A Twisted Path into the Disenchanted Forest

Apr 20, 2015, 08:48 AM by Melissa Harman

AKA: Leave a trail of bread crumbs so you can find your way back to reality!

Politics are not going “as usual” in Austin this session. There are lots of twists, turns, switchbacks, and trap doors on the journey to Oz. We have been doing a lot of visits with members and office staff these past few days, trying to get a sense of where they are heading. The answer is more often than not, “Beats me! We are on divergent paths.”

Hopefully the paths will converge before all is said and done. The House voted out its budget a few weeks back, and its version of formula funding, hospital base funding and inter-professional education building TRB ($67.8 million) were as expected for UTMB. There is also a more generous addition to the CMC base of ($84 million), but not for capital improvements at the units, staff raises or expansion of services.

The Senate version of the budget is not as good for UTMB since it has less for our TRB request ($59 million) and much less for CMC ($54 million, which includes base, capital and expansion of services, but nothing for employee raises).

So both budgets will head to Conference Committee. Members will be named at a future date, but we can guess from the Senate side that it will include Chairman Nelson and Vice Chair Hinojosa, and most likely Senators Schwertner (Health and Human Services Committee) and Huffman (State Affairs), and perhaps Taylor (Education). From the House will be Appropriations Chairman Otto and Vice Chair Sylvester Turner, and maybe three of the following Representatives: Zerwas, Ashby, Price, Crownover, Sarah Davis or another. These 10 individuals from both chambers of the Texas Legislature will have the onerous task of reconciling their budgets into one document that can be supported by Senate, House and Governor.

Conference committee members will take all Articles of the budget and review them one by one, comparing where each chamber is on the issues and trying to find common ground. That process usually works. But, this time the chambers have pretty wide disparities in the items they feel are priorities and worthy of funding, so it is not just a matter of finances but also of ideology. That ideological split within the majority party could potentially be used by the minority party to leverage a few items on their priority list. We will have to be patient and wait to see where it all ends up!

At present, it is fair to say that the House and Senate budgets are miles apart in regards to their budget priorities, and there is serious skepticism from major leaders that they will be able to reconcile those differences during the scheduled session (ending May 31). Many staffers have cancelled vacation plans and members are extending rentals in Austin preparing for the worst-case scenario — a Special Session during June.

It could be a long hot summer! The voice from the Governor’s Mansion has been pretty quiet, unlike that of former Governor Perry, who frequently nudged the Legislature in the direction he wanted it to go. It has been Governor Abbott’s style to leave the Legislature to do its job; after all, he has given them clear instructions in his initial address and the Governor’s recommended budget. The Governor is likely waiting like the rest of us to get a damage estimate from the conference committee and go from there with some more “instructions” about what he will or will not sign related to the budget.

In addition, both houses disagree on the promised tax cut proposals, with the Senate wanting a property tax cut and a decrease in franchise taxes on businesses and the House wanting to reduce sales tax and increase homestead exemptions without a tax cut on property. Right now there are no real words of compromise but lots of shouting at each other through the media. I would predict that will continue for a few more weeks, with the rhetoric becoming increasingly impassioned from both chambers.

The gun bill literally misfired this week when Rep. Trey Martinez Fisher raised a point of order as it came to the House floor. The point of order — a violation of committee rules in which the record of testimony was filled with errors related to persons testifying for and against the bill — was sustained and the bill was sent back to the committee to be “fixed” (we hear they have brought in a gunsmith to work on it). It will make its way back to the floor for reconsideration, where it will likely pass. Although most of the state’s universities (except A&M) have gone on record opposing the right to carry on university campuses, the Legislature’s love affair with guns has not waned. Over 50% of the House members are already co-sponsors of the bill.

As you know, many consider the right to bear arms a birth right, and it can be a Republican “litmus test” (like opposition to abortion) for the truly conservative members. One mis-vote on such “litmus test” issues can result in the member not getting re-elected in the future. So, it is going to be a hard sell to find members willing to move against the party line and vote common sense on the guns-on-campus issue. After all university campuses are filled with young adults with immature neurological systems frequently exposed to and inexperienced with alcohol; that combined with gunpowder in many minds is a recipe for disaster. And, one must also be somewhat concerned about the wisdom of allowing anyone to carry weapons in hospitals, clinics or mental health facilities.

