Cover Story - August 2007
When legislators came back to Austin for the 2007 session, Texas
Medical Association members were waiting for them with an ambitious
agenda of proposed legislation that boiled down to one goal:
preserving patient care. After two years of preparation that began
when the 2005 session ended, TMA asked lawmakers to reduce the
state's embarrassingly high rate of uninsured residents, reform the
health insurance industry, enhance access to care, and bolster the
public health infrastructure.
And when the legislature adjourned at the end of May, it had
done just that, thanks to the hard and almost around-the-clock work
of TMA physicians, medical students, alliance members, and staff;
the support of political and business leaders gained through TMA's
Healthy Vision 2010
summits last year; and numerous legislative champions of both
political parties. Dozens of Texas physicians testified on bills
before legislative committees. And thousands of physicians, medical
students, and TMA Alliance members helped back TMA legislative
priorities during First Tuesdays at the Capitol events or through
personal contact with lawmakers.
The result was a resounding victory for patients and physicians
that one key lawmaker called a "watershed moment" for health care
TMA enjoyed many successes in the 80th Texas Legislature.
Physician leaders and lobbyists say these are the top 10:
- Approval of a 25-percent increase in physician payment rates
for children's Medicaid, as well as a 10-percent hike in fees for
- Creation of the Cancer Prevention and Research Institute of
Texas and submission of a proposed constitutional amendment to
sell $3 billion in general revenue bonds to fund it to voters in
- Restoration of Children's Health Insurance Program (CHIP)
- Passage of legislation that will require greater transparency
from health plans, physicians, and hospitals in terms of both
pricing of services and adequacy of health plan networks;
- Passage of a bill expanding to middle school students the
same mandatory physical education (PE) requirements already in
place for elementary school students;
- Defeat of attacks on the 2003 medical liability reforms;
- A $35 million graduate medical education funding and
appropriation of new funds to enable Texas Tech University Health
Science Center at El Paso to complete its conversion to a full
four-year medical school;
- Defeat of scope-of-practice legislation, including a bill to
lessen physician supervision of retail health clinics;
- Workers' compensation reforms that require peer review to be
done by Texas-licensed physicians in specialties appropriate to
the care being provided; and
- Increases in Texas Medical Board funding - without
licensure fee hikes - to help process physician license
Austin obstetrician-gynecologist Albert T. Gros, MD, chair of
TMA's Council on Legislation, says the results are "very
encouraging" for patients and their physicians.
"It's been a whirlwind session," Dr. Gros said, "but overall, in
spite of all the adrenalin and excitement of the session, when it
all came down to it in the final analysis, we came out with a
result that we should be very happy with."
One of TMA's legislative champions, Sen. Jane Nelson
(R-Lewisville), chair of the Senate Health and Human Services
Committee and author of some of the key health care bills this
session, says TMA's efforts this year were critical to development
of good health care policy.
"TMA is an invaluable resource to us, especially in the
she said. "We had 7,000 bills filed this session, and you can't be
an expert on all those issues. I have learned to depend on those
who are experts. TMA, during the legislative session, is here
almost 24 hours a day every day, making sure legislators have the
information we need, making sure we know the pros and cons of those
issues that TMA's directly involved with, and then following
If asked, Gov. Rick Perry and legislative leaders probably would
admit that the session did not exactly come off without a
Lawmakers balked early at major initiatives Governor Perry laid
out to require human papillomavirus immunizations for all Texas
schoolgirls and to sell the state lottery to pay for such things as
the $3 billion cancer research fund.
In the Senate, a dustup over a voter identification bill between
senators and Lt. Gov. David Dewhurst left some senators questioning
the lieutenant governor's leadership style. And, as the session
wound down, some House members were in open revolt against House
Speaker Tom Craddick (R-Midland), even mounting a late effort to
Despite what some political observers have labeled as some of
the most interesting "political theater" in quite a few sessions,
however, lawmakers were able to work through their differences and
accomplish a great deal, particularly on the health care front.
"We set forth a new blueprint for Medicaid and the uninsured,"
said Senator Nelson. "We invested in cancer research. We expanded
our provider network. And my war song about preventive health
finally started to catch on."
While the trials and tribulations of legislative leaders may not
have had a direct impact on organized medicine's issues, political
observers say they truly defined the session.
