TMA Legislative News Hotline: Friday, Feb. 24, 2017

Watch this week's TMA Legislative News Hotline video to see a medical student leader testify before a House subcommittee, urging legislators to provide adequate graduate medical education (GME) funding; and hear concerns from a TMA committee chair about planned public health budget cuts. That and more in this week’s video report.



This week the House Appropriations subcommittees were at work examining their assigned elements of the state budget and agencies. 

Public Health Funding: On Thursday, TMA expressed “grave concern” over funding for public health infrastructure. 

TMA urged the House Appropriations Subcommittee on Article II to adequately fund the Department of State Health Services (DSHS), particularly the department’s key exceptional item requests: ensuring basic public health capacity, strengthening the state public health laboratory, and preventing and controlling the spread of infectious diseases.

“We must express grave concern with the proposed budget and its potential impact on public health at the state and local level. We can detail concerns about proposed chronic-disease budget reductions in several key areas of particular interest to the medical community,” TMA’s testimony reads. “This is the time to secure the department’s critical role in protecting public health capacity and infrastructure for activities like ensuring children and pregnant women are vaccinated and protected from preventable diseases.”

The testimony, submitted by TMA along with the Texas Public Health Coalition (TPHC) and five medical specialty societies, urges support of infrastructure and adequate state clinical staffing that communicates with local physicians. This is needed to respond properly to infectious disease outbreaks and other public health threats, chronic disease threats, and prevention efforts like tobacco control.

“Physicians are joined in the understanding that investing in evidence-based public health interventions is the only way to help us ensure there is not an even higher price tag in the future,” the testimony reads. “Texas’ exploding population in our large and mobile state means we need to not only maintain our current public health system, but also seek improvements and enhancements to respond to the problems raised as our state and population continues to grow.”

Austin family physician Phil Huang, MD, chair of TMA's Committee on Infectious Diseases, testified on the issue Thursday night.

Safety Net Programs: On Thursday, Austin pediatrician Louis Appel, MD, testified to the Article II Subcommittee urging it to protect safety net programs, including Medicaid, women's health programs, and the Children’s Health Insurance Program (CHIP).

Dr. Appel urged the subcommittee to reject reductions in Medicaid eligibility for pregnant women, which the Texas Health and Human Services Commission (HHSC) has identified as a potential cost-containment measure. He also raised the issue of less-than-enticing physician payment rates for Medicaid and CHIP, asking the committee to consider targeted physician payment rate increases for Medicaid and CHIP services for which access is particularly troublesome.

On Wednesday, Texas Commissioner of Health John Hellerstedt, MD, described to Article II Subcommittee members the importance of funding public health and prevention initiatives, citing the expected increase in Texas Zika cases as one example. On Tuesday, the same subcommittee met to hear invited testimony regarding House budget recommendations for the Department of Family and Protective Services.

Graduate Medical Education: In the midst of hearing comments on GME by Texas medical school presidents and leaders Wednesday, the House Appropriations Subcommittee on Article III heard from someone on the front lines — a medical student.

Kayla Riggs, a University of Texas Health Science Center at Houston medical student, asked legislators to adequately fund the GME positions that have been created through state grants.

Ms. Riggs, a TMA Board of Trustees member, testified that Texas will add more than 300 medical school graduates by 2022, and residency slots must keep pace. If those Texas students cannot stay in Texas, they’ll look out of state but might still face difficulties. 

“There also are no guarantees they will be able to find a training position elsewhere because the shortage of entry-level GME positions is a national crisis,” her written testimony says. “If training positions are not available, these graduates ultimately will be delayed in entering practice or in a worst case scenario, will be forced to forego a career in medicine.”  

“Selecting a residency is one of the most difficult decisions a physician makes,” Ms. Riggs told legislators, adding many factors go into the decision. “If only limited opportunities are offered, however, many residents will have to go elsewhere — and as you know when a physician leaves the state for training, 40 percent do not return to the state.” 

