Political Prognosis: Fun's Over, The Work Begins

Texas Weekly Editor Ross Ramsey observed in early March that the "county fair" section of the legislative session was coming to a close. Indeed, the festival-like atmosphere that dominates the early days of a legislative session is over, and lawmakers are getting down to serious business, although still at something of a snail's pace. Political observers say there appears to be little urgency among legislators to pass anything but the budget, the only bill they are constitutionally obligated to pass. And, a fight in the Senate over a controversial voter ID bill slowed progress on any other legislation in that body for a few days in mid March.

As the bill filing deadline approached on March 13, it appeared lawmakers were filing bills at a record pace. Officials at the Legislative Council, the legislature's bill-drafting arm, were estimating that as many as 8,000 could be filed this session. A week before the filing deadline, Texas Medical Association lobbyists already were tracking more than 1,000 pieces of health care-related legislation, including many that are part of TMA's own legislative agenda.

Spend, spend, spend
While progress may have been slow in other areas, the Senate Finance Committee and House Appropriations Committee were hard at work crafting a new state budget for fiscal 2010-11. The panels' various subcommittees already had reviewed most areas of the budget-including Article II, which covers health and human services programs, and Article III, which includes undergraduate and graduate medical education-by mid March. TMA leaders say chances are good the Senate will pass its budget bill by late March, and the House could act by Easter, giving lawmakers roughly six weeks to reach a compromise in conference committee before the end of the session.

The bright spot in the budget could be Medicaid. TMA officials say there likely is enough money from the economic stimulus package passed by Congress to fill the holes in the state's Medicaid budget. Of the more than $16 billion Texas will receive from the stimulus bill, about $5.45 billion is earmarked for Medicaid.

Lawmakers came into the session with a shortfall of more than $1 billion in Medicaid due to underestimating enrollment growth in the program. It appears the stimulus money will help cover that shortfall, as well as an additional $2 billion to $3 billion needed to meet enrollment growth in the coming biennium. TMA is urging lawmakers to use a portion of the federal stimulus dollars to fix the broken Medicaid eligibility system and to increase Medicaid and CHIP physician payment rates. Lawmakers are being exceedingly careful, though, not to over-commit the state this biennium and end up with an even more dire fiscal situation next session.

What also may be problematic is graduate medical education (GME) funding. A coalition that includes TMA, the state's medical schools, teaching hospitals, residency programs, and other medical education stakeholders are pushing for a substantial increased in formula funding for GME slots in the state. The coalition wants funding increased from about $5,000 per slot to $16,000 to cover full faculty costs associated with residency programs.

Lawmakers are hesitant to commit additional funds without assurances that the money will be used to create new residency training slots. "Our position is they're not adequately funding the existing slots, much less trying to fund new slots on top of it," said Darren Whitehurst, TMA vice president of advocacy

Meanwhile, the other budget issues backed by TMA also are facing uncertain futures -- a substantial boost in an existing physician student loan repayment program to help attract more doctors to underserved areas, restoring a primary care preceptorship program cut in 2003, and additional funding for the Texas Medical Board (TMB). TMA has proposed boosting maximum loan repayment amounts under the loan program from $45,000 over five years to $140,000 over four years, which it says will complement a new Medicaid loan repayment program designed to get more physicians participating in children's Medicaid.

The TMB has asked for $3.5 million in additional funds to hire investigative staff to help it keep up with record numbers of physicians seeking licenses in Texas since the passage of the 2003 medical liability reforms. TMA continues to express concerns about some of the board's processes, but it wants to maintain a strong, effective medical board and does support the funding increase.

Pushing transparency
While the budget seems to be dominating the session so far, TMA is hard at work pushing its legislative package to make health insurance more transparent for patients. Sen. Kip Averitt (R-Waco) and Rep. Craig Eiland (D-Galveston) filed the centerpiece of TMA's health insurance reform agenda - the health plan code of conduct bill -in early March. Senate Bill 1257 and its House companion, House Bill 2750, would require insurers to notify patients in advance before cancelling policies. It also would allow small businesses to challenge premium quotes and require insurers to provide information to justify premium increases, require health plans to disclose how much of patients' premium dollar is spent on health care, regulate so-called silent PPOs, and require plans to use scientifically valid data in physician ranking programs.

Other pieces of TMA's insurance agenda also have been filed, including measures to require health plans to provide a "soup can" style label showing exactly what their policies cover, real-time adjudication of claims, and coverage of routine care for patients involved in clinical trials.

TMA leaders say the primary thrust of this legislative package is to put more information in the hands of patients so they can make better decisions regarding their health care. TMA lobbyists say these bills may face tough sledding in the Senate.

The good and the bad
Meanwhile, TMA was anticipating the filing of legislation that might be good news in terms of getting more information into the hands of physicians, but which also likely will include other elements that physicians won't like.

