For medicine, one word characterized the start of the 78th Texas Legislature - anxiety. Organized medicine had an ambitious, complex agenda, ranging from much-needed professional liability reform to workable prompt pay standards to maintaining health care coverage for hundreds of thousands of poor and low-income patients. The Texas Medical Association worked diligently throughout the 18 months preceding the session to build support for its varied and important legislative goals, working hand in glove with county medical and specialty societies to educate legislators about the issues at stake. Yet, despite all the preparation, two factors presented a considerable challenge to realizing medicine's initiatives: new legislative leadership, including a new speaker of the house, new lieutenant governor, and more than 25 freshman members, and the biggest budget deficit in more than a decade.
Just as legislators settled into their desks, the comptroller of public accounts announced that an expected $5 billion budget deficit had ballooned to $10 billion. The announcement cast a long shadow over every issue confronting the legislature, even those not related directly to an appropriation, since the deficit meant more legislative horse-trading than usual to accomplish legislators' - and their constituents' - goals. Grassroots advocacy assured that TMA started off on the right foot with the new legislators, yet, as is expected with new relationships, each side had a lot to learn about the other.
In spite of the challenges, medicine accomplished what it set out to do on four of TMA's five top priority issues: enact meaningful professional liability reform; require logical, timely prompt pay standards; improve education about and availability of childhood vaccinations; and prevent nonphysicians from practicing medicine. Only health care funding fell short, although TMA advocacy did avert the most draconian budget proposals considered by the legislature, including a 33-percent Medicaid physician rate reduction. TMA will continue working during the next three to six months to convince the legislature to allocate unspent state and federal dollars for restoring the health care cuts.
On another major priority, workers' compensation reform, TMA was unable to enact a statutory fix to the impending payment reductions. (A legal challenge is still in process.) However, the association did block implementation of an ill-conceived, employer-directed network bill that would have jeopardized patient access to care and obliterated the workers' compensation physician network.
In addition to tracking bills related to TMA's top five priorities, the association followed more than 800 bills that impacted patient care and the practice of medicine. This legislative compendium describes the bills that passed, the near misses, and the bills TMA helped to defeat. Bills that TMA backed but did not make the final cut are described along with the political context in which they dissolved. The information below also describes how new legislation is likely to impact physician practices, the regulatory and legal activities regarding its implementation, and the activities already underway at TMA to assure medicine achieves its 2005 legislative goals.
To maintain TMA's credibility and success in the legislature, the Board of Trustees, Council on Legislation, and other policy bodies within the association already are preparing for the 2005 legislative season. TMA's postsession plan includes active engagement of grassroots physicians in local meetings and educational forums with legislators; participation in the election cycle through TEXPAC, TMA's political action committee; assessment of nascent physician issues through member surveys; participation in legislative interim studies; and formation of internal TMA policy groups to develop legislative recommendations on key issues facing patients and physicians.