Wellness Promotion and Prevention
State Employee Wellness/Promotion
House Bill 1297 by Rep. Dianne Delisi (R-Temple) and Sen. Jane
Nelson (R-Lewisville) calls for the creation of a state employee
wellness program to improve the health and wellness of state
employees. TMA strongly supported the legislation, as did the Texas
Public Health Coalition. The idea for a statewide employee wellness
program emerged over three
TMA Healthy Vision 2010
summit meetings held in 2006. The summits brought together leaders
in medicine, business, health plans, and communities to identify
ways to improve health care in Texas.
HB 1297 requires that a wellness coordinator create and develop
a statewide wellness program to improve the health and wellness of
state employees. The state's Legislative Budget Board (LBB)
estimates this type of plan could save Texas $80 million in the
first three to five years. The program may include:
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Educational opportunities that target the most costly
health care claims, including stress management, nutrition,
healthy eating habits, emotional well-being, fitness, disease
prevention, and smoking cessation;
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Health risk assessment tools and programs;
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Health, nutrition, and fitness-related resources;
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Development of policy and environmental change strategies
that integrate health behaviors and physical activity,
including providing nutrition food choices in vending machines
and state cafeterias; and
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Optional incentives that encourage participation in the
wellness program, including allowing extra leave time for
physical activity and participation in the wellness program and
coordinating discounts with gyms and fitness centers.
The bill also establishes employee wellness demonstration
projects that incorporate best practices for encouraging employee
participation and the achievement of wellness benefits. A TMA
member will be appointed to the Worksite Wellness Advisory
Committee.
Health Plan Wellness Promotion
House Bill 2252 by Rep. Larry Taylor (R-Friendswood) and Sen. Tommy
Williams (R-The Woodlands) allows health plans to provide consumers
with information about wellness services (e.g., gym memberships and
smoking cessation programs) when shopping for health insurance
coverage. It also allows health plans to establish premium
discounts, rebates, or a reduction in applicable copayments,
coinsurance, or deductibles, or any combination of these
incentives, for an insured person who participates in programs that
promote disease prevention, wellness, and health.
Prevention and wellness promotion also were heavily featured in
SB 10, the Medicaid reform bill by Senator Nelson and
Representative Delisi.
Diabetes
Diabetes Mellitus Registry and Pilot
House Bill 2132 by Rep. Joe Strauss III (R-San Antonio) and Sen.
Leticia Van de Putte (D-San Antonio) requires the Texas Department
of State Health Services (DSHS) to create and maintain a diabetes
mellitus registry as a pilot program. The pilot program would be
implemented in a municipality with a population of between 1 and 2
million. The program would require tracking the prevalence of
diabetes mellitus and the level of control of the disease among
varying demographics. Trends of new diagnoses of diabetes and the
health care costs associated with diabetes mellitus also would be
monitored. The bill calls for DSHS and the participating public
health district to promote educational programs about diabetes
mellitus. The bill further outlines confidentiality measures to
protect registrants.
Diabetes Prevention and Treatment
House Bill 3735 by Rep. Jim McReynolds (D-Lufkin) and Sen. Robert
Nichols (R-Jacksonville) establishes a diabetes demonstration pilot
program at the Memorial Health System of East Texas. The aim of the
pilot is to provide a comprehensive approach for the prevention and
treatment of acanthosis nigricans (AN) and diabetes. The program
must: (1) focus on taking an epidemiological approach to disease
surveillance; (2) identify the prevalence of AN and diabetes in
persons in the service area; (3) provide wellness and health
information and services to people positively screened for AN and
diabetes; (4) improve access to care for people diagnosed with AN
or diabetes; and (5) study the cost savings of early detection and
treatment of AN and diabetes. The bill would provide for AN
screening in a region not currently covered by the existing AN
screening program, operated by The University of Texas-Pan
American.
