“With the concerns we had early on that nothing would be discussed except the budget shortfall and redistricting, I think we had a good session.”


The Senate took a slightly less draconian approach to the budget. In fact, the bill that passed the Senate spared physi- cians from any Medicaid and CHIP fee cuts below current rates. TMA backed the Senate bill, telling Senate Finance Committee Chair Steve Ogden (R-Bryan), “When it comes to improving the health of all Texans, the Senate bill is far from perfect, but it’s a far sight better than what the House came up with.” Much of the Senate language made its way into the final budget bill, which appropriated $172.3 billion for the two- year budget cycle. That’s a $15 billion reduction from previous spending levels.


“The good news is that the agreed-upon budget includes no cuts to physicians’ Medicaid and CHIP payments, no cuts to the state mental health programs, and it mitigated the steep cuts initially proposed for tobacco cessation and many other public health programs” Dr. Floyd said. The bad news, however, is that “as lawmakers worked to push every available education dollar into the public schools, they pulled money out of higher education,” he continued. “As a result, undergraduate and graduate medical education took a huge hit.”


In fact, lawmakers cut 31 percent from GME formula fund- ing, slashed 75 percent from family practice residency pro- grams administered by the Texas Higher Education Coordi- nating Board (THECB), and zeroed out THECB primary care residency and preceptorship programs. Lawmakers also eliminated one of two physician loan re-


payment programs and cut the other by 76 percent. Despite those cuts, State Sen. Jane Nelson (R-Flower Mound), chair of the Senate Health and Human Services Committee, hailed the budget as a health care victory. “The budget was a significant health care achievement be- cause we were able to maintain current rates for physicians,


dentists, nursing homes, community care, rural hospitals, and children’s hospitals,” said Senator Nelson, who served on the House-Senate conference committee that hammered out the final budget compromise. “We also protected mental health community services and hospitals.” But Representative Zerwas, who also was on the budget


conference committee, says the legislature avoided deep health and human services cuts by only funding about 19 months of Medicaid. As passed, the budget makes no provi- sion for caseload growth in that program, he says. “If we have growth in the Medicaid program like we project that we’re going to have, we run out of money devoted to the entitlement program on May 1 [2013],” Representative Zerwas said. “What that means is that doctors, hospitals, and nursing homes stop getting paid at that point.” Representative Zerwas says there is no question that some of the $6 billion remaining in the Rainy Day Fund will have to be used to fill that gap when lawmakers return in January 2013. The only question, he says, is how much.


Clinical autonomy defended


While the budget was undoubtedly the dominant issue of the session, a number of other issues of critical importance to or- ganized medicine also were on the table — possibly none more important than the ques- tion of whether hospitals would gain carte blanche authority to directly employ physicians. Working with the Texas


C. Bruce Malone, MD Gary Floyd, MD 24 TEXAS MEDICINE August 2011 Dan McCoy, MD


Hospital Association (THA), the Texas Organization of Rural & Community Hos- pitals (TORCH), Senate State Affairs Committee Chair Robert Duncan (R- Lubbock), and other legis- lative leaders, TMA crafted a compromise on several physician employment bills. They give some hospitals greater latitude to employ doctors, but impose some of the strongest protections


Top: State Rep. Wayne Smith


(R-Baytown) discusses proposed Medicaid and graduate medical


education cuts with Baylor College of Medicine students Brian Gilcrease and Abhinav Khanna and Houston emergency physician Angela Siler-


Fisher, MD, during the First Tuesdays at the Capitol event on Feb. 1.


Bottom: A legislative aide, center, takes notes while physicians and medical


students from The University of Texas Health Science Center at Houston and Baylor College of Medicine express


their concerns over proposed medical education funding cuts. From left to right are Daniel Corredor, MD; Arlo Weltge, MD; Ben Ma; Angela Siler- Fisher, MD; Abhinav Khanna; Nikhil Bhargava; Steven Brown, MD; and Donna Huang.


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