Health Spending Expected to Grow

When I turned on the computer early the morning of July 29, 2015, the “inbox” was filled with articles from multiple media sources with such headlines as:

  • By 2014, Health Spending will be Nearly a Fifth of the Economy (The Washington Post Wonkblog)
  • Health Spending Projected to Grow Modestly, but Faster (USA Today)
  • Health Care Spending Again Accelerating (Politico)
  • Health Care Spending to Accelerate (Associated Press)
  • US Health Spending Growth Jumped to 5.5% in 2014 (Wall Street Journal)

It appears that health care spending is rising at a faster rate than at any time since the Great Recession; costs in 2014 rose 5.5 percent. Economists predict that the annual rise in health care costs will increase by 5.8 percent over the next decade.

In light of other recent stories that have hailed the Affordable Care Act (Obamacare) successes in bringing down the cost of health care, a June 20 Journal of the American Medical Association research article reports that 7.9 percent of Americans were uninsured during the first quarter of 2015. The report also noted that uninsured rates among Latinos dropped by 11.9 percentage points. The study’s author, Benjamin Sommers of Harvard, said, “The ACA may be associated with reductions in longstanding disparities in access to health care,” through improved access to care.

Reuters has reported that Sommers’ study notes that about 15.8 million adults gained insurance coverage under ACA since 2013 and about 7 million more adults surveyed said that they now had a personal physician. Another 4.8 million said that they can now afford their medications.

Doing the math

I never claimed to be a math whiz, but I just cannot get my arms around the numbers.

We have seen a recent (2012-2014) cooling off in the escalation of health care costs, which many have attributed to the ACA. In 2013, the US economy spent 17.4% of our GNP on health care, but Levey reports in the June 29 Los Angeles Times that “by 2024, healthcare is projected to consume 19.6 % of the economy.”

Hold on! That’s a pretty big increase in just nine years. Why the dramatic rise in costs?

I’m just thinking out loud, but I wonder if there ever was a real decrease in health care costs that could be attributed to the ACA. Was that downturn in cost more likely due to the economy being in the doldrums and even people with insurance postponing needed medical care because of high co-payments? Who has done that study?

I wonder, too, about the recent increase in spending. Is that just because more people are insured now and can afford to pay for services? Or is the predicted increase because old guys like me are consuming health care at a greater rate, living up to the concerns that Baby Boomers will break the bank for all of America?

If you factor in expanded coverage of care (ACA), that aging population (Baby Boomers) and society’s demand to live forever (coupled with a generous desire to remain beautiful and fit while doing so), you have the perfect recipe for the predicted $5.4 trillion in health care spending by 2024—or about 20 percent of the US budget. (Currently, health care spending is $3.1 trillion a year.)

Another factor driving up the cost of health care is the demand for newer and more effective pharmaceuticals. These usually fall into two categories: treatment for hepatitis C and treatment for cancer. Prescription drug spending increased 2.5 percent in 2013, but was up by 12.6 percent in 2014.

And, the ever-expanding Medicaid and Medicare rolls contribute to overall increases as well. Medicare and Medicaid turned 50 on July 30. Although we can celebrate the fact that older Americans no longer have to worry about access to health care, we still must be concerned about the skyrocketing cost associated with both programs. Through them, the government will become the dominant player as it assumes a greater share of the health care costs, from 43 percent in 2013 to 47 percent in 2024.

A brief history of health insurance in America

The provision of health care benefits grew out of the Kaiser Company’s need to keep its weapons-manufacturing plants staffed during World War II; Kaiser was the first to offer health care benefits to attract employees. The federal government had frozen wages for workers during the war effort, so the health benefits were a significant drawing card for employees.

Multiple efforts were made over the ensuing years to expand health care coverage, but it was not until Lyndon Johnson’s Great Society initiative that Medicare and Medicaid entered the American health care scene, to provide a safety net for seniors, the disabled, children and certain other groups. Until that time, the only way to get health coverage was to pay for a private policy out of pocket or join a group policy offered by an employer.

But, the unemployed and working poor had virtually no access to health insurance because they didn’t have an employer-provided plan and/or they had too little discretionary income to afford to purchase insurance outright. And many didn’t qualify for Medicare or Medicaid coverage.

In order to address the number of uninsured, most hospitals unofficially adopted a “cost shifting” model to help pay the costs incurred in treating the uninsured. In other words, insured patients paid more than their share of the cost of care because hospital charges were marked up to account for the anticipated failure to collect on charges from uninsured patients. This predictable math equation is not much different from the markup retail stores place on items to cover their costs associated with shoplifting or damage of goods in their store.

Over the past several decades, as the number of uninsured has grown due to economic downturns and welfare reform, so has the outcry from the insured that they were being charged more than fair market value for services in hospitals and clinics. Their unofficial subsidy to the uninsured was deemed discriminatory or unfair. Congress responded to the public’s demand to address the insurance and health care access problem by passing the Affordable Care Act as proposed by President Obama.

The ACA/Obamacare was intended to level the playing field by making insurance required of and accessible to everyone—whether through an employer or through state and federal insurance exchanges.

That health insurance was going to be affordable with four categories: Platinum, Gold, Silver and Bronze. And, a penalty was to be levied on anyone who purchased a health care policy that was a “Cadillac plan” – whatever that is! A year passes and the Bronze plan is defunct. And, more than 15 percent of the people who originally purchased health insurance have failed to sign up for the next round, instead electing to pay the penalty, since it is cheaper than the insurance.

Next, we see from the reports above that the cost of health care is going up! Should we be surprised? The hospitals had already built in “up-charges” to cover those who did not have insurance, through cost-shifting. It is unlikely those charges went away after the ACA was enacted.

More insured people use more insurance to consume more health care, resulting in increased health expenditures. No surprises there, right? What does remain a mystery: How do we get a handle on the costs?

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Scenes from the 84th Legislative Session

Our state Capitol is a beautiful place. It is a majestic building with a grand dome that is beautiful inside and out. As one walks through the front gates at 11th and Congress (the south side), the full grandeur of the building and grounds makes quite an impression.

Each day as I walk through those gates, I encounter people from all over our state and from all over the world coming in to see the Capitol building or to participate in the political process. Often the grounds are filled with school children and other groups who have come to see democracy in action. One might find a group from Paris, Texas, under a giant circus tent treating all the crowds to free barbeque, or a group of protesters / demonstrators lined up at the entrance on the street or on the Capitol steps with signs and chants on the topic of the day.

