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ELECTION
IMPACT
THE 85TH TEXAS
LEGISLATURE
Threats Outweigh
Opportunities
By John Holcomb, MD
Although the 85th Texas Legislature does not convene until Jan. The
10, 2017, Austin traffic is already more bumper-to-bumper than current legis-
usual with legislators and staff personnel, lobbyists, consultants, and lature makeup in-
interested citizens creating gridlock on l-35, hoping to influence the cludes 95 Republicans
outcome of legislation. Looking back at the 84th session, 11,356 and 55 Democrats in the
bills were offered; 1,203 were ultimately signed into law by the gov- House, and 20 Republicans and
ernor, 163 became law without the governor’s signature, and 42 were 11 Democrats in the Senate. The Re-
vetoed. During that session, the Texas Medical Association’s legisla- publican members are heavily influenced
tive staff actively tracked the progress and status of more than 1,200 by the Texas Public Policy Foundation, which
bills with potential impact on doctors and patients. is a high-profile conservative policy organization
based in Austin. TPPF has warned lawmakers against an
Bills may be pre-filed by Representatives and Senators before “all funds” (state and federal) budget of greater than $218.5
the convening of the 85th session. Pre-filing began Nov. 14, 2016 billion, which represents a 4.5 percent increase in the previous
with more than 470 bills filed in the first seven hours. House bills budget to account for population growth and inflation, and Repub-
are filed electronically, but the eccentric Senate rules require paper lican members are very likely to use this as their target, given the
filing. Since the Senate bill numbers are assigned on a first come- political risk of not looking “conservative enough.”
first served basis, and there is political panache in having a bill
with a “low number”; one well-known South Texas Senator as- The most challenging issues facing organized
signed staff to be in line on the Friday before the Monday morning medicine in the 85th session include:
opening of pre-filing.
• MEDICAID REIMBURSEMENT AND EXTREME
The Texas Medical Association, through its Council on Legisla- ADMINISTRATIVE BURDENS ON DOCTORS:
tion and TEXPAC, and the county medical societies have been In 2000, 67 percent of doctors in Texas were seeing Medicaid
watching the legislative landscape over the past year, meeting with
legislators in their home districts, and identifying opportunities patients; by 2014, participation was down to 37 percent. Of note
and challenges to doctors and patients. As is always the case, the was the fact that the 2014 participation rate had actually gone up
challenges far exceed the opportunities. As Texas is a “pay as you from the 2012 rate of 32 percent. This increase was certainly due
go state,” the planned legislative appropriations cannot exceed the to a provision in the Affordable Care Act, which raised primary
Texas Comptroller’s estimate of available revenue, currently esti- care reimbursement to Medicare levels for two years (Texas Med-
mated at between $110 and $113 billion for the two-year bien- icaid pays physicians at about 65 percent of the Medicare rate).
nium. However overall spending is closer to $220 billion, due to The only other transient increase in participation was seen in 2006
federal “match” payments (for example, Texas Medicaid, which ac- when the participation rate increased from 38 percent to 42 per-
counts for more than 25 percent of the budget, receives a 59 per- cent as a result of the Frew lawsuit settlement which temporarily
cent federal match). raised reimbursement to pediatricians. So, when they say it’s “not
18 San Antonio Medicine • January 2017
