Legislative
Preview Special Section
Kessler to Deliver Gardere & Wynne Lecture on February 16, 1999
David
A. Kessler, M.D., J.D., dean of the Yale University School of Medicine
and former Commissioner of the Food and Drug Administration (FDA), will
deliver the second annual Gardere & Wynne lecture at 8:30 a.m. on February
16, 1999. The topic of his presentation will be Regulation of Tobacco:
Health Promotion and Cancer Prevention. The lecture will be held at the
M.D. Anderson Cancer Center. Coffee and refreshments will be served at
8:00 a.m.
Dr. Kessler graduated from Amherst College, the University of Chicago Law School, and Harvard Medical School. He served from 1990 to 1996 as Commissioner of the FDA. On July 1, 1997, he became dean of the Yale University School of Medicine.
The lecture is underwritten by the law firm of Gardere & Wynne, L.L.P. The presentation will be open to the public. For details, e-mail crupf@uh.edu.
Institute Announces Eight New Advisory Board Members
The Health Law & Policy
Institute is pleased to announce the addition of eight new members of its
Advisory Board:
Phyllis Brasher |
Samuel Ward Casscells, M.D. |
Mario Gallegos, Jr. |
Melinda H. Perrin |
Elizabeth D. Rockwell |
J. Michael Solar |
Lex
Frieden, a disability rights advocate, received the prestigious Henry B.
Betts Award on October 29, 1998 in Washington, D.C. The Henry B. Betts
Award is presented to an outstanding individual who has greatly improved
the quality of life for people with physical disabilities. Former President
George Bush and Baylor College of Medicine Chancellor Emeritus Dr. Michael
DeBakey nominated him for the award.
Mr. Frieden has used a wheelchair
since he broke his neck in 1967 and has experienced firsthand the discrimination
and prejudice faced by individuals with disabilities. He helped start some
of this country's first consumer-directed disability advocacy and service
organizations and was instrumental in drafting the Americans with Disabilities
Act. Mr. Frieden, Senior Vice President at The Institute for Rehabilitation
and Research, is a member of the Health Law & Policy Institute's Advisory
Board.
Institute
Celebrates 20th Anniversary
(Link to reception photos)
On October 7, 1998, the Health Law & Policy Institute celebrated its 20th Anniversary with a gala reception in the Frankel Room of the Law Center. Over 150 guests attended the reception. The Health Law Organization presented its annual Alumni Award to J. Richard Cheney (J.D. '75), General Counsel, Methodist Hospital System.
The Institute presented awards to several individuals and organizations whose support was integral to the Institute's development, including: J. Richard Cheney (J.D. ' 75), City of Houston Department of Health and Human Services, Gardere & Wynne L.L.P., Houston Area Women's Center, Houston Endowment, Inc., Elizabeth D. Rockwell, Beverly D. Rudy (J.D. '55), Texas Medical Center, The University of Texas Health Science Center, Thompson & Knight, Mary T. (Mimi) Walker (J.D. '75) and William V. Walker (J.D. '71), and Professor John B. Neibel.
To commemorate the occasion, the Institute published "Reflections of 20 Years," a retrospective of the Institute's past activities and a look toward its future. Reflections was underwritten by Elizabeth D. Rockwell.
Institute Works on Telemedicine Project
The Health Law & Policy Institute is working with the Texas University Affiliated Program for Developmental Disabilities at the University of Texas, College of Education, on a grant project for the Texas Department of Health. The project is funded by the Centers for Disease Control and Prevention and is known as the "On the Right Track" project. Other project participants are Baylor College of Medicine, Scott & White Hospital, Houston Independent School District (ISD), and Temple ISD.
The project focuses on children with disabilities. Objectives include: (1) minimization of secondary disabilities in educational settings for children with primary disabling conditions; (2) enhancement of disability and disability-related issue awareness for health care providers, educators, and parents of children with disabilities; and (3) promotion of systems change in the delivery of services to children with disabilities and their families.
The Institute is investigating and preparing a white paper on telemedicine issues. Among the issues being investigated are the standards that govern the retention, confidentiality, and disclosure of medical records collected by telemedicine and the Food and Drug Administration’s regulatory power over telemedicine equipment.
