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Tony Gutierrez / AP

Barclay Berdan barely started his tenure as CEO of Texas Health Resources when the $4.3 billion hospital system became the notorious site of the U.S. Ebola outbreak in 2014. The health care reform debate has made that incident seem like it happened decades ago.

Berdan sat down with me this week at the annual meeting of the American College of Healthcare Executives to talk about Trumpcare, Medicaid and some of the different business ventures Texas Health Resources is trying. Here's an edited transcript of our conversation.

What's your take on the failure of the Republican health care bill, which would have increased the number of uninsured people?

"We're in a state that didn't expand Medicaid. We have more uninsured than anyone else does. That's been a longstanding problem. We spent a lot of time educating people at the state and federal level about the pros and cons about block grant programs or per capita programs."

"One of the challenges of Obamacare was it was a political compromise. In the end to get it passed, it was a bunch of parts that didn't necessarily work well together. (Trumpcare) was mimicking that kind of development where they might be able to pass something, but we have different pieces that have been put together mostly to get votes and not to get the system to work smoothly. So I was actually relieved when it didn't pass."

With the bill dead in the short term, what is most important for your health system?

Texas is trying to secure a new Medicaid waiver that would continue add-on payments to hospitals for uncompensated care. But more broadly: "The biggest issue is the uninsured. We have to figure out how to deal with that population's access."

Rep. Michael Burgess, who was heavily involved with Trumpcare, is close to where your system is headquartered. Did you communicate with him as the plan was unfolding?

"We have a great relationship with congressman Burgess. A week before the vote, we had a leadership retreat with our board and board committees, and he came for the first hour of that. He gave his perspectives on where things were."

Were there any disagreements?

"I wouldn't say there were disagreements. We never had a chance to talk about a whole variety of the amendments that were tacked on."

What's the strategy behind co-owning a health plan with Aetna? Did you see other health systems struggling to own their own insurance companies? Where do you see this going?

"We recognized early on that we needed someone with much more experience operating a health plan as a partner. We're hopeful over five years we could get up to 250,000 members." Texas Health Resources expects to invest up to $110 million into the joint venture, which will only offer health plans for employers and will not touch the Obamacare marketplace.

Your system also has a joint venture with Adeptus Health, the emergency room operator, where you basically took over the branding of multiple freestanding ERs. Adeptus is in a world of trouble financially and may go belly up. What would happen to you in that scenario?

"We are not a capital investor (in Adeptus). Given the challenges they're having, I'd rather not go into the details of the relationship. What I do know is they've had a real challenge in converting their revenue cycle system and collecting on it. We just have kept in close contact with them and talked internally about how different options might emerge."

Texas Health Resources has an 8% operating margin. That's above average for not-for-profit systems. What have you been doing?

"One is diversifying your revenue streams. Things like the joint venture with Aetna are designed to do that. Also, looking at your overall expense and cost base and asking if you're being as productive as you can. It's not just cutting costs."

Go deeper

Texas urges Supreme Court to leave abortion ban in place

Photo: Emily Elconin/Bloomberg via Getty Images

Texas on Thursday asked the Supreme Court to keep in place a law that bans abortions after an embryo's cardiac activity is detected, which can be as soon as six weeks and before many people know they are pregnant.

Driving the news: Texas Attorney General Ken Paxton is asking the high court to ignore the Justice Department's emergency request that they temporarily block the law while federal courts consider its constitutionality since it "lacks standing because it has not been injured by SB 8."

Felix Salmon, author of Capital
2 hours ago - Economy & Business

Meme stonks lose their appeal to the world of crypto

Data: Cardify; Chart: Axios Visuals

That sucking sound you hear is the outflow of meme-chasing dollars from the stock market.

Why it matters: The caravan has moved on. The dream of getting rich quick still lives, but today it's more often found in the world of crypto, NFTs or even sports betting than it is in the stock market.

Latinas who brew seek to shake craft beer industry

A server at Mujeres Brew House in San Diego rings up a customer in front of a selection of craft beers. Photo: Russell Contreras/Axios

Independent craft brewers are popping up in cities across the country, and a small but growing number of them are Latina-owned or run by a Latina head brewer.

The big picture: Latinas are opening up independent craft breweries from California to Colorado as Latina-owned small businesses continue to be one of the fastest-growing segments of the economy despite a lack of venture capital.