Capitol Update: 82nd Legislature adjourns, special session begins

Health care reform bills get second chance

posted 06.02.11

The last day of the 82nd Texas Legislature, sine die, came on Monday, May 30, but lawmakers were back to work the next morning for the first-called special session. Gov. Rick Perry placed the call Monday evening to wrap up two outstanding issues: school financing and Medicaid reform.

The governor can call a special session at any time to finish work from the regular session. The official call—a proclamation from the governor—spells out what issues he wants to be addressed, and each chamber decides which bills pertain to those issues. As has already happened, the governor can add additional items. Special sessions can last a maximum of 30 days and there is no minimum; at least one expert postulates that this session may last more than two weeks.

Rules and deadlines are a bit different in special sessions because of the shorter schedule. Bills are filed, mostly re-filed from the regular session, and referred to committees for hearings. This session, Lt. Gov. David Dewhurst has said that the Senate will consider bills by simple majority instead of a two-thirds supermajority, notable because of actions taken earlier this session to take up and pass the budget along party lines.

Several health care bills that died at the end of the regular session were revived into one omnibus health care reform bill, Senate Bill 7 by Sen. Jane Nelson. Dubbed the health and human services efficiencies bill, it encompasses elements of the former S.B.7, S.B.8, S.B. 23, S.B. 1177, and H.B. 2546.

The new bill would save money in Medicaid and the Children’s Health Insurance Program by expanding Medicaid managed care into South Texas, and creating incentives for doctors and hospitals to form “health care collaboratives” that provide coordinated, more efficient care. The Legislative Budget Board estimates that measures in the bill could save $467 million over the next biennium.

At a hearing today, Thursday, June 2, Nelson told fellow members of the Senate Finance Committee, “every day that goes by that this is not implemented, we are losing money.”

“We keep using a word that I want to remind everybody of and that is ‘unsustainable.’ Our Medicaid cost trends are unsustainable so we need this bill, but we don’t just need it for [cost savings]. It truly does improve the quality of our system and creates a more efficient system.”

Committee members passed S.B. 7 unanimously and it now goes to the full Senate. Read about health care collaboratives and other proposed reforms in a new post on the Texas Family Docs blog, www.txfamilydocs.org.

$172.3 billion budget puts $4.8 billion on “Medicaid Mastercard”

Before the end of the regular session, both houses of the Legislature approved a budget for 2012-2013 that spends $15 billion less than the budget for the current biennium, which represents an 8.1-percent cut. In crafting the budget, lawmakers for the most part neglected to account for population growth, and they did not consider projected caseload growth in health and human services programs like Medicaid. Because of this, the Health and Human Services Commission says the budget underfunds Medicaid by at least $4.8 billion and will run out of money by May of 2013. Speaking against the budget, Rep. Sylvester Turner, D-Houston, said the state had charged that expense to the “Medicaid Mastercard.”

The budget shorts public schools by $4 billion according to the state’s current school finance formulas, and all efforts to change the formulas failed in the final days of the session, leading to the immediate call for a special session.

Overall, health and human services took the biggest hit, with almost $11.3 billion in cuts from state and federal funds, but Medicaid provider rates were not reduced. A target throughout the session, higher education sustained about $1.2 billion in cuts from general revenue.

Medical schools will get about $280 million less in medical student formula funds, and about $25 million less in graduate medical education formula funds. Funding administered by the Texas Higher Education Coordinating Board for primary care residency programs was slashed by almost 80 percent, leaving just $2.8 million per year for the state’s 29 family medicine residencies. Altogether, the state cut its support for graduate medical education by $47.4 million, or 39 percent.

Sign up to serve as Physician of the Day during the special session

TAFP is in need of family physicians to serve as Physicians of the Day during the special session. Spots are available through June 17. Go to the Physician of the Day page of the TAFP website to sign up and see the available dates. If you have already served in the 82nd regular session, there is no need to fill out another form. Simply e-mail Anna Jenkins at ajenkins@tafp.org with the date you’d like to serve.

The Legislature will convene until they come to agreement on a few issues. In the case that the special session does not conclude by June 17, we will send another call for volunteers.