Building on Success

TMA's 2017 Legislative Agenda Aims to Build on Past Achievements

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Cover Story — January 2017

By Amy Lynn Sorrel 

From maintaining physicians' right to bill for their services and cracking down on narrow health insurance networks, to cutting more Medicaid red tape and making more room for doctors-in-training, the Texas Medical Association's 2017 legislative agenda aims to build on past achievements. A tough budget year and wholesale review of the state's health professions licensing boards could generate some challenges, while the presidential election results should renew conversations over reforming Medicaid and health care delivery overall. 

As with every legislative session, the 2017 session will come with its own unique challenges. Undaunted, TMA is poised to build on significant successes medicine constructed over the past two legislative sessions. 

A sluggish economy and dismal budget outlook will bring some belt tightening that could generate headwinds when advocating new money for Medicaid, graduate medical education (GME), public health, or other projects. But with a presidential election that promises to unhinge the Affordable Care Act, state-level discussions of health care reform — including redesigning Medicaid coverage and benefits — could catch a tailwind in a Republican-dominated Texas Legislature. 

As always, TMA will defend the patient-physician relationship against a backdrop of some potentially big shifts for Texas, such as a major review of the state's health professions licensing boards. And as always, TMA got to work early to lay the groundwork, starting with a successful state election process that yielded two new physician legislators, and coalitions and task forces to study issues new and old likely to surface across the board. These include inadequate health insurance networks, maintenance of certification, a Medicaid vendor drug program overhaul, GME, telemedicine, and palliative care.

Amid those debates, TMA will remain steadfast in "maintaining legislation that protects patients and allows them access to quality health care. No matter what comes up this session, our patients will always come first," said TMA Council on Legislation Chair Ray Callas, MD. 

The Beaumont anesthesiologist stressed the importance of physicians building relationships with their local lawmakers who can give wings to TMA's message. "As medicine continues to evolve, lawmakers need that physician expertise to make laws or recommend regulatory changes, and we want to be a resource and be involved as we all continue to mold and promote the delivery of health care in the state of Texas."

As part of that effort, the Council on Legislation and TMA Board of Trustees have authorized an extensive public relations and advertising campaign to promote TMA's image and the important roles physicians play in the lives of all Texans. 

"We're also proud to have seven physicians in the House and Senate to help represent medicine," Dr. Callas added.

One big reason the Family of Medicine candidates did so well, he adds, was support from the House of Medicine itself through the TMA Political Action Committee (TEXPAC). "Whenever I think of TMA, I think of TEXPAC. Whenever I think of TEXPAC, I think of commitment. And whenever I think of commitment, I think of our patients." (See "TEXPAC Gets Results.")

Among other successful candidates, TEXPAC supported Texas' two newest physician legislators, Rep. Thomas J. Oliverson, MD (R-Cypress), and Sen. Dawn Buckingham, MD (R-Austin), former TMA Council on Legislation chair. The anesthesiologist and ophthalmologist, respectively, both called it significant and timely to represent physicians' voice in the legislature. 

"When you have an industry as complex and highly regulated as health care, you really do need people who've walked those halls and done those jobs and have certain expertise to say, ‘Maybe there is a better way,'" Representative-Elect Oliverson said. "When we start talking about reforming Medicaid, sunset review of the health profession boards, things like out-of-network billing and insurance issues, if you are not from that walk of life, it's hard to anticipate the unintended consequences that might arrive as a result of good intentions."  

Particularly in a time of turnover at the federal level and another round of potentially major change in health care, Senator-Elect Buckingham says, "physicians are in a unique position to step up and lead. We need to be bringing our ideas to the table about how to better deliver health care in the state under the new climate. This [the election] completely changes the conversation at the state level." 

TMA physicians and staff wasted no time seizing the opportunity and planning a post-election strategy. (See "TMA Plans Post-Election Strategy for Health System Reform.") TMA Vice President for Advocacy Darren Whitehurst says association leaders and staff also continue to build relationships with new state leaders at the Texas Health and Human Services Commission (HHSC), the Texas Department of State Health Services (DSHS), the Texas Department of Insurance (TDI), and, soon, the Texas Medical Board (TMB), to name a few.