Everyone has their day at the Capitol:

  • Doctors Day (First Tuesdays), Chamber of Commerce Days, Nurses Day, OT Day, PT Day, Indian-American Day, Black Caucus Day, Muslim-American Day, Pro-Abortion Groups, Anti-Abortion Groups, State Employee Lobby Groups, Public School Lobby Groups, Home School Lobby Groups, Charter School Lobby Groups, et al. I think there may have even been a recognition for third cousins, once removed!
  • And on and on and on …..

It is everyone’s Capitol. Walk inside the entrance and through security (by the way, if you have a “concealed carry” permit, you can bypass security) and as you enter the great dome you will find lobbyists chatting with each other, tourists trying to get the best photo of the ceilings, posing in front of George W. Bush’s portrait for a photo, standing in the star in the center to hear the marvelous echo, laying down on the floor to get a photo of the rotunda (it is really easiest to just put your camera on the floor in the center of the star and shoot the picture; it will be perfect), and looking at all the great art on the entry walls depicting the Texas War for Independence, the Battle of San Jacinto, and portraits of Davy Crockett and others. And, don’t forget to check out the floors.

It is indeed overwhelming.

If you are under the great dome at noon, you may enjoy the music of a high school choir, a symphony, a mariachi band, or a country and western performance. You may bump into anyone from actors and musicians, to astronauts and Olympians. You will see millionaires and homeless people plodding the same halls. You will encounter every race, color, creed and religion in the world. You will see the able-bodied and the disabled, the old and the young, the gay and the straight, the immigrant and the undocumented, all in pursuit of their objectives related to the rules and regulations that govern lives.

Offices in the Capitol main building are reserved for members with greatest seniority. The House offices are located on the left (west) wing, and the Senate offices are located on the right (east) wing. The Speaker of the House has apartments in the west wing, as well as his main office suite. Other senior members also are located in this wing. On the east wing, the Lt. Governor’s suite of offices extends from the Ground (basement) all the way up to the top floor, along with senior Senators and their staffs. There are also member offices scattered through the north and south wings of the main structure.

On the north side of the Capitol is a vast undergrown structure filled with two floors housing member offices and hearing rooms. This is really the “guts” of activity during the committee process, where both the Senate Finance and the House Appropriations Committees meet, along with almost all other legislative committees. The public crowds into these hearings, often resulting in standing room only and/or use of “overflow” rooms. Hearings may last from a few hours to all night. Persons testifying related to bills may be few to many (more than 300). All must register to testify and must take a position of “for,” “against” or “on” the bill.

I hope you enjoy these images of Capitol life from the 84th Legislative Session.

Throughout the 140 days that the Legislature meets every other year in Texas, the visual senses are filled with images of the countless visitors to the Capitol.

Throughout the 140 days that the Legislature meets every other year in Texas, the visual senses are filled with images of the countless visitors to the Capitol.

Knowing where there is an abundance of nuts on the grounds, squirrels scamper around the Capitol.

Knowing where there is an abundance of nuts on the grounds, squirrels scamper around the Capitol.

The Capitol grounds have gotten a facelift over the past few years, making the area an inviting park for tourists, joggers, fitness workout groups and school picnics.

The Capitol grounds have gotten a facelift over the past few years, making the area an inviting park for tourists, joggers, fitness workout groups and school picnics.

Upon entering the Capitol and passing into the rotunda, one stands in awe of the majesty of the history of Texas, as portraits of past Governors hand on the walls from floor to ceiling.

Upon entering the Capitol and passing into the rotunda, one stands in awe of the majesty of the history of Texas, as portraits of past Governors hand on the walls from floor to ceiling.

One of my favorite portraits hangs on the right as one walks into the rotunda.  For the past 15 years, George W. Bush’s image has occupied the “Immediate Past Governor” place of honor.  This year, it will be moved over one spot, and the portrait of Governor Rick Perry will replace it.

One of my favorite portraits hangs on the right as one walks into the rotunda. For the past 15 years, George W. Bush’s image has occupied the “Immediate Past Governor” place of honor. This year, it will be moved over one spot, and the portrait of Governor Rick Perry will replace it.

The House chamber is expansive.  Contrary to popular myth, Democrats do NOT sit across the aisle from Republicans. In fact they all sit based on seniority across the floor of the House.  No one is allowed on the floor except staff when the chamber is in session.  150 desks are paired across the carpet.

The House chamber is expansive. Contrary to popular myth, Democrats do NOT sit across the aisle from Republicans. In fact they all sit based on seniority across the floor of the House. No one is allowed on the floor except staff when the chamber is in session. 150 desks are paired across the carpet.

Each session, the Governor delivers a “state of the state” address and lays out his budget priorities.  This year, newly elected Lt. Governor Dan Patrick and returning Speaker of the House Joe Straus welcomed Governor Abbott and his family to the House podium.

Each session, the Governor delivers a “state of the state” address and lays out his budget priorities. This year, newly elected Lt. Governor Dan Patrick and returning Speaker of the House Joe Straus welcomed Governor Abbott and his family to the House podium.

UTMB students participating in TMA’s First Tuesday program met up with Rep. Susan King and UT System’s new Chancellor, Admiral Bill McRaven.

UTMB students participating in TMA’s First Tuesday program met up with Rep. Susan King and UT System’s new Chancellor, Admiral Bill McRaven.

More than 60 UTMB SOM students participated in the 2015 First Tuesday “meet and greet” with their legislators.

More than 60 UTMB SOM students participated in the 2015 First Tuesday “meet and greet” with their legislators.

Four UTMB students returned to the Capitol for further work with the Legislature on the issue of Graduate Medical Education.  Front left: Chris Wright, Armando Elizondo, Harrison Scofield and Andrew Coskey.

Four UTMB students returned to the Capitol for further work with the Legislature on the issue of Graduate Medical Education. Front left: Chris Wright, Armando Elizondo, Harrison Scofield and Andrew Coskey.

Senator Charles Schwertner took time for a photo with TMA-AMA student leadership. Senator Schwertner and his wife are both UTMB SOM graduates; he remains in the active practice of orthopaedics in Georgetown, Texas. They have three sons.

Senator Charles Schwertner took time for a photo with TMA-AMA student leadership. Senator Schwertner and his wife are both UTMB SOM graduates; he remains in the active practice of orthopaedics in Georgetown, Texas. They have three sons.

I have always liked Senator Schwertner’s office!  He tells it like a true Texan.

I have always liked Senator Schwertner’s office! He tells it like a true Texan.

This painting from Rep. Donna Howard’s office reminds me of my aunts Jewell, Jimmie, Verna and Ruth.

This painting from Rep. Donna Howard’s office reminds me of my aunts Jewell, Jimmie, Verna and Ruth.

There are many occasions for citizens to express their opinions.  There are usually interest groups out daily on specific issues.  This group sought to bring attention to the funding of living centers for the developmentally disabled.

