Politics Versus Policies

Redistricting, Budgt, Partisanship Likely to Influence Health Care Legislation

Texas Medicine Logo

Cover Story -- January 2001

By  Ken Ortolon
Associate Editor

Texas lawmakers will have a full plate of health care issues to debate when the 77th Texas Legislature convenes on Jan. 9, judging by the work that went on during the interim since the previous session adjourned at the end of May 1999.

House and Senate committees carried out some two dozen interim studies on health issues last year, ranging from medical records privacy to Medicaid reform to the cost of prescription drugs to mandated health insurance benefits. Political observers say the recommendations produced by many of these interim studies will have greater "political viability" because of the resolution of political conflicts and enhanced policy sophistication the studies have fostered.

And, numerous health-related bills already have been filed since the prefiling period for the upcoming session began on Nov. 13, 2000. Among them are bills prohibiting pharmaceutical manufacturers from using identifiable patient medical data for marketing purposes, creating a medical school at Prairie View A&M University, and regulating the sale of drugs on the Internet.

Yet despite what appears to be a quick start on health care issues for this session, those concerns may end up taking a back seat to partisan politics. In fact, Austin politicos say the upcoming legislative session may be one of the most politically partisan sessions in recent Texas history because of several factors.

The politics

"Before we even think about the top issues, we have to factor in the fact that this is a redistricting session," said Robert W. Sloane, MD, chair of the Texas Medical Association Council on Legislation. (See " Redistricting: Where Politicians Eat Their Young.")

"We know that this will be a session that will be dominated by two things," added Fort Worth political consultant Bryan Eppstein. "It will be dominated by very bitter partisan battles over redistricting, and we know that the state is facing some very tough budgetary issues."

Redistricting is the once-every-10-years process by which lawmakers reapportion state House and Senate districts, as well as Texas congressional districts. Dr. Sloane says it is a process in which lawmakers "cannibalize each other's districts, make lifelong enemies, and destroy friendships." It is a bitterly partisan process through which the party in power tries to draw safe districts for its incumbents, while the minority party attempts to carve out some new seats that it can win.

This year's redistricting battle could be particularly brutal because of the razor-thin majorities in both houses of the legislature, says Kim Ross, TMA vice president for public policy. The Republicans hold a one-vote edge in the 31-member Texas Senate. The Democrats enjoy a six-vote majority in the 150-member Texas House. Mr. Eppstein says Republicans likely will gain seats through redistricting because the growth areas of the state have been in the largely Republican suburban areas. Because of the growth in those suburban districts, Republican votes likely will be shifted into districts that now are held by Democrats but that are now short of the necessary population, he says.

"You can probably take the 12 most underpopulated districts in the state House and they are all held by Democrats," he said. "And you can probably take the top most overpopulated districts and they are all held by Republicans."

By shifting some of that overpopulation into the underpopulated districts, it's going to destabilize some Democrat seats, he says. That could give Republicans a majority in the House in 2003.

"This is as partisan as it gets," Dr. Sloane said, adding that it almost certainly will inject a level of partisanship into the substantive issues of the session, such as health care. While Democrats and Republicans have crossed party lines to pass health legislation in the past -- such as the sweeping managed care reforms enacted in 1997 -- this session may see more votes along party lines or legislative outcomes that are based more on horse trading over district lines than on legislative merit, he says.

Not only that, but legislators' preoccupation with redistricting as they wrangle for political survival will mean they will have less time to focus on other issues.

Blood in the water

But redistricting is not the only factor likely to inject partisanship into this legislative session. Mr. Ross laments that some Democrats are boiling mad because statewide Republican elected officials openly campaigned against incumbent House Democrats.

He expresses hope that once the heat of battle dissipates, cooler heads will prevail. "Most, if not all, election wounds heal over time, and legislators forgive (and remember), then get back to the work they were elected for."

Nonetheless, even if the Republicans had taken a majority of the House in the 2000 elections, Speaker Pete Laney (D-Hale Center) likely would have retained his post, observers say. But all bets are off for 2003, particularly since Republicans believe they will have the upper hand, he says.