Budget Busters

A dip in oil and gas prices dropped state revenues below expectations, and health care needs will compete with other significant budget drivers this year, including demands for more spending on public education and child protective services, Mr. Whitehurst says. The biennial ritual of underfunding Medicaid caseload growth likely will affect other available money, too, with the state facing a $1.3 billion shortfall this session.

Legislative Budget Board Director Ursula Parks adds 2015 tax relief measures took an "immediate hit" on state revenues, and lawmakers' interest in continuing those efforts could create an additional draw.

The Senate's top budget writer, Finance Committee Chair Sen. Jane Nelson (R-Flower Mound), plans to keep the rainy day fund at arm's length. "We are preparing for a tight budget session, but I am confident we will meet our needs." The Economic Stabilization Fund, she says, "should be reserved for true emergencies and, when accessed, used for infrastructure, debt service, or one-time expenditures."

Texas could end up with roughly $4 billion in reserves leftover from last session — about half of the surplus in 2015 — plus a $10 billion rainy day fund. It is unlikely the state will face a deficit, but if much of the $4 billion surplus is used to cover shortfalls in the current year's budget like Medicaid's, funding existing services at current levels could prove difficult, says TMA Associate Director of Legislative Affairs Michelle Romero

Anticipating a slow economy, state agencies already were instructed to include a 4-percent across-the-board reduction in their 2018–19 appropriation requests, and some programs could be cut up to 10 percent. For HHSC, which oversees Medicaid, that includes a payment cut for some health professionals. Physicians were not among them, but that does not mean they are exempt from future threats, Ms. Romero says. 

It does mean it will be harder to get a payment boost, Mr. Whitehurst warns, although TMA continues to advocate restoration of the 2013–14 bump that raised Medicaid primary care payments to Medicare rates, per ACA. 

Meanwhile, cuts to other professionals also take a toll on physicians' ability to refer patients for critical care, says Jason V. Terk, MD, a member of TMA's Council on Legislation and past president of the Texas Pediatric Society. The Keller pediatrician often has to refer babies and toddlers with developmental delays or a history of premature birth for early childhood interventions like physical, occupational, and speech therapy — payments for which the legislature drastically cut last session. 

Medicaid Reform 2.0? 

Nor are lawmakers expected to budge in their rejection of any expansion of Medicaid as defined by ACA, which Senator Nelson called a "nonstarter. But we are constantly looking for ways to improve Medicaid and deliver services as efficiently as possible." 

Senate Health and Human Services Committee Chair Sen. Charles Schwertner, MD (R-Georgetown), is optimistic the presidential election opens the door for renewed conversations with the federal government and novel ideas for not just Medicaid reform but overall health insurance and health system reform. 

"Medicaid is the biggest piece of our budget now, and conservative leaders like myself have been arguing we need flexibility to design a safety net system that is sustainable from a taxpayer's standpoint and correct for the citizens of Texas," he said. Concurrently, rising premiums and narrowing networks in the commercial markets are bearing down on patients, "so we need to think bigger. We're talking about wholesale health care system reform. I am really excited we have an administration and federal partners who might move us forward."

For Medicaid, Senator Schwertner says that could include a block grant or more global waiver than the current 1115 Medicaid waiver — still up for renewal — that allowed Texas to test new care delivery approaches for poor, low-income, and uninsured patients with limited federal financing. He also envisions "wholesale reform that properly pays providers," while at the same time, redesigning the scope of benefits.

His committee, he anticipates, will be busy, too, with reforming the Department of Family and Protective Services and nursing home regulations, and tackling the opioid epidemic. Members also must ensure the state does not "drop the ball" finalizing the move to Medicaid managed care and the consolidation of certain health agencies following last session's sunset review, he says.

Representative Oliverson is equally optimistic that turnover at the federal level could "give states freedom and flexibility to care for patients who need help and finally create a system that works in your own state." 

