Turn, Turn, Turn…

A couple of weeks ago, I chose the lyrics of The Clash to describe the current legislative session and this week The Byrds classic “Turn! Turn! Turn!” (recorded in 1962 and based on Chapter 3 of the book of Ecclesiastes) seems most fitting as the session comes to an end.

To everything, turn, turn, turn.
There is a season, turn, turn, turn.
And a time to every purpose under heaven.
A time to be born, a time to die.

Today marks the final day of the 140 days of the 84th Texas Legislative Session, otherwise known as Sine Die inside the Capitol. Now we have an opportunity to look back and see what this season meant for all of us in the Harris County Healthcare Alliance. We have been very busy working with the members of the Texas Legislature over the last two years to get to where we are. We have some good things coming and some areas where we did not make as much progress as we had hoped.

A time to be born, a time to die.
A time to plant, a time to reap.
A time to kill, a time to heal.
A time to laugh, a time to weep.

As we have discussed before in this blog, the only constitutionally mandated responsibility for the Texas Legislature is approving a budget for the next two years that funds all activities of the State of Texas. It is with this budget act that the values of the state are represented, and the 84th Legislature maintained the state’s commitment to funding education and health care while accounting for population growth as well as projected increases in the costs of those services. Unlike recent years, there were no cuts to any critical services. In fact, new money was appropriated to help Texans who need mental health services and new money was also appropriated for expanded pre-K. While we were ultimately unsuccessful in our efforts to expand Medicaid or a similar coverage model, we did not lose ground.

A time to build up, a time to break down.
A time to dance, a time to mourn.
A time to cast away stones.
A time to gather stones together.

Although it does not directly relate directly to HCHA priorities, this Legislature will probably be remembered as the one that produced a plan to gather stones and build roads and bridges to move our growing population in Texas. There will be a statewide ballot proposition to let Texans decide whether or not to increase funding for transportation. This process is instructive for those of us who care about health care in that we may need to take our issues directly to the voters of Texas if we expect to make significant progress in improving the access, quality and affordability of health care services. Specific to health and human services concerns, this Legislature did pass a series of reforms to the Health and Human Services Commission that, while not historic, should lead to some improvements relating to coordination between the agencies. We will work throughout the next several seasons on implementing this legislation and will continue to push for all those who need services in our communities.

A time of love, a time of hate.
A time of war, a time of peace.
A time you may embrace.
A time to refrain from embracing.

The 84th Legislature may be remembered for the proverbial train wreck that looked inevitable but never materialized. The cooler heads in both the House and Senate prevailed finding ways to work together (for the most part) and keep some of the worst legislation from passing. In January, there were several bills filed that could have changed the perception of Texas as a state filled with compassion and love to a state filled with bitterness and hate, but those bills made very little progress. Fortunately, our communities can still provide health care to immigrants, and the children of illegal immigrants still have the ability to become “dreamers” by attending college with in-state tuition in Texas.

There is a season, turn, turn, turn.
And a time to every purpose under heaven.
A time to gain, a time to lose.
A time to rend, a time to sew.
A time for love, a time for hate.
A time for peace, I swear it’s not too late.

Finally, please know it is not too late to impact the health and human services in our region and state. The next season starts tomorrow, which will lead to an election season, followed by another legislative season. Turn, turn, turn…

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And They’re Comin’ Round the Corner and into the Final Stretch…

The prospect of an elusive Triple Crown has grown in recent weeks after impressive runs from American Pharaoh in the Kentucky Derby and the Preakness Stakes, so I thought it was only fitting to compare the 2015 Texas Legislature to the world of horse racing. Plus today marks the final 14 days of the constitutionally mandated 140 day session, which means everyone is racing to get their bills passed before the deadline on June 1.

Prior to 1993, both the House and Senate basically allowed for all committee and floor activities up until the final day, which always made that last day a truly epic sprint to the finish line that often included all sorts of crazy amendments and bizarre negotiations (or horse trading). Starting in 1993, both the House and Senate developed rules to ensure rational processes that allowed for proper vetting of legislation, amendments and resolutions. Under these rules, there are several deadlines that bill and resolutions must meet in order to remain viable for consideration. For example, any House Bill that did not make it out of the House as of last Friday (May 15th) is considered dead. Saturday (May 23rd) will be the deadline for Senate Bills to be reported out of a House Committee. This process means that the bills still alive in the final days of session are actually read and understood (although that might be a bit of an optimistic assumption) before they are voted on by the Representatives and Senators. It also means that several bills that died at the hands of the deadline may see new life as amendments that could be added to related bills that are still moving.

Of course, the most important horse in this race (and the only bill that the Legislature is required to pass) is the budget for the next two years. While the last couple of weeks in the Capitol have been very difficult for the budget conference committee, there seems to be a growing sense of optimism that the negotiators have made progress and can finish the race without collapsing before they reach the finish line. The stumbling block that has tripped them up recently is the disagreement between the type of tax cuts they should pass, with the House favoring sales tax and franchise tax reductions and the Senate preferring property tax reductions.

