Filling Out the Lineup

TEXPAC-Backed Candidates Could Have Major Impact on 2003 Health Care Debate

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Political Affairs Feature -- September 2002

By  Ken Ortolon
Senior Editor

In an election year with every major statewide office up for grabs, including a majority of the state Supreme Court, medicine has a lot riding on who wins and who loses. "Politics drives the process that sets health care policy," said former Texas Medical Association Political Action Committee (TEXPAC) Chair David Duffner, MD, of Austin. Who we elect this cycle will be navigating what has characterized by our lobbyists as the "perfect storm."

Current TEXPAC Chair Robert T. Gunby Jr., MD, of Dallas, says this will be a legislative session characterized by substantial budget shortfalls in Medicaid and other heath care services, unsustainable pressure on trauma and other delivery systems, a relatively inexperienced legislature -- insofar as health care policy is concerned -- and a near-complete meltdown of medical liability.

"Physicians and alliance members across the state have methodically and carefully reviewed track records and candidates for office," he said. "We, and our patients, will be asking more of them than ever in recent memory. While in many instances our choices are not exactly between good and evil, we have, after extensive discussion and analysis, endorsed the candidates we strongly believe are the best suited and experienced to keep their hand on the tiller in bad weather."

Below is a look at those candidates and what they are saying about health care issues.

Governor

Without a doubt, TEXPAC's endorsement of Democrat Tony Sanchez over Republican incumbent Gov. Rick Perry has been one of the group's most controversial decisions in recent years. While TEXPAC did not endorse Governor Perry in his race for lieutenant governor in 1998, he ran with considerable physician support and generally was considered a "friendly incumbent" -- at least until his veto of TMA-backed prompt payment legislation in June 2001.

The veto of House Bill 1862 and several other TMA-supported bills angered many physicians who felt the governor failed to give any warning that he had problems with those bills. Still, some physicians wanted TEXPAC to remain neutral in the race, but once the decision to endorse Mr. Sanchez was made, they felt like they had to make a public choice. One of those is immediate past TMA President Tom B. Hancher, MD, of Columbus, who helped organize Physicians for Perry this year.

"We can look at Rick Perry's voting record and see very clearly that, with one major exception, he has been supportive of all of our issues in the past," Dr. Hancher said.

Dallas orthopedic surgeon John Gill, MD, says he was as mad as any other physician over the veto of the prompt pay bill. But that is not the issue upon which TEXPAC should have made its endorsement decision, he says.

"A breakdown in communication occurred somewhere, and a sanitized bill did not make it to Governor Perry's desk," Dr. Gill said. "But he has told me personally, and a number of us in group sessions, that if we fix the arbitration clause, he agrees with every other provision of the bill and will sign it. So I've put that issue to bed. Governor Perry said he vetoed the prompt pay bill because of a provision prohibiting binding arbitration in disputes between physicians and health plans and, therefore, would have resulted in more lawsuits.

"Our No. 1 issue now is medical malpractice and tort reform," Dr. Gill continued, "and we are going to get a much better shake on that bill than we will from Mr. Sanchez. He hasn't made one solid proposal on tort reform."

But Dr. Gunby says there's more to the endorsement of Mr. Sanchez than anger over the prompt pay bill veto. "None of us have any problem with our colleagues supporting candidates opposite us. We encourage their activities in the vital political process," Dr. Gunby said. "But TEXPAC has to make some hard choices as to whom we can really rely on next year when things get very, very tough.

"A lot of physicians say we can't turn against Governor Perry over just one issue, but it's not just one issue," Dr. Gunby added. "It's a way of thinking and responding. His closest advisors and supporters are openly and, I believe, irresponsibly antagonistic toward medicine, especially in the areas of workers' compensation and managed care. They continue to wage war against doctors and organized medicine, attacking our profession and even our motives. This is not a coincidence."

Longview general surgeon John Coppedge, MD, a member of the TEXPAC board, says that on top of the prompt pay veto, the governor's promise to address prompt pay problems by having Insurance Commissioner José Montemayor promulgate tough new rules has not been fulfilled. "The tens of millions of dollars that supposedly have been levied in fines and restitution represent only a miniscule amount of the several billion dollars that are being held by HMOs and insurance companies past 45 days," he said.