In the meantime, TMA continues to take up the torch in its vigorous fight to relieve physicians of bureaucratic burdens as another avenue to increase physician participation and access to care in Medicaid. Since last session, TMA's Select Committee on Medicaid, CHIP and the Uninsured continues to work closely with HHSC and managed care plans to improve and innovate within the program, a welcome partnership says committee chair and San Antonio pulmonologist John R. Holcomb, MD.

Any kind of streamlining that decreases physicians' cost of providing needed health care and increases quality, he says, is significant progress, especially after the 2015 Texas Legislature nixed a plan to raise Medicaid primary care payments to Medicare parity. 

Well on the way to achieving a major milestone, TMA will continue to push for support for the creation of a centralized credentialing platform among Medicaid HMOs. The idea was spurred on by Medicaid reform legislation TMA backed in 2013 and carried out in another package of medicine-friendly Medicaid bills won in 2015.

"We tried this 18 years ago, and nothing happened. This is significant," Dr. Holcomb said.

Waco ear, nose, and throat specialist and TEXPAC Board Chair Bradford W. Holland, MD, cheered the collaboration, calling credentialing one of the "major hassles" physicians deal with in Medicaid. "One of the best and easiest things we can do is a universal application for all HMOs." 

Physicians and health plans hope to continue their collaborative efforts this session in revamping the Medicaid Vendor Drug Program (VDP), a complex program that has become unnecessarily unwieldy for physicians and patients to manage. A major shift may lie ahead as lawmakers consider turning the program over entirely to Medicaid HMO plans that, equally frustrated, say they can do a better job managing it and negotiating lower drug costs. (See "Drug Debacle," July 2016 Texas Medicine.)  

The House Human Services Committee began reviewing VDP as part of its interim charge to assess the overall shift to Medicaid managed care and find ways to ramp up Medicaid participation. Only 37 percent of Texas physicians accept all new Medicaid managed care patients, according to TMA data.  

Confusion over the drug benefit stems largely from the fact that program administration is split between the state and the roughly 20 contracted Medicaid HMOs. Unless the legislature acts, regulations restricting health plans from fully taking over the drug benefit from the state expire Aug. 31, 2018.

TMA leaders say whoever runs the program must make it more straightforward and user-friendly for physicians and patients.

Tackling Insurer Tactics

TMA also continues to target any obstacles that chill physicians' ability to put their patients first and care for them efficiently, effectively, and safely, whether they be insurance plan tactics, scope-of-practice expansions, or regulatory encroachments. 

A possible ban on balance billing is expected to resurface again and capture lawmakers' attention. It's part of a national trend as insurers' shrinking networks and caps on payments for medical care bear down on patients in the form of so-called "surprise" out-of-network bills. (See "No More Surprises," May 2016 Texas Medicine.) 

In Texas, renewed attention stems in part from interim charges state leaders issued to the House Insurance and Senate Business and Commerce committees to examine whether existing laws dating back to 2007 are working to encourage transparency and adequacy of health plan networks and "protect consumers from the negative impacts of disputes over out-of-network services." The issue is in the national spotlight with the proliferation of high-deductible and narrow-network plans sold in the ACA insurance marketplace contributing to rising out-of-pocket costs for patients.

TMA leaders say simply restricting doctors' billing practices does little to solve the root cause of surprise bills. After winning several health plan accountability measures in 2015, TMA will continue to crack down on narrow networks while carefully guarding physicians' right to bill for services they legitimately provide.

Dr. Callas says doctors need to be able to negotiate fair payment with insurers to keep their doors open. "If you take away that leverage, physicians as a whole are very nervous about how that would hurt access to patient care." 

After studying the issue in-depth, TMA's Balance Billing Task Force came up with a host of recommendations that start with building on compromise legislation TMA won in 2015 (Sen. Kelly Hancock's Senate Bill 481), making the state mediation process for out-of-network services more accessible to patients. 