"This is the session in which the Republican leadership pretty
much hit the wall," said Harvey Kronberg, publisher of the online
Mr. Kronberg has been following the Texas Legislature for nearly
20 years and says this session provided "some of the best theater
Despite those distractions, however, lawmakers were able to
concentrate on a number of key issues for organized medicine. And
TMA was well prepared to help frame the debate on those issues.
As in past legislative sessions, the association used a number of
ad hoc committees between the 2005 and 2007 sessions on issues such
as Medicaid, commercial health insurance, and scope of practice to
identify key issues facing medicine and potential solutions. Those
ad hoc committees also gave TMA a ready pool of physicians with
specific expertise who could be called on to testify or lobby for
TMA's goals. (See "
Physician Testimony Plays Key Role in
In addition, TMA convened three
Healthy Vision 2010
summits that brought physicians together with business leaders,
insurance executives, and others to look for opportunities where
groups with very diverse interests might be able to work together
to address issues such as the uninsured or wellness and
Darren Whitehurst, director of the TMA Division of Public
Affairs, says the summits differed from other coalitions TMA has
been involved in because this time physicians partnered with groups
that "don't necessarily agree with us on all of our legislative
TMA also once again joined state specialty societies in the
PatientsFirst Coalition to help block any scope-of-practice
expansion efforts by allied health practitioners.
Dr. Gros says all that groundwork truly paid off during the
"I think it was a very good session," he said. "We managed to
kill off a lot of bad bills, and we managed to get some notable
successes, particularly with regard to CHIP and Medicaid funding
Finding a Medical Home
Indeed, the 80th legislature produced a historic Medicaid
physician payment increase that could dramatically impact access to
care for low-income Texans.
TMA helped convince lawmakers to appropriate nearly $2 billion
in new state and federal funds to boost Medicaid physician and
dental payments and to increase access to services within
children's Medicaid by improving outreach, case management, and
transportation services. Still to be negotiated are other
"strategic" initiatives as part of the settlement of the
Frew vs. Hawkins
lawsuit, a federal class action suit challenging the adequacy of
the state children's Medicaid program. For children's services, the
funding pool will increase by 25 percent for medical services and
by 50 percent for dental services. The funding pool for adult
medical services will increase by 10 percent.
If Health and Human Services Commissioner Albert Hawkins
approves recommendations of the Medicaid Physician Payment Advisory
Committee (PPAC), physicians will see their Medicaid reimbursement
rates improve considerably. Vaccine administration fees, for
example, would go up by 30 percent under the PPAC recommendation,
and all evaluation and management codes would increase 27.5
percent, in addition to other changes.
Going into the session, TMA made a strong push to improve
Medicaid payment rates in the face of declining participation in
the program. In a letter to key legislative leaders in October,
then-TMA President Ladon W. Homer, MD, urged lawmakers to push
Medicaid fees up to a level comparable to Medicare and commercial
health plan payment rates.
Armed with a substantial budget surplus, lawmakers seemed
inclined to enact at least a 10-percent fee increase for both
children's and adult Medicaid services, but then the
settlement resulted in an even larger increase in children's
Meanwhile, lawmakers also restored most of the cuts made to CHIP
in 2003, including the 2.5-percent cut in physician fees. They
eliminated the 90-day waiting period and restored 12 months
continuous coverage for children whose families earn less than 185
percent of the federal poverty level. The increases will allow an
estimated 127,500 additional children to qualify for CHIP during
the next two years.
Dr. Gros says these increases are encouraging for both patients
"We not only restored the cuts that were made previously but we
also managed to actually get an increase,"
he said. "That's definitely moving in the right direction."
Senator Nelson says the political climate was right to not only
restore the 2003 Medicaid and CHIP cuts but to also enact the first
significant fee increase in some 15 years.
"Having a good economy and a budget surplus certainly helped,"
she said. "However, we had great momentum heading into this
session. The nation's focus is on health care right now, and we
needed to seize this opportunity to make progress while there is
political will for change."
The senator believes the payment increases will ensure that
Medicaid patients will have access to a "robust network of
Abilene otolaryngologist Austin I. King, MD, immediate past
chair of the TMA Council on Legislation, also says he is "ecstatic"
with the Medicaid fee increases.
"This is going to be extremely helpful to physicians who have a
large majority of their practice that is Medicaid, particularly the
[Lower Rio Grande] Valley physicians," he said.
