TMA Legislative News Hotline: Friday, Feb. 17, 2017

Watch this week's TMA Legislative News Hotline video to hear a top physician describe the logic behind the push to increase Texas’ tobacco-use age to 21, and see the House budget-writing committee in action.



TMA Legislative Priority – Tobacco-Use-Age Bills

Wednesday two lawmakers filed bills to raise the legal age from 18 to 21 to possess and use tobacco. House Bill 1908 by TMA physician member Rep. John Zerwas, MD (R-Simonton), and Senate Bill 910 by Sen. Joan Huffman (R-Houston), each delay — and therefore perhaps prevent — tobacco use.

TMA and the Texas Public Health Coalition (TPHC, of which TMA is a member) both support the bills, which are the cornerstones of the “Texas Tobacco-21,” or T-21, initiative. 

“It’s time for our state to address an issue with devastating impacts on public health and great costs to our health care systems,” Representative Zerwas said. “The goal of the legislation [HB 1908] is not to regulate the choices the citizens of Texas make but to widen the gap between the availability of tobacco products and high school-aged people.”

Senator Huffman agrees. “Without a doubt, the long term effects of this legislation [SB 910] will save lives,” said the Houston senator. “I look forward to working with my colleagues and all of the stakeholders to get this meaningful legislation signed into law.”

“Raising the minimum legal age of sale of tobacco to 21 will help reduce smoking rates and health care expenditures — and, importantly, contribute to saving lives,” said Ronald A. DePinho, MD, president of The University of Texas MD Anderson Cancer Center, which is part of the T-21 group.

T-21 supporters say nearly a half-million young Texans alive today will die early from a tobacco-related disease if no action is taken to stop it. Legislation to delay tobacco access might prevent young people from starting the habit, and in turn, save lives. More than 13,000 kids per year start smoking, and a US Department of Health and Human Services survey shows 95 percent of adult smokers started the habit before their 21st birthday

In addition to TMA, TPHC and the University of Texas MD Anderson Cancer Center, the “T-21” initiative is backed by the American Cancer Society Cancer Action Network, American Heart Association, American Lung Association, the Campaign for Tobacco-Free Kids, and the March of Dimes.  


The House Appropriations Committee began analyzing state agencies’ budgets this week. 

Chair Zerwas also listed Appropriations Subcommittee assignments. The subcommittees will begin meeting next week: 

Articles I (which includes CPRIT, the Employee Retirement System and Teacher Retirement System), IV and V: Chair: Rep. Oscar Longoria (D-Mission); Vice-Chair: Rep. Rick Miller (R-Sugar Land); Rep. Giovanni Capriglione (R-Southlake); Rep. Scott Cosper (R-Killeen); and Rep. Toni Rose (D-Dallas).

Article II - Health and Human Services: Chair: Rep. Sarah Davis (R-Houston);
Vice-Chair: Rep. Greg Bonnen, MD (R-Friendswood); Rep. Dawnna Dukes (R-Austin); Rep. Sergio Munoz, Jr. (D-Palmview); Rep. Kevin Roberts (R-Houston); Dr.-Representative Sheffield; and Rep. Gene Wu (D-Houston). 

Article III - Education (including higher education and including medical schools): Chair: Rep. Trent Ashby (R-Lufkin); Vice-Chair: Rep. Helen Giddings (D-Dallas); Rep. Mary Gonzalez (D-Clint); Rep. Donna Howard (D-Austin); Rep. Linda Koop (R-Dallas); Rep. John Raney (R-Bryan); and Rep. Gary VanDeaver (R-New Boston).

Articles VI, VII, and VIII (Regulatory, which includes the Texas Medical Board): Chair: Rep. Larry Gonzales (R-Round Rock); Vice-Chair: Rep. Amando Walle (D-Houston); Rep. Jay Dean (R-Longview); Rep. Mary Ann Perez (D-Houston); Rep. Dade Phelan (R-Port Neches); Rep. Justin Rodriguez (D-San Antonio); and Rep. Ron Simmons (R-Carrollton).

Budget Transparency and Reform Committee: Chair: Representative Capriglione; Vice-Chair: Representative Howard; Representative Roberts; Representative Simmons; and Representative Walle. 

This week the Appropriations committee heard testimony from Legislative Budget Board staff members, who told committee members Medicaid caseload and costs are the two primary drivers of Medicaid expenditures, and children compose the majority of those Medicaid serves. Total Medicaid funding in the 2016-17 two-year budget is $26.3 billion in General Revenue (state-only dollars) and $64.6 billion in All Funds (a combination of state and federal funds). House Bill 1, the House budget proposal, currently recommends an increase in Medicaid funding, at $27 billion in General Revenue and $65.5 billion in All Funds for 2018-19. (In comparison, the first draft of Senate Bill 1, the senate’s budget bill, proposes less spending overall, and does not include any allowance for Medicaid cost and caseload growth.)

The house budget committee also heard summaries about spending in early childhood intervention; the Medicaid Prescription Drug Program; mental health and behavioral health; and in the state employee retirement and teacher retirement systems. And a budget staff expert told committee member Rep. J.D. Sheffield, MD (R-Gatesville), that the state would lose close to $30 billion over a five-year period if the Medicaid 1115 waiver is not renewed.

House and Senate budget writers face a tight budget: Texas Comptroller Glenn Hegar estimated lawmakers would have $104.9 billion in the state’s budget to spend, compared to the House initial budget bill of about $108.9 billion, and the initial Senate plan of about $103.6 billion. 

This week Representative Zerwas said he would consider drawing some of the state’s Economic Stabilization Fund (“Rainy Day Fund”) to cover necessary budget gaps, noting a healthy fund surplus.

The Senate Finance Committee, chaired by Sen. Jane Nelson (R-Flower Mound), delved into Article VIII of the budget this week, which encompasses state regulatory bodies, notably the Texas Medical Board. 

The House of Representatives returns Monday at 2 pm, and the Senate returns Tuesday at 11 am.


Register now to attend the second First Tuesdays at the Capitol event of the session, March 7. TMA’s “2017 Prescription to Keep Texas Healthy” legislative agenda summarizes TMA’s top priority issues. Texas Medical Board sunset, protecting medical liability reform caps; requiring the same care standard for telemedicine as in-person care; creating a Texas-run health care solution for low-income families, seniors, and people with disabilities; investing wisely in mental health and public health; stopping health insurance tactics that cause surprise medical bills; funding graduate medical education adequately; upholding scope of practice to protect patients; and using technology, not mandates, to address “doctor shopping” and opioid diversion.



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