Testimony by Philip Huang, MD, MPH
Senate Finance Committee
Jan. 31, 2017
Members of the Finance Committee, thank you for the opportunity to testify on behalf of the Texas Medical Association, representing more than 50,000 members, as well as the Texas Pediatric Society; Texas Academy of Family Physicians; Texas Association of Obstetrics and Gynecology; District XI, American Congress on Obstetricians and Gynecologists; and Texas Society of Psychiatric Physicians and the Texas Public Health Coalition. I’m Dr. Philip Huang, a family physician and medical director and health authority for the Austin/Travis County Health and Human Services Department, and chair of TMA’s Committee on Infectious Diseases. Previously I was the medical director of chronic disease prevention at the Texas Department of State Health Services (DSHS) and also an epidemic intelligence services officer with the Centers for Disease Control and Prevention (CDC). I am here today to speak on the DSHS proposed 2018-19 budget request and potential budget reductions.
Medicine’s perspective on the DSHS budget is in behalf of the patients and communities we care for — the 27 million Texans who depend on a strong public health system — and the public actions we and state and local leaders can take to prevent and reduce illness and disability. We must express grave concern with the proposed budget and its potential impact on public health at the state and local level. Let me speak to the proposed chronic disease budget reductions and to these exceptional items of particular interest to the medical community:
- Basic Public Health Capability,
- Strengthen the State Public Health Laboratory, and
- Prevent and Control the Spread of Infectious Diseases.
We support your efforts to redirect the responsibilities of DSHS to focus solely on public health. This is the time to secure the department’s critical role in protecting current public health capacity and infrastructure for activities like quality laboratory testing, surveillance, and managing potential outbreaks. Texas needs to prepare and respond to disease outbreaks, disasters, and chronic disease. But we also must be prepared to do so with potential reductions in federal public health funding associated with the Affordable Care Act. Texas is expected to see $147 million in cuts.
Each year and each legislative session present a new challenge to our state and local public health agencies, our physician infectious disease experts, and those who care for populations at greater risk in a disaster or an infectious disease outbreak. At the core of our responsibility is having a public health infrastructure that can work with the medical community to identify and respond to these events. Whether it is mumps in north Texas; a foodborne illness outbreak; or hundreds of tuberculosis, Zika, and HIV investigations going on throughout Texas — we must have a trained public health and clinical workforce addressing each event. Each outbreak represents dozens of investigations of individuals and their contacts with families and others in their communities and schools. There is a cost to the meticulous professional work that occurs every day in communities across the state, but not all communities are equally equipped to address the needs of their high-risk populations. DSHS will need to address these needs.
Just this week, CDC reminded states that the seasonal flu epidemic is widening. Texas and 36 other states are reporting widespread flu, including deaths of 19 people, three of whom were children. Furthermore, avian flu is on the rise in Asia — a plane ride from spreading to Texas. I tell you this not to monger fear but as a reminder that preventing and detecting flu and all other infectious diseases depends on the state’s high-functioning public health system.
Children, pregnant women, persons with chronic conditions, and the elderly are most vulnerable in an outbreak or a disaster. Our work and experience in public health emergency management and infectious diseases tells us that Texas physicians can fully support the agency’s request to fund improvement in our state’s laboratory network capacity. The state lab is an essential function on so many levels but especially in an outbreak. We know that Zika will be revisiting us — will our capacity be sufficient for all the testing that could become necessary? Your decisions can impact this. Any reductions in staffing likely will shrink the number of clinical personnel available to talk to physicians in the community during outbreaks. Please let me stress how critical is the need for increased clinical staffing abilities at DSHS.
Proposed Reduction in Funding for Chronic Disease Activities
In less than 15 years, one in five Texans will be 60 years old or older, and a great proportion of these likely will have one or more chronic diseases — diseases that often mean a person is unable to participate fully in the normal activities of daily living. Chronic conditions like arthritis, cancer, diabetes, and cardiovascular diseases are most likely to cause disability. But aging does not have to lead to disability from a chronic disease. State chronic disease prevention programming can enable individuals and communities to access programs that we know help prevent or mitigate a chronic illness. For example, programs that support physical activity and healthy eating can slow the rate of increase of overweight and obesity in Texas children and adults.
While physicians can advise our patients that a healthy lifestyle is essential to healthy aging, the preventive and clinical care we offer our patients in the medical home is most effective when complemented with strong public health services. The collaboration between medicine and public health presents the best opportunity to reduce and manage the chronic conditions and disabilities associated with aging. For this to work, we need your continued support so that state and local public health agencies have the ability and resources to provide services and programming.
We are also greatly concerned about reductions in tobacco-control activities. Each Texas household already pays hundreds of dollars each year for the costs of smoking in our state. The reductions in tobacco control will have an immediate impact on current effective efforts to promote use of the Texas tobacco Quitline, support local tobacco control coalitions, reach out to children and youth on tobacco use, and maintain the current level of tobacco enforcement activities. These reductions would be shortsighted and will only contribute to increased budget costs in the future. Tobacco use is associated with costly and potentially preventable hospitalizations, which represent substantial costs to the Medicaid program and other programs across the state.
CDC concurs that tobacco-related diseases contribute significantly to Medicaid costs. State-level, smoking-attributable medical expenditures among adult Medicaid recipients range from $40 million in Wyoming to $3.3 billion in New York. Texas’ costs are estimated at $943 million. Reducing smoking rates among Medicaid patients is a constructive approach to reducing costs while saving lives.
We understand the many complex decisions you face as you work to achieve a balanced budget this session. But physicians are joined in the understanding that investing in evidence-based public health interventions sponsored by our state and local public health providers is the only way to help us ensure there is not an even higher price tag in the future. Texas’ exploding population in our large and mobile state means we need to ensure that we not only maintain our current public health system, but also seek improvements and enhancements to address the problems raised as our state and population continue to grow. As you review the DSHS’ request for funding for 2018-19, we offer our assistance and will continue to encourage you to support our public health system and workforce, and our capacity to respond to old and new public health threats and concerns. We are especially pleased that you and DSHS recognize that physicians are on the front lines on a daily basis and in emergencies. Texas physicians are directly involved in the diagnosis, treatment, investigation, and monitoring of Texas residents whether it is an exposure to tuberculosis or Zika, issues on the U.S./Mexico border, or the victim of a foodborne disease outbreak. Thus we will continue to advocate for a robust public health system that can work with medicine to prevent disease and respond as our state continues to grow in size and diversity. We urge you to reverse decisions that reduce the state’s public health funding.
I am happy to attempt to answer any questions the chair or the committee may have. Thank you.
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