Ben’s Blog 2019 (#2)
Another few weeks of the legislative session have gone by very smoothly. Both the House Appropriations Committee and the Senate Finance Committee are working their agendas, with highly organized meetings broken into study groups by each Article of the Budget.
For UTMB that means we pay special attention to Article II, which deals with the Health and Human Services Commission budget. Last session (the 85th), HHSC offered up a reduction of revenue from unclaimed lottery receipts that was designated for UTMB’s indigent care use. This helped HHSC meet its budget reductions goal, but also eliminated most of the funds used to offset UTMB’s provision of indigent care to patients from counties other than Galveston, Harris, Brazoria, Chambers and Montgomery. This $8.9 million reduction has resulted in UTMB having to “ration” care for individuals who do not meet their county’s eligibility criteria for receiving indigent care support. Unfortunately, these individuals are most often the “working poor” who have recently lost a job or have become unable to work because of illness or injury.
Article III hearings regarding Health Related Institutions (medical schools) in both the House and Senate have occurred over these past two weeks. In the Senate, President David Callender provided compelling testimony regarding UTMB’s request for restoration of funding cuts from the 85th session. Those reductions resulted in the elimination and/or downsizing of some of UTMB’s premiere educational and clinical programs, including the Primary Care Educational Program, the Area Health Education Centers, our home dialysis program, institutional enhancement programs, indigent health care funding and primary care residency support. Dr. Callender also requested, as did other HRI presidents, additional funding for the formula support of students, research and infrastructure. Adequate formula support usually translates into lower out-of-pocket tuition and less indebtedness for students.
A pitch also was made for a $157 million Tuition Revenue Bond to support the construction of a multipurpose educational, research and clinical facility on our League City Campus. This would complement the ongoing expansion on the campus, which will add 60 new hospital beds in 2020.
In terms of Article V, we provided information to appropriators regarding the need for continued support of the Correctional Health Care contract. The legislature has failed over the last two sessions to provide incremental base funding to adequately cover inflation in expenses such as supplies, salaries and pharmaceuticals for the CMC program. In addition, the number of offenders over 55 years of age who have multiple, high-cost chronic health conditions continues to tax the economic integrity of the system. Conditions such as dementia, cancer, liver failure, stroke and orthopedic maladies create a steady stream of referrals to specialists from this group of patients.
The ever-growing high demand for medical and surgical care among an aging offender population, combined with a lack of adequate funding year-to-year, has contributed to a CMC shortfall of almost $200 million for UTMB. Unless the legislature provides adequate financial resources for the expenses required to provide a constitutional level of care to CMC’s patients, UTMB would have to use its cash reserves to close the gap. Using cash reserves is just not sustainable in the present or the future, as it would require us to cut back on educations and clinical programs in our schools. In addition to funding to shore up the program going forward, we need a $200 million Supplemental Appropriation funded immediately to cover past-due amounts and avoid a negative impact to UTMB’s finances. This scenario has been a recurring saga for UTMB from session to session. One of our priorities this session is to address the funding of our successful CMC program.
Meetings these past several weeks have included key leadership in the executive circles in the Capitol, with Dr. Callender and his team meeting directly with Governor Abbott, talks with Lt. Governor Dan Patrick, and great sessions with Senator Larry Taylor and his highly placed and productive staff. (Senator Taylor is chair of the Senate Education Committee and member of the Senate Finance Committee.) Additional meetings with other leaders, such as Senators Hinojosa, Nelson, Hancock, Creighton, Huffman and Kolkhorst, and their very attentive staffs have been encouraging.
On the House side, Dr. Callender and the UTMB Government Relations team have been welcomed into the offices of Representatives Armando Walle, Mary Gonzales, Donna Howard, Matt Schaefer, Carl Sherman, Lynn Stuckey and Gary VanDeaver—all of whom sit on the Article II Appropriations Sub-committee. Chair Sara Davis of the Article II HHSC Sub-Committee has been equally attentive and helpful related to our loss of indigent care funding.
Newly sworn-in Representative Mayes Middleton was present at Tuesday’s House Appropriations Sub-Committee Hearing on Article III to lend his support to UTMB’s requests. Dr. Callender did a marvelous job explaining the importance of UTMB’s request for a mission-specific formula for the institution’s hospital funding, citing that the same funding approach had already been extended to UT MD Anderson and UT Health Science Center at Tyler. UT Southwestern is requesting a similar funding methodology this session. Hospital formula funding recognizes and affirms the unique roles that each medical school plays in contributing to health care, research and health sciences education in our state.
Watch Ben’s Blog for more updates as we work our way through the 86th Session.