Favorable political climate during the interim good indication for next session

By Kate McCann

Though the most noticeable battles take place at the Capitol during the first five months of odd-numbered years, the meetings, hearings and lobbying that occur between sessions of the Texas Legislature have a great impact on the climate of the upcoming political season. As legislators check off their interim charges, here is a list of a few key happenings.

TDI appears before Sunset

The Texas Sunset Advisory Commission held hearings on the Texas Department of Insurance during which TAFP and other allied professional associations called for the commission to consider strengthening TDI’s oversight of the health insurance market and increase transparency of health insurance premiums. To the dismay of nearly everyone in the health care community, most of the discussion during the hearings focused on property and casualty issues and not on health insurance. However, Sen. Bob Deuell, R-Greenville, was able to edge in a strong point when discussing the role of government regulation.

“Markets don’t work well when there are monopolies in some of the insurance industry, especially health,” Deuell, a physician, was quoted in the Lone Star Report. “We have monopolies that are created by health plans capturing a large number of patients and sometimes relatively small areas, but I think what we’re looking at with regulation and helping [TDI] is to give people more of a choice if we’re trying to get transparency and let all parties see the numbers.”

Sen. Juan “Chuy” Hinojosa, D-McAllen, also focused on health insurance, raising an interesting proposal to make the TDI commissioner a state-elected position instead of having this post appointed by the governor.

The next chance the Academy will have to make recommendations for the health insurance market will occur during the legislative session. Here’s how the process works: This fall, the Sunset staff will release the final report containing recommendations collected from the Advisory Commission hearings and hearings by the Sunset Commission comprised of House and Senate members. This report will be used as the foundation for the omnibus legislation to be filed during the 81st session. As the bill moves through new rounds of committee hearings and the legislative process, stakeholders will be able to submit comments to influence the final recommendations and, presumably, how TDI will function in the next 12 years.

New attention on physician shortages

One interim charge from the 80th session directs lawmakers to examine whether the current supply of physicians and other health care professionals will be adequate to meet the health care needs of a growing population. Both the House and the Senate held joint committee hearings to discuss physician shortages and remedies for the future, with much of the attention falling on primary care and its impact on the poor and uninsured.

At the joint hearing of the House committees on Appropriations, Public Health, and Border and International Affairs, TAFP provided reference materials on the contributions of family medicine residency programs on rural health and the underserved. The Texas Association of Community Health Centers submitted testimony that supported TAFP’s efforts. TAFP member Roland Goertz, M.D., M.B.A., of Waco, gave a presentation on behalf of TACHC highlighting statistics on the primary care shortage. He emphasized the low Texas ratio of primary care physicians to population, which sags behind the U.S. ratio—approximately 68 per 100,000 population in Texas compared to 81 nationally. He also gave his recommendations for increasing the amount of primary care physicians in Texas, a large part of which centered on increasing support for recruitment and retention programs such as physician education loan repayment programs.

The joint hearing of the Senate committees on Health and Human Services and International Relations and Trade on May 28 addressed the current and long-range needs of the health care workforce, especially along the Texas-Mexico border. Texas state demographer Karl Eschbach, Ph.D., explained to the committee that the border population is growing rapidly at both ends of the age spectrum, exacerbating the physician supply. He said that recruitment and retention of health care professionals has improved due to “tort reform, lowered malpractice insurance and a robust state economy.”

Other attendees expressed the need to expand current residency programs to encourage Texas medical students to remain in the state after graduation. Nancy Dickey, M.D., family physician and president of the Texas A&M Health Science Center, recommended investing in additional medical schools and encouraging “pipeline activities” that cultivate science curricula in high school-aged students and younger, encouraging them to pursue health careers.

Committee staffs will collect recommendations from the hearings and release their final reports in the fall, which will be considered in the next legislative session.

Proposal could fund EMR implementation

Based on the numerous studies that suggest that greater implementation of health information technology such as electronic medical records could improve patient outcomes and greatly reduce the overall cost of health care, it’s not difficult to see why many legislators have jumped on the HIT bandwagon. Of course, while the state could see a big pay-off, the bulk of the cost of implementing new electronic medical record systems falls mostly on the shoulders of the physicians.

To address this cost and encourage more physicians to adopt this technology, TAFP advocacy staff is working on a proposal to create a grant program for physicians that would provide monetary support for physicians to purchase and maintain systems to facilitate management of medical information and secure exchange between providers and patients.

Looking ahead

The value of primary care has picked up steam during the interim, providing TAFP the opportunity to educate Texas lawmakers on the concerns of family physicians. With the release of the Primary Care Coalition’s third policy document, “The Primary Solution,” featured on page 28, and other issue briefs, TAFP is gearing up to advocate for family medicine in the next legislative session.