"The Republicans believe that after redistricting they will have a majority," said Harvey Kronberg, editor of Quorum Report , an Austin-based political newsletter. "That means you've got five or six viable Republican speaker candidates who won't actually be waging a speaker's race this session but will be positioning themselves for 2003."

Lame duck?

While not necessarily increasing potential partisan tensions, one other factor could weigh heavily on the atmosphere surrounding the 2001 legislative session. That is the future of George W. Bush.

The Texas governor was still locked in a neck-and-neck race for the presidency with Vice President Al Gore at press time. If the vote in Florida and the state's 25 Electoral College votes ultimately swing to Vice President Gore, Gov. Bush will be returning to Texas either as a lame duck or preparing for a third term. If they swing to Gov. Bush and he becomes president, Lt. Gov. Rick Perry will ascend to the governor's mansion.

If that should happen, the dynamic in the Texas Senate could change. That body would choose a new lieutenant governor from among its own ranks. The new acting lieutenant governor would serve as the Senate's presiding officer and represent his or her Senate district until the next regular election.

With Republicans in control of the Senate, the new lieutenant governor likely would be a Republican. But Mr. Kronberg says Republicans aren't likely to unite behind one candidate. That, he says, could put the Democrats "in the catbird seat" because no Republican could win without Democratic support.

Meanwhile, if Gov. Bush is still governor, he may not be as significant a factor in the session because the governor's staff has not been able to make a serious effort to develop a legislative agenda, Mr. Kronberg says.

The policy

So, it is into that political dynamic that lawmakers return to Austin on Jan. 9 to take up the people's business. Any lawmaker or advocacy group that wants to advance a legislative agenda will have to break through that anticipated partisan environment to accomplish it.

Sen. Jane Nelson (R-Flower Mound), chair of the Senate Health Services Committee, has worked continuously since the end of the 1999 session to prepare for 2001. She says redistricting may require much of the legislature's time and energy but adds that health care will take a front seat.

"The rapid changes in our health care environment, even since the last legislative session, are so great that we have no choice but to put health care at the top of our priority list," Sen. Nelson said.

Mr. Ross says that both House and Senate health committees have worked nonstop for the last 18 months. "These are by far the best-prepared and best-schooled legislative committees that we've ever seen," he said.

Below is an issue-by-issue breakdown of health-related issues that either will be high on the legislature's radar screen or are likely to be advanced by physicians, employers, health plans, or other interest groups.

The budget

Foremost on lawmakers' minds (behind redistricting) probably will be the state budget.

Unlike the past two budget cycles, lawmakers likely will not have substantial surpluses to play with in 2001. Although preliminary estimates from State Comptroller Carole Keeton Rylander showed the state would have as much as $1.4 billion in unanticipated revenue for the biennium, State Rep. Rob Junell (D-San Angelo), chair of the House Appropriations Committee, says most of that money is as good as spent.

"We've got about a $500 million shortfall in Medicaid that we're going to have to make up for when we go back into session," Rep. Junell said. "So that eats up part of that surplus."

Another $130 million likely will be spent on contracting with private facilities and county jails to house inmates that the state prison system doesn't have room for, he adds. The remainder of the surplus revenues likely will be eaten up by inflation.

"When you start putting a budget together as [Senate Finance Committee Chair Bill] Ratliff and I have been doing and when you look at the figures just to keep current services even, that pretty well eats all that money up," Rep. Junell said.

Medicaid/the uninsured

Dr. Sloane says Medicaid will be among the most important issues lawmakers deal with in 2001, both in terms of physician reimbursement and reform of the system.

In 1999, the legislature passed the first Medicaid fee increase in more than six years. But because that relatively modest increase was spread out over the two-year budget period and because it was applied toward children's services, immunizations, and other targeted services, it had little impact for physicians, Dr. Sloane says.