There are many occasions for citizens to express their opinions. There are usually interest groups out daily on specific issues. This group sought to bring attention to the funding of living centers for the developmentally disabled.

Others sought to bring attention to the need to increase health services for women.

Others sought to bring attention to the need to increase health services for women.

UTMB students with Dr. Greg Bonnen, State Representative from Friendswood and UTMB alum.

UTMB students with Dr. Greg Bonnen, State Representative from Friendswood and UTMB alum.

Students with Rep. Wayne Faircloth, who lives on Galveston Island and represents UTMB.

Students with Rep. Wayne Faircloth, who lives on Galveston Island and represents UTMB.

State government employees marched on the Capitol to emphasize their desire for salary increases.

State government employees marched on the Capitol to emphasize their desire for salary increases.

A very vocal group drew support from Rep. Sylvester Turner regarding continued funding for therapy services to children and disabled individuals.

A very vocal group drew support from Rep. Sylvester Turner regarding continued funding for therapy services to children and disabled individuals.

“No cuts” seemed to be a pretty consistent theme for every group this session.  With the proverbial overabundance of monies in the state’s treasury, many advocacy groups—especially those in education and health care—could not understand the parsimonious allocations to services in those underfunded areas.

“No cuts” seemed to be a pretty consistent theme for every group this session. With the proverbial overabundance of monies in the state’s treasury, many advocacy groups—especially those in education and health care—could not understand the parsimonious allocations to services in those underfunded areas.

Senator Kel Seliger and Chief of Staff for Education Mark Kavanaugh ponder the Senate’s allocations to the education budget.

Senator Kel Seliger and Chief of Staff for Education Mark Kavanaugh ponder the Senate’s allocations to the education budget.

Senators Nichols, Hinojosa and Nelson listen to testimony as they knit together the Senate’s budget proposal.  The House and Senate budgets were about the same in numbers but vastly different in their methodology of financing.  A Conference Committee is tasked with resolving those differences and producing a budget that can be endorsed by both chambers and signed by the Governor.

Senators Nichols, Hinojosa and Nelson listen to testimony as they knit together the Senate’s budget proposal. The House and Senate budgets were about the same in numbers but vastly different in their methodology of financing. A Conference Committee is tasked with resolving those differences and producing a budget that can be endorsed by both chambers and signed by the Governor.

Senator Larry Taylor (seated, far right of photo), who represents Galveston County, served as chair of the Senate Education Committee and also chaired the Senate’s Budget Committee.

Senator Larry Taylor (seated, far right of photo), who represents Galveston County, served as chair of the Senate Education Committee and also chaired the Senate’s Budget Committee.

Senator Schwertner, flanked by Lt. Governor Dan Patrick and Senators Donna Howard and Lois Kolkhorst, held a press conference related to health care proposals for the state.

Senator Schwertner, flanked by Lt. Governor Dan Patrick and Senators Donna Howard and Lois Kolkhorst, held a press conference related to health care proposals for the state.

This T-shirt covers about all the social issues that find their way to the Capitol steps and into the chambers.

This T-shirt covers about all the social issues that find their way to the Capitol steps and into the chambers.

Lauren Sheer working with Dr. Maureen Milligan, Executive Director of Teaching Hospitals of Texas (THOT), who assists us with issues both state and federal that impact medical education, Medicare, CHIP, Medicare and hospital regulatory issues.

Lauren Sheer working with Dr. Maureen Milligan, Executive Director of Teaching Hospitals of Texas (THOT), who assists us with issues both state and federal that impact medical education, Medicare, CHIP and hospital regulatory issues.

Bought this T-Shirt in front of the Capitol for my son-in-law!  Gotta keep my only granddaughter safe!

Bought this T-Shirt in front of the Capitol for my son-in-law! Gotta keep my only granddaughter safe!

Yes sir!  The Dean of the Senate, A.R. “Babe” Schwartz himself, is still as quick as ever in giving new members a bit of advice; Babe is talking with Rep. Wayne Faircloth at a new members’ welcome reception.

Yes sir! The Dean of the Senate, A.R. “Babe” Schwartz himself, is still as quick as ever in giving new members a bit of advice; Babe is talking with Rep. Wayne Faircloth at a new members’ welcome reception.

King Hillier, Laura Smith and myself at a THOT meeting.

King Hillier, Laura Smith and myself at a THOT meeting.

Laura and Angie Hamouie, our UTMB Health Policy Elective student.

Laura and Angie Hamouie, our UTMB Health Policy Elective student.

Highlights of the session are always covered by Evan Smith from The Texas Tribune, shown here reviewing the state tax proposals with Speaker Pro Tempore Dennis Bonnen of Brazoria County.

Highlights of the session are always covered by Evan Smith from The Texas Tribune, shown here reviewing the state tax proposals with Speaker Pro Tempore Dennis Bonnen of Brazoria County.

Another demonstration focusing on the importance of graduation from high school or college for advancement of minority opportunity.

Another demonstration focusing on the importance of graduation from high school or college for advancement of minority opportunity.

Representatives Jeff Leach, Sarah Davis and and Pancho Navarez sort out the 84th Session for Evan Smith at Texas Tribune.

Representatives Jeff Leach, Sarah Davis and and Pancho Navarez sort out the 84th Session for Evan Smith at Texas Tribune.

L&L with Rep. John Raney’s very capable staff.

L&L with Rep. John Raney’s very capable staff.

Representative Faircloth’s staff; some of the best people in the entire state.  Wes Starnes, as Chief of Staff, manages a very responsive office.

Representative Faircloth’s staff; some of the best people in the entire state. Wes Starnes, as Chief of Staff, manages a very responsive office.

Representative Trent Ashby’s staff—a great group of folks who treat the public like their own relatives.

Representative Trent Ashby’s staff—a great group of folks who treat the public like their own relatives.

Rep. Fletcher argues his case for SB11, “Campus Carry.”

Rep. Fletcher argues his case for SB11, “Campus Carry.”

Rep. Sara Davis states her case on SB 11, requesting the exemption of health-related institutions regarding “campus carry.”

Rep. Sara Davis states her case on SB 11, requesting the exemption of health-related institutions regarding “Campus Carry.”

Working with Senator Taylor’s staff on multiple issues was always a pleasure.

Working with Senator Taylor’s staff on multiple issues was always a pleasure.

And the rains came!

And the rains came!

Some days were pretty foggy.

Some days were pretty foggy.

But the skies cleared, and so did our minds.

But the skies cleared, and so did our minds.

Is there really a pot of gold at the end of that rainbow?

Is there really a pot of gold at the end of that rainbow?

Our Governmental Relations colleagues.

