This page contains a Flash digital edition of a book.
When the curtain rises this month on the 83rd Texas Legislature, organized medicine faces another tight state budget as it seeks to mend the grueling cuts levied last session on various health care programs. That’s just one of the many ambitious goals the Texas Medical Association has in its legislative agenda. More money from increased state revenue and more physicians serving in the legislature may give some wings to TMA’s advocacy efforts. TMA will work to restore funding for treating dually eligible Medicare/Medicaid patients and for graduate medi- cal education (GME); mitigate financial and regulatory pressures that have Medicaid physician participation rates at an all-time low; and defend against scope-of-practice infringements, cracks in liability protections, and attempts to undermine physicians’ clinical autonomy. TMA also hopes to make headway on public health initiatives like smoking cessation and chronic disease prevention.


ut a Republican-dominated legislature bent on belt-tight- ening will generate substantial headwind as lawmakers seek to get the state budget back in the black while still climbing out of a $27 billion hole from last session. A $4.7 billion shortfall in the current Medicaid budget and

increasing caseloads will put the program front and center this session and likely impact other available funding. Now that the presidential election likely secured the fate of

the Patient Protection and Affordable Care Act (PPACA), dis- cussions on state-level implementation of the federal health system reform law — or lack thereof — also should hit the Capitol floor.

Amid those debates, “TMA will be focused on finding ways

to utilize the health care delivery system and make it such that physicians can function and have the ability to deliver the care that’s needed as we move forward in a much more compli- cated system,” said Dallas psychiatrist Leslie Secrest, MD, chair of TMA’s Council on Legislation.

“Our priorities Gary Floyd, MD John Holcomb, MD 20 TEXAS MEDICINE January 2013

are to maintain the gains we’ve accom- plished, while mov- ing forward in terms of addressing fund- ing issues, medical education, and pro- viding a stable phy-

sician workforce. Some things we’ll have to look at and ask whether they are broken before we tinker with them. But a lot of physicians might say a lot of things are broken, and we have to ask ourselves, how do we improve them?” he said.

A BETTER BUDGET? Fort Worth pediatrician Gary Floyd, MD, a consultant to the

Council on Legislation and a former chair, says the 2013 Med- icaid shortfall and other budget outlays going into this session will “make it difficult” to advocate for new funding for Medic- aid or other projects. An unexpected boost from sales, oil, and gas taxes spiked 2012 state revenues beyond expectations, possibly generat- ing enough cash flow to cover the Medicaid deficit and other shortfalls, according to the Texas Taxpayers and Research As- sociation, of which TMA is a member. If the trend holds — a big “if” — there also could be enough funds to cover normal spending demands for 2014–15, though “normal” would not include costs related to a pending school finance lawsuit, for example. Nor is it clear whether enough funding would remain to restore last session’s massive cuts or monies diverted to get by, at least without dipping into the state’s Rainy Day Fund, a reserve estimated to reach $8 billion in 2013. Legislative Budget Board (LBB) Assistant Director Wayne Pulver told Texas Medicine that lawmakers this session will need to address more than $11 billion in budget shortfalls and deferrals. They resulted in large part from the 2011 legis-

Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64  |  Page 65  |  Page 66  |  Page 67  |  Page 68