Type 2 Diabetes Education and Risk Assessment
Senate Bill 415 by Sen. Eduardo Lucio (D-Brownsville) and
Representative McReynolds require that the Acanthosis Nigricans
(AN) screening program be supplanted with the Type Two Diabetes
Education and Risk Assessment Program, administered by UT Pan
America Border Health Office. The type 2 diabetes screen is to be
conducted among public and private school students in Texas
Educational Agency (TEA) service centers. SB 415 also requires that
body mass index (BMI) and blood pressure screens be conducted. In
the event that the initial screen for type 2 diabetes yields a
positive result, the bill requires that the parent and/or guardian
receive a written report and be provided information on how to
apply for Medicaid and CHIP. The bill establishes the Type Two
Diabetes Risk Assessment Program Advisory Committee, which will
include a member of TMA and the Texas Pediatric Society.
Obesity/Physical Education
Physical Education for School-Age Children
Senate Bill 530 by Senator Nelson and Rep. Rob Eissler (R-The
Woodlands) calls for increased physical education in grades K-8,
requires an annual physical fitness assessment of students in
grades K-12, and makes TEA responsible for implementation.
Specifically, the bill requires 30 minutes of daily physical
activity for students in grades K-5, and four out of six semesters
of physical activity for middle school students. The bill allows
schools to use structured recess to accomplish the physical
activity requirement. However, local school health advisory
councils are directed to consider and make policy recommendations
about the importance of daily recess for elementary school
students. The bill also requires annual physical fitness assessment
of students in grades 3-12, beginning in 2007-08. TEA is directed
to analyze the results by school district, and correlate the
results to student academic achievement levels, attendance levels,
obesity, disciplinary problems, and school meal programs by Sept. 1
of the following year.
Interagency Obesity Council
Senate Bill 556 by Senator Lucio and Representative McReynolds
establishes an interagency obesity council with representatives
from DSHS, TEA, and the Texas Agriculture Commission for the
purpose of discussing the status of each agency's programs that
promote better health and nutrition and prevent obesity among
children and adults. The council also will consider the feasibility
of tax incentives for employers who promote activities designed to
reduce obesity in the workforce. The council is required to give an
annual report.
Obesity Awareness Week
House Bill 2313 by Rep. Patrick Rose (D-Dripping Springs) and
Senator Nichols designates the second full week in September as
Obesity Awareness Week. The goal is to raise awareness of the
health risks associated with obesity and to encourage Texans to
achieve and maintain a healthy lifestyle.
Preferential Contracting for Vendors Providing Healthier
Foods
Senate Bill 35 by Senator Nelson and Representative McReynolds
gives preferential contracting for food vendors bidding to operate
in public cafeterias who provide food with higher nutritional value
and who do not provide foods containing trans-fatty acids. In the
final days of session, the bill died in House Calendars but was
revived when it was added to an unrelated bill, House Bill 3560 by
Rep. David Swinford.
Oversight of Nutritional Programs
House Bill 4062 by Rep. Sid Miller (R-Stephenville) and Senator
Nelson moves the following nutrition programs from HHSC to the
Texas Department of Agriculture: the commodity supplemental food
program, food distribution program, emergency food assistance
program, school lunch program, summer food service program, child
and adult care food program, special milk program, and school
breakfast program. The bill also calls for a study regarding
trans-fatty acids and increasing participation in the school
breakfast program.
Smoking Cessation/Tobacco Prevention and Control
Cigarette Safety
House Bill 2935 by Rep. Phil King (R-Weatherford) and Sen. Royce
West (D-Dallas) prohibits the sale of cigarettes in Texas that do
not meet certain fire safety standards. Cigarettes sold or offered
for sale in Texas must be certified by the State fire marshal.
Penalties are to be appropriated to the State fire marshal to
support fire safety and prevention programs.
Point-of-Sale Health Warning
Senate Bill 91 by Senator Van de Putte and Rep. Bill Zedler
(R-Arlington) amends the point-of-sale health warning signage for
tobacco products to include the following language: "Pregnant women
should not smoke. Smokers are more likely to have babies who are
born premature or with low birth weight."
