We Need to Come in Force: Physician-Lawmakers Look Ahead to 2021
By Joey Berlin


A panel of medicine’s representatives in the Texas Legislature said Saturday that 2019 was a good year for medicine in Austin, but unfinished business remains for the next session in 2021. 

At the 2019 Texas Medical Association Fall Conference on Saturday, Debra Patt, MD, chair of TMA’s Council on Legislation, moderated a panel featuring four current state lawmakers and one soon-to-be departed one: Sens. Dawn Buckingham, MD (R-Lakeway), and Charles Schwertner, MD (R-Georgetown); Reps. Tom Oliverson, MD (R-Cypress), and Greg Bonnen, MD (R-Friendswood); and outgoing Rep. John Zerwas, MD (R-Richmond), who is retiring at the end of September. 

The lawmakers touted medicine’s 2019 successes, including raising the age to purchase tobacco to 21 and stopping all the troublesome scope-of-practice measures that other professions pushed. Representative Oliverson told the crowd that the status quo shifted in medicine’s favor during the session, especially on medical insurance issues. He lauded the passage of House Bill 2536, which instituted new drug-price transparency requirements for drug-makers and pharmacy benefit managers (PBMs), and House Bill 1264, which introduced baseball-style arbitration for a number of out-of-network medical bills for state-regulated insurance plans. 


“Folks, you’ve got to consider that in the House, we literally had the most friendly-to-medicine insurance committee that we probably ever had, certainly in recent memory. And we were able to move a lot of legislation,” said Representative Oliverson, vice chairman of that committee (above right). “We had some major victories. We now have the strongest pharmaceutical price transparency bill in the nation.” 

Still, the session left legislators with a meaty health care wish list for the future. When Dr. Patt asked the lawmakers to identify issues that will be top of mind next session, Senator Buckingham named scope of practice, payments, and decreasing physicians’ regulatory burden. She advised her fellow physicians not to be shy when it comes to advocating for their profession. 

“I’ll be honest. The chiropractors came into my office – six or seven people, a bunch of cute, young-faced students that were so awesome, and with straight faces handed me literature on how they had more education than any MD,” Senator Buckingham (above left) said to laughter from the audience. “So don’t be shy, because the other groups are not shy.” 

For Representative Oliverson, prior authorization will be at the top of the list next session, and PBM reform will also be important. Far too many barriers sit between patients and practitioners, he said, and a lack of price transparency. It’s time to remove that middle man from the process, he said to applause from the room, and promote alternative care models that don’t involve insurance. 

“Direct primary care, that’s how we save the American health care system,” he said. “We get the patients to actually be consumers again.” 

Dr. Zerwas said TMA should be involved in addressing the overly permissive vaccination exemptions that have created an “out-of-control” unvaccinated rate in the state. In the 2018-19 school year, 64,176 Texas schoolchildren claimed nonmedical exemptions from required immunizations, according to the Texas Department of State Health Services. 

“I really think we missed the boat this last legislative session. By ‘we,’ I mean us and all of us out here in this room. The vaccination rate in Texas is out of control,” Dr. Zerwas (below right) said to applause. “We missed a great opportunity, during a measles outbreak in this state, that we didn’t respond to that. … We need to have some thoughtful policy about the exemptions around vaccination. 

“And this is going to be hard, because the anti-vaxxers, as we refer to them, are loud. They’re not large in numbers, but they’re loud, and they make it their absolute personal mission, because it’s a very personal mission that drives them, that we should never … have a requirement for vaccinations. We’re seeing the eruption of diseases that we conquered decades ago, diseases that have serious consequences.” 


Senator Buckingham said it’s important for medicine to pick its fights and for physicians to be specific in their messaging during First Tuesdays at the Capitol, TMA’s monthly White Coat Takeover during session. 

“There will be significant bills being heard, and we need everyone to come and drop a card for those bills. Because there were days that we had major bills being heard on a First Tuesday, and we had maybe five cards dropped in support. And those cards matter, because we have a natural, somewhat antagonistic relationship with the hospitals and the insurances companies. … And they come in force. So we need to come in force, too.”

Last Updated On

September 18, 2019

Originally Published On

September 18, 2019

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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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