Lawmakers Dish Themselves Up a Record Number of Health Issues to Study
Cover Story -- April 2000
By Ken Ortolon
The Texas Legislature meets for only 5 months every other year, but that doesn't mean lawmakers take a 19-month vacation between each session. On the contrary, state lawmakers traditionally have remained busy between sessions with a wide range of interim studies designed to give them a running start on issues likely to generate debate in the next legislative session.
For this interim, a blizzard of health care-related issues is on the agenda. In fact, lawmakers and lobbyists say this year will be one of the busiest ever in terms of the number of health care issues under review by the legislature.
"This is going to be an incredibly busy interim," said Fort Worth surgeon Robert W. Sloane, Jr, MD, chair of Texas Medical Association's Council on Legislation . "The leadership in the legislature has appointed more interim studies on health care issues than I think have ever been appointed before. TMA staff and TMA councils are going to have to closely scrutinize and monitor these interim studies, giving testimony where needed, to ensure that the concerns of physicians and our patients are adequately addressed."
Sizing up the task
Indeed, nearly 30 interim studies on health-related topics -- ranging from medical privacy and pharmacy issues to disease management to workers' compensation to rural and border health issues -- have been assigned to 15 different standing or special legislative committees. TMA already has geared up to track each study and look for opportunities to address issues of key concern to Texas physicians.
Working under the direction of the Council on Legislation, TMA staff members from all policy areas and divisions have been assigned to monitor the interim studies. Other TMA councils and committees, as well as state specialty societies, also are being consulted and will work with staff to make sure physician input is provided to all the interim committees when needed.
"TMA has got to monitor every one of these studies and start having policy debates internally on these issues because you never know which one is going to become politically viable, which one is going to get legs, so to speak," said Alfred Gilchrist, TMA director of legislative affairs. "We're making a very concerted effort inside the association to have committees and councils and specialty societies closely look at these issues so we are prepared when the time comes."
Much of the interim work will occur in the two committees with primary responsibility for health care issues -- the Senate Health Services Committee and the House Public Health Committee.
Senator Jane Nelson (R-Flower Mound), who chairs the Health Services Committee, welcomes the interim studies. "The interim period is really a time for lawmakers to listen," she said. "It gives us the time we need, away from the frenetic pace of the legislative session, to solicit input from the people who elected us and who are impacted by the laws we enact and to engage in a thoughtful dialogue on the most pressing issues affecting our state."
Lieutenant Governor Rick Perry has asked the committee to:
- Analyze pharmaceutical, biotechnology, and genetics research in Texas;
- Evaluate recent changes in Medicaid and review its effectiveness in managing chronic illnesses;
- Review state policies on medical privacy, including the availability of prescription data;
- Monitor implementation of the Children's Health Insurance Program; and
- Assess Texas' health care workforce needs.
Under directions from House Speaker Pete Laney, the House Public Health Committee will look at some of these same issues. The committee also will examine opportunities and risks associated with the sale of medical devices and drugs over the Internet, the feasibility of expanding telemedicine to improve care in underserved areas, and the impact of hospital system mergers on medically underserved rural communities and the level of charity care provided.
Focusing special attention
Besides these and other standing committees, several special panels have been created to examine health issues this interim. A Blue Ribbon Task Force on the Uninsured was formed by lawmakers themselves during the 1999 session to examine possible solutions to the state's uninsured problem. Members of that panel were appointed by Gov George W. Bush, Lieutenant Governor Perry, and Speaker Laney.
Also, lawmakers ordered special studies on mandated health insurance benefits and Medicaid managed care. And Speaker Laney has created a House Select Committee on Rural Development.
Mr Gilchrist says that panel is likely to command a lot of attention and generate some high profile legislation for debate in 2001. The committee is chaired by Rep Barry Telford (D-DeKalb), who also heads the powerful House Calendars Committee, and includes four other influential House committee chairs.
"It looks as if the speaker wants to see rural issues addressed," Mr Gilchrist said. "And that opens up a great opportunity for community leaders to bring their concerns about a wide range of issues, including health care, to a committee that's going to be very interested and that's going to have the ability to get things done."
Dr Sloane says there are many reasons lawmakers are examining so many health care issues this interim. First is simply the need to monitor the impact of legislation enacted in 1999. Second is the existence of the tobacco lawsuit settlement funds, which has generated a lot of interest in financing public health projects.