Dr. Callas, a task force member, testified before the Senate committee on TMA's recommendations, which include tougher state regulation of network adequacy and expanding the mediation process to include all out-of-network physicians, other health care professionals, facilities, and vendors. Other recommendations ensure health plans, brokers, and agents, as well as physicians, all are involved in educating patients on their coverage and care options and empowering them to make informed decisions.

"Lawmakers want physicians to be part of the solution. And, yes, physicians play a role. But all entities taking care of the patient need to be accountable," Dr. Callas said. 

Some lawmakers are receptive to the message. 

Senator Schwertner plans to continue the work he started last session, having championed legislation beefing up Medicaid HMO network adequacy under Senate Bill 760. TMA is actively involved as regulations are drafted.

"Unfortunately, TDI is not doing its job in the regulation and oversight of our managed care organizations [MCOs], in particular regarding network adequacy and making sure they have robust networks of providers when they say they do," he said. "And it's not just Medicaid MCOs. It's all MCOs. It's a problem people are facing with employer-sponsored insurance and in the individual market where Obamacare networks are notoriously narrow."

TMA lobbyist Clayton Stewart says the association is actively monitoring and commenting on TDI's update to state network adequacy rules on HMOs — the first review in 10 years. "So far, neither medicine nor the health plans like the rules, so legislation is expected," he said.

Pointing to ongoing inaccuracies in health plan network directories, physicians are looking to shorten the window of time insurers have to make corrections. TMA won transparency measures last session requiring insurers to publicly post the information. 

TMA also wants to make sure entities like public and private insurers, hospitals, and employers don't require maintenance of certification as a condition for things like payment, licensure, employment, and hospital staff membership. Physician pushback against what is supposed to be voluntary continuing education has sparked legislative action banning such mandates in a number of states, most notably Oklahoma, and TMA is following suit. (See "MOC Revolution," September 2016 Texas Medicine.)

Boosting Behavioral Health, Women's Health, GME

Lawmakers also say they share TMA's goals to build on the progress made over the last two sessions to boost behavioral health, women's health, and GME. But TMA officials warn there is still plenty of work ahead. 

Another budget fight could be for additional public health funding for TMA's priorities as a member of the Texas Public Health Coalition and a possible new line item for Zika preparedness. (See "Health Matters in Texas.")

TMA Associate Director of Public Affairs Troy Alexander says the association is working closely with DSHS on Zika. TMA hosted a successful tele-town hall meeting to get the most timely and critical information out to physicians across the state. Ensuring strong health department response with adequate clinical personnel could pose budget questions, and legislation may be required for the state to collect more data on Zika, among other infectious diseases. 

As the state addresses the foster care child crisis, TMA will work with pediatricians to ensure every foster child is seen by a physician within 72 hours of removal and the criticized "medical passport" for foster child medical records is reformed and replaced. 

Senator Nelson says public health is "always critically important" and the state "will continue to work with our federal partners to ensure we are prepared for the Zika threat." 

And after increasing the behavioral health budget by more than $500 million over the past two legislative sessions, she is "confident we will maintain that commitment." 

Representative Oliverson also called behavioral health "a huge priority. We really have to do a better job." Investments in behavioral health could yield significant savings on the criminal justice side, for instance, because law enforcement is often the first line of defense for what he says is a health care access issue. 

Parolees, for example, typically get only a 10-day supply of medication. But having worked in the local mental health authority system, "I know it takes more than 10 days to get an appointment [with a behavioral health professional]. So there are some pretty easy fixes we could make and be smarter and save money by making [behavioral health care] more accessible," he said. 

With women's health funding at an all-time high, and a tripling of the network of physicians and other health professionals under the new Healthy Texas Women program (HTW), Senator Nelson adds, "women's health needs to remain a priority."

Physicians question the accuracy and adequacy of the HTW network rolls as the state still works to reconstruct the program in the wake of major change. The state drastically cut women's health programs in 2011 after parting with federal support over abortion disagreements, and it is still undergoing a wholesale reorganization following a sunset review of all state health agencies in 2015. HTW is the result of a consolidation and revamping of HHSC's former Texas Women's Health Program and DSHS' Expanded Primary Health Care Program.