Our Governmental Relations colleagues.

A Longhorn view of the Capitol.

A Longhorn view of the Capitol.

The End!

The End!

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140 Days and 140 Nights

Torrential rainfall wasn’t the only downpour in Austin this spring. The political analysts are all trying to enumerate the positives in this 84th Legislative Session. It was a watershed session for social issues, to be sure. And although there will be much talk about the expansive tax cuts passed out of the session and the really, really conservative FY16-17 budget ($209.432 billion compared to the total of $190.9 billion for FY14-15)—all of that comes at a huge cost to what many would have liked to have seen added to public education, community colleges, higher education and health care. There was no adjustment in Medicaid rates, so hospitals and physicians did not receive a boost in funding. So where did all the money go?

  • Almost $20 billion remains in the state treasury in case it is needed in the future.
  • A small amount of money went toward “tax relief,” which translates into a larger deduction in homestead exemptions for homeowners. People who don’t own a home will see no tax relief.
  • A total of $23.1 billion in funds from various programs went to the Texas Department of Transportation for the state’s highway network. Some would say that amount is still less than what’s needed to expand highways, get started on new construction, maintain existing roads, and acquire right of ways for new improvements.

In truth, the budget could probably have been wrapped up much earlier than the end of May, because there were no substantial changes from the one first released in April. Most of the time has been spent debating a myriad of social issues, especially in the waning days of the session. Those issues included everything from bills related to banning same-sex marriage to those tightening abortion restrictions. The most pressing issue for a while in the Legislature seemed to center on expanding the right to carry guns on college campuses in addition to the open carry of guns. Before the session was over, there was still hope among some members to pass a bill that guaranteed “constitutional carry”—meaning that one can carry a weapon without licensure or prior screening.

Passions about issues ran high throughout the session, and members seemed to become more stressed as the session wore on, probably even more so after the American Phoenix Foundation announced that it had accumulated over 800 hours of secretly filmed video and audiotapes of members’ private conversations and life in general. Then came long discussions about to what extent the public has a “right to know” about the private lives of elected officials. Many members approached the invasion of privacy without concern, noting that, “it all comes with the turf” and “if you aren’t doing anything that you would not want to read on the front page of the paper, then don’t worry about it.” Others became angrier over the questions and photographs and responded by likening the audio-video surveillance to stalking.

Tensions also flared even among members of the same party. The old admonition of “speak no evil about a fellow party member” seemed to evaporate as procedural gimmicks and tricks were used to kill fellow members’ bills. There was lots of gamesmanship in both parties. Rep. Jimmie Don Aycock, who had worked all session to produce a laudable funding plan for Texas’ public schools, sadly pulled down his landmark bill rather than clog up the House calendar after ranking Senate members made it clear that they would not take up the legislation even if the House passed it. Rep. Aycock announced his retirement from the House just days after the session’s end joining 12 other legislators who have also already resigned their posts.

As deadlines approached and members raced the clock to get bills heard before midnight, both parties seemed to zero in on a few specific bills, especially those related to guns and social issues. Frankly, the Democrats did not want to see them pass, and many Republicans did not want to have to vote on them and leave a track record for later scrutiny. So when the “chubbing” (slowing down) of legislation started with the proverbial inane questions and points of order being raised, it was almost a relief to many Republicans who were just as happy to not have to vote on some of the topics that lay before them.

Amid all of that background of intrigue and rhetoric, how did Texas’ institutions of higher education, UT System and UTMB, in particular, fare in this most recent exercise in democracy?

On a scale of 1 to 10, I would have to award achievement of UTMB’s outlined legislative goals at least a 9. And I would also applaud the executive leadership of the House, the Senate and the Governor’s Office for the excellent job they did of keeping the agenda focused and working diligently to resolve problems. That statement is measured with the numbers:

  • The Texas Senate voted 30 to 1 in favor of the budget
  • The Texas House voted 115 to 33 for the budget
  • The Comptroller certified the budget
  • The Governor signed the budget

So let’s look at UTMB’s objectives and our end results:

  • Increase in formula funding (the money designated for the education of each student enrolled)Formula funding was increased, with UTMB receiving an additional $10 million. UTMB has seen nearly a 40 percent increase in enrollment over the past 6 years, so this is a welcomed increase in funding. Nevertheless, the formula funding amount is still markedly less than that which was allocated in 2001.
  • Maintain current level of funding for UTMB Hospitals and Clinics—UTMB retained its $10 million addition from the 83rd Legislature. We were happy to maintain that amount, but would welcome the Legislature’s consideration of our request for mission-based funding for our health system, like that received by MD Anderson and UT Health Northeast in Tyler.
  • Exceptional Item funding—Although UTMB had requested funding for programs at the Galveston National Lab, research in vaccine development and research in regenerative medicine, the Legislature awarded UTMB $8.2 million to construct the state’s first (and only) BSL-4 Treatment Facility. Other funding from state sources will increase that overall amount to almost $14 million.
  • Funding for the construction of an Interprofessional Education Building—The Legislature was most generous to all higher education facilities in granting requested funding for one such building project at each institution. UTMB was awarded $67.8 million (the full amount requested) for the construction of a new Interprofessional Education Building. Total cost for the building will be about $90 million; the remaining funds for construction will come from philanthropic resources. The building will be sited on the west end of UTMB’s Galveston campus.
  • Correctional Health Care Operations—$84 million was allocated to the Texas Department of Criminal Justice for CMC operations as the Legislature recognized the current low cost provided by UTMB and Texas Tech ($9.40 per member per day) as well as the inflationary drivers such as offender aging, pharmacy costs and increases in costly chronic conditions among offenders.
  • Correctional Health Salary Adjustments—The Legislature allocated $60 million for CMC employee salary increases, marking the first adjustment for those employees in 4 years.
  • Correctional Health Supplemental Appropriation—The Legislature awarded TDCJ an additional $42 million to complete payments due to UTMB for the prior year’s services.
  • Graduate Medical Education funding—$60 million in new funding was added to the state’s GME programs. UTMB will receive funding increases based upon its addition of new residency slots and/or programs.