"I'm sure a lot of physicians scarcely noticed that there was an increase," he said. "There is still dissatisfaction with reimbursement in the Medicaid system, and it's beginning to lead to access difficulties around the state." (See " Managing Medicaid," November 2000 Texas Medicine. )

Alfred Gilchrist, TMA director of legislative affairs, adds that an already fragile safety net is unraveling. "Doctors cannot stay afloat under the present reimbursement schedules," he said. "They are drowning in red ink, and access for the Medicaid patient is drying up."

Reimbursement rates under the Children's Health Insurance Program (CHIP), which are tied to the Medicaid fee schedule, also are a concern, he says. While enrollment in CHIP continues to increase, some areas of the state lack physicians to care for CHIP beneficiaries because of low reimbursement rates.

TMA is working with a coalition of other health-care groups to advocate for a fee increase, although the groups have not yet determined the depth and breadth of the increase they will seek.

Meanwhile, momentum is building for some reform of the Medicaid managed care system. Three separate interim studies have looked at problems with Medicaid managed care and their impact on access and quality of care, utilization patterns, and cost.

Mr. Gilchrist says so much attention has been given to Medicaid managed care that he believes it is almost impossible that lawmakers won't pass some type of Medicaid reform bill this session.

Dr. Sloane says there is some sentiment among lawmakers to scrap the current Medicaid managed care system in favor of an alternative. More likely, the existing system will be overhauled.

Suggestions for changes fall mainly in two areas, he says. First is a reduction in physician hassles, such as simplification of the fee schedules and preauthorization forms. The second is lengthening the period of enrollment for Medicaid beneficiaries so they don't float in and out of the system every month. By letting patients enroll for a longer period, perhaps a year, Medicaid beneficiaries could truly establish a medical home, Dr. Sloane says.

Medical records privacy

Sen. Nelson already has filed Senate Bill 11, which places some strict new limits on how identifiable patient information could be used. The legislation, which TMA supports, is the result of an interim study conducted by the Senate Health Services Committee, which found what Sen. Nelson called "significant gaps" in Texas law concerning confidentiality of medical records, especially prescription drug records.

The measure would prohibit pharmaceutical manufacturers from using individually identifiable patient medical data for marketing purposes. It also requires that no patient information other than data necessary for treatment or payment of claims be released by insurers without the patient's consent.

Nonidentifiable personal medical information would be made available for public health and research efforts, and employers would have access to non-individually identifiable, encrypted, and aggregated forms of medical information regarding their employees' health care.

Sen. Nelson says Texans have a fundamental right to decide who has access to their medical data. "The doctor-patient relationship is built on trust," she said, "and the foundation of trust is confidentiality. Our medical records, including our prescription drug records, are perhaps our most personal information."

Connie Barron, TMA's associate director of legislative affairs, says some drug manufacturers, pharmacy benefits managers, and pharmacies that use patient information for marketing purposes may raise objections to parts of SB 11.

"They will find it very difficult to oppose the principle of the bill," she said. "They likely will propose language that will provide a loophole big enough to let them continue doing what they're doing. They are pushing for an opt-out provision that allows them to use this information for anything they choose unless the patient specifically says no. We've been pushing for an opt-in provision that says you can't use it unless you have signed consent."

Prescription drugs

Another of the major interim legislative studies involved prescription drug costs and was conducted by the House Public Health Committee, chaired by State Rep. Patricia Gray (D-Galveston). (See "Prescribing a Cure," December 2000 Texas Medicine , pages 54-49.)

Following the lead of several New England states, the Public Health Committee looked at pooling the purchasing power of numerous state health programs -- such as the Employee Retirement System, Medicaid, the prison health care system, and others -- to empower the state to negotiate for better drug prices.

While drug manufacturers have not overtly opposed the concept, they have raised concerns about including Medicaid in such a purchasing pool because of federally mandated rebates those companies already are required to provide the state.

The proposal does not address the cost of private sector prescriptions, but Rep. Junell says it could be a major boon for the state, which saw the cost of its employees' health coverage skyrocket this year. It might also help lawmakers find some much-needed dollars to partially pay for health coverage for the state's public school teachers. Several state teacher organizations have made that a priority issue this session.

