Bills and more bills being heard all over the Capitol, but not much really moving…

This has been the first week where several committees have held hearings that have lasted well after midnight. For example, the House Insurance committee was still discussing several health insurance related bills Thursday morning at 2:30am. But, while committees are meeting late into the night, very few bills have actually made it out of committee. There seems to be a developing pattern where bills are brought up for consideration, explained by their authors, testimony is taken, and then the bills are left pending without the chair of the committee calling for a vote. Traditionally, difficult or controversial bills were left pending so that the legislative staff and interested parties could work together to modify the bill and develop it into a committee substitute that would (hopefully) be an improvement on the original bill, but this year it is happening to almost every bill.

While chatting with several advocates about this, I did a little counting and found that the House Public Health Committee has only reported out 13 bills to the full House (last session it was 33 at this point), and the Senate Health and Human Services Committee has only reported out 39 bills (last session it was 146 by this point). Lest you think this is a healthrelated phenomenon, only 89 bills have been passed by either chamber and sent to the other for consideration (last session it was 797 by this point). Simply put, by the end of the second week in April in any of the legislative sessions in my memory (going back to 1993), there were lots of bills moving through the process. So, does this mean there is a flood of bills coming in the next couple of weeks or is it just a slow year? I would postulate that due to the nature of the limited issue-related discussions during the elections of 2014, we will simply see significantly fewer bills get to the Governor’s desk.

The easiest bills to track are sometimes the ones we like the most but are not moving, like Medicaid expansion and a contingency plan for the subsidized insurance purchased through the federal health insurance exchange (thanks for the effort to Reps. Garnet Coleman, Chris Turner, Sens. Rodney Ellis, Sylvia Garcia, and many others). One of the most important bills that is actually moving is SB 200, by Sen. Jane Nelson, relating to the continuation of the Health and Human Services Commission (the HHSC sunset bill); but even tracking this has been somewhat of an adventure this session. The reason for the challenge is that the authors chose to first pass SB 219, a non-substantive recodification bill, which simply updates and cleans up outdated language. SB 219 had to get passed by both chambers before the substantive bill, SB 200, could really get rolling. So, now we have a 96-page committee substitute to SB 200 that was adopted on Tuesday. While some of the deadlines in SB 200 relating to the reorganization were pushed to 2019, it is fundamentally still a streamlining effort for HHSC and a consolidation of administration that we anticipate will take years to make any impact at the local level.

One of the bills that has actually made it out of the Senate and relates to Alliance priorities is SB 760 by Senator Schwertner, which should enhance the adequacy of provider networks in managed care organizations that manage Medicaid populations in Texas. The House received SB 760 on April 8 and will likely send it to a committee on Friday, April 10 or early next week.

Another important bill is HB 2474 , by Reps. John Zerwas, J.D. Sheffield, et al, relating to improving the tracking of immunization exemption rates in children. Based on the recent measles outbreak at Disneyland, several public health advocates raised concerns that such an outbreak could occur in several Texas schools where immunization rates have become very low due to parents exercising their exemption rights. This bill seeks to improve transparency on immunization rates to help inform parents of children who may be vulnerable due to compromised immune systems.

These are just a few of the active issues right now in Austin, but as things continue to accelerate, we will do our best to keep you informed. If you have questions about specific bills you have read about or heard about from other sources, please feel free to shoot me a question via email at tschauer@cgagroup.com.

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At the Halfway Point of the 84th Texas Legislature

With 10 weeks in the books and 10 weeks left to go, this week marks the halfway point for the Texas Legislature in 2015.  The cold weather of the winter is fading fast as bluebonnets bloom along the highways of our fine state, and inside the Capitol the pace of activities has definitely moved into high gear. So, how are things going for the priorities of the Harris County Healthcare Alliance? Let’s take a quick look at each point relating to our goal of improving access to healthcare through innovative funding and coverage initiatives:

