Capitol Update: Senate stalls on budget debate, passes revenue measure

posted 05.03.11

After a week of political positioning and caucus meetings, the version of the budget approved by the Senate Finance Committee April 21 has made little progress on its way to the Senate floor. Though the disagreement falls mostly down party lines, splintered groups cry foul on the amount of the cuts—some saying the budget doesn’t cut enough and others saying it doesn’t spend enough—and the use of the Rainy Day Fund—some demanding it be left alone and others demanding more be spent.

Either way, Senate rules require a bill to have 21 votes to be brought up for consideration and Finance Committee Chairman Steve Ogden, R-Bryan, is stuck trying to gather those votes.

As reported previously, the Senate budget for 2012-2013, or Senate Bill 1, spends $176.5 billion in all funds over the next two years, about $12 billion more than the House budget and about $11 billion less, or 5.9 percent, than the budget for the current 2010-2011 biennium. Though it doesn’t raise taxes, it spends up to $3 billion from the Rainy Day Fund—one of the contentious issues.

As for health and human services, the Senate budget spends about $3.7 billion more in all funds than the House budget and does not provide funding for caseload or cost growth in Medicaid, estimated to cost $1.7 billion in general revenue. It anticipates federal flexibility in Medicaid that would save $700 million in general revenue, according to the Austin American-Statesman.

S.B. 1 also retains drastic cuts to graduate medical education, formula funding for family medicine residency programs through the Texas Higher Education Coordinating Board, the Texas Education Loan Repayment Program, and the Texas Statewide Primary Care Preceptorship Programs.

In other budget news, the Senate acted Sunday night to pass Senate Bill 1811 by Sen. Robert Duncan, R-Lubbock. The amended bill frees up $4.1 billion in non-tax revenue for the 2012-2013 budget through payment deferrals to school districts and accelerated tax collections. Ogden called it a “must-pass bill” critical to pay for the budget plan. Modifications during debate took away $130 million in revenue from the original measure.

Impending legislative deadlines could doom many bills

With just 27 days left in the 82nd Texas Legislature, a series of deadlines will spell death for a host of bills. As it goes in the legislative process, there are six steps to pass before a bill becomes a law. After being filed, the bill must be heard in its originating chamber and passed by one of that chamber’s committees. Then it must be brought up for floor debate, be read a second and third time, and pass that chamber. It then goes to the other chamber to be heard in and passed out of committee, and then heard on the floor. Only then is it engrossed and sent to the governor who can sign the bill, veto it, or allow it to pass without signature. And that’s without any amendments along the way.

This means that toward the end of the session, legislators face a time crunch, rushing to pass bills out of committees before the deadline. For the House, this deadline falls on Monday, May 9, to give a bill time to be placed on one of four House calendars—an essential step to be heard on the House floor. As for other deadlines:

• Thursday, May 12 is the last day for the House to consider House bills on second reading on the Daily or Supplemental calendars.
• Friday, May 13 is the last day for the House to consider consent bills on second and third reading, and all House bills on third reading on the Supplemental calendar.
• Friday, May 20 is the last day for the House to consider local House bills on second and third reading, and it’s the first day the Senate can consider bills posted the first day on its Intent calendar (instead of the typical one-day waiting period).
• Saturday, May 21 is the last day for House committees to report Senate bills, and Tuesday, May 24 is the last day for the House to consider Senate bills on second reading on the Daily or Supplemental calendars.
• Wednesday, May 25 is the last day for the House to consider local and consent Senate bills on second and third reading, and all third reading Senate bills on the Supplemental calendar. It’s also the last day for the Senate to consider any bills on third reading.
• Friday, May 27 is the last day for the House to consider Senate amendments.
• Monday, May 31 is the last day of the session, or sine die.

TAFP continues to watch the progress of family medicine’s top legislative priorities, but as all stakeholders have experienced in the past, nothing is certain until June 19—the last day the governor can sign or veto bills.

“Health care efficiency” bills head to House

Senate bills 7 and 8 by Sen. Jane Nelson, R- Lewisville, passed another major hurdle in the legislative process: On Tuesday, April 19, they were both passed out of the Senate. They now await hearing in the House Public Health Committee.

S.B. 7 introduces alternative payment systems for Medicaid and the Children’s Health Insurance Program. It creates the Medicaid and CHIP Quality-Based Payment Advisory Committee, which would work with the HHSC to use quality-based measures to adjust Medicaid and CHIP reimbursement, award incentives to physicians who serve as medical homes, reduce payments to hospitals for preventable readmissions, implement co-payments for unnecessary emergency room visits, and study the feasibility of pay-for-performance expansion to long-term care services.

S.B. 8 provides two key mechanisms to help align physician and hospital incentives with society’s goals. First is the creation of health care collaboratives. These collaboratives, similar to accountable care organizations, would provide incentives for physicians and hospitals to coordinate care to improve quality and reduce costs. Second is the creation of the Texas Institute of Health Care Quality and Efficiency, which would provide a safe harbor from antitrust laws for hospitals, insurers, and physicians to experiment with alternative payment and delivery systems.

Thanks to the Physicians of the Day

Remaining dates: May 6 and 30

Thanks to the physicians who volunteered for the Physician of the Day program this week and last: Jeffrey Edwards, M.D., of Stephenville; Mary Helen Morrow, M.D., of North Zulch; David Vander Straten, M.D., of Austin; C. Kelley Tibbels, M.D., of Decatur; Max G. Latham, M.D., of Bowie; Dana Sprute, M.D., of Austin; and P.J. Mock, M.D., of La Porte.

The Physician of the Day program brings a family physician to the Capitol each day of the legislative session to provide health care to members of the Capitol community. If you have not had a chance to sign up this session and would like to be placed on a waiting list for a possible special session this July or the 83rd Legislative Session in 2013, e-mail ajenkins@tafp.org.

For more information, go to the Physician of the Day page of the TAFP website, www.tafp.org/advocacy/get-involved/physician-of-the-day.