comes from a diverse industry background, having served on the Governor’s Broadband Council, the Lower Colorado River Authority and working in finance.

With that broad experience in hand, Smith is running with an eye on the effort to ensure that Texas’ health care infrastructure and systems are robust. He was spurred into action after noticing the lack of attention paid to key development areas. Neither chamber of the Texas Legislature currently has the voice of a hospital administrator among its members.

“I realized that I have not heard or seen enough productive talk in Austin about helping us with our health care needs, our mental health crisis, [or] rural hospital needs,” he said. “My feeling is if we’re going to be a state that says, ‘Hey, folks, come in, we’re business-friendly, move to Texas,’ we need to have all those pieces of the infrastructure addressed.”

Hatch Smith meeting voters

Also at the top of Smith’s policy priorities are issues specifically related to rural Texas, which often lacks access to medical care, especially for those seeking behavioral health care. For the most vulnerable regions in rural Texas, THA and the Texas Organization of Rural & Community Hospitals have diligently engaged with the Legislature to ensure services are available and sustainable in these regions – a sentiment echoed by Smith.

“We need to do a better job in addressing our mental health issues,” he said. “It’s a problem both in rural and urban settings, but … it’s more polarizing and probably more of an issue in our rural settings because we just don’t have any resources.”

He added that rural emergency departments “don’t have the resources to deal with mental health, and our counties and municipalities as a whole are ill-equipped to do this. So, I think we need to focus on some mental health resources to get out to our communities and hospitals so that we can help these folks.”

Smith also wants to shed light on programs that hinder patient care. In Washington, D.C., THA and other hospital advocates continue to push back against the anti-consumer, anti-patient care practices of Medicare Advantage plans, which hinder coverage through cumbersome prior authorization processes and high denial rates.

“I think the main issue and the number one factor troubling rural hospitals is Medicare Advantage plans,” he acknowledged. “I would be remiss to not say how important it is for us to continue to educate and tell everyone that will listen how bad Medicare Advantage is for our health care industry and the health care providers.” Although THA helped drive progress on Medicare Advantage in a final federal rule released last month, he says education on the topic to lawmakers continues to be vital going forward.

If elected, Hatch Smith would represent one of hospitals’ own at the Capitol: a rural hospital CEO, rancher and Texan who understands the challenges of serving Texans.

“People don’t realize [how important hospitals are] until their hospital is gone. And so, I think [hospital leaders and employees] need to be proactive,” he emphasized. They need to elect leaders who understand this and ensure that we still have the health care that we need.”

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