Institute Prepares Cancer Guides
The
Health Law & Policy Institute has prepared two self-help and resource guides
intended to assist people with cancer, cancer survivors, and others concerned
with cancer coverage to better understand and choose health care plans, and
to deal with Texas and national legal issues related to cancer. The two guides,
Choosing a Health Care Plan and Cancer
and the Law: 1998, are available on our web site. We have a limited
number of printed versions of the brochures available to organizations that
are able to distribute them to their intended audience. If you would like copies
for distribution, please contact Ronald L. Scott at 713-743-2121 or via e-mail
at rscott@central.uh.edu.
The guides were prepared under the direction of the Texas Cancer Council's Managed Care Steering Committee, with funding provided by the council.
From the Web
Health Law Perspectives, a publication available on the Health Law & Policy Institute's web site, features articles by Health Law & Policy Institute faculty and scholars analyzing recent developments in health law. The Institute recently added its 100th article to Health Law Perspectives. All of these articles can be accessed on the Institute's web site at http://www.law.uh.edu/healthlaw.
The following is a list of
the articles that were published in Health
Law Perspectives on the Institute's web site from August
15 to November 15, 1998:
|
|
The University of Houston Law Center Health Law Organization (HLO) has been busy throughout the fall semester. On September 1, 1998, HLO held an introductory meeting. HLO's party at the home of Professors Laura and Mark Rothstein on September 11, 1998 was well-attended despite flooding around town caused by a tropical storm. On September 15, 1998, HLO sponsored a panel discussion of health law faculty concerning their research projects.
HLO held a meeting to provide information to students concerning various health-law-related degree programs on October 13, 1998 and hosted a happy hour at Two Rows Restaurant on October 15, 1998. Along with the Asian Law Students Association, the Black Law Students Association, and the Hispanic Law Students Association, HLO hosted a bowling party on October 23, 1998.
A meeting of the HLO on November 10, 1998 featured Betty Nesmith of CASA, a child advocacy organization, who spoke about CASA's work. This HLO meeting also kicked off HLO's holiday toy drive benefiting CASA children.
In addition, HLO held its annual Alumni-Student Networking Breakfast on November 13, 1998 at the Law Center. Usually, HLO presents its Alumni Recognition Award at this breakfast. This year, however, HLO presented this award to J. Richard Cheney, General Counsel, Methodist Hospital System at the Institute's 20th anniversary reception held on October 7, 1998.
Focus on an Adjunct Professor
J.D. Epstein
J.D.
Epstein teaches Health Care Finance at the University of Houston Law Center.
He has taught as an adjunct professor since 1982, and in 1997 he received
the Institute’s Distinguished Service Award. He is our adjunct with the
longest tenureand one of our most popular teachers.
Since 1991, he has been a partner in the Houston office of Vinson & Elkins L.L.P. and serves as Chairman of the firm's Health Industry Group. From 1974 to 1991, he was with the firm of Wood, Lucksinger & Epstein, serving as its managing partner from 1983.
Mr. Epstein has concentrated his practice on health care issues and has represented numerous hospitals, nursing homes, home health agencies, HMOs, prepaid group practices, medical staffs, and various vendors to the industry nationwide, and non-health care industry corporations with health care benefit concerns.
Mr. Epstein received his B.S. and J.D. degrees from the University of Illinois in Champaign, Illinois. After law school, Mr. Epstein served two years as an Artillery Officer in the U.S. Army on active duty. He is licensed to practice in the state and federal courts of Illinois, Texas, the District of Columbia, various Circuit Courts of Appeals, and the United States Supreme Court. He is a member of the American, Illinois, Texas, Chicago, and Houston Bar Associations. Mr. Epstein is an Executive Committee member and Immediate Past-Chairman of the Gulf Coast Chapter of the March of Dimes. In addition, he is a member of the Health Law & Policy Institute's Advisory Board.
Publications
Mary Anne Bobinski
Mary Anne Bobinski
Lex Frieden, Senior Vice President at The Institute for Rehabilitation and Research, was featured in a front-page feature article in the Houston Chronicle on October 25, 1998. Mr. Frieden is a member of the Health Law & Policy Institute's Advisory Board.
Kathryn Stream, Vice Provost for Health Affairs at Texas Woman's University, was featured in an article entitled "Health-field Challenges," in the Houston Chronicle on October 20, 1998. Dr. Stream is a member of the Health Law & Policy Institute's Advisory Board.
Our Students and Graduates
Melissa Cantrell (J.D. ‘00) wrote "The International Response to Dolly: Will Scientific Freedom Get Sheared?" which appeared in Issue 13:2 of the Journal of Law and Health. She will be working for Senator Edward Kennedy, beginning in January 1999.