Tobacco settlement funds

The state is scheduled to receive some $942.5 million in installment payments on the tobacco lawsuit settlement during the upcoming biennium. TMA would like to see all of those funds earmarked for health care initiatives but expects intense competition for those funds from a variety of interest groups.

Rep. Junell says he and Sen. Ratliff remain committed to dedicating those funds to health care, and he is not aware of any nonhealth groups planning to seek a portion of those funds.

Gayle Harris, director of TMA's Public Health Department, says the association believes CHIP should have first shot at a portion of the tobacco dollars. Rep. Junell adds that health insurance programs for children of low-income state workers and children of legal immigrants who don't qualify for CHIP also will get a portion of those funds.

The TRUST Alliance, a coalition of the state chapters of the American Heart Association, American Lung Association, and American Cancer Society, also is expected to ask for $150 million of the tobacco money to be put into the endowment for tobacco prevention and control that was created in 1999, plus another $50 million out of general revenue for tobacco prevention projects.

Rep. Junell warns that the full $942 million may not materialize. The tobacco settlement allows the tobacco industry to reduce scheduled payments if tobacco sales and revenues decline. That was the case in 2000, when the state received 11 percent less the scheduled amount. A similar reduction could cut this biennium's payments by more than $100 million.

Managed care

Unlike the past three sessions, TMA is not likely to pursue major managed care reforms this year. "Texas managed care laws are the most comprehensive in the country," said Dr. Sloane. "It's like the third day of a garage sale -- most of the big stuff already has been taken."

Instead, the association's managed care agenda largely will try to tighten existing statutes, such as prompt payment and clean claims legislation.

"The managed care industry has made contracting end-runs around that legislation," Dr. Sloane said. He says insurers have contracted their way out of or simply ignored the prompt payment statute. And regulations promulgated to implement the law have been more detrimental to physicians than helpful, Ms. Barron adds.

"We're going to have to rewrite the law and fix it so that health plans cannot contract their way out of the provisions," she said.

Another priority will be further refining the 1999 physician negotiation law, authored by State Sen. Chris Harris (R-Arlington) and State Rep. John Smithee (R-Amarillo). Ms. Barron says regulations adopted by Attorney General John Cornyn, although greatly improved from the original proposals, still are too burdensome on physicians and discourage them from using the law.

The Texas Association of Health Plans (TAHP) is expected to seek legislation to place minimum solvency requirements on physician networks, independent practice associations, and others that accept risk from HMOs. TAHP also will seek legislation to require standardized credentialing by having the state contract with private credential verification organizations (CVOs).

While TMA questions the underlying reasons for the solvency bill, the association has supported the concept of standardized credentialing and could reach an agreement with TAHP, Ms. Barron says. Similar legislation was considered in 1999 but ran into opposition because it placed authority for standardized credentialing with the Texas State Board of Medical Examiners (TSBME). Eventually, TSBME was given authority to collect and disseminate information on core credentialing information that is not subject to change, such as where a physician attended medical school.

"Part of the problem in 1999 was having the state do something that private, for-profit entities were out there in the marketplace doing," Ms Barron said. "Maybe by contracting with an independent CVO we can do away with the concerns about the state replacing private industry. So we may be able to agree."

TMA also will revisit legislation to prohibit tied products and mandatory hospitalists, and reenact the law prohibiting plans from dumping financial risk and other tasks on physician networks. That law will sunset this session if not reenacted.

Finally, employers, led by the Texas Association of Business and Chambers of Commerce (TABCC), are expected to seek legislation to require that any proposed health insurance benefit mandates be evaluated to determine their potential cost impact. The proposal came out of a special interim task force requested by TABCC. While TMA supports the idea, the task force found that mandated benefits might not be as expensive as employers believe they are. Ms. Barron says the task force found that all of the mandates currently in Texas law account for less than 6 percent of premiums.

