Legislative Budget Board on the Department of State Health Services’
Legislative Appropriations Request
Sept. 25, 2014
The leaders of the Texas Medical Association recently identified our priorities and vision for our state’s health care system. Our strategic roadmap for the next decade, Healthy Vision 2020, caring for patients in a time of change (www.texmed.org/HealthyVision), addresses in depth the health care issues of greatest concern to Texas physicians and our patients. We know a healthy and economically sound Texas depends on a health care system with access to quality medical care and local and state public health services. We are pleased to see the Department of State Health Services’ (DSHS’) legislative appropriations request for 2016-17 addresses many of the same health issues identified as TMA’s Healthy Vision 2020 priorities. Our comments today are focused on funding for exceptional items requested by DSHS.
Maintain FY 2015 health service funding levels
Mental Health: We support DSHS’ request for continued and increased funding for two mental health initiatives begun during the 2014-15 biennium: (1) implementation of the mental health community collaboratives, and (2) home- and community-based services for the adult mental health program. Both programs show great promise in establishing local services for Texans with mental illness and in providing needed services for those with long-term residence in state mental health facilities. We believe state and local collaborations on community-based care offer a critical framework for providing comprehensive care. This is essential to enabling people with mental illness to remain in their community and for their families and loved ones to continue providing them much-needed support.
Tobacco Prevention: With a reduction in tobacco settlement funds for tobacco prevention and control, we support the agency’s exceptional item request to maintain base-level funding in 2016-17 for tobacco control. While our goal is for Texas to be smoke free, we must ensure people who want to quit their tobacco use have access to evidence-based services as provided by Texas’ Quitline. We also will continue to support interim measures encouraging cities to adopt uniform policies for smoke-free public places, restaurants, and bars.
Expand and enhance women’s health
Texas physicians strongly support increasing funding for women’s preventive health services to ensure all women can obtain services. DSHS’ proposal to increase funding for the Expanded Primary Health Care (EPHC) program is absolutely essential because it will allow the program to increase availability of services in urban areas where demand has grown faster than supply, while also establishing coverage and outreach in rural and border counties that lack EPHC providers.
Almost 60 percent of Texas’ low-income women lack health insurance . This means many women of childbearing age frequently forego preventive care critical to help them plan and space their pregnancies and obtain wellness services, such as contraceptives and screenings for cancer, diabetes, and heart disease. Preventive services are an important opportunity for physicians to educate women about nutrition, exercise, and tobacco cessation — factors that may contribute to healthier pregnancies and birth outcomes.
But more work remains. Increasing the number of women who enroll in the Texas Women’s Health Program and other family planning programs, and increasing the number of physicians and clinics who participate also will be essential to Texas’ efforts to improve maternal health and birth outcomes.
Enhance substance abuse services
TMA wholeheartedly endorses DSHS’ proposal to enhance community-based substance abuse prevention services including a public awareness campaign on alcohol, marijuana, and prescription drug abuse. Every day our members see the health, social, and economic problems caused by substance abuse, which also is often associated with mental illness. People with untreated mental illness with a co-occurring addiction often make unhealthy decisions, making them more likely to behave in ways that put them at high risk for contracting diseases such as HIV, hepatitis, and sexually transmitted diseases, and for developing serious chronic health conditions, such as cardiovascular disease or diabetes. Studies show patients with substance abuse and mental health illnesses have higher health care costs, including frequent reliance on costly emergency departments for care.
Reducing substance abuse disorders in Texas’ community will help the state decrease the high number of adult and juvenile offenders in state prisons, on parole, or on probation for criminal activity associated with their substance abuse and mental illness.
Community mental health initiatives
We are greatly encouraged by DSHS’ focus on expanding community-based care for children in crisis with severe emotional illnesses and for day treatment for adults in rehabilitation.
With more than $13 billion spent already each year on mental health care in Texas, mental illness and substance abuse hurt the Texas economy through lost earning potential and the costs of treating coexisting conditions, disability payments, homelessness, and incarceration. Keeping individuals in their community will reduce costs to local officials and ensure stronger family support for those in crisis.
State hospital system improvement
State hospital system improvement is a concern for all Texans, but we also must continue being able to address the ongoing demand for high-quality services for people needing treatment. We endorse DSHS’ proposal to allow more people needing hospitalization to remain in their communities in local private residential treatment facilities. This not only will reduce the strain on state hospital beds but also enables patients to be closer to their family support system.
We also are encouraged by the agency’s efforts to build the behavioral health workforce by funding more psychiatric residency positions in the public health system. This increase, albeit minimal, along with improvements in compensation for psychiatric services, will help with state hospital staffing and the critical need for more psychiatrists in the state. Currently, Texas has a lower ratio of psychiatrists per capita than any other type of medical specialist when compared with national ratios.
Improve prevention of chronic diseases
We enthusiastically support the DSHS’ proposal to continue proven efforts to reduce and prevent the development of chronic diseases. In particular, we call on you to support DSHS’ award-winning efforts with counties to reduce potentially preventable hospitalizations through exceptional item No. 9 related to prevention of chronic diseases. These locally driven initiatives rely on evidence-based public health strategies. Data collected by DSHS show the interventions prevent morbidity and hospitalizations and save dollars. We strongly encourage you to support expansion of these efforts to more counties.
TMA also supports the expansion of funding to enable more communities to target tobacco prevention efforts to their high-risk populations and to promote enforcement of tobacco laws. We believe these expanded efforts will directly help Texas reduce the more than $11 billion expended each year on health care and lower productivity for those exposed to tobacco. We ask that you to continue funding for the Texas Quitline to help those Texans trying to stop their tobacco use. TMA is calling on DSHS to use the Quitline to monitor the current use of electronic cigarettes in Texas and to expand other support services.
While tobacco use is decreasing, Texas continues to have higher rates of death attributable to smoking — 273 per 100,000 — than the national average of 248.5 per 100,000. A key way to decrease smoking- attributable illnesses and deaths is to prevent minors and young adults from taking up the tobacco habit. More than two out of three of Texas’ adult smokers started smoking regularly at age 18 or younger, and 85 percent started at age 21 or younger. And this year, another 23,000 Texas minors will start smoking.
In closing, TMA strongly urges the Legislative Budget Board to seize this opportunity to invest in Texas’ public health infrastructure as it relates to these costly issues and prevent paying an even higher price in the future.
 2014 National Women’s Law Center
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