Kayhan Parsi (J.D. '93) recently completed a 1-year fellowship at the Institute for Ethics at the American Medical Association (AMA) in Chicago, Illinois. He completed a Ph.D. at the Institute for the Medical Humanities at the University of Texas Medical Branch in Galveston, Texas, where he currently serves as the medical ethics education specialist and is developing an ethics curriculum based on the AMA's Code of Medical Ethics for physicians, medical students, and ethics committees.
Ray Martinez (J.D. ’98) has been appointed by Donna Shalala, Secretary of the U.S. Department of Health and Human Services (HHS), to serve as Regional Director of HHS for Region VI, which includes Arkansas, Louisiana, New Mexico, Oklahoma, and Texas. He will be a key representative of Secretary Shalala in working with other federal, state, and local officials on a wide range of health and social service issues.
Gregory A. Triber (J.D. '98) recently had an article entitled "Prospecting for Genetic Gold: Compensating Genetic Research Donors" published in the Autumn 1998 issue of the Journal of Biolaw & Business.
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SPECIAL
SECTION – THE 76TH TEXAS LEGISLATURE
Introduction
The 76th Texas Legislature convenes on January 12, 1999, and the session promises to bring a variety of health care legislation for consideration by Texas legislators. The articles that appear in this Special Section, by the Commissioner of the Texas Department of Health and a number of state legislators, provide a preview of the health care legislation that will be addressed in the upcoming session, including children's health insurance, indigent health care, sunset review of health care agencies, HCR 44 from the 75th Legislature, cardiovascular disease, tobacco money, epilepsy, EMS, genetics, and long-term care.
Interim Studies. Interim studies are assigned by the Lieutenant Governor and Speaker of the House to the legislative committees, which conduct research, hold public hearings, and convene work groups with state agencies to prepare reports and policy recommendations for the upcoming legislative session. The House Public Health Committee and the Senate Health and Human Services Committee have traditionally prepared reports that set the agenda for health policy initiatives to be considered in the upcoming session.
Topics studied by the House Committee on Public Health include indigent health care, cardiovascular disease, and the Texas Healthy Kids Corporation. Topics examined by the Senate Health and Human Services Committee include fraud and improper payments under Medicaid and welfare programs, minors' access to tobacco, federal tobacco settlement negotiations, demographic trends that impact health and human services delivery systems (immigration, rural concerns, aging population), and hospital billing practices.
In addition, the Senate Interim Committee on Home Health and Assisted Living Facilities has looked into personal care homes and assisted living facilities, the Long-Term Care Legislative Oversight Committee has reviewed the state's nursing facility regulatory system, and the Senate Interim Committee on Economic Development monitored the implementation of S.B. 386 of the 75th Legislature, which allowed patients to sue managed care organizations for negligent health care decisions.
Pre-filed Bills. Pre-filing of bills began on November 9, 1998. Bills can be filed until March 12, 1999. A number of pre-filed bills relate to health care topics, including: abortion; liability, licensing, and regulation of health care professionals; long-term care; and insurance issues.
CHIP. The second phase of the Texas Children's Health Insurance Program will be considered by the Legislature in 1999. Phase 1 was approved by the Health Care Financing Administration on June 15, 1998.
Indigent Health Care. The Legislature will consider amending the Indigent Health Care and Treatment Act. Legislators will have to determine who will be covered, what services will be covered, and the rate and manner of reimbursement.
Sunset Commission. Under the sunset process, 150 state agencies must prove their necessity to the Legislature every 12 years. Legislation must be passed by the Legislature and signed by the Governor in order for an agency under sunset review to continue in existence. Many of the health and human services agencies in Texas are currently under sunset review. The Sunset Commission staff will complete its studies and make recommendations concerning the continued need for these agencies. The staff will issue a report, due to the 76th Legislature in January 1999, that will include recommendations for each HHS agency. The recommendations may be to continue, abolish and transfer functions or consolidate specific programs among agencies. The Legislature will consider the Sunset Commission's recommendations during the session.
Institute’s Legislative Work During 1997-1998 Interim Session
The Health Law & Policy Institute researched and prepared reports on two of the Legislature’s interim charges. On the Senate side, the Institute assisted Senator Judith Zaffirini’s staff in investigating legal and practical issues related to the Committee on Health and Human Services’ interim charge on patient billing. On the House side, the Institute assisted Representative Garnet Coleman’s staff in analyzing indigent health care services and exploring ways to improve the current system in connection with the Committee on Public Health’s interim charge on the Indigent Health Care Act of 1985. The Institute’s efforts included conducting legal research and literature reviews, advising the Senate and House Committees on the law, participating in working group meetings, and attending public hearings.