Medical education

Legislation already has been filed by State Rep. Ruth McClendon (D-San Antonio) to authorize the Texas A&M University System to study the possibility of creating a doctor of medicine program at Prairie View A&M. Also, Texas Tech University will seek funding to create a full four-year medical school in El Paso. Currently, its El Paso program educates third- and fourth-year medical students from the main campus in Lubbock.

TMA currently does not believe additional medical schools or an increase in class size are needed in Texas. Workforce projections through 2005 indicate there likely will be an adequate number of physicians to meet future health care needs.

TMA also expects graduate medical education (GME) funding to get considerable attention this session. An interim Senate subcommittee has recommended establishing consistent guidelines for financial operations, standards of reporting, and accounting definitions related to GME programs. It also recommended maximizing Medicaid GME reimbursement, establishing and funding a rural physician recruitment program, and establishing a workgroup to coordinate and maximize telemedicine resources.

TMA also will support development of a Texas Medical School Rural Pilot Project to increase interest in rural health among medical students, and may support additional funding for the State Physician Education Loan Repayment Program.

Public health

TMA's public health priorities for 2001 will include efforts to improve the state's immunization tracking system and its cancer registry. The state stands to lose some $1 million in annual funding from the U.S. Centers for Disease Control and Prevention if shortcomings in the cancer registry program are not resolved. Because of staffing and other issues, the Texas Department of Health is more than 18 months behind in collecting and inputting data into the cancer registry system. (See "Reporting Cancer," August 2000 Texas Medicine , pages 58-61.)

TMA will work with the state's business leaders on air and water quality concerns as the state seeks to comply with federal standards and the state's chief pollution surveillance and enforcement agency goes through the sunset review process.

"A growing body of science more clearly establishes the relationship between known carcinogens and neurotoxins in our air and water," Mr. Gilchrist said. "We have been asked by key business leaders to help local industry improve air and water quality in their communities."

TMA also will work with a coalition of children's health advocates to seek funding to increase physical education for Texas public school children. And TMA will seek to address the underfunding of children's mental health services by the state, as well as the feasibility of providing access to behavioral and mental health services for children through state programs such as Medicaid managed care and CHIP.

The Texas Cancer Council, which funds TMA's Physician Oncology Education Program, also will seek additional funds for a statewide colorectal cancer prevention and early detection program.

Professional liability

Given an inexplicable rise in claims frequency and an emerging pattern of lawsuit abuse in the Rio Grande Valley, TMA likely will seek targeted remedies for malicious and frivolous claims and abuse of process, says Harold Freeman, assistant director of legislative affairs for TMA. The association also will evaluate underwriting practices in the Valley to determine the extent of redlining or cherry picking of insured physicians that has exacerbated an already difficult practice environment.

Efforts are under way by TMA to educate the legislature about this increased frequency of claims and increases in insurance premiums, which are beginning to have an effect on access to care in the Valley and other areas of the state. (See "Analyzing Liability Insurance in Texas," July 2000 Texas Medicine , pages 11-13.)

The association likely will seek some remedies for a rise in the frequency of medical malpractice claims in the state either through strengthening the state statute against frivolous lawsuits or giving physicians the ability to countersue when a frivolous suit is filed.

Workers' compensation

Workers' compensation is another area that is likely to see some minor changes but no major overhaul. Business groups continue to express concern about costs, and TABCC and TMA have jointly proposed measures to remove health care professionals who have substantially abused the system. TABCC specifically has targeted chiropractors.

TMA continues to have concerns about the ability of injured workers to get care. TMA likely will support legislation to simplify the system, reduce paperwork requirements, and codify a fiduciary duty on the part of workers' compensation carriers to help injured workers navigate the system.

Scope of practice

The 77th session could be an active one for scope of practice issues. TMA has expressed opposition to a rule recently proposed by the Texas State Board of Podiatric Medical Examiners to expand its definition of the foot, which would greatly expand podiatrists' ability to treat problems with both the ankle and the skeletal structure of the leg.

Acupuncturists, psychologists, physical therapists, and chiropractors also are expected to pursue expanded scope issues during the session.

