Capitol Update: Lege strengthens physician workforce, improves women’s health care, and reduces administrative hassles for physicians

posted 06.11.13

The 83rd Texas Legislature finished the regular session with mixed scores on health care’s most perplexing problems, but compared to last session, organized medicine and the patients of Texas have several reasons to celebrate. Facing what appeared to be a significant financial shortfall last session, lawmakers cut programs across the board in 2011, leaving everyone from public schools to women’s health programs scrambling to make ends meet.

What a difference a couple of years and several billion dollars can make. Flush with cash and a swelling Rainy Day Fund, the Legislature faced teams of advocates from every sector seeking restored funding.

Graduate Medical Education

Topping TAFP’s legislative priorities for the session was restoration of graduate medical education funding, which sustained a 43 percent cut in state support in 2011. This session lawmakers were determined to address GME by partially restoring funding to existing efforts and by investing additional funding in new initiatives designed to increase the number of training positions available in the state. As a result, total state GME funding will increase by $30 million, or about 45 percent in the upcoming biennium, and planning grants will help develop new residency programs in needed specialties.

Family medicine residency programs receive a special line of direct state funding that goes to train the bulk of Texas’ future primary care physician workforce. Those funds were slashed by almost 74 percent last session, from $21.2 million in 2010-2011 to $5.6 million in 2012-2013. In the next two years, those programs will receive $12.78 million, more than doubling their appropriation.

Strengthening Texas’ Physician Workforce

The Legislature put $2.1 million into a new incentive program to encourage medical schools to develop innovative programs to produce more primary care physicians, and it increased funding by almost 46 percent for the Joint Admission Medical Program, which helps economically disadvantaged Texans study medicine.

Lawmakers appropriated $33.8 million for the Physician Education Loan Repayment Program, which is an almost 500 percent increase over the current budget. The program will cover up to $160,000 in medical education debt for physicians who agree to practice for four years in an underserved community. Enrollment in the program was closed in 2011 after the Legislature cut the program by almost $18 million, but with the promise of reinvestment, the Texas Higher Education Coordinating Board reopened the enrollment process in late May, with a deadline for the first group of enrollees set for Aug. 31, 2013. For more information and to apply, go to www.thecb.state.tx.us/lrp.

Women’s Health Care

Last session, the combination of the deficit threat and a political determination to deny state funding to Planned Parenthood had a devastating effect on women’s health care programs in Texas. Next biennium, programs that provide preventive and contraceptive care for women will be almost completely restored to their 2010-2011 levels, thanks to a dedicated group of lawmakers and advocates, like the Texas Women’s Healthcare Coalition.

The Legislature increased state funding to the DSHS Family Planning Program by $32.1 million to replace federal funding under Title X awarded to the Women’s Health and Family Planning Association of Texas, and it gave the DSHS Primary Health Care Expansion an additional $100 million for the biennium for women’s health care. About $60 million of that is expected to go for family planning services including contraceptive care. The budget also adds $71.3 million for the Texas Women’s Health Program.

Mental Health

Patients needing mental health services in Texas will be much more secure after this session, as lawmakers pledged more than $225 million in new funding to a number of initiatives targeting prevention, early detection, community-based programs, and inpatient care.

Universal Prior Authorization

Physicians will be relieved to know that lawmakers passed a bill designed to end the hassle of dealing with hundreds of prior authorization forms from different insurance plans. The legislation directs the Texas Department of Insurance to convene workgroups that will develop standardized prior authorization forms for prescription medications and medical services for private and public payers.

Medicaid expansion fails

With the backing of state leadership, this Legislature refused to expand Medicaid coverage to poor adults under the Affordable Care Act, a decision that will have lasting repercussions. For now, Texas will continue to have the highest rate of uninsured people in the nation. TAFP News will follow developments and examine the policy and political considerations surrounding Medicaid expansion in the future.

Physician of the Day

Thank you to the physicians who recently volunteered to serve as Physician of the Day: Jasmine Sulaiman, M.D., of the Woodlands, who brought student Soniya Joshi; Richard Young, M.D., of Fort Worth; Georgeanne Freeman, D.O., of Austin; Daniel Voss, M.D., of Jarrell; Dan Sepdham, M.D., of Flower Mound, who brought third-year students Megan Gilbert and Alyssa Bahorich, and first-year student Adam Culver; Vip Mangalick, M.D., of San Marcos; Rick Edwards, M.D., of Fort Worth; Barbara Estment, M.D., of Fort Worth; Troy Fiesinger, M.D., of Sugar Land; Elise Sadoun, M.D., of Sugar Land; John Redman, M.D., of Anahuac; and Lamia Kadir, M.D., of Austin.

With the special session currently taking place, there is still a need for Physician of the Day volunteers. However, dates are tentative, so physicians local to the Austin area are preferable. Go to www.tafp.org/advocacy/get-involved/physician-of-the-day to sign up, or e-mail Juleah Williams at jwilliams@tafp.org.

Throughout the session, family physicians and their patients were represented by a number of members and physician leaders volunteering to serve as Physician of the Day, providing testimony before legislative committees, and providing counsel to lawmakers and their staffs. Thanks to all who wrote letters, made phone calls, sent e-mails, and played a part in your Academy’s efforts this session. Expect a thorough report on family medicine in the 83rd Texas Legislature including interviews and analysis in the next edition of Texas Family Physician.