by William W. Hinchey, MD
President, Texas Medical Association
ne of the strangest and most tumultuous months in
Texas legislative history has thankfully come to a close.
But bills rescued from the detritus of the parliamentary
storms include numerous measures that will be quite
beneficial to Texas patients and their physicians.
When the 80th Texas Legislature convened in January, the
Texas Medical Association issued a plea for lawmakers to pass
physicians’ multi-point plan: “Preserving Patient Care.”
And that’s just what they did. Led by medicine’s numerous champions in the House and Senate, the legislature passed
bills to reduce our uninsured population, reform the health
insurance industry, enhance access to care and bolster our
public health infrastructure.
The highlight reel will point out that the 2007 Texas
Legislature:
• Enacted a historic 25 percent overall increase in Medicaid
payments to physicians for children’s care, and a 10 percent
hike for adult services
• Allowed no dilution of Proposition 12 or the landmark
2003 medical liability reforms
• Rescinded most of the 2003 cuts made in eligibility for the
Children’s Health Insurance Program (CHIP), providing
health insurance for 120,000 additional children
• Relaxed health plans’ stranglehold on patient information
• Approved funding for a premier Cancer Prevention and
Research Institute
• Maintained physicians’ tax deductions for Medicaid, Medicare,
TRICARE, worker’s compensation, charity care and CHIP
• Established lower marginal tax rates on the state’s new business
tax for businesses with less than $900,000 in annual
gross receipts
• Instituted changes to protect access to care for worker’s compensation
patients and ensure appropriate review mechanisms
are instituted by the health plans
• Took the first steps toward requiring health plans to use
smart card technology for patients
• Put structured physical education back into Texas public
schools
Preparation
TMA’s 2007 goal was to enter the 80th legislative session
with strong stakeholder support and smart strategies for each
top-priority item.
Two tactics were initiated in fall 2005. The first was to create
special ad hoc committees to study and develop recommendations
for TMA’s legislative platform. These committees
studied Medicaid and the uninsured, scope of practice, health
insurance reform and responsible ownership.
The second was to bring key players together at three TMA
Healthy Vision 2010 summits. More than 65 stakeholders
attended the summits, representing medicine, business, insurance,
hospitals, other health care providers and government.
The summits helped to build support among political and
business leaders, and to develop collaborative legislative agendas
on the uninsured and on wellness and prevention.
Expand All Texans’ Health Coverage Options
At the onset of the 2007 legislative session, TMA argued that
lawmakers could no longer ignore the growing and alarming
numbers of uninsured children and adults in Texas. The cost to
care for the uninsured was fast becoming a huge burden for
many communities. Nor could lawmakers disregard the impending
Frew vs. Hawkins lawsuit settlement that would demand
they allocate more funds to children’s Medicaid services.
As a result of these two forces, lawmakers were quick to
support TMA’s legislative agenda aimed at reducing the ranks
of the uninsured. Every single item on TMA’s legislative platform
for the uninsured was passed. The legislature:
• Restored physician fees for Medicaid services: 25 percent for
children’s Medicaid services and 10 percent for adult services
• Simplified enrollment and eligibility requirements for the
Children’s Health Insurance Program (CHIP), including 12
months’ continuous coverage for nearly all children on
CHIP and children’s Medicaid
• Supported measures to reform Texas’ Medicaid using state
and federal dollars that will:
~ Extend private coverage for low-income parents and
reduce the number of uninsured children
~ Create and maintain local public-private collaborations to
address the uninsured
~ Test new initiatives such as health savings accounts
Protect Patient Access to Appropriate, Quality Care
Texas’ fast-growing population exacerbates the demand for
medical care. Competitors in the health care market place had
ambitious legislative agendas, using this demographic trend to
secure their footing. More than 88 bills were filed that would
expand the scope of practice for non-physician practitioners.
Retail health clinics sought authority for nurse practitioners to
provide medical services beyond their education, training
and skill.
The trial lawyers shot out of the gate early, trying to weaken
the 2003 liability reforms. Despite all of these forces working
to dilute patient care, not one single bill passed that would
put patients in harm’s way. Instead, lawmakers supported
TMA-backed legislation. They:
• Stopped scope-of-practice expansions for non-physician
practitioners beyond their level of training and experience
• Preserved the historic 2003 medical liability reforms and
Proposition 12
• Allocated nearly $86 million to graduate medical education
so more homegrown physicians can take care of Texas patients
• Approved $81 million to expand Texas medical schools,
Texas Tech University’s Health Science Center in El Paso and
Texas A&M
• Allocated more than $5.2 million to the Texas Medical
Board (TMB) for additional staff and health information
technology to speed up the physician licensing process
• Imposed no new limits on physicians’ rights to own equipment
or facilities
• Improved injured workers’ access to appropriate care, in that
only a physician licensed in Texas and in the appropriate specialty
now may conduct workers’ compensation peer reviews
Don’t Let Health Insurance Put Profits Before Patients
Our plan to reform health insurance ... to put power back
into the hands of employers and workers who buy it ... enjoyed
a strong start. Important advancements were made to loosen
health insurers’ stranglehold on patients and physicians. Legislators
sought big-picture solutions, such as health care transparency
and patients’ right to know what their health care
dollars purchase.