The Institute also responded to individual requests from Senate and House members:
Public Health Perspectives
By William R. Archer III,
MD
Texas Commissioner of Health
As
we at the Texas Department of Health (TDH) prepare for the upcoming legislative
session, we are focused on three important legislative issues: Children's
Health Insurance (CHIP), an interim study on local public health infrastructure,
and the Sunset Commission's review of the department.
Legislative leaders have worked hard over the last year on Phase I of CHIP, which was implemented in July 1998. Phase I makes teens ages 15 to 19 with family incomes under 100 percent of the federal poverty level eligible for Medicaid.
Legislative committees are now considering options for Phase II. Options include: a further expansion of Medicaid; a program that builds on existing administrative and eligibility processes; and one that builds on existing administrative structures, but substitutes new eligibility processes.
As legislators consider these options, they have the heavy responsibility of weighing available resources to determine how many children we can cover, how extensive the medical benefits package can be, and a host of details about how to design the eligibility and services systems. This is no small task, yet I have been impressed with the professionalism and wisdom of all involved in the process.
House Concurrent Resolution 44, sponsored by Rep. Dianne Delisi, was passed by the 75th Legislature in 1997. HCR 44 directs TDH to join with The University of Texas, Texas A&M and other partners to study the role of local governments in providing public health services and to report their recommendations to the 76th Legislature.
Many issues have surfaced about exactly which public health services should be provided to every Texas citizen; which level of the public health system (state, regional, local) should be responsible for specific services; and how these services should be funded. After interviewing officials and citizens throughout the state, the HCR 44 workgroup drafted recommendations and the final report will be ready for the Legislature in January 1999.
Though public health protections are extensive in cities with local health departments, too many rural areas lack the basic protections that many of us have come to expect. HCR 44 should be an important landmark in our state's efforts to provide equitably for the health of all our citizens.
The review process of the Sunset Commission began almost a year ago with a self-review, out of which TDH identified areas for improvement. The Sunset staff also spent 7 months conducting a review of the agency, then published a report with 10 recommendations for improving TDH.
Sunset staff recommendations include requiring TDH to develop a blueprint to allow more effective service delivery; integrating health care delivery programs; evaluating and improving our regulatory programs; improving public input during the rule-making process; and improving how we monitor agency contracts.
The Sunset Commission voted in favor of all staff recommendations, adding three: to increase EMS testing around the state; create an EMS advisory committee in the statute; and require TDH to evaluate the impact of Medicaid managed care on recipients and providers.
The Sunset Commission will introduce these 13 recommendations during the session. We have had a very positive experience with the Sunset review process and are pleased with the recommendations, which will enable us to move in a positive direction.
Funding Key Part of Health Policy Debate
By Senator Frank Madla
Member, Senate Committee
on Health and Human Services
During
this past interim of the 75th Legislative Session, many health-related
issues have come into the forefront of the public's agenda. The federal
government has made funds available for providing insurance to children,
the Lieutenant Governor has charged three interim committees to review
health-related issues, the Sunset Commission is reviewing 17 agencies that
provide health and human services, and other health-related issues have
generated interest from public policy makers. Although each of these issues
is very important, the fundamental fights in health care this session will
be about money, specifically about tobacco money.
The Attorney General reports that under the final settlement agreement, the State will receive $17.3 billion from the tobacco industry over the course of 25 years. The total for general revenue is approximately $15.1 billion, with the balance of $2.275 billion available to assist local governments with their indigent health-care costs. The 76th Legislature will receive almost $2 billion, of the $15.1 billion, for the general revenue fund for spending through 2001. The $2.275 will be divided with approximately $450 million to be paid to political subdivisions that provide indigent care, between 1999 and 2001, and $1.8 billion to be placed into a permanent health care trust which will be used to reimburse local government for uncompensated indigent health care costs incurred in the future. The additional funding is expected to generate debate on issues varying from funding specific health programs like immunizations, to reimbursement rates for Medicaid health care providers, and even to renovating old health facilities like the Department of Health's Tuberculosis Hospitals in Harlingen and San Antonio.