Dr. Gunby says Mr. Sanchez was thoroughly vetted on health issues and passed with flying colors. "He's very much in favor of the prompt pay legislation as it was written and supports medicine on every one of its issues, including tort reform. Mr. Sanchez has promised he will stick with us on these issues," he said.

"Tony Sanchez has repeatedly committed orally and in writing to putting medical liability and managed care payment reforms on a fast track, to work closely in support of our priorities, and even keep the legislature in session until we have meaningful relief from the liability crisis," Dr. Gunby said.

Mr. Sanchez also has proposed a comprehensive health care plan that he says will ensure access to care for all Texans. That plan includes managed care reforms, such as prompt pay legislation and standardized contracts; comprehensive liability reform to restore fairness to the system and lower liability premiums; and Medicaid and Children's Health Insurance Program (CHIP) reforms to reduce costs and increase provider participation, enroll more eligible children, and create more insurance options for working parents and small businesses.

TMA President Fred Merian, MD, called the Sanchez proposal a "comprehensive series of sound solutions" to problems of both availability and affordability of health care. "His plan includes not only the positive steps Mr. Sanchez would take to address the medical liability crisis, the cash flow crisis, the Medicaid crisis, and the nursing shortage crisis; it also outlines how he would pay for those steps," Dr. Merian said.

Governor Perry also has issued a health care proposal that includes providing employers more options for obtaining health insurance for their workers, creating more federally qualified health centers in underserved areas of the state, requiring Medicare supplemental policies to offer a prescription drug benefit, seeking a federal waiver to allow CHIP-eligible families to purchase employer-sponsored health insurance, and funding breast and cervical cancer treatment for poor women.

U.S. Senate

In the race to replace retiring U.S. Sen. Phil Gramm (R-Texas), TEXPAC endorsed Republican state Attorney General John Cornyn against Democrat and former Dallas Mayor Ron Kirk. That was hardly a surprise. TEXPAC endorsed him in 1990 when he ran successfully for the Texas Supreme Court and again in 1996 when he won re-election. And, TEXPAC was the first major political organization to back his bid for attorney general in 1998.

"General Cornyn built a formidable team of legal experts on managed care and has persistently sought vigorous enforcement of our managed care reforms," Dr. Coppedge said. "They have successfully defended our hard-fought patient protection laws in federal court and worked closely with TMA on a wide range of medical issues in the legislature and Congress. He is uniquely qualified to defend these gains in the U.S. Congress."

Attorney General Cornyn has made empowering patients and their physicians a central theme of his campaign. He vows to back policies that provide more individual choice, such as portability of coverage, incentives for insurers to keep individuals healthy, and giving power to individuals to choose the type of coverage they need.

"I believe health care reform should be based on free market principles," Attorney General Cornyn said. "I oppose government dictates and a government takeover of the health care system. I will support steps to increase consumer choice and accessibility to affordable, quality health care."

He says two of the most important issues facing Congress are prescription drug benefits for Medicare recipients and access to quality health care. "I support legislation to guarantee drug coverage under Medicare for all senior citizens, reform Medicare to provide more choices, reduce the cost of prescription drugs immediately, and strengthen Medicare for the future.

"To increase access to affordable health care, I support providing a refundable tax credit to help low-income individuals purchase health insurance, reducing regulations hampering efforts by businesses to provide health coverage for employees, allowing self-employed business owners to deduct health insurance costs, and eliminating the cap on medical savings accounts."

The San Antonio Republican pledged to work with Texas physicians to allow physicians to jointly negotiate better contracts with health plans, and he has endorsed a U.S. House bill that would roll back scheduled physician fee cuts in the Medicare program and provide a 6-percent increase over the next three years. And, he vowed to ensure that any federal patients' rights legislation does not supersede Texas' tough patient protection statutes.

Mr. Kirk also supports a prescription drug plan for seniors and has urged Congress to act quickly on a plan that is both "fiscally responsible and serves the best interest of seniors." He also pledged to find affordable health insurance solutions for small business owners and their employees.

Lieutenant Governor

Four years ago when Democrat John Sharp faced off with now-Governor Perry in the lieutenant governor's race, TEXPAC decided to stay out of the fray. Both candidates had considerable support among physicians, and TEXPAC officials felt that whoever won the race would be an advocate for medicine.

