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AUSTIN, Texas — Eleven years ago, local officials promised voters in the most liberal county in Texas that if they supported tens of millions of dollars in new taxes, they’d deliver a win-win scenario: Austin would get a new medical school, and poor people navigating the health care system in a state with the country’s worst uninsured rate would get more health care services.

Politicians pitched a grand vision to transform Austin. There would be the medical school and a new teaching hospital, a way to attract new health care businesses, investments, and jobs. After voters approved those initiatives, politicians and university officials proposed turning the site of a demolished hospital into a glittering hub of medical and biotechnology innovation like Boston, San Francisco, and Chicago. All of it, they pledged, would expand health care services for Austin’s low-income residents.

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But more than a decade later, the reality has fallen short of all that was promised.

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