overall tax relief package to cut the state franchise tax rate by 15 percent and, subject to voter approval, provide property tax relief. Physicians also could ben- efit from a separate measure, Senate Bill 8, allowing businesses with total rev- enue of $4 million or less to qualify for exemptions from the state franchise tax.
MEDICAID-MEDICARE PARITY FIZZLES; REFORMS ADVANCE On the other hand, TMA Vice President for Advocacy Darren Whitehurst ex- pressed extreme disappointment with the decision against reinstating the Med- icaid-Medicare parity payments for primary care. The pay raise — originally funded by the federal government in 2013 and 2014 — led to a 5-percent bump in physician Medicaid participation “and keeps us from losing doctors in places we can least afford to lose them,” he said. Governor Abbott and other state leaders announced at the outset of the 2015
legislative session that any kind of Medicaid expansion prescribed by the federal government was a nonstarter. With health care consistently consuming a third or more of the state bud-
get — and for the first time surpassing education in the 2016–17 budget — Mr. Whitehurst said, “Past legislatures have been equally reluctant to do anything proactive on Medicaid. But we are quickly headed toward crisis if we don’t do anything. This [decision] is reflective of work we are going to have to do in the interim to recalibrate the Medicaid program and engage state leadership.” Representative Zerwas says he counts the boost to GME and mental health
funding “as a real success. But I do think we passed up some opportunities to deal with Medicaid payment rate issues for physicians.” The 2013 legislative session “put the spotlight on the whole GME issue and
was an important part of where we are. We also continued to build on the sub- stantial investments from last session in mental health. And that will go a long way,” he said. “But we also have to systematically look at how we deliver mental health care services. That didn’t get as much attention this time around, and it’s something we need to continue to look at very seriously.” Representative Zerwas says the $460 million Medicaid pay increase “was a
“Our biggest win was making sure the practice of medicine is still sacred.”
big number” that caused consternation among some legislative members. But he also called it “bothersome” that in the final hours of the budget negotiations, conferees still put roughly $300 million into enhancing hospital Medicaid pay- ment rates “without recognizing the importance of keeping the physician net- work in tact by at least maintaining their [primary care] rates.” Taking away the primary care pay bump, however, also represents a “sub-
stantial decrease in rates for those physicians,” Representative Zerwas said. “We already have a very fragile network of physicians, and if we compromise that any more, I worry about access to health care for the Medicaid population.” Depending on the service, the parity payments raised primary care physi-
cians’ Medicaid pay in Texas by 45 percent to 95 percent, in some cases more than doubling rates, according to TMA research. Lawmakers also ignored medicine’s call to fully restore the 2011 cuts made to
coinsurance payments for treating dually eligible Medicare-Medicaid patients. Ms. Romero says the legislature nevertheless budgeted for costs associated
with Medicaid caseload growth. TMA also won long-sought Medicaid reforms that aim to take away some of
the other big reasons doctors don’t participate, besides low pay. One big step in that direction was Senate Bill 207 by Sen. Juan “Chuy” Hinojosa (D-McAllen), which outlines clear criteria for Medicaid fraud investigations by the Office of Inspector General (OIG). (See “Fair Play,” page 31.) The new law builds on TMA- backed Senate Bill 1803, passed in 2013, which paved the way for due process improvements.
August 2015 TEXAS MEDICINE 33
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