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LEGISLATIVE
INTRODUCTION

ON CALL AT THE CAPITOL:

TMA’s 2019 Legislative Agenda

By Joey Berlin and Sean Price, Texas Medicine

T he faces at the Capitol change. The legislative flashpoints A healthy budget?

and fights come and go. But every two years, the House
Funding for Medicaid, behavioral health, and women’s health will
of Medicine’s commitment remains the same: Persuade
legislators to improve Texas laws for physicians and patients. be among medicine’s foremost budgetary focuses, though the leg-
islature will be weighing such asks against its priorities for public
The Texas Medical Association will keep that focus in 2019 as it school finance reform, Hurricane Harvey relief, state infrastructure
pursues better Medicaid coverage for postpartum women, insurer needs, and lowering property taxes, TMA leaders say.
accountability for narrow networks, more funding for community On the plus side, TMA lobbyist Michelle Romero says a better-
mental health, and many other aims. than-expected economy has put the state in good position to cover
When the 86th Texas Legislature convenes on Jan. 8, TMA will the current budget’s Medicaid shortfall, estimated at $2-3 billion due
build on its major successes of 2017, renew some of the biggest to caseload growth, without tapping the state’s “Rainy Day” fund.
battles that stalled two years ago, and tackle relatively new ones. In September, state Comptroller Glenn Hegar announced that
Physicians will make their case to a somewhat new makeup of law- the fund was on track to reach nearly $12 billion at the end of 2019.
makers. That’s about 10 percent of the overall budget and the most in the
After the Democrats flipped seats in both state chambers in No- fund since 2015. Sales tax and oil and gas revenue also were up.
vember’s elections — gaining 12 in the House of Representatives The question is whether that positive economic outlook will con-
and two in the Senate — this year’s session will feature a somewhat tinue, Ms. Romero cautions. The comptroller always issues another
more bipartisan legislature. Republicans still control a majority in revenue estimate just before the session begins.
both chambers, but at press time the new breakdown was 83-67 in
the House and 19-11 in the Senate, with a December special election Medicaid, women’s health, GME
set to fill one Senate seat. And there is a new Speaker of the House TMA President Doug Curran, MD, has made Medicaid the cen-
— Rep. Dennis Bonnen (R-Angleton) — to replace outgoing Rep. terpiece of his presidency. TMA hopes lawmakers will take up that
Joe Straus (R-San Antonio). mantle with solutions to reduce costly red tape, streamline care co-
Jason Terk, MD, chair of TMA’s Council on Legislation, says ordination for the most complex patients, and improve coverage
Medicaid will be a top-priority issue for the council. He thinks the for the state’s working poor.
new makeup of the Legislature bodes well for medicine’s push to In addition, Medicaid’s low payment rates have depressed physi-
get more money for Medicaid payments, which is part of the per- cian participation in the program. In written remarks to the Leg-
petually contentious budget process. islative Budget Board (LBB) in September 2018, TMA said it
“It’s always a food fight. But I expect it,” the Keller pediatrician supports revitalizing Medicaid and Children’s Health Insurance Pro-
said. “In years past, of course, we have always supported improve- gram (CHIP) physician networks, noting physicians haven’t received
ment in payment rates. But I think that there’s a little bit different a meaningful payment increase in Medicaid in nearly two decades.
dynamic now, [such] that we potentially have a higher chance of But improving Medicaid coverage goes well beyond properly
getting some substantive improvement this year.” compensating physicians, and medicine will throw its weight behind
From budgetary matters and insurance legislation, to public other hoped-for improvements.
health gains and much more, here’s a look at some of medicine’s TMA will urge lawmakers to enact a maternal health platform
biggest goals. also supported by the state’s Task Force on Maternal Mortality and

12 San Antonio Medicine • February 2019