A second front line issue will be the further development of the federally funded Children's Health Insurance Program (CHIP). In the Balanced Budget Act of 1997, Congress appropriated $24 billion over five years to states implementing a children's health insurance program. Texas stands to gain nearly $2.5 billion over that five-year period with the implementation of a Texas CHIP. The Texas CHIP will be developed in two phases. Phase 1 was approved by the Health Care Financing Administration (HCFA) in mid-June and started on July 1, as an extension of Medicaid coverage to teenagers 15 through 18 years of age with family incomes below 100% of the federal poverty level (FPL). To date, an additional 11,000 children have enrolled in Medicaid statewide. The second phase of the Texas CHIP is being developed by the Health and Human Services Commission (HHSC), the Department of Health (TDH) and three legislative committees which have been charged to study the issue. Phase 2 will require legislative approval by the 76th Legislature and the most debated issues will be the extent of covered benefits, the delivery system to be used to make the health insurance available and the income eligibility level required to qualify for coverage.
The most comprehensive policy issues to be discussed will be generated by the Texas Sunset Commission. The Sunset Commission is charged to perform a periodic and systemic review of each state agency to determine whether it should be renewed or "sunsetted." Seventeen agencies that provide health and human services are under review in 1999. From the Health and Human Services Commission and the Texas Department of Health to the Texas Cancer Council and the Texas Commission for the Blind, the Sunset Commission is taking an extensive look at each agency and at the structure of all 17 agencies as a whole. The Sunset staff has begun the process of reviewing each agency individually and issuing recommendations for improvement of each agency, and will issue recommendations on cross-agency issues and restructuring recommendations in December of 1998. The object is to insure that there is an efficient system to: provide public benefits and health care services, including Medicaid, to eligible individuals, provide a cohesive and effective system for rehabilitative, and intervention services, and maintain an effective public health system.
The Legislature will also consider issues which were, at the request of the Lt. Governor, investigated by Interim Committees. The Health and Human Services Interim Committee monitored the implementation of reforms to Welfare and Medicaid Fraud, and studied the billing practices of health providers. The Senate Interim Committee on Home Health and Assisted Living Facilities studied the state's regulatory framework for personal care homes and the home health care and rehabilitation services industry. The Long-term Care Oversight Committee monitored the implementation of nursing home reform regulations passed in SB190 during the 75th Legislature. Each of these committees will develop recommendations for addressing the specific concerns identified through their investigations.
Additional issues that will be discussed during the session will include funding for epilepsy programs, funding of school-based health clinics, border and rural health care issues, funding for trauma systems and EMS systems and the traditional funding and policy issues in health care. I expect this session to generate rigorous debate on very important issues for our health and human services systems.
Making Sure Personal Care Homes Really Care
By Senator Mike Moncrief
Chair, Senate Interim Committee
on Home Health and Assisted Living Facilities
Member, Senate Committee
on Health and Human Services
As
we enter the 21st Century, Texas is confronted with major challenges regarding
the delivery of long-term care services for persons who are disabled, mentally
ill and mentally retarded. Most significant is the growing number of elderly
Texans. Every eight seconds a "baby boomer" turns 50 years of age in the
United States. Between 1990 and 2025 the state's population of persons
aged 65 years and older will increase a projected 155 percent to an estimated
4.3 million Texans. The number of the very oldest, aged 85 and older, will
double between 2000 and 2010.
These dramatic changes aren't just statistics. More of our loved ones will need help with the basics of living: bathing, cooking, getting dressed, taking medication. It might be your frail elderly grandmother, your disabled adult son, your mentally ill sibling. While they don't need the level of care offered by a nursing home, they can't live completely unassisted -- and you can't quit your job to provide them with all the care they need.
Increasingly attractive alternatives to medical or institutional care are community-based services that maximize resident independence. The home health and assisted living industries have boomed -- and government has failed to keep pace. Agencies are doing their best to fulfill individual responsibilities but their efforts are too compartmentalized to effectively organize their long-term care efforts and people are falling through the cracks.
In response, the Senate Interim Committee on Home Health and Assisted Living has made several recommendations about how our long-term care system might be improved.
76th Legislature to Prioritize Health, Human Services Issues
By Senator Judith Zaffirini,
PhD
Chair, Senate Committee
on Health and Human Services
"The
time is always right to do what is right," said Martin Luther King Jr.,
and when the 76th Texas Legislature convenes in January 1999, we must do
what is right by prioritizing the needs of the most vulnerable segment
of our state's population, our elderly, and our most valuable resource,
our children. My goals include building on legislative successes, such
as Medicaid and welfare reform, and prioritizing health and human services
issues that improve the well-being of Texas families.