Other issues impacting UTMB and other institutions of higher education also passed out of Austin this session. Among them:

  1. The State Budget (HB 1) grew by only 3 percent over the current budget when adjusted for tax relief. It is “balanced” and left almost $20 billion in reserves.
  2. Supplemental Appropriations (HB 2) provides money to cover items in the prior two-year budget timeline that were under-funded. $768 million was placed into TRS-Care (the state’s teacher retirement health plan), and $800M was added to cover border security operations.
  3. General Revenue Dedicated Account Reform (HB 7) reduces the state’s reliance on GR dedicated funds for budget certification, increases budget transparency and ensures that fees are spent on intended purposes. In short, it does away with a host of “slush funds” and accounts with unexpended balances that have cluttered the accounting systems for years. Rep. Sarah Davis led this move to improve accountability and transparency.
  4. Open Carry, which was passed by both Houses and signed by the Governor, permits Texans with gun permits to carry their weapons openly in a holster.
  5. Campus Carry passed in spite of objections from UT System’s new Chancellor, Admiral Bill McRaven, and the objection of multiple university presidents, faculty and students. The bill calls for each university president to study the issue and develop a plan that accommodates students’ and employees’ right to carry; however, the plan may exclude certain areas of the campus and/or certain events. For instance, the Galveston National Lab is already excluded. UTMB will work under UT System guidance in developing the plan for its campuses.
  6. Trauma funding accounts with over $150 million in reserves will be paid to the state’s network of regional trauma centers in a move by Rep. Sarah Davis to improve state budget transparency by eliminating reserves from multiple state accounts. UTMB will benefit from these funds.
  7. Medicaid rates for physicians and hospitals were NOT adjusted during the session; therefore, inflationary costs in health care will have to be absorbed by providers of Medicaid services. Predictions are that more and more physicians will drop out of the already depleted ranks of those accepting Medicaid payments.
  8. Early Childhood Education did benefit through HB 4, signed by the Governor in late May 2015, which implements high-quality education standards for the Texas Pre-K programs. The Governor also signed SB 934, which provides training academies for public school teachers and enhances mathematics instruction and reading excellence programs in kindergarten.
  9. On May 31, 2015, the Governor also signed SB 632, which implements his higher education research emergency item by eliminating the Emerging Technology Fund and creating the Governor’s University Research Initiative. The fund will permit Texas universities to recruit prestigious, nationally recognized researchers to their faculty.
  10. Two bills provide the promised tax relief package: HB 1 increased the homestead exemption for school district property taxes from $15,000 to $25,000. HB 32 reduced the franchise tax on Texas businesses by 25 percent.
  11. State Contracting Reform (SB 20) strengthens contracting oversight across state government. After the revelation of contracting irregularities in the Health and Human Services Commission this year, the Legislature demanded that a better process be put in place for all state agencies.
  12. Health and Human Services Commission Sunset Review (SB 200) reorganized the five agencies related to health and human services by consolidating several into the overall Health and Human Services Commission umbrella and re-defining the role of the Department of State Health Services (SB 202).
  13. Public Education (HB 2804) redesigned the accountability system for evaluating school districts with the use of a straightforward “A” to “F” rating system.
  14. Mental Health funding received an increase of $150.7 million (not including Medicaid) for an overall designated $3.6 billion in all funds for behavioral health and substance abuse initiatives.
  15. Higher Education overall received a $391.5 million increase in funding for a total of $7.2 billion in general revenue funding and $1.3 in General Revenue Dedicated Funding for enrollment growth and formula increases. Community colleges were not included and therefore did not receive any increases in core operational funding.
  16. Tuition Revenue Bonds were approved for the first time since 2006 for the construction of new facilities on university campuses around the state.

Even as we reflect on the success of the 84th Legislative Session, we’re thinking ahead to January 2017 and the beginning of the 85th Legislature. During the coming “interim” year, we’ll continue to educate elected officials about UTMB and its mission and we’ll begin the important work of setting priorities for the next session.

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The Budget

Finally, the verdict is in on the conference committee report: Both chambers still have to vote on the budget, but the agreed-upon template from the committee members was released yesterday and more was revealed today. More details continue to dribble out in small amounts at a time; the decision-making continues to be a very fluid and iterative process. And remember that it’s not over ‘til it’s over. Items can be added that increase or decrease “final” decisions made so far, agreements can fall apart before the final legislative step, and then there are always the governor’s potential vetoes, which can occur up to 20 days after the end of session.

That said, as of today, here’s what the conference committee has done:

budget blogSo good news on the formula—although all universities and health-related institutions are still not up to the desired 2001 levels of funding, this increase is a step in the right direction.

We asked specifically to maintain our hospital base, and the Legislative Budget Board recommendations to the Legislature did just that. In turn, the Legislature did also.

With a 42 percent increase in enrollment and a scarcity of space for student group learning and study, the passage of funding for a new interprofessional educational building is a welcomed gift from the Legislature. Although House and Senate will conference on this issue, UTMB should receive a minimum of $59 million for the building and hopefully up to the $68 million amount recommended by the House.

Budgeteers have put more emphasis on formula funding and less on new or increased special item funding—few institutions received more than a small portion of their requests for special project funding; some received none. Conference awarded UTMB $8.2 million, which is designated for the construction of an infectious diseases treatment facility for UTMB Hospitals. In addition, Rep. Wayne Faircloth was instrumental in getting statutory language adopted that was necessary to allow the Health and Human Services Commission to distribute federal or other funds to UTMB for infectious disease treatment. Funding for TDCJ’s Correctional Managed Health Care program is directed to both Texas Tech and UTMB; UTMB receives about 80 percent of the funds because of the number of units operated and because UTMB treats those patients requiring higher acuity of care (i.e., hepatitis C, cancer, surgical cases and others). For operation of the units and medical, mental health and hospital acute care, the Legislature appropriated $84 million over the next biennium. This will bring funding in line with what is currently being spent in correctional health care, since there is a shortfall this biennium.

Although we had requested raises for correctional health care unit staff, the original recommendations from both House and Senate contained no designated funding for this area. Thankfully, as conference went forward, conferees championed that cause and their efforts resulted in an allocation of $60 million for staff salary increases over the biennium.

With funding issues moving toward closure, the House and Senate will work Saturday and Sunday to complete the packed calendar of bills awaiting passage or rejection before the stroke of midnight June 1.

Remember to go forth and do good—and to do it well!

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Good News on Tuition Revenue Bonds from the Hill

For the past decade, UTMB has been dreaming of a new building to house its educational programs—specifically, an interprofessional educational center that focuses on shared lab, learning and simulation programs to provide the most appropriate learning environment in which to train future care providers. That vision is one more step closer to reality with action taken by the Senate on Tuesday.

House Bill 100 had been approved by the House and sent to the Senate; the Senate had its own version of an omnibus facility construction bill that would permit the new construction and remodeling of educational/research buildings on campuses across the state. During the past two legislative sessions, similar proposals died a slow and painful death in the waning days of the legislative process. But this year, after a decade of drought in construction funding, the Senate agreed (in part) with the House, passed out its version of the construction funding bill, and sent it back to the House for conference.