We do have an acceptable amendment excluding the GNL from campus carry; it should move ahead unimpeded. The NRA actually looked it over and stamped their seal of approval on it! There will certainly be efforts in the House to amend the bill to provide a safe environment on college campuses, in courts of law, health clinics and hospitals, and other places of public assembly and sometimes high emotion.

Emotional testimony seems to be trumping scientific facts, studies, reason and even common sense in hearings. A bill requiring all athletes to have an EKG (and maybe a cardiac ultrasound) as routine pre-participation screening for sports in the 9th and again in the 11th grade is sailing through the House unimpeded. This is in spite of testimony from the Texas Pediatric Society and children’s cardiologists citing that the testing is too costly and would impact too few kids. Economic issues on this specific topic are ignored despite the expert testimony. It reminds me of the misguided recommendation to screen all athletes for steroid abuse that was later repealed. We have a lot of legislators providing guidelines for medical practice at the moment without a careful review of the scientific literature.

On another front, the Texas Medical Board (TMB) issued its guidance related to telemedicine practice. Dr. Alex Vo of UTMB has been a godsend in providing advice and recommendations to the board. He has created a great positive relationship with Executive Director Mari Robinson of the TMB, who values his guidance and expertise. The board rules will not impair UTMB’s current telemedicine practice. According to one’s viewpoint, the rules may actually improve our access and ability to offer patients improved access. Mari Robinson is also helping us with DEA-related issues by assisting with the request to include MHMR clinics as accepted telemedicine sites. One of my recent blog posts covers this subject.

Graduate medical education recommendations will also be a major part of the conference process since both House and Senate have placed money in the budget for this program, but not exactly the same allocation of resources. This will be a matter of discussion also for future resolution.

On a different subject, the Senate did vote out Senate Bill 200 by Jane Nelson to partially consolidate the state’s massive health and human services system. The original intent was to consolidate the entire effort into a single multipurpose conglomerate to improve efficiency, lower operational costs and provide better services to clients. However, those intentions got sidelined due to the controversy surrounding the outsourcing and contracting of services to external vendors by the Health and Human Services Commission (HHSC).

Instead of proceeding with the anticipate consolidation of the existing five state agencies, the Senate has recommended that HHSC (which administers Medicaid programs and oversees the other four agencies) merge with the Department of Aging and Disability Services (DADS) and the Department of Assistive and Rehabilitative Services to form one agency next year. The other two agencies — the Department of State Health Services (which oversees public health as well as mental health services) and the Department of Family and Protective Services (which manages children and adult protective services) — would be added to the mix in the future. The timing of the merger would be determined by a committee of four Senators, four House members and three public citizens.

Audits of HHSC by both the Governor’s Office and the State Auditor brought public attention to serious lapses in the handling of private contracts. It was apparent that the contracting processes had not followed usual state protocols to ensure competitive bidding. Those issues and some “perks” provided to HHSC staff became lightning rods for the media. An FBI investigation continues to look at the contract irregularities, and several senior staff members associated with these alleged errant activities have resigned.

Executive Commissioner Dr. Kyle Janek remains the head of the massive HHSC agency, which boasts 54,000 employees and a budget in excess of $34 billion. The Texas Tribune quoted Governor Greg Abbott on April 15, 2015, as saying, “It is now clearer than ever that the Texas HHSC has been riddled with operational, managerial, structural and procedural problems that go far beyond any individual or contract. That is unacceptable.” Anyone interested in public health in Texas will want to keep an eye on how things go for HHSC.

Big agenda items in the next few weeks include a resurrection of “the Right to Open Carry” bills and the appointment of a conference committee to iron out the wrinkles in the budget. Of course, there will also be a host of other bills hitting the floor of the House and Senate.

Be on the lookout for the dire wolf in our own version of “Game of Thrones.” You never know what will fall to the sword next.

Stay tuned for “Sights to Behold.”