Meanwhile, TMA, through its Ad Hoc Committee on Collaborative Practice, is negotiating with advanced practice nurses and physician assistants on a number of issues, including Medicaid reimbursement for advanced practice nurses, and a physician-based collaboration model for prescriptive authority.

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

SIDEBAR

Redistricting: Where Politicians Eat Their Young

  By Allison Griffin
TMA Media Relations Manager

In the wee hours of the morning, the Texas House of Representatives struggled to pass a redistricting plan. The House had given preliminary approval to a plan, and then-Speaker Billy Clayton wanted to suspend the rules and go ahead with the final vote on the plan he favored.

However, liberal representatives had other ideas. They began exiting the chamber in an effort to break the quorum to prevent the House from considering the plan being pushed by their more conservative Democratic colleagues.

When Speaker Clayton realized what was happening, he ordered the House sergeants-at-arms to lock the doors, and dispatched Department of Public Safety troopers to locate the absent members and bring them back to the House chamber.

It was high drama that night in 1981, as members hid in their offices or bathrooms or left the Capitol to avoid voting on the highly controversial redistricting plan. More than two hours later, after the DPS had rounded up enough representatives, the speaker narrowly passed his plan.

While the upcoming session may not produce the same level of drama witnessed 20 years ago, political observers predict the process of redrawing the district lines will generate some fireworks and divide state legislators along partisan lines more than ever before.

The process

Every 10 years, the U.S. government conducts a census to count every man, woman, and child in America. And every 10 years, the Texas Legislature takes those new census numbers and redraws the lines for legislative and congressional districts.

The federal government is required to provide the 2000 census numbers to the legislature by April 1, which gives lawmakers less than 60 days to develop and pass redistricting plans before they adjourn on May 28. Redistricting bills for congressional and State Board of Education (SBOE) districts may be introduced in either the House or Senate, but each chamber traditionally initiates its respective district plans.

The Texas Constitution limits the makeup of the legislature to 150 state representatives and 31 state senators. Although the state's population continues to grow, the number of elected legislators remains constant. So every 10 years, the state must rearrange itself to provide more representation to areas that have experienced significant population growth and less representation to areas that have experienced either declined or less-than-average growth.

The process sounds simple on its face. After all, how hard could it be to split the citizens of the state evenly among the set number of House, Senate, and congressional districts?

As former State Rep. Robert Earley (D-Portland), who served on the redistricting committee during the 1991 session, explained, "Looking at the issue in mathematical terms is simple. However, politicians are commonly not math-oriented during this process. Ten thousand new voters may be added to a legislative district that equals the right number, but if you are a Republican incumbent and those new 10,000 voters have a propensity to vote Democratic, then one plus one does not equal two."

Conflicts arise because the redistricting process forces lawmakers to make many difficult decisions, often putting their personal interests in direct conflict with their partisan interests and compelling them to choose between friends.

"This is where it gets very personal," said David Marwitz, a political consultant and former director of the Texas Medical Association Political Action Committee (TEXPAC). "What if the House passes a plan that doesn't significantly increase the number of Republican seats but protects all the incumbents, including you? Do you vote for your party or take care of yourself?"

Once the House and Senate adopt redistricting plans, they are sent to the governor. The governor may sign the bills into law, allow them to take effect without his signature, or veto them. If the governor vetoes the House or Senate redistricting plans, the Legislative Redistricting Board -- comprised of the lieutenant governor, House speaker, attorney general, comptroller, and land commissioner -- is required to meet within 90 days of the end of the regular session and adopt a plan within 60 days. If the governor vetoes either the congressional or SBOE plan, he may call a special session to consider alternative plans.

Once a redistricting plan is enacted by the legislature or adopted by the Legislative Redistricting Board, it is filed with the Texas secretary of state and is subject to federal approval under the Voting Rights Act.

In addition, outside organizations may file lawsuits against a redistricting plan, as they did in the early 1990s.

If the governor allows the redistricting plans to become law, and if they pass federal muster, and if no other organizations file lawsuits that force judges to draw new maps, then the plans adopted by the Texas Legislature in 2001 will become effective for the 2002 primary and general elections.