Discussion regarding the construction of new facilities (and remodeling of outdated facilities) was heated, with almost everyone weighing in with their version of what should or should not be done. Senator Schwertner proposed an amendment that would have linked his proposal for a tuition increase cap to the building appropriation. Others, like Senators Kolkhorst and Ellis, proposed that tuition be re-regulated. Although the rhetoric was extensive, the bill ended up passing with only five Senators opposed: Birdwell, Burton, Hall, Huffines and Van Taylor. Senator Larry Taylor of Galveston County voted for the bill; he has also chaired the Senate Education Committee and served as a leading proponent for the investment in higher education space.

For UTMB the passage (and further tweaking of the bill by the conference committee) is quite meaningful. UTMB has had a 43 percent increase in student enrollment over the past four years. Since Hurricane Ike in 2008, enrollment has increased from 2,600 to over 3,200. This substantial growth (ranked 5th in the entire nation among universities) continues to tax facilities on our Galveston campus.

As UTMB wraps up construction of the new Jennie Sealy Hospital and the Clinical Services Wing, as well as final remodeling of the John Sealy Hospital, efforts will focus on the design of and fundraising for the new Interprofessional Educational Building. Tuition Revenue Bond funding from the state will be a huge help in building the new facility.

Tax Relief and Other Hot Items!

The House and Senate are still working out the mysterious “tax relief” measures; the Senate has wanted an increase in the homestead exemption, but the House has favored a sales tax reduction. A compromise will likely contain a homestead exemption decrease and a reduction in the business margins tax. We should know the favored formula within a few days.

Higher education formula funding is also scheduled for a 3 percent increase; details are imminent. The chambers also are sorting out the methodology for distributing special research funds for higher education institutions through the Texas Research University Fund (TRUF) for the flagships, the Texas Research Incentive Program (TRIP) and the newly proposed Governor’s University Research Initiative (GURI). So, among the TRUF, TRIP and GURI, the state’s research universities should see new sources of potential funding available to them. Proposed changes also would provide funds from the Texas Enterprise Fund (TEF) for a new category of university research commercialization awards. Next will come a proposal to end the acronyms in legislation!

On the Agenda

On Wednesday, the House will discuss Senate Bill 18, which proposes new Graduate Medical Education funding for the state. HB 3078 also will be heard; this bill addresses a uniform pre-nursing curriculum. HB 3348 does likewise, along with authorizing the Texas Higher Education Coordinating Board (THECB) to allow certain public junior colleges to offer baccalaureate degree programs (especially nursing).

With just a few days left in the 84th regular session, much remains to be done and much of it is of interest to UTMB and its mission. We’ll keep you posted as we learn more.

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Where Are We?

The timer on my iPhone says there are 13 days left in the 84th Session of the Texas Legislature before adjournment, or sine die! At midnight on the 140th day (June 1), Cinderella’s coach turns back into a pumpkin, the horses are white mice again, and the excitement of the royal ball and the search for a wife for the prince all end abruptly. Such are the waning days of the legislative session. Some parts of the story end happily; others, sadly. As in the storybook, Cinderella always wins in the end, and the wicked stepsisters get their just deserts when all is said and done. In politics, history will anoint who’s a Cinderella and who’s a stepsister.

As we face that stroke of midnight on June 1, what would an observer say about the players in this legislative session? The orchestra is led by two very competent and powerful conductors, the Speaker of the House and the Lt. Governor. There are 31 Senate players and a cast of 150 in the House. No one is a bit player. There have been some top performances delivered by newcomers to the scene; there have been some less-than-stellar moments that will, no doubt, be chronicled in statewide media, such as Texas Monthly and Texas Tribune. But with respect to UTMB:

Senator Larry Taylor has taken a lead role on numerous issues of great importance to the Gulf Coast—in particular UTMB—and for the state as a whole.

Representative Wayne Faircloth has gone where few have gone before; he can never be accused of being timid. Take a peek at his 10-minute debate (scroll down to the 4/09/15 archive and the debate begins at the 2hr 50min mark) with seasoned House member and soon-to-be candidate for Houston’s Mayor, Sylvester Turner. In an effort to eliminate funding restrictions for UTMB and Galveston County, Rep. Faircloth stood his ground and delivered a vote in favor of his position. He did the same with a key funding issue related to the establishment of a state infectious diseases treatment center (again at UTMB). In fact, that amendment sailed through so fast that leadership was left scurrying around wondering what happened.

And, Rep. Greg Bonnen took on his own brother (Dennis Bonnen, the House Speaker Pro Tempore) in a debate over water rights for Galveston County.

At 125 days into the session, the numbers tell a story! Look for yourself:

Day-125 Statistics—84th vs. 83rd Legislature (Regular Sessions)

blog chart crop

The House has passed out more bills than in the previous session, but the Senate has moved quite a bit slower. Friends of the Senate likely feel that their work has been of greater priority to the state—quality versus quantity. The House might not agree with that interpretation, citing that it has been more focused and that its leadership has been very effective in moving bills along at an aggressive pace. The Senate might argue that the House was slow to take up its bills on the House side; the House might argue the same against the Senate. But no matter how they get there, at the end of the day, both chambers will have to find a way to work together if significant legislation will make it into the public domain.

While budget and policy issues have languished, there has been a spirited debate on any number of social issues that has diverted time and attention. To name a few:

  1. Immigration reform similar to Governor Perry’s executive order from last December continues to move forward in the Legislature. At the same time, new reports from demographers for the state note that immigration from Latin American counties is at an all-time low in Texas and that immigration from Asian counties has increased by 42 percent.
  2. Last week, members from both chambers continued to grapple with settling their differences on tax cuts, restraints on local property tax increases, state ethics cases, border security, and the right to carry handguns.
  3. HB 4105 opposing same sex marriage continued its fight to live in the House.
  4. House Public Education Chairman Jimmie Don Aycock threw in the towel Thursday evening, giving up on his finely crafted education finance package of $3 billion after the Senate sent word that it would not act on the bill even if it passed in the House. The sentiment seems to be “let the courts decide.”
  5. The reintroduction of “deep fat fryers” and soda pop machines in public schools by Agriculture Commissioner Sid Miller touched off major controversy from proponents for healthier diets for kids. As you may recall, then-Agriculture Commissioner, later-Comptroller Susan Combs tossed those items out of schools a decade ago—in this pediatrician’s opinion, all the better for child nutrition!

And what about higher education?

Prospects look good for the passage of legislation to fund Tuition Revenue Bonds (UTMB’s TRB would help build a much-needed interprofessional education building) and for an increase in education formula funding. UTMB remains hopeful for an increase in base funding for the hospital and for TDCJ to receive increased funding for the Correctional Managed Care program that will include funding for employee salary increases. We continue to work with our agency partners to educate legislators about the importance of this funding.