  • Supporting efforts to provide health coverage to the over one million uninsured Harris County residents who could be eligible for coverage under federal law. It is seriously hard to believe that we have made so little progress on the issue of coverage expansion, especially considering that so many support this effort – our own Harris County Judge and several other urban and rural counties have endorsed the effort; the hospitals, physicians and health plans support it; the consumer groups, several religious organizations and all the disease groups are vocally supportive of it; and numerous business groups including the Texas Association of Business and the Greater Houston Partnership are on board. Unfortunately, the leadership in this state seems to be convinced (mostly by the TPPF, a conservative think tank) that any sort of expansion of coverage will give the appearance of handing President Obama a political victory, so they won’t even allow a legitimate public discussion of the issue. I wish I could be more positive, but it would seem that unless and until these leaders see the healthcare safety net collapsing, they just don’t seem interested.
  • Defend federal and state spending on Medicaid/CHIP for currently covered populations (including extending CHIP Reauthorization at the federal level). We actually have what appears to be good news on this front as the budget writers in both the Texas House and Senate are not looking to make any sort of cuts. It helps that the State of Texas has more cash on hand than at any time in my memory, but given the talk about tax cuts, we remain vigilant to ensure that existing programs are defended. Furthermore, there seems to be optimism in Congress that they can actually agree on extending the life of the CHIP program for another 2-4 years. How they work that extension into some sort of legislation is still anyone’s guess, but leadership from both parties and both chambers seem committed to helping kids and families who rely on CHIP coverage.
  • Encourage continuation of the Texas Medicaid 1115 Transformation and Quality Improvement Waiver. This issue is less about political courage and leadership at this point as it is about Texas bureaucrats negotiating with federal bureaucrats. The good news is that there seems to be bipartisan support for all the good work that has taken place across this state in the projects and programs that were initiated under the existing 1115 waiver. We are optimistic that we will be able to maintain at least some of that momentum going forward at the project and clinical levels. Unfortunately, the supportive funding that was included for uncompensated care in the original waiver will be difficult to renew at its current levels because the federal government had intended for the people below 100% of the federal poverty level to be covered by Medicaid. It would appear, based on the negotiations in other states, that they do not seem interested in continuing to subsidize hospital care for people who should have comprehensive (and already funded) Medicaid coverage.

Additionally, HCHA is working hard to promote and foster the development of sound healthcare policy; specifically, supporting the development of a comprehensive, coordinated system in Houston/Harris County that meets the healthcare needs of its residents. Here is a brief update on what the outlook is on those areas.

  • Supporting efforts to protect and improve the physical and behavioral health of adults, families and youth, including individuals and populations with special and/or chronic health-related needs. This Legislature has before it significant legislation relating to the entire enterprise of the Health and Human Services Commission that was developed by the Texas Sunset Commission over the last two years. The legislation was initially designed to complete the streamlining of the agencies started in 2003, but the contracting abnormalities discovered at the beginning of the year starting in the Office of the Inspector General seems to have dampened the aggressive timeline that Senator Nelson and Representative Price were targeting. Just last week, it was announced that the timelines for reorganization were being moved back a few years to ensure that the contract management pieces are cleaned up. While several consumer advocates still believe that this reorganization will put too much power into the hands of too few whom answer only to the Governor, there seems to be growing momentum for the streamlining effort. We will remain vigilant in this process to ensure that the actual needs of the people served by these programs are prioritized over bureaucratic wrangling.
  • Encouraging prevention programs and disease awareness through early screening, immunizations, clinic-based treatment and public health efforts. Thanks in part to the Ebola crisis last fall, there are several bills that look to help ensure our state is prepared for potential disease outbreaks, and even more bills have public health efforts. Stay tuned for next week’s blog where I will break down several efforts that HCHA is working to support.
  • Building awareness of the healthcare system sustainability and its impact on community health. We regularly reference the HCHA State of Health Report in our advocacy efforts and have talked with numerous legislators about the findings in this report. While this report is chocked full of useful data and trend information, it also includes policy recommendations to address the challenges with our region. We will continue to build awareness whenever we can relating to the excellent work that went into this report.

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!