TMA was disappointed lawmakers chose not to increase adult
Medicaid and CHIP rates by the same amount as the children's
Medicaid increases, but TMA President William W. Hinchey, MD, of
San Antonio, says he will personally urge physicians to return to
the program or open their practices to new Medicaid patients in
light of the fee hikes. If physicians do not return to the program,
TMA leaders fear lawmakers may turn to limited licensed providers
to solve access problems in Medicaid. (See "
Medicaid Rate Hike
an Enormous Opportunity
A more detailed look at the fee increases can be found in the
July issue of
. (See "
Another significant advance in Medicaid and the uninsured was
passage of legislation to promote healthy lifestyles, improve cost
efficiency in Medicaid, and expand coverage for the uninsured.
Senate Bill 10, authored by Senator Nelson, directs the Texas
Health and Human Services Commission (HHSC) to seek federal waivers
to conduct a pilot program to provide positive incentives, such as
expanded benefits or value-added services, for Medicaid recipients
who participate in weight loss, smoking cessation, or other disease
The bill also creates a Medicaid health savings account pilot
program for adult patients. It also authorizes HHSC to seek waivers
to create tailored packages of benefits customized to meet the
specific health care needs of certain recipients and authorizes
HHSC to seek a waiver to create a Texas Health Opportunity Pool to
help uninsured Texans purchase private insurance. The pool would
use hospital disproportionate share and upper payment limit funds
in addition to any new federal funding to help subsidize private
insurance through Three-Share - which provides coverage
by having the government, the employer, and the employee share the
cost of health insurance - or other programs.
Clear as Glass
In 2005, there was considerable debate about the adequacy of
health plans' physician networks and physicians, particularly
hospital-based physicians, balance billing patients for charges not
covered by their health plan. Some lawmakers sought to ban balance
billing, while TMA wanted legislation to set adequacy requirements
Lawmakers failed to resolve that debate then, so transparency,
as the issue came to be known, became a major buzzword this
TMA worked very closely with Sen. Robert Duncan (R-Lubbock) to
craft a balanced bill that puts new transparency requirements on
health plans, hospitals, and physicians, and gives employers
purchasing health coverage for their workers, as well as the
enrollees themselves, plenty of information about what they are
getting for their premium dollars.
The plan requires facility-based physicians to tell patients in
advance that they may not be in their health plan's network. If
they provide out-of-network care, the physicians also must tell
patients that they are being billed for out-of-network services and
provide a phone number to call to discuss the charges and set up a
payment plan. Physicians also must give a cost estimate in advance
to patients who are paying all or part of the cost of treatment out
of their own pockets.
Hospitals similarly are required to inform patients that they
may be seen by out-of-network physicians and make arrangements for
Health plans must publish in any of their product literature
information that patients may be responsible for out-of-network
charges. If a plan sends a statement to a patient indicating that
he or she has seen an out-of-network physician, the plan must give
the patient the Texas Department of Insurance (TDI) Consumer
Protection Division's telephone number so that he or she can
complain about the amount the health plan paid.
Finally, the bill sets up a network adequacy study group within
TDI and requires development hospital, physician, and health plan
report cards so consumers can compare prices.
Dr. King applauded Senator Duncan's willingness to work with TMA
and other stakeholders to come up with a balanced approach to the
transparency issue. And Dr. Gros says the final legislation was a
"very positive step that we were able to achieve."
Also on the health plan front, lawmakers passed legislation
creating a pilot program to test the use of "smart card" technology
to deliver real-time information between physicians and health
plans on patients' health coverage, deductibles or copayments, and
The legislature also approved a bill by freshman member Rep.
John Zerwas, MD (R-Richmond), that will spare some patients from
out-of-network charges. Under the bill, a physician who joins a
group practice already in a health plan's network would be paid as
an in-network physician while the credentialing process is under
For more on health plan transparency, see "
A Clear Win
Getting the Fat Out
While Medicaid funding and the
settlement grabbed much of the headlines this session,
lawmakers put a lot of emphasis on public health issues, as
The legislature passed a TMA-backed bill by Senator Nelson that
strengthens physical education (PE) requirements in middle school
and mandates an annual physical fitness assessment of students in
kindergarten through grade 12. It also approved legislation by Rep.
Dianne Delisi (R-Temple) to create worksite wellness programs for
state employees. The measure establishes a Worksite Wellness
Advisory Board under the Texas Department of State Health Services
and calls for biannual studies of existing worksite wellness
programs to determine best practices. The advisory board will
include a TMA representative.