The politics

Nearly everyone agrees that the Republican Party has the most to gain once the new districts are drawn. But just how big a gain is open to discussion.

"There is debate within the Republican Party about whether to draw fewer Republican districts that are very safe, say 70 percent to 80 percent Republican, or whether to draw more districts that lean Republican, maybe 50 percent to 60 percent Republican, to increase the size of the majority," said Mr. Marwitz. "Some of the more conservative members would like to see compact, safe districts, while some of the more moderate Republicans would prefer to see the districts be more competitive to give them more flexibility."

Regardless of how many seats the Republicans gain, the state's demographic shift from rural to primarily suburban areas means Democrats will be hard-pressed to protect their seats, especially conservative Democrats in rural areas who traditionally have held leadership posts in the legislature.

Even urban Democrats may find they have lost population to the suburban areas surrounding them, most of which are represented by Republicans.

"For example, Sen. Jane Nelson (R-Flower Mound) has a zillion more Republicans than she needs because she's in a growth area, as does Sen. Chris Harris (R-Arlington), whose districts are adjacent to Sen. Mike Moncrief (D-Fort Worth)," said Kim Ross, TMA's chief lobbyist. "There are not enough voters out to the north of Fort Worth for Sen. Moncrief to pick up, so a disproportionate share of Republican precincts are going to get offloaded into his district. That will destabilize his seat."

The same is true of other urban and suburban districts, he says, and may result in forcing a pair of minority incumbents to run against each other in a redrawn district.

"So whom do you pair or inject with a fatal dose of precincts that favor the other political party?" Mr. Ross asked. "That's the kind of thing that will tie them up, all the 'what ifs.' That way of thinking means that if you're Rep. Short Timer and you're chairing a subcommittee, and the redistricting chair has a bill in your subcommittee, Rep. Short Timer is going to say, 'If you want to get your bill out, then don't pair me. Pair him with that other fella.'

"This is a process in which politicians eat their young," said Mr. Ross. Even though lawmakers go through what amounts to ritual hazing, the final map of districts has been drawn or modified by a three-judge panel of the U.S. 5th Circuit Court of Appeals for the last three decades.

"So it will be the lawyers from both parties who will be arguing to a panel of judges at the end of the day," Mr. Ross said, "but in the meantime, careers will be ruined, rivalries will emerge that have never existed, friends will become bitter enemies, and the usual collegiality among peers will deteriorate into blood feuds and ambushes."

The impact on medicine

In recent sessions, Texas physicians have forged relationships and alliances that transcend party lines, enabling TMA to pass far-reaching legislative reforms. However, some physicians worry that partisan maneuvering associated with redistricting could impact medicine's agenda.

"We quite often have been able to just argue for what's right for our patients and what's right for our own profession across party lines," said Robert W. Sloane, MD, chair of the TMA Council on Legislation. "We may not have that option this time. We may find ourselves in a much more partisan atmosphere even for our own issues," he said.

"Redistricting, from the very beginning, will dominate the session," predicted Mr. Marwitz. "The process will move along more slowly, but all the members really will want to talk about when you go to see them is redistricting, not the issue you go to visit about."

Although redistricting will rule the session, Mr. Ross says TMA will pursue important legislation. "We can't afford to fold our hand. The serious impairments to medical practice won't take a time out. We have to play every card in our deck. But it has to be put in the context of having less enthusiastic expectations, simply because the legislators will not have the same amount of time or focus on some of our more complex or controversial issues." 

SIDEBAR

TMA Advantage: Extra! Extra! Read All About It

Keep up with legislation that affects you and your patients during the legislative session by subscribing to the TMA Legislative News Hotline. From opening gavel on Jan. 9 to sine die in May, the hotline will provide the latest news and inside scoop on what's happening at the State Capitol.

News updates will be delivered to your computer Monday through Friday while the legislature is in session. Or, you may receive the Hotline Replay with a review of the most important news of the week every Friday.

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January 2001 Texas Medicine Contents
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