All of those details have to be worked out in the next 13 days! If they aren’t, then I will become one of those grumpy pumpkins that terrorize the graveyards of dead bills.

Stay tuned!

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With a Little Help from Our Alumni

During a recent Development Board meeting at UTMB, a number of questions were asked about the status of UTMB’s funding requests from the state legislature. Obtaining access to new members of the legislature is always difficult. I commented that I really could use some help in getting an appointment to see our new Lt. Governor, Dan Patrick. Within an hour I had a call from Development Board member Michele Purgason, volunteering her time to help set up a meeting with Lt. Governor Patrick to discuss UTMB’s need for support related to our exceptional growth in recent years.

Michele is a UTMB School of Nursing graduate and has some great stories of her time as a cheerleader with the Houston Oilers. She married Tom Purgason, a graduate of UTMB’s School of Medicine. After his residency training, Tom and Michelle made their home in Arlington, Texas, where they built a highly respected internal medicine practice and raised their children. Their daughter Ashley is an alumna of UTMB’s Graduate School of Biomedical Sciences, where she was distinguished for her research in aerospace medicine as well as her service as a student member of the UT System Board of Regents.

Michele has been a trusted advisor and mentor for several successful candidates for elected office over the years. In her role as president of the Arlington Republican Women’s Club, she had met then-Senator Dan Patrick and kept in touch with him during his successful campaign for Lt. Governor.

When Michele called Lt. Governor Patrick’s office and asked for an appointment to discuss UTMB, her request was immediately granted. She called me, and said, “We have an appointment next Wednesday at 4:30! Can you be there?” We seized the opportunity.

Lt. Governor Patrick received us with great hospitality and revealed an extensive knowledge of UTMB’s research in infectious diseases, our safety net role in the delivery of regional trauma services and our role in health professions workforce development. We had the opportunity to expand his understanding regarding future potential threats in the area of emerging infectious diseases. We also discussed how UTMB’s requested research funding in this area, as well as hospital funding we’ve requested (similar to that provided to other state-owned hospitals), would benefit Texans.

We left the meeting feeling pleased that we had been able to state our case and be heard, and delighted to know that there are alumni like Tom, Michele and Ashley Purgason who daily look for ways to further our mission of improving health for the people of Texas and around the world.

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A Visit to the White House

In March, I had the opportunity to participate in a Government Relations Academy as a mentor for the America’s Essential Hospitals (AEH) group (formerly the National Association of Public Hospitals). Our UTMB executive vice president and Health System CEO Donna Sollenberger is on their Board of Directors. As a part of the Academy, we paid a visit to the office of Domestic Policy at the White House.

No, I did not get to meet with President Obama, nor the First Lady. On a prior visit I did get to greet the First Dog in the actual residence. He has his own security detail.

When people visit the “White House” for the purpose of providing information to policy analysts, that visit actually takes place in one of the many auxiliary buildings next to the residence. Security is still the same and consists of passing through multiple screenings contingent upon advance background checks and clearances. Our meeting was in the Eisenhower Building, which in itself is a beautiful piece of architecture.

Eisenhower Annex

Eisenhower Building

The meeting was productive in that we had the opportunity to discuss any subject that we wanted to with the domestic affairs staff. I had heard so many rumors about the imminent demise of the Medicaid 1115 Waiver that I asked the staff member if that was indeed true. He replied promptly that he had heard nothing of that issue, and responded that he would check into it.

He did ask me for a description of “how” the 1115 Waiver was making a difference in Texas. I provided him some specific examples of projects in our 1115 program that Craig Kovacevich and Katrina Lambrecht have so effectively administered, and I described the personal cases with which I was familiar: how lives were changed because of the expanded reach through education, disease management programs, telemedicine, hospital readmission reductions, and the learning collaborative that enables program leadership to share best practices.

As we left the meeting, staff asked for my card. As I handed it to him, he said, “I would like to talk more about the 1115.” Thinking this was a formality, I doubted that I would ever hear back from him. So I was quite shocked when I got a call from Bruce Siegel, president and CEO of AEH, that Domestic Policy Council staffer Tim Gronniger wanted to meet and finish the conversation we had started related to the 1115 Waiver.

Tim and AEH staff

Mr. Gronniger and AEH staff

Bruce is very strategic policy expert. He immediately seized the opportunity to invite me to attend meeting #2 with Tim and his staff, along with Dr. Mitch Katz, representing the Los Angeles 1115 Waiver program, and LaRay Brown, senior vice president of the New York City Health and Hospital Corporation.

Craig and Katrina provided me with a comprehensive list of our outstanding 1115 Waiver projects, and Dr. Maureen Milligan, president and CEO of Teaching Hospitals of Texas, put out a request on my behalf to regional anchors for the waiver all over the state of Texas to send examples of their favorite projects. I had an abundance of information to sift through for the April 29 meeting in DC.

On Tuesday evening, I flew to Washington and joined Bruce and his colleagues for breakfast to plan the meeting with Tim Gronniger at the White House. We walked over to the White House gates after numerous detours because of increased security procedures. Finally, we worked our way through the multiple checkpoints and found our way to the Domestic Policy conference room on the third floor of the Eisenhower Building.

Bruce made the introductions and we immediately plunged into our personal explanations of “why” the 1115 Waiver has played such an important role in the transformation of health care and the improvement in access and quality in America’s health care marketplace. Since every minute counts in meetings like this, there was no small talk or comments on the beautiful Washington weather. We immediately got down to business.

My colleague from L.A. described the tremendous impact the 1115 Waiver has had on the improvements to access to care in their entire hospital and clinic system and the marked decrease in readmissions they’ve seen for patients with chronic health problems. He addressed their improved ability to address those social determinants of health that impact patients and their families, such as food security, housing, transportation, prescription medicine access and health wellness education.

My turn came to describe Texas’ and UTMB’s programs. I sensed Tim’s desire to hear more about the individual impact to patients and evidence of real transformation in the system.

I told him the story of Tyler County Hospital in Woodville, Texas, and its DSRIP (Delivery System Reform Incentive Payment) project designed to improve patient satisfaction, value-based purchasing and access to “after hours” care. I also told him of my firsthand knowledge of that hospital, having been born there six decades ago. I described the impoverished “eastern border” of Texas, which is home to a diverse population with high incidence of chronic disease, premature death, serious mental health disorders, food and housing insecurity, unemployment and overall lack of access to health care.