Smoking Prevention Near Miss
Statewide Smoking Ban
House Bill 9 by Rep. Myra Crownover (R-Denton) and Senate Bill 368
by Sen. Rodney Ellis (D-Houston), as filed, would have eliminated
smoking in all workplaces and public places. Specifically, the bill
prohibited smoking in all public places, places of employment, and
seating areas of outdoor events. It also would have prohibited
smoking within 15 feet outside of an entrance, operable window, or
ventilation system of an enclosed area in which smoking was
prohibited. The original bill exempted private residences unless
used as child-care, adult day-care, or health care facilities;
designated motel or hotel rooms; designated private or semiprivate
rooms in nursing homes or long-term facilities; and private clubs
that did not employ any employees. To win support, amendments were
added to the bill that would exempt cigar bars and tobacco shops,
and reduce certain penalties within the bill.
TMA, the Texas Association of Restaurants, the Public Health
Coalition, the American Cancer Society-Texas Chapter, and many
others were very supportive of the bill as filed. Given the broad
support, this issue is likely to reemerge next session.
Immunizations
Human Papilloma Virus Mandate Prohibition
House Bill 1098 by Rep. Dennis Bonnen (R-Angleton) and Sen. Glenn
Hagar Jr. (R-Katy) allows students to be admitted to elementary
and/or secondary school without having had the human papilloma
virus (HPV) vaccine. The bill calls for HHSC to provide educational
material about HPV that is unbiased, medically and scientifically
accurate, and peer reviewed. The bill also requires HHSC to make it
available to parents or legal guardians at the appropriate time
within the immunization schedule. The bill preempts the executive
order previously issued by the governor, but expires Jan. 11, 2011,
to allow for the legislature to revisit the HPV mandate.
HPV Vaccine Education
House Bill 1379 by Rep. Joe Deshotel (D-Beaumont) and Senator
Nelson requires DSHS to produce and distribute informational
materials about the HPV vaccine. The materials must include
information relating to the effectiveness, availability, and
contraindications of the vaccine. Course materials and instructions
about sexually transmitted diseases should express that:
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Sexual intercourse is not required to become infected with
HPV, and the avoidance of skin-to-skin contact involving the
genital areas offers the best protection. Materials should
state that both males and females may be infected with HPV. The
virus' symptoms may not be present, and younger women are at
greater risk of acquiring HPV than older women.
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HPV may be transmitted to an infant during
childbirth.
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HPV plays a role in the development of genital warts,
cervical cancer, and other diseases.
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Women need to continue to undergo pap smear testing, even
if they have received a vaccination against HPV.
DSHS must collaborate with the Texas Cancer Council to develop
educational programs for parents regarding HPV, and promote
awareness of a minor's need for preventive services for cervical
cancer. The bill also requires DSHS to develop and maintain a Web
site that targets the public and health care professionals, and
provides accurate, comprehensive information on all aspects of
cervical cancer prevention, including vaccination against HPV.
Materials must be provided in English and in Spanish. TMA strongly
supported this bill.
Immunization Education/Awareness by School Districts
House Bill 1059 by Rep. Tan Parker (R-Flower Mound) and Senator
Nelson is referred to as the "Emily Lastinger Act" in honor of
children who have died from the flu. The bill requires school
districts to post the following on their Web sites in English and
in Spanish: (1) required vaccinations for school entry, including
the influenza vaccine; (2) recommended vaccinations for public
school students; (3) health districts that offer the influenza
vaccine; and (4) a link to the DSHS Web site for exemption
procedures. The bill instructs DSHS to prepare a list, suitable for
posting on schools' Web sites, of required and recommended
immunizations for school-age children.
Rotovirus Vaccine Coverage
House Bill 2636 by Rep. John Smithee (R-Amarillo) and Sen. Kim
Brimer (R-Ft. Worth) is not health related, but in the last days of
session, was amended to add rotovirus vaccine to the list of
childhood immunizations required to be covered by health plans.
Flu Vaccine Education
House Bill 3184 by Rep. Garnet Coleman (D-Houston) and Sen. Bob
Deuell, MD (R-Greenville), requires DSHS to provide information on
its Web site about the benefits of annual vaccinations against
influenza for children 6 to 59 months of age, and to distribute the
information to parents of children in day-care facilities in August
and September of each year.
House Bill 532 by Representative Dukes was amended to this bill.
