Texas House Approves Budget With Gains for Medicine, Teeing Up Senate Debate
By Emma Freer

The Texas House recently voted 136-10 to approve a record-breaking $302.6 billion state budget, which includes increased funding for several of the Texas Medical Association’s legislative priorities, including graduate medical education (GME), targeted Medicaid physician payment adjustments, and tobacco prevention and cessation efforts.

But the Senate has its own competing budget bill, which prioritizes school vouchers and property tax relief. So, TMA lobbyists will be working with Senate leadership to maintain health care gains.

House Bill 1 by Rep. Greg Bonnen, MD (R-Friendswood), a neurosurgeon, advances several of TMA’s legislative goals, including bolstering GME resident slots that support the state’s physician workforce and stave off scope-of-practice encroachment.

“These are significant gains that TMA hasn’t really seen in a long time,” TMA lobbyist Caitlin Flanders said.

The bill includes a total of $347 million in support of GME, with $233 million for the state expansion grant program and $114 million to help offset faculty costs for medical schools.

TMA President Gary Floyd, MD, recently testified before the House Appropriations Subcommittee responsible for public education funding about the importance of such positions, especially given the state’s astronomical population growth in recent years.

“We know when a physician completes medical school, and especially when he or she completes postgraduate residency training in the state, 80% are likely to remain in practice in Texas,” he told lawmakers on Feb. 21.

Although the number of first-year residency positions has outpaced the number of medical school graduates in recent years, the number of Texas medical schools – and their graduates – is growing, and there’s a need to create more first-year GME positions to ensure Texas graduates can remain in-state for training.

“With the opening of The University of Texas at Tyler School of Medicine this year, seven new Texas medical schools will have opened since 2016,” Dr. Floyd said. “We project almost 300 more first-year residency positions will be needed by 2027.”

In addition to GME funding, TMA successfully advocated for increased investment in the Texas Medical Board (TMB) and physician pipeline programs, the latter being aided by Rep. Suleman Lalani, MD (D-Sugar Land), during a marathon amendment session on the House floor.

The House increased funding for the:

  • Physician Education Loan Repayment Program by $6 million to $35.5 million. The assistance incentivizes primary care physicians and psychiatrists to practice in rural and underserved areas by paying off their student loans.
  • State Mental Health Care Professional Loan Repayment Program by $25.9 million to $28 million. The program includes seven types of health care professionals, including psychiatrists.
  • Family Practice Residency Program by $7 million to $16.5 million. The grants go to the state’s nationally accredited family medicine residency programs to increase the number of physicians who choose that specialty.
  • Joint Admission Medical Program (JAMP) by $2 million to $11.7 million. JAMP encourages economically disadvantaged students to pursue careers in medicine by offering scholarships, paid internship opportunities, mentorship, and other support.
  • Primary Care Preceptorship Program by $2 million to $4.9 million. The direct funding goes to Texas medical students to encourage them to choose primary care careers.

The chamber also increased funding for TMB by $17 million. Currently, the board only retains 40% of its revenue, which TMA testified isn’t enough to keep up with processing record numbers of license applications and renewals.

In testimony before the Senate Finance Committee and a House Appropriations subcommittee, Dallas anesthesiologist Zachary Jones, MD, and Temple internist Jimmy Widmer, MD, urged lawmakers to ensure a greater proportion – 60% – of TMB licensing fees stay in-house, as is the norm in other states.

“Having a well-run, efficient and adequately staffed and resourced Texas Medical Board is essential for meeting our state’s physician recruitment and retention needs,” they said.

Gains in women’s, children’s health

HB 1 also increases funding to improve access to women’s reproductive and pediatric health care, which TMA and House leadership have prioritized in the wake of the June 2022 U.S. Supreme Court decision in Dobbs v. Jackson Women’s Health Organization regarding abortion. The decision triggered additional restrictions under state law and is expected to lead to an increase in pregnancies and young children.

Specifically, the House budget includes riders that would:

  • Increase Medicaid payments by 10% to physicians caring for children aged 0 to 4;
  • Triple rural hospital material health add-on payments from $500 to $1,500 to help preserve local access to these services;
  • Add $10 million to the 2024-25 state budget for mobile women’s preventive health units, which provide cervical cancer screening and family planning services; and
  • Boost eligibility for the Medicaid Breast and Cervical Cancer Program, which includes cancer treatments and reconstruction, to Texans with a household income at or below 250% of the federal poverty guideline, up from 200%.

Hanoch Patt, MD, a pediatric cardiologist and a member of TMA’s Committee on Medicaid, CHIP and the Uninsured, says such targeted Medicaid physician pay raises could have a catalyzing effect.

“It’s important for [physicians] to achieve what we can to start working on rate increases that will improve access to care and outcomes for these patient populations,” he recently told Texas Medicine.

And despite attempts to scuttle tobacco prevention funding, HB 1 includes $20 million for the Texas Department of State Health Service’s related efforts, heeding TMA’s advocacy on the issue and responding to physicians’ concerns about vaping among youth.

Austin pediatric infectious disease specialist Donald Murphey, MD, submitted testimony on behalf of TMA, the Texas Public Health Coalition, and five specialty societies supporting investments in health promotion and chronic disease prevention.

“Our organizations strongly support fully funding at least [the Texas Department of State Health Services’] initial $6 million exceptional item to boost Texas’ tobacco cessation efforts, including more funding to prevent youth and young adults from becoming tobacco users in the first place,” he wrote.

The Senate Finance Committee approved its counterpart legislation, Senate Bill 1, on April 12, and the full Senate will likely consider the bill within the next week.

Find all the testimonies by TMA physician advocates during the current session in TMA’s advocacy center.

Last Updated On

April 24, 2023

Originally Published On

April 14, 2023

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Emma Freer

Associate Editor

(512) 370-1383

Emma Freer is a reporter for Texas Medicine. She previously worked in local news, covering city politics, economic development, and public health. A native Clevelander, she graduated from Columbia Journalism School and the University of St. Andrews.

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