Senator Nelson says she thinks the new PE requirements could
have the most immediate impact on improving health in the
"We desperately need to restore basic health and exercise in our
schools to prevent our young people from becoming the first
generation in modern history to live shorter lives than their
parents," she said.
While she was pleased lawmakers passed her worksite wellness
bill, Representative Delisi was disappointed they did not provide
funding for wellness programs in the budget. She plans to work with
the executive branch to try to find other funding, she says.
Representative Delisi is a "big believer in primary preventative
care" and thinks wellness initiatives ultimately will cut state
health care costs.
On another front, legislators recognized the need to improve the
availability of public mental health care by investing $82 million
in state funds to improve community and crisis stabilization
But probably the most significant action was passage of
legislation creating the Cancer Prevention and Research Institute
of Texas and a proposed constitutional amendment to sell $3 billion
in general revenue bonds to fund cancer research, prevention, and
treatment. The proposed constitutional amendment authorizing the
bonds will be on the ballot for voter approval in November. (See "
TMA Takes on
TMA counts approval of the cancer research initiative among its
top legislative achievements this session, and Senator Nelson says
the research institute eventually could extend the lives of nearly
90,000 Texans who are diagnosed every year with some form of
TMA had success on a number of other fronts. Most notably,
medicine won almost $35 million in new graduate medical education
funding over the last biennium, helped secure needed funding for
the Texas Medical Board to hire additional staff to clear a backlog
in licensing applications, and gained significant workers'
compensation reforms that will require peer reviewers to be
Texas-licensed physicians and in a specialty appropriate to the
care being reviewed. (For more on graduate medical education
funding, see "
Beaumont orthopedic surgeon David Teuscher, MD, says those
reforms will add some accountability to the workers' compensation
peer review process by making reviewers subject to oversight by the
Texas Medical Board.
"Hopefully, this will stem the tide of abuse that continues to
go on and streamline the system so that it works for both the
injured workers as well as the physicians who are trying to take
care of them," he said.
And, TMA won reforms in the new state business tax that will
lessen the potential tax burden on some physicians, while
maintaining the tax credits for physicians who care for Medicare,
Medicaid, uninsured, workers' compensation, and other patients.
TMA also worked closely with Representative Delisi on
legislation to establish a public-private partnership known as the
Texas Health Services Authority to serve as a catalyst for creating
a seamless interoperable electronic medical record (EMR) system in
Representative Delisi says that the critical issue for
physicians and other stakeholders in developing EMRs is
interoperability and that bringing a private component into the
effort is critical to ensuring interoperability.
"It became apparent to me that we could not do electronic
records within state government," she said. "It had to have a
private component that is at the cutting edge of all of this
Other issues, such as privacy, ownership of the medical records,
and compliance with the federal Health Insurance Portability and
Accountability Act will be studied as the bill rolls out,
Representative Delisi says.
On the Defensive
Possibly even more significant is what TMA prevented from
passing. Trial lawyers made a run at the 2003 medical liability
reforms with legislation that would have lowered the burden of
proof in liability cases involving emergency care. (See "
Under the 2003 reforms, plaintiffs must prove that gross
negligence occurred in emergency cases. A bill filed by Sen. Rodney
Ellis (D-Houston) would have lowered that standard to simple
The bill was approved unanimously by the Senate State Affairs
Committee but went no further.
An effort by chiropractors to gain authority to perform school
physicals also failed. Chiropractors were able to amend a bill in
committee to add language granting them authority to do physicals,
but TMA convinced lawmakers to remove that provision. TMA also
succeeded in adding language to another bill banning chiropractors
from doing school physicals, but it was later stripped off the
In addition, TMA defeated measures to expand the number of
advance practice nurses and physician assistants that a single
physician could supervise at retail health clinics. That measure
also would have reduced the amount of time supervising physicians
would have to spend on site at such clinics.
TMA leaders credit the PatientsFirst Coalition with playing a
major role in keeping scope issues off the agenda. The coalition,
created two years ago by TMA and some two dozen specialty
societies, gives physicians a forum to talk to lawmakers with one
voice on scope issues, they say.
Arden Aylor, MD, a former chiropractor who recently completed a
stint as chief resident at Scott and White Hospital in Temple,
testified on the chiropractor bills on behalf of TMA. He says
chiropractors simply don't have the training or experience to
detect pathological issues that could put student athletes' health
"If we're trying to decide if a kid has the dexterity to
participate in sports, then chiropractors are great at that," Dr.
