With the Texas Health and Human Services Commission (HHSC) and Department of State Health Services (DSHS) set to undergo the state’s agency review process ahead of the 2027 Texas Legislature, the Texas Medical Association is poised to weigh in on the fate of these and other entities instrumental to the state’s health infrastructure.
Every 12 years, each state agency is subject to the sunset review process which culminates in legislation seeking to continue, change, or abolish them – significant stakes that TMA leaders say warrant medicine’s input and vigilance.
“DSHS needs to remain an autonomous agency,” said TMA Vice President of Public Affairs and Chief Lobbyist Clayton Stewart. “Especially from an infectious disease standpoint, this is critical for the health protection of Texans.”
Keeping DSHS autonomous may also keep the agency nimble and responsive in case of emergencies like disease outbreaks, TMA contends.
According to David Lakey, MD, chair of TMA’s Council on Medical Education and DSHS commissioner from January 2007 to February 2015, “[Sunset review] is an opportunity to strengthen that basic health infrastructure in Texas,” he said, observing medicine will be watchful in particular “that [DSHS] continues to be physician-led.”
For example, when HHSC and DSHS previously went under sunset review in 2014-15, some stakeholders suggested that DSHS be fully consolidated under HHSC, which TMA advocated against. DSHS was retained and allowed to largely function as an independent entity, but the DSHS commissioner is employed by the executive commissioner of HHSC, and the executive commissioner holds rulemaking authority instead of DSHS. Additionally, administrative services are provided through service agreements with the broader Texas Health and Human Services structure.
TMA staff note that while health agencies may not undergo as dramatic a transformation this round as they did in 2015, commission members are also scrutinizing the Texas Maternal Mortality and Morbidity Review Committee (MMMRC) and the Perinatal Advisory Council (PAC) during the current review. MMMRC is facilitated by DSHS and PAC is facilitated by HHSC; each group will face its own review.
Patrick Ramsey, MD, a member of that statewide advisory council as well as a member of TMA’s Council on Science and Public Health, says medicine will also be vigilant to ensure MMMRC and PAC are fully maintained. The panels, working “hand-in-hand but parallel,” he said, contribute to the ultimate goal of improving maternal and neonatal health outcomes statewide.
“The work we've been doing through the [PAC] is critically important to make sure that we have a very clear system of what different levels of maternal care we should have, as far as the resources, and to ultimately improve care for patients,” said Dr. Ramsey, who also serves on the MMMRC and as a consultant to TMA’s Committee on Reproductive, Women’s, and Perinatal Health.
“Additionally, we would want to make sure that the MMMRC stays strong and funded, collecting the data needed to help the state properly serve women and their babies,” Mr. Stewart added.
Leading up to the 2027 legislative session, Sunset Advisory Commission members will research and analyze each agency on their review list, per the commission website. That process includes reviewing the self-evaluation each agency up for review provides to the commission. Reports for DSHS and HHSC should be issued this coming October, per a commission spokesperson.
Once the Sunset Advisory Commission files a report on an agency:
- The commission holds a public hearing to solicit testimony on the report, and at that time, commentary gathered is made public via the commission’s website;
- The commission then votes on recommendations to make to the Texas Legislature;
- During the next session, legislators will file bills proposing which agencies should continue, which also may incorporate recommended changes, and
- Both chambers and the governor must approve a bill authorizing a particular agency to continue. If that does not happen during the session, the agency is abolished, but is able to continue business for a year, and its functions are then transferred to another agency.
Anyone who wishes to advocate or suggest improvements for agencies or specific departments can use the Commission’s online public input form, though they can choose to not make those comments public prior to the commission's report.
Learn more about TMA’s state advocacy efforts, including its work to preserve medicine’s interests during the most recent legislative session. TMA is working through its councils and committees to capture physician input for upcoming hearings.
Phil West
Associate Editor
(512) 370-1394
phil.west[at]texmed[dot]org
Phil West is a writer and editor whose publications include the Los Angeles Times, Seattle Times, Austin American-Statesman, and San Antonio Express-News. He earned a BA in journalism from the University of Washington and an MFA from the University of Texas at Austin’s James A. Michener Center for Writers. He lives in Austin with his wife, children, and a trio of free-spirited dogs.