3 March 19 - 25, 2026 dallasobserver.com DALLAS OBSERVER Classified | MusiC | dish | Culture | unfair Park | Contents Hello, Doctor? Anyone There? Problems with miscommunication, high expectations and transparency derailed a unique public tele- health program in Garland. BY AUSTIN WOOD D ave Novara doesn’t go in for doctor’s visits often. Not uncommon for a 43-year-old, Novara has had some blood pressure spikes and wondered about his testosterone levels after his friends jested he might not have it in him anymore. By day, he works as a mechanic for an auto repair shop off West Buckingham Road in Garland. It’s an industrial area dotted with mechanic shops, warehouses, storage facilities and heavy manufacturing facilities. Novara has called the blue-collar inner- ring suburb home for close to two decades and, like approximately 28% of its popula- tion, according to a 2024 U.S. Census Bureau survey, doesn’t have health insurance. He goes to the doctor about once a year for a routine physical. Without insurance, his bills for the consultation and lab work typically run $350 to $380. His last physical was mostly routine, although he did ask for a testosterone test to make sure he still had his “mojo.” The north-central Garland resident did, he said, but also had an elevated blood pres- sure index. His physician talked to him for a few minutes about it. The testing he re- quested brought his bill up to around $400, but the added consultation added an extra physician visit to his bill. His out-of-pocket total was close to $680. “It was insane,” Novara said. “The medi- cal system is broken.” MD Health Pathways I n Garland, where city officials estimate more than 40% of roughly 250,000 resi- dents are uninsured or underinsured through programs such as Medicaid, the failure of a recent telehealth program of- fered through the city left some residents continuing to wrangle with questions over care, while others celebrated a win for pub- lic choice. Garland is one of the largest U.S. cities without a hospital within its city limits, a void left after Baylor Scott and White closed its medical center in 2018. In an effort to address healthcare gaps that sometimes result in unnecessary ER visits and long EMS wait times for vulnera- ble residents, the Garland City Council voted 7-2 in August to approve a contract with Dallas-based MD Health Pathways to provide residents with affordable online care through its Tap Telehealth service. Novara said he used Tap Telehealth’s free pilot program, offered to 10,000 households, to connect with a care provider and get a prescription for Tamiflu within two hours. The visit got him back to work and avoided a costly office visit. “It was going to cost me $72 for an entire year to have the ability to text message or call MD Health Pathways for something that isn’t urgent, and they can help me, and they can get me to medication or whatever …. If I go to my doctor just to say hello, it’s $175 for a visit,” Novara said. A low-cost, easily accessible program that promised to relieve strain on emer- gency services appealed to council mem- bers in Garland, which recently considered, among other options, privatizing some EMS services as the Fire Department re- ported overtime budgets exceeding $1 mil- lion annually. The program would have largely been “revenue-neutral” for Garland, according to a statement from the city, with MD Health Pathways paying for associated administrative costs. “I love this program,” Mayor Pro Tem- pore Margaret Lucht said before voting to approve it. “I think it’s wonderful. I think you’re doing something that will pave the way for larger cities to adopt a program like this and help people who don’t have the means, the desire or the ability to have in- surance.” Telehealth was set to roll out in late spring or early summer of 2026, although billing software issues complicated the an- nouncement of an official launch date. But by the beginning of February, it had become increasingly clear that the program’s future in Garland had been thrown in doubt. Problems Arise M idway through the month, Lucht and other council members di- rected interim City Manager Mike Betz to terminate the contract, less than two weeks after essentially putting it up for a citywide May referendum at a Feb. 3 council meeting. Tap Telehealth was off the table af- ter months of recall threats and backlash over the program. The problem? Low-cost healthcare, in this case, meant the $6 monthly fee was added to utility bills via an “opt-out” struc- ture, under which all of Garland’s 81,000+ households tied to municipal customer ac- counts would have been automatically en- rolled for the service. Opting out would have required a phone call or email, planned as a simple process for residents, but many felt even that was too much to ask. The ‘tariff’ would have increased to $9 in the program’s seventh year. “When I found out about this whole thing, I was shocked. I couldn’t believe the city enrolled me in a program without my knowledge or consent, whether I wanted it or not. Additionally, there wasn’t any com- petitive bidding,” Garland resident Sharon Morgan said at the February council meet- ing. “Opting out is like someone pulling a $10 bill from my backpack while I’m trying to eat my lunch. No one’s going to notice, but it should concern everyone.” The public comments at the February meeting capped months of backlash from a growing, rapidly mobilized group of resi- dents who were staunchly opposed to the program for a variety of reasons, including some who questioned the city’s role in pro- viding it in the first place. But above all, the $6 fee and lack of public knowledge before the vote fueled dissent. Council member Ed Moore, who voted against the contract’s original August ap- proval alongside Mayor Dylan Hedrick, said in an interview that he felt the level of public awareness was concerning and that the city should have looked more closely at MD Health Pathways and other potential op- tions. “I just felt that no, we need to do a lot more public engagement. I just did not feel that’s a function of government,” Moore said. “If you’re going to do something like that, I really feel that you need to take that to the community, and you need to have vetted them. You need to find out a lot more infor- mation.” Moore also said that while he thinks Tap Telehealth is a “good service” and that coun- cil members voted with good intentions, he felt emotions fueled the process. | UNFAIR PARK | Mike Brooks Dave Novara, a mechanic in Garland, is frustrated with health care costs. >> p4