Aylor said. "They do well with musculoskeletal stuff. But if we're
trying to uncover an undiagnosed pathology that may put these kids
at risk, then they don't have the adequate training."
Dr. Gros says this session saw few attempts by allied health
practitioners to expand their scope of practice, but that could
change in 2009. A moratorium on scope expansions agreed to several
years ago between TMA and advance practice nurses expires after the
current legislative interim, and Mr. Kronberg of the
says nurses and other practitioners are already talking among
themselves about potential scope agendas.
"I don't know whether a serious coalition is going to emerge
next session, but there is at least some talk of the
scope-of-practice challengers trying to come on as a united front,"
Regardless of how scope issues develop, medicine is well
prepared to confront the issues with a united voice through the
"We're obviously looking ahead to next session," Dr. Gros said.
"With the drop of the moratorium, it's going to be open season on
The ability to celebrate successes on the legislative front is
short lived. The fight for the 81st session has already begun with
the upcoming campaign cycle.
"The challenges facing medicine are more acute today than ever.
We are finding it more and more difficult to care for our patients.
We must be proactive legislatively to ensure our patients can get
the care they need and deserve," said Manny Acosta, MD, the 2008-09
chair of the Texas Medical Association Political Action Committee
(TEXPAC). "As such, if you are engaged in the practice of medicine,
then you are involved in the politics of medicine. The decision to
participate is yours. I am asking that each of you take up this
call to action and participate in TEXPAC so that we can elect
legislators who will help medicine address these challenges."
can be reached by telephone at (800) 880-1300, ext. 1392, or
(512) 370-1392; by fax at (512) 370-1629; or by e-mail at
Physician Testimony Plays Key Role in Legislative
Arden Aylor, MD, says he used to just sit back and gripe about
things going on in health care that he didn't like. Then he decided
those problems might be at least partially his fault for not
getting involved in medical politics and voicing his opinion.
So he got involved.
Dr. Aylor, a former chiropractor, was one of dozens of Texas
physicians who helped secure legislative victories for organized
medicine this year by testifying before House and Senate
"It was a little stressful," said Dr. Aylor, who made his first
appearance before a legislative committee when he testified on a
chiropractic scope-of-practice bill, "but it was something I felt
passionate about and had experience in with the scope of practice
Darren Whitehurst, director of Texas Medical Association's
Division of Public Affairs, says the importance of having a
physician serve as the face and voice of medicine before the
legislature cannot be overstated.
"You're talking about a citizen legislature for the most part,
and they certainly are not going to understand what happens in real
life in a doctor's office," Mr. Whitehurst said. "Most of the
members of the legislature have no idea what goes on in the
day-to-day practice of medicine. So it is critical to put a face on
what is happening to physicians on a day-to-day basis."
Former TMA President Jim Rohack, MD, says testifying before
legislative committees can be nerve-racking if you've never done it
"The first time is always intimidating," said Dr. Rohack, a
member of the American Medical Association Board of Trustees.
"You're in a crowded hearing room, the legislators sit on an
elevated platform looking down on you, and you may have to wait
hours for your turn to address the committee."
In fact, there are many uncertainties for those who are
testifying. Most committee hearings are held on adjournment of the
House or Senate for that particular day. If House or Senate
sessions run long, the start of the hearing can be delayed. And, if
the committee has a lengthy agenda or a hot issue that draws a lot
of interest, the hearing could extend into the wee hours of the
Also, committee members frequently come and go from hearings to
meet with constituents, attend other committee meetings that are
going on at the same time, or carry out other business. So, a
physician may get to give his or her testimony to only one or two
Finally, witnesses can face tough questioning from the
lawmakers, particularly lawmakers who are on the opposite side of
Dr. Rohack, who testified this year on Medicaid and the
uninsured at the initial meeting of the House Public Health
Committee, says those factors may be disconcerting to physicians
but are just part of the process. Physicians who want to get
involved in the legislative process should not let those factors
stand in their way, he says, adding that TMA advocacy staff members
do a good job preparing physicians on the issues at hand and what
to expect from the committee.