HB 532 allows each health care provider to select the specific
influenza vaccine to be used under the Vaccines for Children (VFC)
program from a list of approved vaccines. Currently, the VFC
program offers the vaccines that it gets directly from the Centers
for Disease Control and Prevention (CDC). Companion legislation was
Senate Bill 811 by Senator Janek.
Immunizations for Low-Income Students of Higher Education
Institutions
Senate Bill 140 by Senator Nelson and Rep. Lois Kolkhorst
(R-Brenham) requires DSHS and the Texas Higher Education
Coordinating Board to conduct a joint study of the feasibility of
providing immunizations without charge or at a discount to
economically disadvantaged students enrolled in health profession
degree programs at institutions of higher education in this state.
The study must examine potential methods of providing those
immunizations.
Electronic Medical Records Interface With Immunization
Registry
Senate Bill 204 by Senator Nelson and Representative Delisi
requires that electronic medical records vendors in Texas must
provide the ability to electronically interface with the Texas
Immunization Registry, ImmTrac.
Pandemic Flu Preparation
Within the supplemental appropriations bill, HB 15, legislators
allocated $11 million to purchase flu antiviral in the event of a
pandemic flu outbreak.
Immunization Near Miss
Lifespan Immunization Registry
House Bill 1896 by Rep. Donna Howard (D-Austin) would have
eliminated the age limit for maintaining records in the state
immunization registry and required the retention of this
information until the person's death. The bill also would have
required health care professionals who administer an immunization
to a person over 18 years of age to submit data of the immunization
to DSHS. It also would have required DSHS to develop a program to
educate first responders regarding the benefits of being included
in the immunization registry, and it would have required DSHS to
work with stakeholders to identify adult immunizations necessary in
the event of a public health disaster.
The House Committee Substitute required recording of adverse
reactions to vaccines and allowed for a regional health information
exchange, in addition to central and local registries. It also
would have provided specific immunity from liability for persons
reporting, added a new section specifically relating to the
administration of immunizations and medications during disasters
and emergencies. It would have required that data elements be
compatible with the standards of the Health Information Technology
Standards Panel. TMA strongly supported this bill and will continue
to advocate for it in the next legislative session.
Child Health and Safety
Seat Belts on School Buses
House Bill 323 by Rep. Mike Hamilton (R-Mauriceville) and Senator
Lucio requires three-point seat belts on buses that transport
schoolchildren. The provisions of this bill apply to all school
buses purchased after 2010, and require implementation for all
buses purchased or contracted as of 2014. Chartered buses and mass
transit buses that transport schoolchildren are exempt from the
seat belt requirement. This bill is contingent upon appropriations
for reimbursement to school districts for the expenses incurred
related to this statute. It allows for donations to fund the
purchase of the seat belts and for acknowledging donors by signs on
the school buses.
Child Protective Services
Senate Bill 758 by Senator Nelson and Representative Rose revises
Child Protective Services (CPS) reforms adopted in 2005 and
implements new ones. Significant components of the bill:
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Remove the requirement that the state privatize substitute
care and case management;
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Support in-home support services for families in which
poverty is the primary underlying cause of neglect and for
which such support could result in the child staying in the
home or being reunited with the family more quickly;
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Establish adoption subsidies and create initiatives for
increasing the number of foster care families; and
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Establish a Committee on Pediatric Centers of Excellence
for the assessment, diagnosis, and treatment of child abuse.
The committee must include three pediatricians specializing in
treating victims of child abuse.
Child Safety Month
House Bill 1045 by Rep. Vicki Truitt (R-Keller) and Sen. Judith
Zaffirini (D-Laredo), accompanied by House Calendar Resolution 73
by Representative Truitt and Senator Nelson, establishes April as
Child Safety Month.
Child Health/Safety Near Miss
Booster Seat Bill
Senator Bill 60 by Senator Zaffirini and Rep. Fred Brown (R-College
Station) would have raised the age that a child must be secured in
a child passenger seat in a vehicle to age 8, or taller than four
feet, nine inches. The bill passed the Senate 26-4 but died in the
House Transportation Committee even though similar legislation
passed in the House previously. TMA and TPS strongly supported the
bill. Texas will lose $19 million in federal transportation funding
for failure to adopt the legislation.
