Physician-Led Results: TMA Advocacy Pays Off in Tangible Legislative Wins
By Joey Berlin

After more than four months of masking up, logging on, and clicking “send,” it all paid off handsomely.

Texas physicians made the most of an extraordinary, scaled-back session of the Texas Legislature in 2021. With fewer floor meetings, no in-person First Tuesdays at the Capitol lobbying events, and limited air time for agenda items – made even more limited by the historic February winter storm – the House of Medicine needed its advocates to work harder than ever. Physicians needed initiative and drive to help get crucial legislation across the finish line – and help stop bad bills from becoming bad law.

They did all that with gusto. They helped pass laws to curb prior authorization hassles; keep physicians from incurring new practice costs; install liability protections for future pandemics like COVID-19; extend postpartum Medicaid coverage for new mothers; and keep graduate medical education (GME) fully funded. And so much more.

“Despite it being the most challenging year for doctors, we had more engagement than ever before leading to a very successful session,” said Austin oncologist Debra Patt, MD, who served as chair of the Texas Medical Association’s Council on Legislation during the 2021 session and testified 14 times at the Capitol.

This year’s edition “posed unique challenges. But I will say there was a lot of grassroots advocacy,” she said. “TMA quickly pivoted to Zoom, virtual outreach, and a lot of TMA members attended virtual meetings with their legislators.”

Nearly 90 TMA members testified for the House of Medicine during the session, and members responded in droves to urgent alerts TMA sent out urging action on specific measures like scope-of-practice bills.

Appropriately, the result was a pandemic-era shot in the arm for Texas health care that doesn’t cure all, but will leave lasting positive impacts inside the system. Here’s an overview followed by specifics you also can read in Texas Medicine Today throughout this week and next.

Early Win, Strong Finish

Medicine scored the very first piece of law to result from the 2021 session when Gov. Greg Abbott signed a measure eliminating an upcoming tax on outsourced medical billing services.

Advancement on key measures slowed after that, but a furious final few days produced a slew of other wins. A measure allowing physicians to earn a “gold card” out of the prior authorization process – and requiring peer-to-peer calls for utilization reviews to be conducted by a Texas-licensed physician in the same or similar specialty – survived to become law despite dogged insurer opposition. Insurer transparency will be enhanced thanks to a bill providing for an all-payer claims database.

In Medicaid, TMA shot for one year of postpartum coverage for women who give birth, but settled for six months – a four-month improvement on the status quo. Children in Medicaid now will have the opportunity for two continuous six-month periods of coverage, contingent on a household eligibility check near the end of the first six-month period.

Pharmacy benefit managers will no longer be able to “claw back” millions of dollars in “direct and indirect remuneration fees” from Texas practices; a bill to outlaw those fees passed thanks to TMA advocacy. Telemedicine, having proved its immeasurable value during the pandemic, got a boost with permanent relaxation of certain Medicaid restrictions on its use, as well as a measure aimed at improving the state’s broadband capabilities. Public health wins for the House of Medicine included a licensure requirement for e-cigarette dealers – helping establish a framework to tax vaping products in the same manner as other tobacco products – and measures that help ensure the state’s personal protective equipment and improve public health reporting for the next disaster.

Budget success and a look ahead

Throughout the session, TMA was adamant that the state’s GME grant program continue to be fully funded in the state budget to maintain the 1.1-to-1 ratio of residency slots per medical school graduate. The legislature listened, allocating the full $199.1 million that medicine was asking for over the next two years. Other wins included a slight increase in women’s health funding ($352.6 million overall), level funding for early childhood intervention services ($339 million), and nearly $20 million more for the Texas Mental Health Care Consortium ($339 million).

Houston emergency physician Diana Fite, MD, TMA’s president for the majority of the session, notes medicine had to fight to successfully avoid cuts for health care services because in the midst of the pandemic in 2020, Gov. Greg Abbott asked many state agencies to cut their then-current budgets by 5%. She says the expectation was that when lawmakers constructed the 2022-23 budget, further cuts would be in store.

“We really worked to at least get back up to what [funding] was in the first place, and then, in some of those items to actually get a little more money coming in was a win,” said Dr. Fite, who testified four times for medicine.

On the other hand, TMA’s push for some form of coverage expansion for uninsured Texans and its perennial pursuit of physician payment increases in Medicaid went unrealized, although the state will conduct a study on the cost-effectiveness of a pay bump for pediatric Medicaid care.

John Carlo, MD, current chair of the Council on Legislation and a seven-time testifier during this session, says the budget was ultimately a mixed bag.

“We got some things we needed, but we were missing some other things that we really would like to have seen happen,” he said, adding that budget writers could have paid more attention to the state’s pandemic response. “I think we want to see continued support of our laboratories. What we’ve learned is that there’s still some need for stronger public health infrastructure.”

The House of Medicine’s work won’t be done this year. At press time, Governor Abbott had signaled a special session was ahead with one task for the legislature being to mete out $16 billion in federal COVID-19 aid. TMA will push for those funds to be allocated in a way that’s beneficial for the health of Texans.

“The physicians who testified, they really worked so hard on getting things accomplished in a time when it was very, very difficult and different,” Dr. Fite said. “I just really appreciate our legislative team. I think they were outstanding.”

Last Updated On

June 23, 2021

Originally Published On

June 22, 2021

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Joey Berlin

Associate Editor

(512) 370-1393

Joey Berlin is associate editor of Texas Medicine. His previous work includes stints as a reporter and editor for various newspapers and publishing companies, and he’s covered everything from hard news to sports to workers’ compensation. Joey grew up in the Kansas City area and attended the University of Kansas. He lives in Austin.

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