The 82nd Legislative Session has been quite a roller coaster ride — and it’s not over yet, with a special session starting today because the major fiscal matters bill needed to fund the budget died in a Senate filibuster Sunday night.
By law, the special session can last 30 days; the Governor will determine what is “on the call” (i.e., what the Legislature is allowed to address). Some have lasted the full 30 days; others have finished in a few days, depending on the complexity of the issues in the call. As of today, two large items are on the call: fiscal matters needed to implement the appropriations bill, including school finance reform; and health care cost containment, managed care, and Medicaid structural and economic incentives.
But for now, here’s an update on where things stand as the regular session ended. .
It seems like a century ago when Dr. Callender provided testimony before both the House and the Senate budget committees regarding UTMB’s remarkable resiliency and recovery from Hurricane Ike. Callender described a rapidly recovering campus, growing student enrollment and expanding clinical services, including recertification of the university’s Level 1 Trauma Center. He laid out the potential for an exciting future for the campus that many had previously thought should be moved, closed or otherwise diminished. He confirmed that the 120-year-old battle cry, “The University of Texas Stops for No Storm!” is still relevant.
And there have been plenty of storms in the 82nd Regular Legislative Session. From initial budget bills cutting UTMB funding by as much as 25%, to an audit critical of UTMB’s CMC division released in the first days of the session, to months of heated legislative debate on difficult health care issues with potentially profound impacts on patients and providers, to final hours when major revenue bills died and a special session loomed, the session was anything but smooth sailing.
UTMB’s requests during the legislative session were modest compared to the requests of many others. The list was simple:
- Fund the Tuition Revenue Bond for construction of the Jennie Sealy Replacement Hospital that was approved in the 81st Session ($11 million)
- Permit UTMB to have continued access to the monies appropriated in the 81st Session for use related to Ike recovery and the FEMA match
- Treat our hospital’s base appropriation reductions in a manner comparable to other health-related institutions with hospitals, and
- Restructure the correctional health care contract to permit UTMB to contract directly with TDCJ, and provide a supplemental appropriation for UTMB’s CMC-related losses from FY10-11.
Achieving any of these objectives was a serious challenge given the guidelines under which the legislators were working: (1) no new taxes, (2) limited use of the Rainy Day Fund, (3) a conservative revenue estimate, and (4) a promise of “limited government/smaller government.”
The Legislature also found itself with new political forces in play. Many political pundits had predicted that the new “Tea Party” movement would have an impact on the 82nd Session, but most failed to predict just how powerful an influence this block of new legislators would have on the Legislature’s budget and policy agenda.
The appropriations process took many twists and turns, involving complicated interactions between several bills to produce savings, reform school finance and create revenue to fund the appropriations bills. The final result is a state budget that is about $15 billion less than the previous biennium, with only about 18 months of the next two years’ Medicaid being funded and public schools being $4 billion down from what the formulas would require for projected enrollment. The Legislature openly acknowledged that it will have to fill in the FY13 Medicaid shortfall next session. All state agencies, higher education institutions and public schools took reductions.
Final appropriations for UTMB are much better than they could have been, given the circumstances. In the end, UTMB’s overall GR appropriation is a total of about $472M for next biennium, which includes $11 million for the proposed replacement hospital TRB debt service. UTMB’s hospital appropriation level was a major issue in the negotiations leading to the final total; thankfully the hospital reduction in the end was less than 15%, after being more than 25% for several months of negotiations on the bill.
In addition, UTMB’s Ike recovery funding from last session was carried forward for two more years, a critical help to UTMB due to the fact that some FEMA approvals are finalizing much later than expected. Although this funding had been appropriated last session, it was still a major step for the Legislature to give us access for two more years; they could have swept any unencumbered funds and used them for a host of other state budget needs. Even though that action would seem unlikely given the more than $1 billion in FEMA dollars these funds draw, there were several times during the negotiations when it appeared likely that UTMB would lose access to a portion of the appropriated funds. Thankfully, the Legislature’s final decision gives us full access through the coming biennium; we can continue with our Ike recovery as planned. This result was nothing short of miraculous work on the part of the Senate and House leadership and their staff.
Financial issues and contracting issues surrounding the correctional health care contract have long been a source of concern for UTMB. Prior arrangements have resulted in all budget shortfalls being borne by UTMB until such time that the Legislature could meet and provide a supplemental appropriation to cover the amount of money UTMB had spent on offender health care. After much discussion with key leadership in the executive branch and both houses, changes to the correctional health care program will now place the financial responsibility for the program’s funding in the TDCJ budget. UTMB (and Texas Tech) will become vendors for health care services through a direct contract with TDCJ. The role of the correctional managed health care committee will be determined by TDCJ and will focus on dispute resolution, standards of care and review.
In addition to the budgetary issues related to UTMB’s future, many other issues affect our ongoing delivery of health care services. Funding for indigent care, trauma, diabetes and family planning were among the many reductions, along with reductions in Medicaid programs and rates. Higher Education Coordinating Board programs for graduate medical education and student loans were reduced. All of these affect UTMB and our fellow academic health centers.
In other areas of interest, there were no major scope of practice changes in the health care arena, except for an amendment that requires insurance companies to accept bills from chiropractors. There was no increase in scope of practice specifically for nursing or any of the allied health fields. Students were big losers in the state budget, with large reductions in student loan programs such as Texas Grants. Major reductions in funding were also seen in the women’s health care arena, especially for family planning programs.
As House Bill 1 finally left the Senate, the vote was 20-11. As House Bill 1 finally left the House, the vote was 97-53
Remember, it’s still not over. The budget bills and major policy bills are on their way to the Governor, and he has until June 19th for vetoes. And with the special session (possibly the first of several) starting today, anything can happen.
As usual, stay tuned for the “rest of the story!”