There are 1.8 million low-income women of reproductive age who need preventive care like disease screenings and family planning services, "and we [Texas] are serving fewer than 25 percent," said San Antonio family physician Janet Realini, MD. She is vice chair of HHSC's Women's Health Advisory Committee and a consultant to TMA's Committee on Maternal and Perinatal Health. She also chairs the Texas Women's Healthcare Coalition, a statewide consortium of health care organizations and physician practices advocating access to preventive women's health services. TMA is a member. 

And what physicians describe as a dreadful maternal mortality report translates to "a need for better coverage," Dr. Realini said.

Without an option to improve Medicaid coverage and with no guarantee of extra money under the 1115 waiver, considered a stopgap by many, "our safety net is in mortal danger," said Barry S. Lachman, MD, a member of TMA's Medicaid committee and medical director of the Parkland Community Health Plan.

The potential undoing of TMA's landmark victories over the past couple of sessions securing fairer Medicaid fraud rules is just another example of the kind of issues that go into physicians' consideration of whether to participate in programs like HTW and Medicaid, Ms. Romero says. As the state seeks to broaden fraud definitions as a means to recover more cost savings, "that is definitely something we'll be playing defense on," she said.

Texas still needs more doctors to keep up with rapid growth of the population and medical schools. Texas has roughly a dozen new campuses on tap. 

Last session, the TMA-backed Senate Bill 18, championed by Senator Nelson, channeled $53 million to GME expansions — more than triple 2013 funding — helping to fund the creation of more than 700 residency slots from 2014 to 2017. A new $300 million GME "permanent fund" established under the law also was part of the state's answer to continuing expansion and addressing the mismatch between the legislature's two-year funding cycle and residency training that takes many years. (See "GME Milestone," August 2016 Texas Medicine.)  

Collin Juergens, MD, says given Texas' constitutional mandate to budget only on a biennial basis, it's a constant battle "to approach the legislature for funding for GME programs five to 10 years down the line." He is a first-year ear, nose, and throat resident at Baylor Scott & White Health in Temple and a member of TMA's Resident and Fellow Section Executive Council.

The Texas Higher Education Coordinating Board's 2018–19 request for $83 million would continue support for the slots created from 2014 to 2017, "but pretty much says expansion stops," Ms. Romero said. Programs would need a total of $115 million to continue GME expansion efforts at the current rate. 

Senator Nelson anticipates using interest from the permanent fund to continue the expansions and to supplement, rather than supplant, the state's GME investments with an expected $21 million available for 2018–19. She acknowledges the interest income "is not enough to fully support GME. But it proves the state has a permanent commitment to the future of GME. We need qualified physicians to treat our growing population." 

That's why TMA's Council on Medical Education started a Workgroup on Sources of GME Funding dedicated to identifying additional long-term future money streams, says council Chair Steven R. Hays, MD, who practices nephrology in Dallas as part of the Baylor Scott & White Health Quality Alliance. To start, the workgroup is drawing on other states' experiences in their quests for sustainable GME funding. 

As hospitals commit to partner with academic institutions to support new residency programs, current funding levels aren't enough to keep up with the teeming pipeline of new medical graduates, adds Jim Donovan, MD. "If we don't continue to fund those positions, the next time we [approach] that hospital [to sponsor a residency], it's going to have a tremendous chilling effect," said the vice dean and assistant professor of family medicine at Texas A&M Health Science Center College of Medicine in Round Rock.

Staying Vigilant at Sunset

Too, TMA will remain on guard during sunset review of the state's health professions licensing boards, including TMB, which could open up infringements on the practice of medicine and board autonomy and threaten inconvenient mandates for physician practices. 

Among the usual flurry of scope-of-practice expansions medicine faces each session, TMA has a careful eye on certain health professions looking to the sunset and legislative processes to skirt court battles challenging their ability to practice beyond the limits of their education and training. Dentists and chiropractors, for instance, have sought to expand into sleep medicine and eye and ear testing, respectively. 