Cancer Prevention and Screening
Cancer Prevention and Research Institute
House Bill 14 by Rep. Jim Keffer (R-Eastland) and Senator Nelson
calls for the creation of the Cancer Prevention and Research
Institute of Texas to: (1) create and expedite innovation in the
area of cancer research and to enhance the potential for a medical
or scientific breakthrough in the prevention of cancer and cures
for cancer; (2) attract, create, or expand research capabilities of
public or private institutions of higher education and other public
or private entities to promote a substantial increase in cancer
research and the creation of high-quality new jobs; and (3)
implement the Texas Cancer Plan.
The bill creates an oversight committee for the institute, a
scientific research committee, and a cancer research fund.
Physician members will be included on the oversight committee.
The Scientific Research Committee will review grant and loan
applications and make recommendations to the oversight committee
regarding the award of research, therapy development, and clinical
trial grants and loans from the Cancer Research Fund.
Accompanying HB 14 was House Joint Resolution (HJR) 90, by the
same authors, authorizing $3 billion in bond sales over 10 years to
fund the institute. The bond measure must be approved by voters
this fall. If approved, the new funding would be placed in the
Cancer Research Fund, a dedicated account in the general revenue
fund that consists of: (1) money received from the sale of bonds;
(2) patent, royalty, and license fees and other income; (3)
legislative appropriations; (4) gifts, grants, including federal
grants, and other donations; and (5) interest earned on investments
of money in the fund. Every dollar in state funding would have to
be matched by 50 cents from federal or private sources.
The fund will be used to pay for: (1) grants and loans for
cancer prevention and research and facilities to realize therapies,
protocols, and medical procedures that will result in, as speedily
as possible, the cure for, or substantial mitigation of, all forms
of cancer in humans; (2) the purchase of needed laboratory
facilities by or on behalf of a state agency or grant recipient;
and (3) operation of the institute. Authorizes the Texas Public
Finance Authority to issue and sell general obligation bonds of the
state for the cancer research fund.
The bill additionally calls for reorganization of agencies
involved in cancer research and prevention.
Medicaid Coverage for Breast and Cervical Cancer Treatment
Senate Bill 10, the Medicaid Omnibus bill includes a provision that
will expand the number of women who may receive treatment under the
Breast and Cervical Treatment Act (BCCTA).
BCCTA is a special Medicaid program that provides cancer
screening, diagnosis, and treatment for low-income, uninsured
women. Currently, a woman must be screened by a designated provider
in order to be eligible for treatment. The provision specifies that
as long as a woman is otherwise eligible for coverage, she may
receive treatment regardless of whether the screening was performed
by a designated BCCTA provider and regardless of whether federal
matching funds are available. While the woman is being treated, she
is eligible for full Medicaid benefits. HB 1 allocates state
general revenue to provide additional coverage. As a result of the
legislation, 1,200 additional low-income women are expected to get
cancer treatment.
Dating Violence
House Bill 121 by Representative Dukes and Sen. Juan "Chuy"
Hinojosa (D-McAllen) requires that each school district adopt and
implement a dating violence policy that includes a definition of
"dating violence," and that addresses safety planning, enforcement
of protective orders, school-based alternatives to protective
orders, training for teachers and administrators, counseling for
affected students, and awareness education for students and
parents. The bill became effective immediately.
Infectious Diseases
Health Care-Related Infections
Senate Bill 288 by Senator Nelson and sponsored by Representative
Delisi establishes an Advisory Panel on Health Care-Related
Infections and a reporting system under the auspices of DSHS. This
statute requires the reporting of risk-adjusted infection rates for
central line, specified surgical sites, and pediatric respiratory
syncytial virus on at least an annual basis.