The most important reason, however, likely is that lawmakers have to stay busy just to keep up with all the changes occurring in our health care delivery system, Dr Sloane says. "The pace that's being picked up in the whole society with Internet access may just be rendering our system of meeting every other year out of sync," he said. "Legislators are feeling a need to continue learning and gathering data so they can make the most out of the next session."
Senator Nelson agrees. "The reason we are focusing so much attention on health care is that we cannot afford to let these rapid changes in the industry put any additional strain on patients and on physicians," she said. "It is critical that we keep up with the times because our policies will have a direct impact on the health of all Texans."
Representative Patricia Gray (D-Galveston), chair of the House Public Health Committee, adds that the heavy emphasis on health care is a reflection of public interest. And, when there is public interest, legislative interest soon follows.
"Health care is one of the top two or three issues on people's minds today," Representative Gray said. "Part of it has to do with the rising cost and the changes that are taking place within the insurance market that are making individual consumers assume a greater and greater share of the cost of their health care."
Most of the interim committees were just getting started on their studies during January and February. The committees will hold a series of public hearings throughout the year, then issue reports on each of their interim charges in time for consideration by the 77th Legislature, which convenes in January 2001.
The Senate Health Services Committee already has held two public hearings in Houston and Dallas, and a third is scheduled for April 10 in San Antonio. The House Public Health Committee held its organizational meeting in January. Representative Gray has assigned various members of her committee the task of leading the investigation of individual issues. She says that will increase member interest and involvement in the studies, as well as allow for a more thorough review of each issue. Representative Gray held a hearing on disease management in February and has placed Reps Ruth Jones McClendon and Carlos Uresti, both San Antonio Democrats, in charge of that issue.
Meanwhile, Texas physicians already are at work providing input for these studies. At a January 11 hearing on medical privacy held by Senator Nelson's committee, Dallas psychiatrist Leslie H. Secrest, MD, told committee members that ensuring confidentiality of medical records is particularly important in protecting the quality of mental health care. "Confidentiality protections should cover not only medical records but also individually identifiable medical information such as psychiatric notes, pharmacy records, and genetic tests," Dr Secrest said.
Senator Nelson says the stories the committee heard about invasion of patient privacy convinced her that it is a serious problem . "Personally and as a legislator, I am outraged that our medical records seem to be available to just about anyone who has both the desire and the resources to uncover them," she said. "I think it undermines the trust between a doctor and a patient."
TMA members also already have testified on issues ranging from Medicaid managed care to physician workforce to graduate medical education before the Senate Health Services Committee, House Public Health Committee, and Senate Finance Committee.
While not every interim study will translate into successful legislation in 2001, both Dr Sloane and Senator Nelson say there are certain issues among these studies that the legislature must address, including Medicaid managed care and the uninsured.
"The legislature last session placed a moratorium on any expansion of Medicaid managed care," Senator Nelson said. "We did this to take the proper amount of time necessary to conduct an in-depth study of our current programs. We have to ensure that patients are receiving the best care and that physicians are able and willing to participate."
Dr Sloane says the study will determine whether Medicaid managed care is to be dominated by HMO products or a more "physician-driven, independent model" designed around primary care case management.
Along those same lines, says Senator Nelson, lawmakers also must look closely at the state's overall medical infrastructure. "As policymakers, we must determine whether there is an adequate number of health care professionals and services statewide," she said. "If there is not, we must offer creative incentives to make sure that all areas of the state have access to quality health care, including the further utilization of advance technologies such as telemedicine."
Another key component, she says, is efficient utilization of the Children's Health Insurance Program (CHIP). Both Senator Nelson's and Representative Gray's committees will monitor CHIP implementation this year.
Having your say
While both physician leaders and TMA staff are hard at work monitoring the interim studies, Dr Sloane says the interim study process also affords physicians the chance to make their voices heard. He urges physicians to get involved in the process.
"The interim studies have gotten the attention of both lawmakers and the health care community," Dr Sloane said. "Physicians can have direct input into these studies. They can have input through TMA. They can have input through their specialty societies. But most importantly, physicians can have input directly to the committees of jurisdiction. I urge you to call, write, or email these committees and express your concerns on these issues."
Ken Ortolon can be reached at (800) 880-1300, ext 1392, or (512) 370-1392; or by email at Ken Ortolon.
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