The bills in this session that prohibited balance billing
didn’t move. Instead, landmark measures that Texas legislators
passed stopped health insurance abuses that confuse and frustrate
our patients. The laws:
• Instituted transparency of health care costs from hospitals,
physicians, other health care professionals and health insurers
so patients can make better health care decisions
• Required health plans to report important health care information
such as where they spend health insurance premium
dollars and the adequacy of their physician networks
• Prevented patients from paying out-of-network costs when
seeing a physician new to a medical group that already is
contracted by a health plan
• Provided employers access to health insurance information
so they can evaluate employee health care expenditures
• Required a study that will explore the feasibility of health
plans using smart card technology
Enhance Our Physical Health to Preserve Our Fiscal Health
TMA physician leaders worked overtime to make certain
that legislators clearly understood one thing: Texas’ future is in
jeopardy. They emphasized that now is the time for Texas to
invest in improving our physical and fiscal health.
Organized medicine asked lawmakers to invest in public
health initiatives that will reduce obesity and tobacco use and
improve immunization rates. The message was heard across
the rotunda; it was a banner year for public health. Legislators
took steps to address many of TMA’s concerns. Legislators even
upped the ante by passing legislation that:
• Created a Cancer Prevention and Research Institute to the
tune of $3 billion, if Texas voters agree. The institute, if
approved, will fund a statewide tobacco prevention and
cessation effort
• Put physical education back into Texas
public schools for middle schoolers.
Students also get an annual fitness test
• Allowed health plans to advertise
their health and wellness programs
and benefits, as well as provide
financial incentives that encourage
healthy behavior
• Created a worksite wellness program
for state employees
• Developed advisory councils that will
oversee and guide the state’s worksite
wellness, obesity and type 2 diabetes
programs
Health Information Technology
for the 21st Century
Health information technology (HIT)
has tremendous potential to improve
the quality of care, prevent medical
errors and streamline the health care
delivery system. Physicians look forward
to the day when they can easily access
their patients’ clinical information electronically,
find treatment protocols to
help them make evidence-based clinical
decisions and participate in data-based
quality improvement activities.
Investment in HIT is expensive. TMA
strongly encouraged legislators to create
a true public-private partnership to
guide Texas into an era where health
care technology can be used to improve
quality care and efficient care. We also
urged lawmakers to actively seek public
and private sources of funding to help
physicians acquire HIT for their practices— particularly in underserved areas of
Texas. Three bills passed supporting
TMA’s vision. They will:
• Create a public-private entity to explore
how physicians can take advantage of
linkages that will enable them to share
and compare electronic data. This partnership
also sets the stage for data
exchanges where patient insurance verification,
coverage, prescription histories,
lab results, physicians-in-network,
and eventually, real-time claims adjudication
become a reality
• Modernize the state’s Medicaid system
with health information technology
• Create a pilot program that will provide
HIT, including electronic health
records, to high-volume primary care
physicians who participate in Medicaid
Sound Science and Care
at the End of Life
The tremendous pace of modern scientific
advances gives physicians amazing
new potential to diagnose and cure
disease. Those same advances, however,
threaten to outstrip society’s financial
capabilities and ethical boundaries.
This debate was a focal point during
the 2007 legislation session, especially as
it relates to end-of-life care. Legislation
changing the Texas Advanced Directives
Act was introduced and would have
rewritten state law on continuing medical
treatment for a terminally ill patient.
MA argued that physicians never quit
caring for dying patients. At some point,
however, further medical treatment does
more harm than good for the patient.
TMA made good-faith efforts to
achieve a compromise. Nevertheless, the
bill failed in the waning days of the session
and TADA was left unchanged.
TMA will continue to work on addressing
concerns that were identified during
session to ensure appropriate care is provided
to patients at the end of life.
Taxes and Public School Finance
During a 2006 special session, Texas
legislators enacted a broad-based business
activity tax on most Texas businesses,
including some physician practices.
Recognizing that saving lives should not
be taxed like other services, lawmakers
incorporated tax deductions for free and
under-reimbursed care that physicians
provide to Medicaid, Medicare, CHIP,
workers’ compensation, military and
charity patients. Physician practices were
the only business that received these
deductions.
Medicine’s mission during the 80th
legislature was to preserve the tax deductions
to help preserve patients’ access to
health care services. TMA reiterated this
message from 2005-06: Health care is
not a traditional business activity and
should not be subject to a traditional
business tax. Legislators listened. In the
end, lawmakers protected physicians’ tax
deductions and instituted a graduated
tax rate that reduced the business tax for
companies with gross incomes from
$300,000 to $900,000.
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