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
.