HIV and AIDS
HB 1370 by Representative Coleman and sponsored by Senator
Zaffirini, updates the statute governing the Interagency
Coordinating Council for HIV and hepatitis with the new names of
the health and human services agencies. The bill adds the Texas
Higher Education Coordinating Board to the list of agencies that
compose the council. The council is placed under the Texas Health
and Human Services Commission rather than DSHS. The bill also calls
for the identification of all statewide plans related to these
diseases; a complete inventory of all monies spent; state agency
interactions and policy issues; assessment of gaps in service;
identification of barriers to services, particularly for
marginalized populations; identification of unique service needs;
evaluation of levels of service and quality of care provided for
persons infected with HIV, AIDS, and hepatitis as compare with
national standards; and identification of emerging issues.
Methicillin-Resistant Staphylococcus Aureus
House Bill 1082 by Representative Straus and sponsored by Senator
Van de Putte, establishes a pilot program to research and implement
procedures for reporting cases of Methicillin-Resistant
Staphylococcus Aureus (MRSA) and requires the reports to be made
public with a summary by location.
Needle Exchange
Senate Bill 10, the Medicaid Omnibus Reform bill by Senator Nelson
and Representative Delisi, includes a provision allowing Bexar
County to establish a needle exchange program to help reduce
incidence of communicable diseases such as hepatitis B and HIV.
Disaster Preparedness and Planning
Statewide Mutual Aid System
Senate Bill 11 by Senator Nelson and Rep. Frank Corte Jr. (R-San
Antonio) creates a Texas Statewide Mutual Aid System that will
provide integrated statewide disaster preparedness aid response
capability among local government entities without a written mutual
aid agreement. The bill also calls for the division of the state
into disaster districts to engage homeland security preparedness
and response activities along the boundaries of the state
transportation regions. More than 15 other bills were absorbed into
SB 11, including provisions related to school safety, establishment
of a Border Security Council, trafficking of persons, street gangs,
and enhanced driver licenses.
In the closing days of session, several other bills important to
organized medicine also were added to SB 11:
- Senate Bill 1186 by Senator Nelson, allowing for the
inclusion in the immunization registry information about
immunizations for first responders.
- Senate Bill 810 by Senator Janek, allowing for quarantine for
persons exposed to or infected with a communicable disease.
- Senate Bill 1499 by Senator Zaffirini, requiring that the
notice of an emergency meeting to address the relocation of a
large number of residents in the event of a disaster be provided
to the news media no later than one hour before the meeting.
Filling of Prescriptions in the Event of an Emergency
Senate Bill 1658 by Senator Nichols and Rep. Charles Hopson
(D-Jacksonville) allows pharmacists to use their professional
judgment in dispensing non-Schedule II prescription drugs in an
emergency. In the aftermath of Hurricanes Katrina and Rita, it was
realized that the traditional access to health care is often
compromised when prescription drugs may be needed the most. SB 1658
is intended to allow continued access of a patient to his or her
prescription drugs during these situations. Pharmacists are allowed
to dispense prescriptions without physician contact in the event
that not filling the prescription may disrupt the patient's
therapy, the pharmacist is unable to contact the physician after
considerable effort, the quantity does not exceed a 72-hour supply,
or there is a natural or manmade disaster preventing contact with
the physician.
Disaster Planning for Pets
House Bill 88 by Representative Branch added a provision to the
government code regarding disaster planning for the humane
evacuation, transport, and sheltering of pets in a disaster. The
bill requires that service animals be evacuated with the person
with a disability and household pets with owners, if it is feasible
and does not cause any danger.
TMA Public Health Staff Team:
Legislative: Greg Herzog
Policy: Gayle Love, Audra Bryant, and Susan Griffin
Legal: Lee Spangler and Kelly Walla
Overview
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Managed Care/Insurance Reform
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Scope of Practice
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Retail Health Clinics
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Responsible Ownership
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Corporate Practice of Medicine
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Health Care Funding
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Medicaid, CHIP, and the
Uninsured
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Border Health
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Mental Health
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Emergency Medical Services and
Trauma Care
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Rural Health
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Medical Science and Quality
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Physician Workforce, Licensure,
and Discipline
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Health Information Technology
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Prescription Drugs
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Long-Term Care
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Workers' Compensation
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Abortion
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Franchise Tax Reform