Public Health's Lean Year
By Sean Price Texas Medicine August 2017

Texting Ban, Zika Measure Highlight This Year's Legislative Victories

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Charting the Texas Legislature: Public Health — August 2017

Tex Med. 2017;113(7):40-42.

By Sean Price
Reporter

Medicine's agenda advanced on many fronts in the 2017 Texas Legislature. But it made only modest gains in public health. 

"There were few improvements in public health this legislative session," said David Lakey, MD, chair of TMA's Council on Science and Public Health. "A lot of our priorities did not move forward." 

Nevertheless, TMA did see several public health victories in the 85th Legislature. The most significant came in a package of reforms and budget increases for mental health care (see "Thinking Big."). Medicine kept several bad public health bills bottled up in committee. Another long-sought victory came with the passage of House Bill 62, a statewide ban on texting while driving.

The texting ban, authored by Rep. Tom Craddick (R-Midland) and supported by TMA, creates a fine of up to $99 for a first offense of texting while driving. Texas had been one of only four states without such a ban.

Bans on texting while driving have been proposed in three previous sessions. In 2011, the ban passed both houses of the legislature only to be vetoed by then-Gov. Rick Perry. In 2013 and 2015, it passed the House but died in the Senate. Representative Craddick and Sen. Judith Zaffirini (D-Laredo) have been the primary sponsors of the legislation throughout those sessions

Although Gov. Greg Abbott signed the bill into law in June, he also added a texting measure to the agenda for the mid-summer special session, saying he hopes for broader legislation that fully preempts local governments from passing "any regulation of mobile devices in vehicles."

"We don't need a patchwork quilt of regulations that dictate driving practices in Texas," Governor Abbott said.

Jason V. Terk, MD, a member of TMA's Council on Legislation, said the statewide ban is a "wonderful thing" that shows the value of persistence.

"I think it was just a typical thing that happens in the legislature, where something comes up and up and if there's enough push behind it, it will eventually pass," Dr. Terk said.

The legislature also took an important step to combat the spread of Zika, a mosquito-borne illness that can cause severe birth defects. Zika is not widespread in Texas, but it does have a toehold in many parts of the state. As of June, there were 14 confirmed cases of Zika in Texas this year, but the illness is often difficult to spot. 

Lawmakers passed House Bill 3576, sponsored by Rep. R.D. "Bobby" Guerra (D-McAllen) and supported by TMA, which provides resources to the Texas Department of State Health Services (DSHS) to track, study, and prevent the spread of Zika.

Representative Guerra, who sits on the House Committee on Public Health, said improved vigilance on Zika is badly needed, especially in his South Texas district. The Rio Grande Valley and South Florida are the two regions most likely to see Zika outbreaks, according to the National Center for Atmospheric Research.

"Mosquitos don't know borders," Representative Guerra said. "They're going to cross county lines and from Mexico into the U.S. So my concern was that with hurricane season coming up, we need to be prepared ― more proactive than being reactive."

Lawmakers also approved Senate Bill 1680, authored by Sen. Eddie Lucio, Jr, (D-Brownsville), which will establish a border task force designed to improve communications among public health officials on both sides of the U.S.-Mexico border.

Two public health measures that did pass the legislature were vetoed by Governor Abbott. One was Senate Bill 570, another TMA-backed measure designed to combat Zika. Sponsored by Sen. José R. Rodríguez (D-El Paso), SB 570 would have regulated the retention, storage, transportation, and disposal of used or scrap tires. Its goal was to eliminate breeding grounds for the mosquitos that spread Zika, chikungunya, dengue fever, and related illnesses.

Governor Abbot said in his veto message that he opposed the bill because it "criminalizes the violation of administrative rules governing the proper disposal of tires." Senator Rodríguez said a wide range of stakeholders approved the bill, from tire producers and dealers to environmental and public health groups.

"What the governor has done is put the health and safety of Texans at risk by removing a tool that would have reduced illegally dumped tires, which are breeding grounds for mosquitoes that carry Zika and other dangerous illnesses," the senator said in a press release.

Governor Abbott also vetoed Senate Bill 790, which would have continued the Women's Health Advisory Committee beyond September. Governor Abbott said the committee had fulfilled its duty. He said its job was over once women's health programs at the Health and Human Services Commission (HHSC) were consolidated last year under the Healthy Texas Women's (HTW) Program and the Family Planning Program.

"Senate Bill 790 does nothing more than extend the expiration date of a governmental committee that has already successfully completed its mission," the governor said in his veto message.

Janet Realini, MD, vice chair of the advisory committee and chair of the Texas Women's Healthcare Coalition, said the committee still had important work to do. For example, the committee recently heard important testimony on a Medicaid 1115 waiver application designed to increase federal funding for HTW. In addition, state programs have far to go to meet the needs of low-income Texas women. She said the veto sends a disheartening message given that Texas' maternal mortality rate has doubled in recent years.

"I'm very disappointed with the governor's veto," she said.

Budget Cuts and More

One of the biggest hits to public health came in the budget for DSHS. Most state agencies faced cuts in the 2017 session. Declining oil prices meant the state brought in less revenue in the past two years. Also, in 2015, lawmakers made tax cuts and dedicated funds to highways. This left much less money for other priorities, including health care, which makes up more than one-third of the total budget. 

"There's a rider to help [DSHS] minimize the impact of their budget cuts by working with the HHSC," Dr. Lakey said. "But they're still figuring out how to mitigate what amounts to a $28 million decrease in the public health budget."

Another major disappointment came in preventing tobacco use. House Bill 1908, sponsored by Rep. John Zerwas, MD (R-Richmond), would have prohibited the sale of tobacco to anyone younger than 21. Likewise, there were numerous bills designed to improve immunization rates and to combat infectious diseases. But the only one that passed ― aside from the Zika-prevention bills ― was House Bill 970, a state plan for Streptococcus pneumoniae education and prevention. Texas accounts for a large proportion of the more than 400,000 annual cases of pneumococcal disease in the United States.

Other TMA-supported measures that became law include Senate Bill 81, which renewed the Cancer Prevention and Research Institute of Texas (CPRIT) (see "Funding Cancer Research"), and House Bill 1076, which requires spinal screenings for public and private school students. 

TMA's efforts also helped prevent some potentially harmful bills from becoming law. Dr. Terk says that many of these bills disregarded established medical practice and scientific evidence. For instance, House Bill 3476 would have mandated screening electrocardiograms, or ECGs, for any student who participates in school athletics. TMA opposed the bill in part because ECGs are not reliable as a screening tool. TMA also fought hard to kill House Bill 1124, which would have made it even easier for parents to opt out of required immunizations for their children.

"I think societally we are facing an era now where science is no longer viewed as something we should all get behind," Dr. Terk said.

He says the solution is for physicians and public health advocates to remain determined. The same persistence that created the ban on texting while driving can also lead to victories in areas like maternal health and tobacco, he says. 

"Oftentimes, if you keep on talking about the same thing after two or three sessions, you might make some progress," Dr. Terk said. "So you have to be patient."

Sean Price can be reached by phone at (800) 880-1300, ext. 1392, or (512) 370-1392; by fax at (512) 370-1629; or by email.

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Last Updated On

July 25, 2017

Originally Published On

July 20, 2017