I told him about Dr. Wright, the CEO and administrator of Tyler County Hospital, and her passion to improve access to care and patient satisfaction. I shared the success of her efforts and the fact that she had just informed us that the hospital had receive a 5 Star rating from CMS (the highest ranking obtainable) as a result of their 1115 improvement efforts. I described the pride in the hospital’s staff that led them (on their own time) to repaint and decorate the hospital cafeteria and break areas for staff and families of patients.

I also shared the multiple improvements that have occurred in the delivery of mental health services in the entire 16-county Region 2, for which UTMB is the anchor. Improvements have included the Burke Center’s collaboration with law enforcement, outpatient providers, supportive housing options and comprehensive care clinics.

Other innovative programs resulting from the 1115 Waiver include the use of Community Health Workers and their inclusion now in Texas as certified health profession workers, as well as the collaborative work among the Texas Medical Board, Health and Human Services Commission, UTMB and the DEA to ensure access to prescription medication for behavioral health patients in underserved areas and delivery of psychiatric services to children.

LaRay Brown provided an overview of the challenges faced in the New York City health department and the challenges facing access to services. In spite of East Texas and NYC being polar opposites in many respects, both share many of the same barriers to health care access, food insecurity, housing issues and other social determinants that diminish the wellness of the community.

At the conclusion of our session, I played a two-minute video of the work done to open a cancer treatment center in Childress, Texas, with partners from Texas Tech—demonstrating the power of the 1115 Waiver to bring about transformations in health care that would not have occurred without that startup funding and technical support. This powerful video brought home the message of transformation for remote cities across our state.

Now it is wait-and-see time. Will our visit and talks make a difference? Who knows? We can only hope that the power of those personal accounts and glimpses into the impact zone of health care transformation will make a difference. Meanwhile, visionary people like Donna Sollenberger, Katrina Lambrecht and Craig Kovacevich will continue the battle for improved health on the front lines, both in Galveston and in rural Texas.

I boarded a plane at DC’s Reagan Airport a couple of hours later and headed back to Austin, where another messaging battle is raging. What will the state legislature do to improve access to health care for those individuals in Texas who remain uninsured and without adequate access to health care? It is all too easy to stereotype the disenfranchised as lacking personal accountability or being irresponsible, but in truth most of our state’s uninsured are working people who simply make too little money to afford the high cost of health insurance.

In the end, all of us pay for that care through higher insurance premiums so that hospitals can shift costs and recover their losses on the delivery of care to the uninsured. This has been an age-old problem in health care. In truth, it is a hidden tax on every American and every American business that provides health care benefits for its employees.

As Texas continues to seek solutions to the crisis facing health care in the state—or the lack thereof for significant parts of our population—we must come to grips with how to ensure access to care for vulnerable populations. Like it or not, the costs are greater when we do nothing because of the negative impact on our state’s future productivity. Pay now or pay (more) later! Never a good choice!

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A Discussion on Telemedicine

I recently had the pleasure of participating in a panel discussion on telemedicine during the Texas Tribune’s Symposium on Health Care.

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A Special Update for TDCJ Correctional Managed Care Employees + A Reminder for All University Employees

There have been many specific questions related to the status of the CMC budget.

Remember your civics and Texas government course? (Of course you do; you took it in the 7th grade.) The House and the Senate each produce a budget. Those budgets are put together for the next two years of operations of each state agency. Sometimes the House and Senate budgets look alike, but sometimes they look very, very different. This is the normal ebb and flow in the process.

This year, each budget looks vastly different from the other one. TDCJ and CMC budget items are allocated to Article V, having to do with criminal justice, prisons, the Department of Public Safety, and the like. This Article fared no better than others in each chamber, with marked differences in the overall as well as the specific allocations to budget items. Overall, it looks like this going to be a topic of serious consideration for the to-be-named conference committee. (See my April 20 blog post for more information on the conference committee process.) In past sessions, CMC has usually been discussed in more detail during Conference Committee.

Correctional Health Care LAR HB 1 Comparison

cmc chart blog

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senate cmc

So what does this mean? The House of Representatives put $84.9 million into its budget for CMC, but put it all into the first area designated for health care services (hospital and clinics). This amount covers the shortfall from the past biennium in building the next two-year budget and also allocates resources for predicted growth in costs related to like pharmaceuticals and treatment of elderly patients with chronic diseases.

The House did NOT allocate any monies for capital equipment, expansion of services (building back staff to 24/7 operations in selected sites) or for employee salaries increases. Rather, Representatives put these items into Article XI, the “wish list” Article. This means that they did not provide funding for the items, but they did leave the discussion open in the Conference Committee.

The Senate provided less money for the CMC enterprise than did the House: $50.5 million to be exact. Senators put $20 million into continuing operations of health care services, which creates quite a substantial shortfall for the next two years. The Senate made no provisions for pay raises in Article XI. They did fund the entire amount requested for capital and for expanded operations.

As you can see, the proposed budgets are vastly difference. So how does this get resolved? In Conference Committee.

What does that mean? The House and Senate leadership (the Speaker of the House and the Lt. Governor, respectively) will each appoint five members to a Conference Committee to meet and go through the budget article by article. They are called upon to reach a compromise that is acceptable to each chamber of the Legislature. For CMC in Article V, the Conference Committee will have to evaluate the money allocated in the budget for the program and decide how to spend those funds for the coming two years. Members could decide to “find the money” for employee raises, for capital, and/or for expansion of services. Sending this work to Conference Committee also means there is another step in the process, and funding decisions regarding correctional health care have not been finalized.

In “finding the money,” the Conference Committee has the option of adding more money to the allocation or subtracting funds from it. (It works both ways!) If the House or the Senate members have a compelling reason to add or subtract funds, they could do so in creating a final budget for each house to approve. And of course, that final budget would have to be acceptable to the Governor in order to obtain his signature and pass to become law.

We, along with leadership from the partner agencies, have been meeting with legislators and their staff throughout this session regarding the importance of all these CMC items, and in particular salary increases. We will continue to work with the Legislature on funding for CMC during the conference process. Nothing is “over” until the final gavel.

Now for the reminder: Many people working in CMC and other parts of the university have asked us about contacting their local elected officials regarding their thoughts and concerns about the budget and other matters. Expressing one’s opinion to elected officials is every American’s right, but for both state and federal employees, contact with officials must be done in the proper manner in order to comply with state and federal law.

Employees cannot make contact with Legislators on state time, or using state resources like telephones, computers, printers, email addresses, or paper and stamps. And no employee may speak as a representative of UTMB unless specifically invited to do so by university leadership. But all employees are free to contact a federal or state official to express opinions about any matter on their own time, using their own resources, and speaking on behalf of themselves as individuals. The state has created the following web site to help members of the public learn more about the Legislature, legislation under consideration and representatives for each district: www.capitol.state.tx.us.

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