For HCHA’s purposes, we expect the final version of this budget to be somewhat of a mixed bag. On the one hand, we do not believe there will be cuts to the important health and human services that have been cut too many times since 2009, and it actually includes some increases in the areas of mental health and women’s health; but on the other hand, there will be no coverage expansion or even a directive incorporated in the budget to pursue alternative methods to draw down earmarked federal dollars. Most of the advocates in the health and human services arena would have preferred that the additional revenue be spent on improving the lives of low-income Texans, but most of the participants in this Texas Legislature believe that tax cuts benefit more people than increasing state services.

As a side note, like horse racing, the audience/fans often engage in partying and silly behavior, with generally no noticeable effect on the actual race, but this year at the Capitol may have a bit of a different story. There have been a number of stories coming out of Austin the last couple of weeks about a conservative group that has been secretly filming legislators, both inside and outside of the Capitol. Those stories have fueled further rumors that the 800 hours of recordings include enough embarrassing material that several elected officials may choose to end their political careers after the videos are released. Reportedly, none of the recordings will be released before June 1, but will begin to be shared after that date. Somewhat of a “photo-finish,” but from a different point of view (sorry, I couldn’t help incorporating at least one ugly pun).

Medicaid Talks, Tax Cut Challenges, and Looming Lawsuits

Last week started with a very difficult press conference for health advocates. On Monday, March 2, Lt. Governor Dan Patrick and Sen. Charles Schwertner brought together the GOP caucus in the Senate to declare necessary reforms to the existing Medicaid system that must happen before progress on Medicaid expansion could ever be considered. While this may have sounded positive, the stipulations they set out included several “poison pills” that they knew the federal government would not likely approve. The only positive thing that several of us in the health care advocacy community noticed is that neither the Governor nor the Speaker was in attendance. Sometimes we have to look for small victories.

Budget discussions progressed last week with no decisions being made, but the Senate held two days of hearings on several tax cut proposals. These hearings culminated with the Senate leadership laying out a suggestion that tax cuts and debt reduction should not count against the spending cap. The House leadership did not seem to agree with the Senate on this issue immediately either, but it did lay out an interesting opportunity for legislators to consider ways that they could meet several obligations at once with the extra revenue they have this year without having to vote to break the spending cap.

Finally, much attention was on the US Supreme Court which heard the beginning arguments of the King vs. Burwell case. In summary, this critically important case could either reaffirm or discontinue the health insurance subsidies that have helped over a million Texans purchase health insurance this year under the ACA. Most importantly, it shined a light on the opportunities the Texas Legislature has to control its own destiny or be at the mercy of the court. A special thank you to State Representative Chris Turner  who has developed HBs 817 and 818 which would facilitate a state-based exchange and thereby protect the coverage subsidies that so many Texans need to maintain their coverage. We are not optimistic that either of these bills will make it to the Governor’s desk for signature, but it is good to know that there are members of the Legislature that see the challenge and are responding to it.

Now that the introductory committee hearings have all been completed and they are all comfortably staffed and operational, we are expecting substantive bills and decisions to come into focus. Considering we are eight weeks into a twenty week session, things will start to happen quickly.

Spotlight at the Capitol Squarely on the Budget

The main focus at the State Capitol right now is the state budget.  Recently the US Secretary of the Treasury, Jacob Lew astutely described the budget process in saying, “The budget is not just a collection of numbers, but an expression of our values and aspirations.” Every two years in Texas, our elected Legislature holds public hearings in Austin to listen to all of the agencies and interest groups that have some role in showing where Texas expresses its values and aspirations through its budget. If you have several days to study it, click here to see the basic budget documents and related presentations from the Legislative Budget Board: LBB.

It is a huge budget by most people’s standards, authorizing state spending for the next two years with a revenue estimate set by the Texas Comptroller of Public Accounts at $113 Billion in general funds. With additional federal funds and dedicated funds, the total is somewhere in the range of $205-210 Billion. Of course, while this number is big, remember that this budget will impact approximately 27 million people who call Texas home. When the Senate Finance Committee and House Appropriations Committee finish their hearings over the next couple of weeks, they will have listened to presentations about almost every dollar in that budget.

To complicate matters, most of the future revenue and expenditures are very difficult to predict over the course of the coming two years. If the economy continues to be strong, there could be less demand on Medicaid and there will be more sales tax revenue. If the economy goes south, it could be a double whammy by increasing demand for support services while reducing funding. Additionally, the state has an obligation to pay for part of education based on attendance, and estimating the number of children in public schools across this state has traditionally been difficult to correctly hit. These uncertainties explain why every two years the Legislature either is looking at a fairly substantive deficit or surplus. Fortunately this year, they are sitting on a nice sizeable surplus. Which brings us to the big question: when you have a budget surplus in Texas, what is the best way to budget?

