Legislative Update, April 30
Texas has seen a twentyfold increase since 2003 in the number of nonmedical exemptions for school vaccination requirements. Vaccination exemptions tend to cluster geographically, create pockets of under-vaccinated children, and leave communities vulnerable to disease outbreaks, such as measles and whooping cough. On April 23, Senator Kel Seliger (R-Midland) laid out Senate Bill 329, also known as the “Parent’s Right to Know Bill,” in the Senate Health and Human Services Committee. The bill aims to improve community awareness on the importance of vaccinations and improve the state’s ability to identify pockets of disease and implement timely public health interventions.
Immunization exemption data currently collected by the state of Texas is aggregated at the school district level. Parents in support of SB 329 contend that sharing the data at the local campus level will improve community awareness and allow families to make informed decisions when enrolling their children in school. Testimony shared with committee members pointed out that parents of children with compromised immune systems need access to the data collected by the government on their child’s immediate surroundings so that they can make decisions related to their child’s health and well-being. Rekha Lakshmanan, with The Immunization Partnership, testified in support of SB 329, noting the bill ultimately seeks to provide greater transparency regarding the number of immunization exemptions which puts Texans unnecessarily at risk of vaccine-preventable diseases. Witnesses opposed to the bill claimed improving transparency would result in a backlash against unvaccinated individuals.
Organizations signing up in support of SB 329 included the Texas PTA, Williamson County Health District, Texas Public Health Coalition and Texas Medical Association, which explained how the school campus data would be invaluable in responding quickly to disease outbreaks. Methodist Healthcare Ministries supports SB 329 and is a longtime advocate of immunization policies that protect children and their families. The bill was left pending in committee.
Texas ranks 47th in the nation in its ratio of primary care physicians to total population. The low ratio of primary care providers impacts access to care, especially for the 6 million Texans living in 123 counties with a full primary care professional shortage area designation. To encourage new physicians to work in underserved communities, Texas currently pays up to $160,000 of a physician’s student loan in return for a four-year commitment to practice in an underserved area and care for patients enrolled in the CHIP and Medicaid programs. Over the last five years, the program, known as the Physician Education Loan Repayment Program (PELRP), has enrolled 750 physicians caring for patients in rural communities, urban community health centers and correctional facilities. On April 23, the Senate Higher Education Committee took testimony on Senate Bill 998 by Senator Chuy Hinojosa (D-McAllen), which revamps the PELRP by increasing the maximum available loan repayment amount to each participating physician by $20,000 over a four-year term for a maximum of $180,000. This increased amount more closely reflects the educational debt load of recent medical graduates.
According to the Association of American Medical Colleges, 76 percent of medical students graduate with student debt and their total debt load has increased significantly over the past decade. The average educational debt of a new physician has grown from $173,000 in 2011 to $190,000 in 2016. Testifying in support of SB 998, Alan Schalscha, Chief Medical Officer of CommUnityCare, emphasized that the increased loan repayment amount is necessary to remain competitive with actual physician debt and will assist in attracting physicians to practice in medically underserved areas. The bill received support from many stakeholders, including the Texas Association of Community Health Centers, the Teaching Hospitals of Texas and the Texas Medical Association. Methodist Healthcare Ministries works to secure physicians for rural clinics who are often unable to successfully recruit providers for their communities. Passage of SB 998 will strengthen the PELRP and allow medically underserved areas to competitively recruit physicians for necessary medical care. The bill was left pending in committee.
In Texas today, there are 206 counties designated as a mental health professional shortage area, with 73 percent of these counties lacking a single psychiatrist. As a result, patients must often wait several weeks or drive several hours for an appointment to see a psychiatrist. Currently, only psychiatrists can prescribe schedule II controlled substances, such as ADHD medication, pain medication or even opioid treatment medications. However, 42 other states already allow advanced practice registered nurses (APRNs) and physician assistants (PAs) to prescribe these drugs under a physician’s supervision. On April 24, the House Public Health Committee heard testimony on House Bill 2250 by Representative Eddie Lucio, III (D-San Benito), which looks to improve continuity of care, increase access to care and reduce administrative burdens for hospitals.
The future of health care depends on a team-based approach to patient care. Under the current law, a supervising physician must be present for an APRN or PA to prescribe or adjust a Schedule II drug. Testifying in support of House Bill 2250, Sharon Hilgartener, with Texas Nurse Practitioners, stated that changing the dosage of pain medication while the patient is in the hospital is currently within her scope of practice. However, upon discharge, if the dosage on a patient’s prescription needs to change, a physician must sign off. The inability to reach a physician often results in delayed patient discharge, decreased throughput, decreased patient satisfaction scores and ultimately lower reimbursement rates. The Texas Medical Association also went on record in support of HB 2250. Methodist Healthcare Ministries values a patient-centered system of care that reflects the patients’ needs and improves access to health care services. The bill was left pending in committee.
Texas’ rapid population increase places an unparalleled demand on its police, firefighters, paramedics and other local community services. As the cost of providing these services continues to rise, local governments rely on their ability to raise funds through property tax revenues to meet the needs of their residents. Under current law, local governments may raise property tax revenue by up to 8 percent without holding a local election. On April 15, the Texas Senate passed Senate Bill 2 by Senator Paul Bettencourt (R-Houston), which seeks to limit the capacity of local governments and special purpose districts to raise taxes by more than 3.5 percent above the previous year’s revenue and retains a 2.5 percent revenue cap for school districts. Reducing the property tax cap restricts local governments from providing necessary services, such as building and maintaining essential infrastructure, investing in schools and protecting against public health threats.
Local government officials and health care advocates from across the state are opposed to the current language in the Senate’s property tax cap legislation. The legislation threatens to weaken an already vulnerable health care safety net system, especially for providers in rural communities, who cannot rely on state and federal reimbursement to remain viable. Property tax revenues are also used to maintain the underfunded Texas trauma system as well as to offset the state’s share of Medicaid payments to hospitals.
Senate Bill 2 differs from the House’s property tax bill, House Bill 2 by Representative Dustin Burrows (R-Lubbock), which will be debated April 30 on the House floor. The current proposal places a 2.5 percent revenue cap on counties, cities and special purpose districts; however, the bill exempts local hospital districts and school districts from the revenue cap.
Methodist Healthcare Ministries remains engaged in tracking state legislation that restricts local governments from meeting their basic obligations to citizens. Texas needs a fully funded and sustainable health care safety net system to serve the uninsured and underserved of this state.
Saturday, May 4 at 10:30 - Minds Matter Conference; Breaking the Silence on Suicide (San Antonio College)
For more information on health care research, policy or advocacy, please contact Chris Yanas at firstname.lastname@example.org.