Reality Check

I've written a lot about the state legislative budget process and its impact on UTMB over the past couple of months. Looking beyond our own focused interests, the Legislature is also dealing with a wide array of other issues that will certainly impact every Texan. There is much that bears watching as the session reaches its final days.


The Legislature has debated just about everything imaginable — from ultrasounds prior to elective abortions to "puppy mills" to raising the speed limit to 85 MPH to texting on your cell phone while driving. Guns-on-campus has been a very controversial piece of legislation that is currently blocked in the Senate because it lacks the necessary vote to be heard. But the Capitol has seen no shortage of gun enthusiasts calling on legislators to advocate for their right to carry on campus.  


We Texans are notorious for the preservation of our independence. So the Legislature most often reflects the mood and character of its people. If people want to drive 85 miles an hour, have a mini-armory at their side, text on the phone, chew, smoke or drink a sugar-laden soda on their way to a "puppy mill," these are matters the Legislature must consider, and the outcome may just reflect the will of the people.


Democracy is like that.


I "predicted" some things that would occupy legislators’ time as they went into this session, and I was right about some of them.


The budget process is far from being over and it has occupied more meeting time and involved more work than one can imagine. Countless hours of committee meetings, number crunching by the Legislative Budget Board, subcommittee activity, compromise and some complaints have kept members so busy that one wonders how they get anything done on all the other topics they must consider — but they do. They legislate and they appropriate.


Issues related to voter identification have certainly been dealt with quickly. New regulations will require voters to show photo IDs in order to vote. A driver’s license or other valid ID, such as a passport, will be required. Proponents cited the fact that photo IDs are required for all sorts of activities and that the same should be true for voting. Opponents point out that not everyone has a driver’s license and that procurement of a valid Texas license is difficult for some people in remote areas.


The requirement for women seeking an abortion to have an ultrasound done, view the ultrasound and wait for 24 hours prior to making a final decision about the procedure  passed the Senate in spite of vigorous opposition by a wide array of interest groups.


A bill to permit local police to establish legal immigration status during any routine contact with a person also passed, as did a request to the federal government requiring them to add a balanced budget amendment to the Constitution.


With large budget cuts looming over this 82nd Legislative session, the potential changes regarding higher education are numerous. . Texas grants providing financial aid to students were reduced significantly. As one legislator noted, this increases the financial burden on students and their families as they seek to obtain an education, with greater impact on the more economically challenged. At the same time almost every college and university across the state has announced tuition increases to compensate in part for the loss of funding from state general revenue.


Redistricting is just now taking center stage in the House of Representatives. The Texas House of Representatives Redistricting Map was released for public view today. As expected, the map was met with immediate opposition from several groups worried about sufficient representation under the proposed districts. This rings especially true for Hispanic voters. There is no doubt that redistricting will be a source for major discussion and political compromise over the next few weeks. 


Gaming (gambling) proponents continue a wait-and-see vigil. There are only one or two bills on file and there has been no strong push to advance these bills toward full discussion on the floor of either chamber. With the deficit so large, it is easy to imagine that the Legislature would jump to gaming as a potential solution. But, the magnitude of the deficit is so great that the contribution gaming revenue would make to the budget is considered small. Nevertheless, one can continue to speculate that it will surface as a $1 billion solution in the next few weeks, and even as I write this, a bill is emerging that would place casinos in five major Texas cities and two coastal communities.


Although border security has been discussed, there has been no major new proposal on this topic. This is likely because anything that the state would do in that arena would take money, and dollars are woefully absent in this session.


Public school funding has clearly been the center of attention for discussion in both the House and the Senate. The original budgets proposed by both chambers could have resulted in a reduction in force of more than 300,000 teachers. This in turn would require teachers to have more students in their classrooms. The backlash from school boards, superintendents and teachers has been a voice that Austin legislators could not ignore. Newly found funds have been quickly diverted to public education as a first priority.


Medicaid and other programs in Health and Human Services continue to face approximately 10 percent reductions across the state with no new funding designated for increased enrollment or expansion of services in these programs. In fact, the programs are being transitioned to "managed" programs or HMO-like programs in an effort to further reduce related costs. The impact to the state's hospitals and healthcare workforce is obvious. Many physicians have already begun to exit the Medicaid program because of its insufficient reimbursement for services. Senate bills 7 and 8 by Sen. Nelson and supported by Lt. Gov. Dewhurst codify many of these changes and incentivize quality, prevention and patient education as ways to curb costs.


Something missing from the forefront of debate has been health education, health reform, scope of practice and mental health services. Loan repayment programs for health professionals have been stymied. The broadening of scope of practice for advanced practice nurses and physician assistants has not received a lot of attention. The Texas Medical Association (TMA) has lobbied against increased scope, citing the shortage of nurses in the state and the need for more front-line practicing nurses in hospitals. Meanwhile the Texas Nurses Association points to the huge shortage of primary care providers in the state and notes that advanced practice nurses could help address access to care issues. 


What to do about addressing the need for increased graduate medical education slots in Texas to keep our medical graduates in-state has received little attention. This is likely because it requires funding. 


The House budget and the Senate budget diverge in scope. The House's proposal for public schools, higher education, and health and human services is quite austere. The Senate's version of the budget is more generous but still quite lean when compared to prior budgets.


The House seeks to use $3.1 billion from the Rainy Day Fund (RDF) to pay off last year’s deficits. The Senate seeks an additional $3 billion from the Rainy Day Fund to support FY12-13 programs. Even though that takes $6 billion from the sustainability fund, it also leaves $3 billion for later use. With the price of fuel going up almost daily, some pundits predict the RDF will replenish that $6 billion by the next legislative session because it is funded, in part, by fuel taxes. One can be sure that the debate on using RDF funds will be long and loud. And, some predict that budget debate will spill over into a mid-summer special session, along with redistricting. 


The deadline for bills to move out of committee hearings, through calendars committee and on to the House or Senate floor for action is fast approaching. Less than 35 days remain in this 82nd session of the Texas Legislature. Watch the action carefully because this is when it really gets crazy!

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