Texas Medical Association leaders knew from the outset that the 2011 session of the Texas Leg- islature would be difficult for organized medicine. “The state had an enormous budget deficit, and special interest groups from hospitals to mid-
level practitioners to those who wanted to emasculate the Texas Medical Board [TMB] were lined up in droves to take on medicine,” said TMA President C. Bruce Malone, MD. “We knew we had an uphill battle and that it was going to be an arduous six months.” But when the 82nd regular legislative session ended on the evening of May 30, TMA had
scored “some important wins for you and you patients,” Dr. Malone told an audience of about 1,400 physicians who participated in a conference call about the session on June 8.
Indeed, bolstered by hundreds of physicians, medical students, and TMA Alliance members who came to Austin for the highly successful First Tuesdays at the Capitol events throughout the session, TMA:
• Staved off substantial cuts in Medicaid and Children’s Health Insurance Program (CHIP) physician fees that could have driven hordes of doctors out of those programs;
• Stymied efforts by nurse practitioners, podiatrists, optom- etrists, and other midlevel practitioners to expand their scope of practice;
• Reformed TMB by ending anonymous complaints and giv- ing physicians due process without endangering the 2003 medical liability reforms;
• Secured legislation that TMA leaders hailed as first-in-the- nation protections for clinical autonomy and independent medical decision making for physicians employed by hospi- tals and nonprofit health care corporations.
• Won a number of victories on the health insurance front, including legislation to ban discretionary clauses in health insurance policies; and
• Improved public health in Texas by persuading lawmak- ers to pass bills requiring college students to be vaccinated against meningitis and ensuring that new mothers receive information about pertussis immunizations. (See “Healthy Debate,” pages 42–48.)
Not all the news was good, however. Lawmakers made some drastic cuts to medical education funding, particularly graduate medical education (GME). And a statewide ban on smoking in public places failed to pass. Still, Dr. Malone says much was achieved in a session that looked less than promising from the start.
“With the con-
Left to right, McAllen ophthalmologist Chevy Lee, MD; Edinburg ophthalmologist Carlos Manrique, MD; TMA Alliance member Donald White; and Edinburg internist E. Linda Villarreal, MD, meet with a staff member for a Rio Grande Valley lawmaker. Mr. White is Dr. Villarreal’s husband.
cerns we had early on that nothing would be discussed except the budget shortfall and redis- tricting, I think we had a good session,”
he said. “We have to think that we had some accomplishments in a session that seemed likely it was going to be totally domi- nated by the budget.”
Medicaid/CHIP payments saved At least one political observer jokingly called this year’s ses- sion a “living hell,” but just about every lawmaker, lobbyist, or observer involved says the session was one of the most difficult in recent history. The budget was the primary reason. “The revenue shortfall and the effort around redistricting
really characterized the struggles that are associated with this legislative session,” said State Rep. John Zerwas, MD (R-Rich- mond). “We had an enormous task trying to bring in a budget that, by law, has to be balanced and at the same time take up something that can be as polarizing as redistricting.” Indeed, lawmakers started the session staring at a projected
$26 billion deficit for the 2012–13 biennium, plus the need to find more than $3 billion to plug a shortfall in the current budget they wrote in 2009. Fort Worth pediatrician Gary Floyd, MD, chair of the TMA
Council on Legislation, says the budget outlook at the outset was bleak because House and Senate leaders appeared unwill- ing to consider new taxes or to spend any of the state’s “Rainy Day Fund,” which had more than $9 billion available. The initial House budget, unsurprisingly, made sweeping cuts in both health and human services and public and higher education, areas that make up two-thirds of state spending, Dr. Floyd says. “They slashed Medicaid payments to physicians, hospitals, and other providers by 10 percent. They also made deep cuts in trauma funding, the ChildrenWith Special Health Care Needs Program, child and adult mental health services, and the tobacco cessation programs,” he said. Harvey Kronberg, publisher of the online political news-
letter Quorum Report, says those cuts were the result of the House setting up “false barriers,” such as refusing to spend the Rainy Day Fund or to tell state agencies to generate additional revenue through higher fees. “We had a whole series of false barriers set up on how to
‘live within our means,’” Mr. Kronberg said. “Those barriers were not necessary. They were just obstacles thrown in the way for ideological purposes.”
August 2011 TEXAS MEDICINE 21
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