Meanwhile, all licensing boards, says TMA Director of Legislative Affairs Dan Finch, could be subject to more state scrutiny as to how professions regulate themselves. This follows a U.S. Supreme Court ruling, siding with the Federal Trade Commission, that professional boards are not immune from antitrust laws. 

As far as TMB is concerned, TMA will work to increase the board's resources to match any new responsibilities that come out of the sunset process, and protect physicians' due process rights throughout the disciplinary process, a continual issue. (See "On Trial," November 2016 Texas Medicine.) 

Now that lawmakers moved the state prescription drug monitoring program (PDMP) from the Texas Department of Public Safety to the Texas Board of Pharmacy — a project TMA spent three sessions advocating — TMA is involved in some functional changes ahead to make sure the new system makes administrative sense for practices, Mr. Finch adds.

"We moved the program to a new agency with clinical expertise, and that was a success. But we still need more timely, accurate data," he said, adding that the boards and law enforcement can look at information on controlled substances across the board, but physicians, pharmacists, patients, and others can see only their own activity. "The goal long-term is to turn this into a good clinical tool."

Moreover, ongoing efforts by the legislature to address opioid overuse, misuse, and abuse could yield onerous mandates for physicians and any other health professionals with delegated prescribing authority, as well as pharmacists. One mandate in particular could require prescribers to check the PDMP before issuing or filling any prescription for a controlled substance. 

TMA is advocating to "let the technology do the work," Mr. Finch says, and have the PDMP proactively push out notifications to physicians and other prescribers of suspicious activity, such as doctor shopping. Another proposed improvement would require licensing boards for all prescribers to furnish licensee information to the Board of Pharmacy to automatically enroll practitioners in the PDMP.

Houston plastic surgeon Russell W.H. Kridel, MD, adds that the legislature should be guided by evidence in its decisionmaking. The past Harris County Medical Society president is a consultant to TMA's Council on Legislation.

He points to several positive national indicators of physician activity that show an overall uptick in naloxone access and the number of physicians trained and educated in narcotics use, and a concurrent decrease in opioid-related deaths. "If we get to a point where pharmacists and physicians are communicating more closely, [the PDMP] could be a very valuable tool." 

Senator Schwertner says he will be looking for a reasonable balance "in how we go about trying to address the [opioid epidemic] issue without being overly restrictive to providers." But when it comes to board oversight overall, "I always worry about boards that are overstepping their statutory authority" and deviating from what he called their "core responsibilities to those receiving medical services and proper regulation and oversight of those providing the services. All boards I look at in that light." 

Telemedicine, End-of-Life Issues Resurface

Unregulated, phone-only generated prescriptions, meanwhile, put telemedicine in the spotlight in Texas, as well as nationally. The issue is expected to heat up again this session after a federal judge sided with the national telephonic health company Teladoc and blocked TMB's recently adopted telemedicine rules prohibiting controlled substance prescriptions without a "defined patient-physician relationship." The rule was supposed to take effect in June.

Telephonic medicine and telemedicine are not the same, Dr. Callas says. "Just because people can swipe a credit card and get a prescription, that's not delivering health care. That's monetary gain." 

TMA is working with a coalition that includes the Texas Academy of Family Physicians, the Texas E-Health Alliance, and a host of other interested parties to define telemedicine practices that meet the standard of care and promote access to care, the centerpiece of which is establishing a legitimate patient-physician relationship, Dr. Callas says. The group is looking at viable models in other states, such as Indiana. TMA also wants to ensure appropriate payment to all physicians providing telehealth services.

Just like any area of the practice of medicine, Mr. Finch adds, the key to a successful telemedicine model "is adhering to the standard of care. That can't be done by phone only, but there is a middle ground. And that requires physicians to have access to clinically relevant information to make a diagnosis."