Senate Bill 7, which was to be filed by Sen. Jane Nelson (R-Lewisville), would create a pilot program within Medicaid to promote use of best practices and give physicians tools to generate data to compare their care with that of their peers. The bill would facilitate adoption of health information technology, but there are a number of potential concerns, including the use of bundled payments and eliminating payment for so-called "never events, which the Centers for Medicare & Medicaid Services defines as serious and costly medical errors that should never happen. Bundled payments is a concept where a payer makes a single payment to a hospital for care provided to a patient, then the hospital decides how much of that payment should go to physicians or other providers who participated in that care.

Best of the rest
Several other issues of interest to organized medicine also were seeing action. Sen. Rodney Ellis (D-Houston) filed legislation to weaken protections for emergency physicians in the 2003 tort reforms. TMA leaders, however, are confident they have the votes in the Senate to keep the bill from reaching the floor for debate.

On the public health front, legislation has been filed to create a statewide smoking ban in public places. TMA supports the bill.

Meanwhile, TMA is working to exempt physician revenue from the administration of vaccines from the new business tax, and is hoping to fend off attacks on the ban against the corporate practice of medicine. There are is a big push by the Texas Organization of Rural and Community Hospitals (TORCH) to repeal the prohibition against the corporate practice of medicine and allow many rural hospitals to directly employ physicians. There are certainly major concerns, that without appropriate protections, other elements would take control of patient care decisions away from physicians and their patients and give them to hospital administrators.  Sen. Robert Duncan (R-Lubbock) filed SB 1500 allowing hospitals in communities of fewer than 50,000 residents to employ physicians directly. TMA is countering with a proposal that would allow creation of regional 501a corporations that could employ physicians under supervision of the Office of Rural and Community Affairs.

To reduce the number of uninsured, Senator Duncan filed SB 6 to implement "Healthy Texas," a health insurance reinsurance program modeled on a successful New York program that, if funded, could make health insurance more affordable for small employers. Additionally, Senator Averitt and Rep. Patrick Rose (D-Dripping Springs) filed legislation to allow families earning too much for the Children's Health Insurance Program to buy into the program on a sliding scale basis to provide affordable health insurance for their children.

Finally, TMA is working on legislation to shift authority for monitoring pain medication prescriptions from the Department of Public Safety to the Texas Board of Pharmacy. And, the association is supporting legislation by Rep. John Zerwas, MD (R-Richmond) to require freestanding emergency departments to remain open around the clock.

TEXPAC in action
The Texas Medical Association Political Action Committee (TEXPAC) takes a lower profile during legislative sessions but is actively working behind the scenes preparing for the 2010 Election cycle which, believe it or not, has already begun. The party primaries will occur in less than a year. Each session, TEXPAC focuses its efforts on taking advantage of those political opportunities and dynamics it worked hard on setting up during the previous 18 months. However, as it looks ahead past the legislative session, it sees many opportunities and challenges that must be immediately addressed to ensure another successful election cycle. Many of those tasks will take an investment of our resources. TMA members, please take this moment to learn more about TEXPAC and how TMA physician-members can play an integral role in medicine's collective political success for today and in the future.

Check out TEXPAC at www.texpac.org .

Texas Medical Association Political Action Committee (TEXPAC) is a bi-partisan political action committee of TMA and affiliated with the American Medical Association Political Action Committee (AMPAC) for congressional contribution purposes only. Its goal is to support and elect pro-medicine candidates on both the federal and state level. Voluntary contributions by individuals to TEXPAC should be written on personal checks. Funds attributed to individuals or professional association (PAs) that would exceed legal contribution limits will be placed in the TEXPAC administrative account to support political education activities. Contributions are not limited to the suggested amounts. TEXPAC will not favor or disadvantage anyone based on the amounts or failure to make contributions. Contributions are subject to the prohibitions and limitations of the Federal Election Campaign Act.

Contributions or gifts to TEXPAC or any CMS PAC are not deductible as charitable contributions or business expenses for Federal income tax purposes. Only contributions to the TMA Foundation, any CMS foundation and The Physicians Benevolent Fund are deductible as charitable contributions for Federal income tax purposes.

Federal law requires us to use our best efforts to collect and report the name, mailing address, occupation, and name of employer of individuals whose contributions exceed $200 in a calendar year. To satisfy this regulation, please include your occupation and employer information in the space provided. Contributions from a practice business account must disclose the name of the practice and the allocation of contributions for each contributing owner. Should you have any questions, please call TEXPAC at (800) 880-1300, ext. 1361, or (512) 370-1361.

Federal law requires us to use our best efforts to collect and report the name, mailing address, occupation, and name of employer of individuals whose contributions exceed $200 in a calendar year. To satisfy this regulation, please include your occupation and employer information in the space provided. Contributions from a practice business account must disclose the name of the practice and the allocation of contributions for each contributing owner. Should you have any questions, please call TEXPAC at (800) 880-1300, ext. 1361, or (512) 370-1361.

Texas Medicine Senior Editor Ken Ortolon prepared this special addition to Action .

 

Last Updated On

July 30, 2010