The Texas Legislature convenes during odd-numbered years to conduct the state’s business and pass thousands of pieces of legislation over a 140-day stretch. Despite currently being in an interim year, legislative work is still under way.
The Speaker of the Texas House of Representatives and Lieutenant Governor have each issued interim charges for their respective chambers to study through committee hearings this year leading up to the opening day of session next January. These charges provide a preview of what the state’s leadership will be prioritizing when lawmakers convene in Austin in 2023.
With health care top of mind for most Texans coming off a devastating pandemic, it’s no surprise that various facets of the issue will be raised in each chamber’s committees. The Texas Hospital Association’s (THA) advocacy and public policy teams have started laying the groundwork for next session’s efforts with the insight the interim charges provide.
“Our advocacy team has begun meeting with the chairs and members of relevant committees to discuss the interim work ahead,” says Jennifer Banda, THA’s senior vice president of advocacy and public policy. “We’ll most certainly participate in the committee hearings that affect our hospital members, providing background information and testimony as needed, and will continue to ensure hospitals’ interests are represented.”
Health Care Named a Priority
When Speaker Dade Phelan issued interim charges for the Texas House of Representatives on March 10, he notably went beyond his chamber’s regular standing committees to prioritize health care matters with the creation of a new House Select Committee on Health Care Reform, as well as a select committee on criminal justice reform.
“The interim charges are the result of my conversations with House colleagues from across the state, many of whom have concluded there is more work to be done to reform the state’s health care and criminal justice systems. That’s why I have formed two interim committees to devote special attention to these issues, which I consider of utmost importance heading into the next legislative session,” Speaker Phelan announced in a press release.
Before the 88th Legislature convenes, the House’s new select committee has been tasked with studying a broad scope of issues affecting statewide health care access and delivery, many of which align with THA’s advocacy priorities.
The committee’s manifold duties include studying “excessive health care costs on the efficacy of Texas Medicaid and the private health insurance market” and how those costs impact Texans, businesses and state government; monitoring and ensuring compliance with current price transparency requirements; evaluating access to health care for low-income and at-risk populations; studying improvements in outreach for enrollment in CHIP or Medicaid for families with children, including in rural areas; and examining the potential impact of delayed care on the state’s health care delivery system, health care costs and patient health outcomes.
“Because the Speaker is now coming into his second term in that office, he’s able to delineate his priorities ahead of the next session,” says Carrie Kroll, vice president of advocacy, public policy and political strategy. “Our team has met with the Speaker’s Office about this new committee and are encouraged by the emphasis that’s been placed on these issues, and not just by a few legislators, but from one of the state’s leaders.”
The health care select committee is not expected to start meeting until mid-June, so it’s unclear which charges will be first addressed and how its interim work will translate into proposed legislation filed during the regular session. But THA’s advocacy team will be actively participating in discussions and hearings to ensure the voice of Texas hospitals is heard as the committee’s work is conducted.
THA Priorities at the Forefront
Health care is always a major area of focus during legislative sessions, but years of the COVID-19 public health emergency and soaring demand for medical care guarantee it will be in the spotlight next session. While both House and Senate interim committee charges cover a range of health care topics, the state’s pervasive workforce challenges are highlighted in a number of charges.
The issue will be examined by several committees in both chambers, including the House Public Health, Senate Health and Human Services, and both House and Senate Higher Education committees. Many aspects of the health care workforce will be studied, including the implementation of House Bill 1616 from the 87th legislative session that allowed Texas to join the Interstate Medical Licensure Compact. The bill was strongly supported by THA last session, as it lets physicians from other states practice medicine in Texas and helps ease the burden of physician shortages in the state.
“We see both chambers really looking at the workforce issues from both an immediate perspective as well as the long-term focus of developing a robust pipeline of a skilled health care workforce,” says Cameron Duncan, THA’s vice president of advocacy and public policy. “This aligns with how THA is approaching the issue and allows us to have the opportunity to discuss what we’ve been working on and considering within the THA workforce task force, and ensure the state is working to address pervasive health care workforce shortages.”
Earlier this year, THA launched a new task force dedicated to exploring Texas health care workforce challenges from both an acute, pandemic-related lens, as well as an ongoing, long-term matter. The task force is divided into two subcommittees that are examining each side of the issue in further detail.
The advocacy team has been having conversations with legislative offices and stakeholders on those two workforce angles and will continue placing a high priority on the issue going into the next session.
Both the Senate Finance Committee and House Committee on Human Services have been issued charges that look into the impact of health care delivery and providers’ financial stability as it relates to supplemental Medicaid funding for Texas hospitals and health care systems. While Texas’ 10-year Medicaid 1115 waiver extension was reinstated on April 22, it does not guarantee future approval by the Centers for Medicare & Medicaid Services of any state directed payment programs or the state’s use of Local Provider Participation Funds that finance the DPPs.
The House Committee on Human Services is also tasked with examining federal changes to the Medicaid Disproportionate Share Hospital Program and the exclusion of certain costs from the uncompensated care program authorized through the 1115 waiver.
“In addition to highlighting the continued need for supplemental Medicaid funding, there will be further opportunities to discuss coverage expansion within the House and the Senate charges. We’ll also be looking at the implementation of the Healthy Families, Healthy Texas initiative from last session and how it relates to continuous eligibility for children and extended Medicaid coverage for postpartum women.”
SARA GONZÁLEZ, THA’S VICE PRESIDENT OF ADVOCACY AND PUBLIC POLICY
Benefits under the Healthy Texas Women program will be looked at, as well as the Medicaid managed care program as it relates to continuous eligibility for children in Medicaid.
Among THA’s priorities highlighted in the current interim charges is a closer inspection of the challenges facing Texas’ rural health care system. The House Committee on Public Health will study the impact of legislation and funding from last session intended to strengthen rural health care and increase access to care in rural areas.
Financial matters affecting Texas hospitals will receive attention throughout this year’s legislative hearings. With property taxes a perennial issue before the Texas legislature, THA will watch for ways adjustments to property taxes could impact hospitals that depend on tax revenue to keep their doors open. And while not spelled out in the list of interim charges, both the Senate Finance and House Appropriations committees will begin work on drafting the next state budget this year as well.
Reviewing Pandemic Protocols
Two years of COVID-19 care have had an enormous impact on Texas health care systems. Many interim charges are tasked with studying the varied aspects of state’s pandemic responses and crisis standards of care.
The Senate Health and Human Services Committee, in particular, has been charged with reviewing several topics that affect how hospitals operate during a pandemic. “These charges are a continuation of the conversations we’ve had before, especially with regard to public health data collection and coordination,” says Kroll. “Legislators want to know what’s happening in hospitals in real time related to the pandemic. While we certainly want to participate in improving patient outcomes, we also want to be mindful of the administrative burden placed on hospitals.”
The committee’s public health data and pandemic response charges appear broad enough for numerous topics to be included in discussions, including how physicians practice medicine within hospitals, visitation regulations during a pandemic and other pandemic-related safety protocols.
While standards of care that create better health outcomes are broadly supported, THA’s advocacy team notes that every pandemic is different and may require flexibility to respond accordingly. “It’s important to have guardrails, but we don’t want to create something rigid in statute that could be unhelpful if a different type of infectious disease outbreak occurred,” says Banda. “We want to look at the situation through a broad enough lens so that physicians and nurses have the ability to care for patients without any inappropriate red tape imposed by statute.”
Despite the legislative session not beginning until next year, THA’s advocacy and public policy teams are busy gearing up to represent the state’s hospitals as numerous health care topics will be identified and analyzed over the coming months.