Fighting physician shortages
This session also was the first in a long time in which lawmak- ers took a hard look at GME in Texas and its impact on ensur- ing an adequate physician workforce, Ms. Romero says. GME funding overall was pieced together in the budget and
through additional legislation with a $30 million, or 45-per- cent, raise over the last biennium. A big part of that boost came from brand new programs aimed at expanding residency slots. Total state dollars dedicated to GME increased from $67
million in 2012–13 to $97 million for 2014–15. GME formula funding, which took a 31-percent hit last session, was partially restored in the budget with a 15.5-percent, or $8.8 million, increase over the 2012–13 biennium. While those figures still fall short of historic funding lev-
els — GME funding peaked at $106 million in the 2010–11 biennium — the budget includes $14.5 million in new monies to grow residency slots through new programs established in House bills 1025 and 2550. Together, the measures create:
• New one-time planning grants of $150,000 to hospitals not currently offering GME and not under Medicare GME fund- ing caps;
• Funding for accredited, unfilled, and unfunded GME posi- tions; and
• Funding for newly developed GME positions, including the potential for development of new GME programs.
TMA officials say the measures represent a greater recogni- tion by lawmakers of the need to not only expand GME capac- ity, but to also offset some of the costs of training Texas’ future doctors in order to keep more medical school graduates in the state. Dr. Speer says lawmakers made some significant amends to help GME. “But this really needs to be looked at every single session, especially if we are going to increase the number of medical schools in Texas, even by one.” Senator Nelson and Representative Zerwas said that like
other areas of health care, the legislature had the money this time around to enhance GME funding. They, along with other budget writers, worked on the issue before and during session, but agreed that more work needs to be done to battle work- force shortages and said lawmakers will continue to track the issue and whether the new expansion programs are keeping pace.
Lawmakers also partially restored the Family Medicine Resi-
dency Program and more than fully restored the state Physi- cian Education Loan Repayment Program, which suffered deep cuts in the last budget cycle. TMA also helped stop off-shore medical schools from buy- ing up clinical clerkships in Texas hospitals and repealed a 2011 law that forced physician visa holders to spend three years working in medically underserved areas.
Big step forward for public health Meanwhile, the Lone Star State took a “major step forward” in expanding access to immunizations, TMA Associate Director for Advocacy Troy Alexander said. In addition to these public health advances, TMA made progress in combatting childhood obesity and in escalating the cost of tobacco to prevent future use, top priorities for the Texas Public Health Coalition, of which TMA is a member. (See “Health Matters in Texas,” pages 41–45.) Rolled into an omnibus franchise tax bill, House Bill 500,
is relief that will help physicians provide vaccinations by al- lowing them to deduct from their taxable revenues the cost of purchasing and stocking vaccines. The legislation also provides tax breaks to small businesses, which includes many physi- cian practices, and TMA worked to preserve existing physi- cian exemptions related to Medicaid, Medicare, CHIP, Workers’ Compensation, and other government payers. TMA backed HB 3169, which helped reverse an interpretation by the state comptroller that made it difficult to determine the taxable sta- tus of certain common medical supplies physicians purchase. Senate Bill 63 by Senator Nelson and Rep. J.D. Sheffield,
DO (R-Gatesville), allows a minor who is pregnant or a parent to consent to his or her own immunizations. Senate Bill 64, by Senator Nelson and Representative Zerwas, requires licensed child care facilities to develop and implement an immuniza- tion policy for their employees to protect the children in their care from vaccine-preventable diseases. The state budget also includes additional money to keep
the state FITNESSGRAM program alive in schools and collect data to address the state’s obesity epidemic.
While efforts aimed at a statewide smoking ban once again failed, Mr. Alexander says Texas did make progress in tobacco prevention. TMA-backed House Bill 3536 subjects tobacco companies that were not part of the 1998 national tobacco settlement to the same taxes on the sale of cigarettes and to- bacco products that the larger companies pay. Those fees were meant to compensate states for future health care costs caused by tobacco use. n
Amy Lynn Sorrel is an associate editor of Texas Medicine. You can reach her by tele- phone at (800) 880-1300, ext. 1392, or (512) 370-1392; by fax at (512) 370-1629; or by email at
amy.sorrel@
texmed.org.
All articles in Texas Medicine that mention Texas Medical Association’s stance on state legislation are defined as “legislative advertising,” according to Texas Govt. Code Ann. §305.027. That law requires disclosure of the name and address of the person who contracts with the printer to publish the legislative advertising in Texas Medicine: Louis J. Goodman, PhD, Executive Vice President, TMA, 401 W. 15th St., Austin, TX 78701.
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