So when Mr. Sharp, the former state comptroller, jumped into the race again this year it was an easy decision for TEXPAC to endorse him.

"John Sharp is arguably one of the most knowledgeable and talented public officials in Texas," said Corsicana dermatologist Dan McCoy, MD, chair of TEXPAC's Candidate Evaluation Committee. "He has a formidable command of the state budget, how the legislature works, and how to make the wheels of government work. He works well with both sides of the aisle and is more inclined to fix problems and not blame others."

Mr. Sharp has extensive experience in public office, having served in both the Texas House and Senate before his tenure as comptroller. In addition to TEXPAC's endorsement, Mr. Sharp also has garnered support from the Texas Hospital Association, the Texas Nurses Association, the Texas Ophthalmological Association, and the Texas Civil Justice League.

In July, he committed to making prompt pay legislation a priority in the next legislative session and vowed to override any veto regardless of who is governor. Mr. Sharp also has expressed support for adequate reimbursement for physicians who treat Medicaid patients and increasing CHIP and Medicaid eligibility. However, he said the most important issue for health care is solving what he called "the budget mess."

"The first thing that has to happen before we can fund CHIP or raise Medicaid rates is to fix the budget crisis," Mr. Sharp said.

Mr. Sharp's Republican opponent, Land Commissioner David Dewhurst, also has expressed support for prompt pay legislation, saying he would support the bill in the next session "if the Department of Insurance doesn't correct it first." However, Commissioner Dewhurst has spent little time discussing health care issues, instead focusing on what he calls his "common sense, business approach to state government." A poll on his Web site asks visitors to rate what issues should take priority in state government. Health care is not listed among the five issue options.

Attorney General

Attorney General Cornyn's entry into the U.S. Senate race left his current office up for grabs, and TEXPAC has enthusiastically endorsed another former Texas Supreme Court justice, Republican Greg Abbott, in that race. Justice Abbott faces former Austin mayor and personal injury lawyer Kirk Watson in November.

"Both candidates are well-regarded, highly competent attorneys, but medicine has a lengthy track record with Justice Abbott, who has a more conservative position on issues such as lawsuit abuse and barratry, subjects where the office of attorney general can help physicians," Dr. Coppedge said.

Justice Abbott has proposed a broad range of tort reforms including limits on personal injury lawyer contingency fees, a $250,000 cap on non-economic damages in medical malpractice cases, expanded immunity for charity and indigent care providers, reduction of the statute of limitations on malpractice suits brought on behalf of minors, and sanctions against abusive lawyers.

"Judge Abbott's proposed health care accessibility plan is the starting point Texas needs to address our state's current health care crisis," Dr. Gunby said. "The issue of frivolous lawsuits must be addressed now. Judge Abbott understands that when good doctors are forced out of business because of the threat of lawsuits, it is the patient who ultimately suffers due to lack of care."

Comptroller of Public Accounts

State Comptroller Carole Keeton Rylander is seeking re-election with TEXPAC's endorsement. The Republican incumbent faces Democrat Marty Akins, the former All-American quarterback for The University of Texas who is making his first bid for elected office.

Because of her role in estimating how much money lawmakers will have to spend and certifying that the final budget is within those available revenues, the comptroller will play a key role in the debate on Medicaid, CHIP, and other health care spending issues.

"In a revenue-starved year and with a huge demand for health care services, how she calculates the value of any cost-containment proposal or any proposals to restore access to care becomes very important to policymakers," Dr. Gunby said.

He praised the job Comptroller Rylander has done in her first term and said she has maintained a close relationship with medicine.

Comptroller Rylander says the budget crisis is going to require lawmakers to examine "every nook and cranny" of the budget for ways to save money. And, she says, tough decisions will have to be made on Medicaid and other health care programs.

"Spiraling health care inflation requires the state to define which services are essential," she said. "The state can't afford to provide all services to all people. The state's current philosophy is 'Cadillac' coverage or no coverage. Well, I believe we should find a middle ground so more of our children can have their own doctor."

Ken Ortolon can be reached at (800) 880-1300, ext. 1392, or (512) 370-1392; or by email at Ken Ortolon.

September 2002 Texas Medicine Contents
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