Medicine continues its collaborative approach in preparation for the end-of-life care debates that tend to surface each session. TMA is watchful of efforts that could tie physicians' hands in writing do-not-resuscitate orders in emergency situations, as well as other measures that confuse the proper use of medical powers of attorney. "Ultimately, physician ethics seek to honor the preferences of the patient or his or her loved one," Dr. Callas said. 

Physicians got to work early, participating in a TMA-supported statewide interdisciplinary palliative care advisory committee established last session by Rep. John Zerwas, MD (R-Richmond), under House Bill 1874. The group has been studying ways to increase awareness of and improve access to end-of-life care and promote such conversations among doctors and patients as a routine part of care. (See "Medicare Pays for End-of-Life Consults," June 2016 Texas Medicine.

Collaboration and coalition-building have proven to be key pillars in TMA's history of legislative success, Dr. Callas notes. "We are meeting with stakeholders and coming up with collaborations so medicine is coming to the table with strong solutions." 

Amy Lynn Sorrel is former associate editor of Texas Medicine.


TMA Plans Post-Election Strategy for Health System Reform 

TMA officials say the 2016 elections put physicians in the Lone Star State in a prime position to help rebuild the state's Medicaid system. 

Both President-Elect Donald Trump's "Great Again" health care platform and the health care agenda in House Speaker Paul Ryan's "Better Way" plan call for Medicaid changes that mirror the "Texas Solution" for expanded coverage that TMA has promoted since 2013. The Texas Solution calls for a comprehensive plan that:   

  • Improves patient care;
  • Draws down all available federal dollars to expand access to health care for poor Texans;
  • Gives Texas the flexibility to change the plan as our needs and circumstances change;
  • Clears away Medicaid's financial, administrative, and regulatory hurdles that are driving up costs and driving Texas physicians away from the program;
  • Relieves local Texas taxpayers and Texans with insurance from the unfair and unnecessary burden of paying the entire cost of caring for their uninsured neighbors; and
  • Pays physicians for Medicaid services at a rate at least equal to Medicare payments.

 "We are entering into a new time," said U.S. Rep. Michael Burgess, MD (R-Lewisville), likely a key player in the health care debate in the next Congress. "I would love it if the governors came to Washington and said, 'OK, guys, you deliver the mail and secure the border, we'll take care of our sick folks.' That would be a far, far more reasonable way to approach it."  

As of this article's writing, TMA staff were preparing a white paper on "Post-Election Strategies for Health System Reform" for discussion at the TMA Advocacy Retreat Dec. 2–3 in Austin.. 

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Health Matters in Texas

The Texas Public Health Coalition, of which TMA is a charter member, works to reduce preventable disease through policies that promote a safe and healthy environment and healthy behaviors for all Texans. Among the coalition's priorities for the 2017 legislative session:  

  • Ensure all state buildings, facilities, and higher education campuses are tobacco-free.
  • Raise the minimum age for purchase of tobacco from 18 to 21 years to align with alcohol regulations.
  • Improve the quality of and/or amount of health education, nutrition, physical education, and physical activity in schools and early childhood centers.
  • Retain the comprehensive statewide physical fitness assessments and evaluation (FitnessGram) currently required by the Texas Education Code. 
  • Ensure parents' right to know about their school's vaccination exemption rate. 
  • Require influenza vaccination for children in child care facilities.
  • Improve access to the state adult safety net immunization program. 
  • Promote driver responsibility by supporting a ban on texting while driving, and educate the public about the dangers of distracted driving. 
  • Develop and fund a public health response team to provide clinical support to local teams and to assist in response during infectious disease outbreaks and/or disasters.  
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TEXPAC Gets Results

To enlist in the Party of Medicine, visit, or call the TMA Knowledge Center at (800) 880-7955. 

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TMA Legislative News Hotline

Stay fully informed of the 2017 Texas Legislature's dealings by subscribing to the members-only TMA Legislative News Hotline. The daily electronic newsletter reports the legislature's latest actions on bills affecting Texas medicine. A weekly edition is also available. Visit www.texmed.org55643.html to subscribe. 

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