TMA’s written testimony noted these chief areas of concern for 2018-19 funding: (1) the need for sustained state support for GME positions previously developed using GME expansion grant funds; (2) the gaps between the number of newly created GME positions since 2014 and the number of additional positions needed to keep pace with growing medical school graduates, and also in meeting the state’s target ratio of 1.1 entry-level GME position per Texas medical school graduate; and (3) proposed reductions to special item funding for medical schools and health-related institutions (for medical education, GME, and research programs at Texas medical schools and health-related institutions).

Public Health — Environment: Tuesday, TMA asked the House Appropriations Subcommittee on Articles VI, VII, & VIII to appoint a voice of medicine to the Texas Commission on Environmental Quality (TCEQ).

“We ask that you consider the appointment of a physician who can contribute to the work of the TCEQ and contribute to helping all Texans reduce their exposure to pollution,” TMA’s written testimony said. TMA noted Texans’ physical and fiscal health would be better served if the agency had public health input into environmental quality issues, citing reducing low-level ozone as one example. “The estimated cost of treating ozone-related asthma in Los Angeles County in 2007 was $441 million,” TMA’s testimony said. Ozone negatively affects asthma and other breathing conditions, and in addition to treatment costs, absenteeism from work and school from asthma-related illnesses have costs as well. Since TCEQ monitors the state’s environmental quality, and pollutants affect human health, a medical voice could help protect the state’s public health, TMA noted.

“As a trusted voice for our patients, we have a responsibility to speak to public policy matters that have an impact on our patients’ health — and in particular in promoting policy measures that will help prevent acute illness or exacerbation of a medical condition.”

Other Business: The House Public Health Committee convened Tuesday for an organizational meeting and invited testimony about public health and safety-net issues, including Medicaid, the 1115 Waiver, the Healthy Texas Women’s Program, and the Early Childhood Intervention program.

And the House Committee on Insurance held a Tuesday morning organizational meeting to hear invited testimony from the Texas Department of Insurance and the Office of Public Insurance Counsel. 


“Parents' Right to Know” Bills Filed: Wednesday two lawmakers filed bills to advance a TMA and Texas Public Health Coalition legislative priority — the “Parents' Right to Know” legislation. Rep. J.D. Sheffield, DO (R-Gatesville), filed House Bill 2249, and Sen. Kel Seliger (R-Amarillo) filed Senate Bill 1010. The bills would allow parents to see the aggregated vaccination rates of students in Texas schools, which the state currently only publicizes on a district-wide basis. Texas already collects student vaccine opt-out data on the school level, but does not publicize that information. The bills are important to parents of immunocompromised children since knowing the vaccination rates in schools would empower parents to protect their young ones by placing their child at a campus with higher vaccination rates.

Child Protective Services: Wednesday the Senate Health and Human Services Committee took a significant step toward answering one of Gov. Greg Abbott’s emergency legislative priorities Wednesday, by unanimously approving a Child Protective Services overhaul bill, the Committee Substitute to Senate Bill 11. The committee approved the measure on a 9-0 vote. Sen. Charles Schwertner, MD (R-Georgetown), the TMA physician-member committee chair, is the bill’s lead author. 

The measure would improve how the Texas Department of Family and Protective Services takes care of abused and neglected children, including ensuring children entering the system would receive medical exams within three days.

On Monday morning, the House Human Services Committee met and heard testimony about the Department of Family and Protective Services (DFPS). The committee unanimously approved the committee substitute to House Bill 5 by Rep. James Frank (R-Wichita Falls), which would make DFPS an executive level agency reporting directly to the governor.


Now is your chance to make your voice heard at the Capitol. Register now to attend TMA’s second First Tuesdays at the Capitol event of the session, on March 7. And you can brush up on TMA’s “2017 Prescription to Keep Texas Healthy” legislative agenda before coming to Austin, as it summarizes TMA’s top priority issues. 



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