Austin orthopedic surgeon Stephen Norwood, MD, also has been a
frequent participant in legislative hearings, particularly on
workers' compensation issues. He says physician testimony can have
tremendous influence if the doctor can tie the issue to specific
"The more a physician can draw on an experience he's had in the
last couple of weeks, especially a patient encounter experience,
the more engaged these committee members seem to be," Dr. Norwood
Dr. Aylor's experience as a former chiropractor made him
uniquely qualified to testify about the pitfalls of legislation
that would have allowed chiropractors to perform school athletic
"Ten years ago if you had asked me about this, I would have been
on the other side of the fence," Dr. Aylor said. "But knowing what
I know now and didn't know then about the subtle changes in heart
rhythms when you're listening to somebody with a stethoscope and
knowing whether something's physiological or pathological, these
are things that it takes experience to learn, not just a course on
Dr. Rohack believes his testimony helped frame for lawmakers the
challenges faced by both physicians and patients in Medicaid and
"Clearly, physicians felt in a difficult position of trying to
take care of patients but also keep their offices open," he said.
"The reimbursement rates were woefully inadequate. But more
important, the administrative hassles that patients and their
families have to go through trying to get good care and having to
fill out onerous forms just wasn't making a lot of sense in terms
of getting the best possible care, especially for patients with
chronic diseases. So I was pleased that as a result of framing the
situation for lawmakers, we helped convince them ultimately to do
the right thing."
Dr. Aylor says he definitely would represent medicine again.
"I really enjoyed it. I learned so much," he said. "That was the
amazing thing - learning how the process really
Back to article
First Tuesdays Vital to Medicine's Legislative Success
Nearly 1,000 physicians, medical students, Texas Medical
Association Alliance members, and county medical society executives
turned themselves into lobbyists, at least for one day, to help
organized medicine score major victories in the Texas
Some 915 members of the TMA family took time out from their
practices, their studies, and their lives to participate in First
Tuesdays at the Capitol, TMA's successful grassroots lobby program
that for the past three sessions has blanketed the Capitol with
white coats on the first Tuesday of each month during the
Organized each session by the TMA Alliance, First Tuesdays has
become such an integral part of TMA's lobby efforts that it has
become something of an institution in Austin and now serves as a
model for programs being started by medical societies in other
"I don't think we can overestimate the importance of First
Tuesdays," said Fort Worth pathologist Ladon W. Homer, MD,
immediate past president of TMA. "We've had numerous
legislators - some who had not been very familiar with
TMA activities in the past - say to us that this showing
of white coats in the Capitol was an extremely important event in
helping them make certain decisions. I have had in the past many of
these folks tell me that of all the things that TMA does in the
legislative arena, this First Tuesday effort with white coat
participation in the Capitol is the most important activity."
Susan Todd was TMA Alliance president in 2003 when First
Tuesdays was launched, and she chaired the First Tuesdays program
this year. She says no one realized then "the huge impact the
program would have."
"As many of you may remember, 2003 was the year when medicine
scored an astounding victory in our struggle for tort reform," Ms.
Todd told participants at the February First Tuesdays event. "And
then our efforts with Proposition 12 made the legislation 'stick'
as the Texas constitution was changed to make the legislation
binding. In 2005, medicine was able to fend off scope-of-practice
attacks and keep a business tax at bay."
TMA held four First Tuesdays events this year, during which
physicians, alliance members, medical students, and county medical
society executives met at the TMA building for legislative
briefings, then fanned out around the Capitol to visit with their
lawmakers on key health care issues.
In March, the TMA Alliance also sponsored an AMPAC campaign
school the Monday before the First Tuesdays event. The campaign
school, which AMPAC only offers to two state medical societies each
year, drew 117 participants.
Dr. Homer participated in all but one of the First Tuesdays
events this year. He says the program has become so important to
medicine's success in the legislature that "you're not likely to
see us give it up any time soon."
Dr. Homer says First Tuesdays truly complements the more
traditional grassroots efforts that always have been at the heart
of TMA's legislative advocacy program.
"What we have seen is that most of the people who have already
been active at the grassroots level with their legislators at home
come to the First Tuesdays events and help us in that program," he
said. "However, one of the things we've also seen is that there are
a lot of new faces. Folks who have not been involved in legislative
efforts on the county level are now coming to First Tuesdays and
they're telling us they're going back and are going to make those
contacts back at home with their legislators. All of that is
extremely important as this momentum builds."
TMA and the TMA Alliance will once again sponsor First Tuesdays
at the Capitol during the 81st Texas Legislature in 2009. Those
events will be held on Feb. 3, March 3, April 7, and May 5.
For more information on First Tuesdays, contact Sandy Solis with
the TMA Alliance at (800) 880-1300, ext. 1328, or (512) 370-1328,
or by email at