100 Days and Counting …

As I write this, we are 105 days into the 83rd Legislative Session. It is time to take stock of where we are and what we have to get done prior to Sine Die on May 28! 

Both the Senate and House have wrapped up their budget proposals with minor (and in some cases MAJOR) tweaking continuing to occur. The President of the Senate has appointed five members to the Conference Committee; they will be joined by five members from the House appointed by the Speaker to put the final touches on the budget for the next two years. 

Conference Committee Membership, 83rd Legislative Session

Senate House
Tommy Williams Jim Pitts
Chuy Hinojosa Sylvester Turner
Jane Nelson Myra Crownover
John Whitmire John Otto
Robert Duncan John Zerwas

The agreed upon budget will have to then pass both houses and go to the Governor for his signature. The Governor may veto the budget and send it back to the Legislature for more work (which almost certainly ensures a special session), he can sign the budget, or he can express his disapproval of the budget by not signing it and simply letting it become law at the will of the Legislature.

As we take stock of the progress made by the Legislature over the past several months, the Senate wins the race in that it has heard as many bills at this time during the session as it did in the entire 82nd Legislative Session. However, the House has passed out only about a third of the number of bills as it did in the prior session. The House’s deliberate pace many be a way of minimizing the debate (and controversy) of certain issues.

Specific actions of interest include the following:

  • SB 143 (Nelson), which allocates $11.5 million in the next budget for Graduate Medical Education
  • SB 329 (Huffman), which prohibits minors from using tanning beds because of the increased link to melanoma in young adults
  • SB 822 (Schwertner), which regulates companies or networks that sell, lease or share physician discounts without the physician’s consent
  • HB 63 (Craddick), which bans texting while driving a motor vehicle (Distracted driving costs the US economy $3.5 billion each month; the impact to Texas is thought to be $3.6 billion annually.)
  • HB 3791 (Zerwas), which has a hearing scheduled this week in House Appropriations; if passed it could serve as a future vehicle for Medicaid expansion in Texas (see below for more information)
  • CSHB 1025, the Supplemental Appropriations Bill, which passed out of the House Appropriations Committee this past week and is on its way to the Senate (This bill provides the requested $39 million Supplemental Appropriations Request to cover the estimated funding shortfall for correctional health services.)
  • $17 million allocated by the House to the Higher Education Coordinating Board for 2014-2015 as additional funding for GME start-up programs

Additional bills related to health care scope of practice are pending, including one which lowers the age limit to 6 for pharmacists to administer vaccinations to children. This has been opposed by the Texas Society for Pediatrics based upon presumed negative impacts on the medical home initiative and adverse impact on health and developmental screening. 

Another proposal that would expand the ability of physical therapists to see patients directly for musculoskeletal problems has met with opposition from the orthopaedic surgery and physician community. Likewise, an initiative that would affirm licensure for clinical laboratory scientists has met with opposition from organized commercial medical laboratories who cite increased personnel costs as their main objection.

Overall the issue of health profession shortages continues to gain much attention during the legislative session; however, there is yet to be an acceptable agreement on the best approach to deal with scope-of-practice and access issues.

The House Appropriations Committee met on Tuesday, April 23, and passed out Zerwas’ bill (HB 3791), which focuses on the following summary from the TMA website:

The legislation would create a ‘Texas’ solution for covering the working poor in Texas. The bill consists of four key components:

  • Structure: First choice for coverage for low-income Texans would depend on the state receiving an unrestricted block grant from the federal government to run Texas' current Medicaid program.
  • Funding streams: If the state cannot obtain a block grant, the Texas Health and Human Services Commission (HHSC) would funnel the money in concert with the Texas Department of Insurance (TDI) to purchase private health insurance policies for people under 133 percent of [federal poverty level].
  • Payment: The bill includes reforms that Texas can implement concurrently with a block grant, such as cost-sharing, which means Medicaid recipients would pay a percentage of the coinsurance and/or deductible.
  • Oversight: The bill creates a committee to oversee the implementation of the program. State leaders would appoint members of the committee.

Representative Zerwas said, "This is not expansion of Medicaid. This is creation of a new program that leverages our partnership with the private sector. This is not an entitlement program." He added, "I understand the political radioactivity surrounding this particular bill. This would have a profound impact around the provision of care … and ultimately see a benefit to the taxpayers."

House Appropriations also moved Texas’ water issues a step closer to a House vote by proposing that $2 billion from the Rainy Day Fund (HB 11) be used to address the state’s water shortage.

Both House and Senate Conference Committee members have started their work on crafting a budget for the state. This is the time that meetings start early in the day and go far into the night. It is also the time that lobbyists and citizens start vocalizing their personal support for issues in that budget.

And in an unexpected twist to an otherwise quiet legislative session, the House voted to NOT extend the Lottery Commission at the time of this blog’s writing. That means there is suddenly a $2.2 billion gap in the revenue projections for the budget (including the potential for UTMB to lose more than $10 million in dedicated indigent care funding for the 2014-2015 biennium). This new development adds quite a challenge for the Legislature as members work to reach agreement on budget.


ADDENDUM:  After realizing the adverse impact on their budget, the House revisited their earlier decision in the afternoon to sunset the Lottery Commission and reversed itself to extend the Commission, thus avoiding a derailment of their budget work over the past 105 days.

It’s not over until it’s over, so as always, stay tuned for updates.


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