In an effort to express Texas’ values and aspirations, there have been numerous recommendations on what to do this year. The discussions have included increasing funding for border security, provide for tax cuts, restoring funding to education from cuts made in 2011, appropriately funding health and human services in Texas, increasing funding for higher education, fixing several budget gimmicks used in previous sessions, and numerous others. At this point, it is tough to see how these competing interests will find common ground as there has only been listening and discussing things in general rather than in specifics. We will know more as the committees start making decisions on the different sections of the budget, and as that happens we will keep you informed. The Alliance is actively communicating with the members of these committees about the importance of health and human services funding, and we talk daily about the impact that these funds have in our region. We collaborate with the efforts of our statewide organizations as well as other Houston groups like One Voice and many other HCHA Members. Most importantly, this is not about just numbers as much as it is an expression of our values and aspirations: improving the health of our citizens and the systems that deliver health care to the sick and injured in our region.

New Faces of Leadership in 2015 House and Senate Committees

The Texas Legislature officially convened on January 13th, but truth be told, the first few weeks of most legislative sessions are more pomp and circumstance with very little work being done, and 2015 has been much the same. Now that the inaugural parades and parties are over and most elected officials in Austin have hired staff, it’s time to get to work. Yesterday (February 4th) marked the de facto beginning of the 84th Regular Session of the Texas Legislature as Speaker Straus named the House Committee appointments. On the other side of the Capitol, Lt. Governor Patrick named the Senate Committee appointments two weeks ago, but the only committee with any official action so far has been the Senate Committee on Finance, which has held hearings on the various articles of the budget. As it relates to the Harris County Healthcare Alliance issues and concerns, let’s take a look at who will be our key players.

The Texas Senate is a mixed bag for health and human services funding and policy that impacts the Houston region. The Senate Committee on Finance is where all the major funding decisions occur, and it includes five members from our region (four Republicans and one Democrat out of 15 total members): Senators Huffman, Bettencourt, Kolkhorst, Taylor (Larry), and Whitmire. While we know and respect all of these Senators, Huffman, Taylor and Kolkhorst have shown a high level of interest and expertise related to health funding, and we are optimistic that we can work with all three of these Senators and their staff. The Senate Committee on Health and Human Services is not quite as receptive to the urban areas, especially Houston. Only Senator Kolkhorst (whose district includes Katy and points west) is on this committee from our region, and only two of the nine members come from urban areas (Uresti of San Antonio and Rodriguez of El Paso). When it comes to the policy issues before this committee, we will be networking strategically with others who have similar concerns from outside our region.

The Texas House committee assignments are full of surprises this year. While we knew that the Speaker had several open chairs to fill from elections and retirements that moved people to the Senate and out of office, there were a number of surprises and some will impact our health and human services champions. The House Committee on Appropriations (HAC) will be chaired by Rep. Otto from Dayton, in the upper northeast part of the Houston region, as well as our good friend from here in Houston, Vice Chair Rep. Turner (Sylvester). This 27 member committee has traditionally broken down into four subcommittees, but those have yet to be named. In addition to this strong leadership from the Houston area, our region will be well represented on the committee by Reps. BellBonnen (Greg), Davis (Sarah), Miles, Miller (Rick), and Phelan. Of note relating to our issues before the HAC is the absence of State Rep. Zerwas, who had been the chair of the subcommittee on health and human services for the last several sessions. While he will not be on the HAC this year, Rep. Zerwas will be chairing the House Committee on Higher Education as well as serving on the House Committee on Public Health. Speaking of the 11 member Public Health Committee, it will be have a new chair in Rep. Myra Crownover from the Dallas region, and will include the following Houston members: Reps. Zerwas, Coleman, Davis (Sarah) and Miller (Rick). Stay tuned, now that we know the players and the roles they will be playing on the various committees, it’s time to roll up our sleeves and get to work…

Texas Legislature in the Starting Blocks

Our new governor was sworn in Tuesday and the 84th regular session of the Texas Legislature officially started last week. With all the new faces in leadership in Texas, nobody is expecting much action the first several weeks; but like any good race, it will accelerate quickly toward the finish line 140 days later.

We are cautiously optimistic that several big health and human services budget and policy items could make progress this year with the new leadership, but fully realistic in our expectations that “Medicaid Expansion” as outlined in the ACA is a longshot. The most important activity of every Texas Legislative regular session is to pass a budget that will cover the next two fiscal years. Even with the falling price of a barrel of oil, most early expert prognosticators indicate that they should have adequate resources to properly fund existing services with perhaps some extra revenue left over (NOT a common occurrence in Texas). The big debate will be what to do with the expected “surplus” revenue.  With several newly elected leaders already promising tax cuts and other voices calling for restoration of cuts that went into effect in 2011, it is likely a safe bet that there will a mix of the two to get a budget adopted in both houses and signed by the new governor.

Speaking of the new governor, Governor Abbott will be the center of attention on where (or if, in reality) he directs the Health and Human Services Commission (HHSC) to focus energies as it relates to negotiating with the federal government on strategies to cover the uninsured. The other big item of attention as it pertains to health and human services will be the Texas Sunset Commission report and resulting legislation relating to reforming the entire HHSC enterprise. Look for regular updates on this legislation as it gets rolling through the process.

And finally, speaking of legislation, there are lots of bills that have already been filed and many, many more to come. We will be tracking all sorts of interesting issues and activating our network when the situation calls for it. Buckle in, it is going to be a bumpy ride!