To address Texans' long-term care needs, in 1997 the 75th Legislature passed Senate Bill 190 by Zaffirini and Rep. Elliott Naishtat, relating to the regulation of nursing homes. The bill created the Long-Term Care Legislative Oversight Committee (LOC), responsible for studying long-term care issues.
Lt. Gov. Bob Bullock appointed me to chair the LOC, which addressed problems in the nursing facility industry's regulatory system and the availability of long-term care services. Our focus was, and continues to be, improving the quality of long-term care. Many of the recommendations adopted by the LOC resulted in draft legislation that will evolve through amendments throughout the legislative process.
As a result of those recommendations, the 76th Legislature may consider a new rate reimbursement plan for long-term care facilities, with an emphasis on quality of care. Other recommendations include expanding the Direct Care Registry for certified nurse aides to ensure a centralized system for tracking those who commit acts of abuse, neglect or misappropriation; and ensuring better regulation of nurse aides by requiring a certification process. The LOC also directed the Texas Department of Human Services to develop standards for training nurse aides.
Lt. Gov. Bullock also charged the Senate Interim Committee on Health and Human Services (SICHHS), which I chair, to study a rich variety of timely issues and make recommendations. He directed us, for example, to monitor the implementation of Senate Bill 55 by Zaffirini and Rep. Hugo Berlanga, which restricts minors' access to tobacco products. The committee developed legislation clarifying portions of the bill and facilitating enforcement.
The SICHHS developed legislation that would establish a Legislative Oversight Committee to evaluate the impact of federal welfare reform policies. Temporary Assistance to Needy Families (TANF) recipients in Texas are exempt from work requirements outlined in the federal welfare reform law if they have a child younger than four. That waiver expires in 2002, then the exemption will apply only to TANF recipients with children younger than one. As a result, the demand for job training, child care and other related services for TANF recipients will increase. An oversight committee to study the impact of reform policies will ensure that Texas can meet the needs of TANF recipients transitioning from welfare to work.
Children's Protective Services (CPS) continues to have difficulty retaining caseworkers. We must confront the challenge of funding CPS adequately to ensure that the agency can reduce caseloads and improve working conditions for caseworkers while continuing to protect Texas children.
During the 76th Legislature I also will prioritize the equitable distribution of funds from the state's $17.3 billion tobacco industry settlement. Because all children should have access to medical care, the success of the Children's Health Insurance Program (CHIP) also will be a priority.
An Arabian proverb rings true today: "He who has health, has hope; and he who has hope, has everything." We must continue to build on the successes of previous legislative sessions as we improve access to health care, increase preventive medical care, provide the highest quality long-term care and improve our system for the delivery of health and human services. This is what Texans expect and deserve.
76th Legislature to Address Health Care for the Uninsured
By Representative Garnet
F. Coleman
Chair, House Subcommittee
on Indigent Health Care
One
of the major issues that the Texas Legislature has dealt with in the past
several legislative sessions is how to effectively and efficiently provide
health care to the large population in Texas without health insurance.
The number of uninsured in Texas continues to rise; by recent estimates
approximately 3.3 million non-elderly adults and 1.3 million children lack
health insurance. That means almost 25 percent of Texas' 19 million residents
rely on the "safety net" provided by counties, hospital districts, individual
physicians, and public and private hospitals for their health care needs.
As Texas' uninsured population grows, so does the strain on limited public resources, which has ripple effects on the entire health care delivery system. But several factors give the 76th Legislature a unique opportunity to address this problem. First, the federal Balanced Budget Act of 1997 allocates $20 billion over the next five years to states to design and implement programs that expand health insurance coverage for children, of which Texas may receive more than $2 billion. Second, Texas stands to recoup approximately $15 billion over the next 25 years as part of the settlement of the lawsuit brought by the state against the tobacco companies. And finally, Texas will have an estimated $6 billion budget surplus in the next biennium available for appropriation.
One method to reduce the strain that the uninsured place on public resources is to increase the number of Texans with health insurance. The new Children's Health Insurance Program (CHIP) created by the federal government may provide health insurance for as many as one million of the 1.3 million uninsured Texas children. As noted above, Texas may receive more than $2 billion over the next five years from the federal government for the purpose of implementing CHIP. CHIP is a state-federal partnership (much like Medicaid) where the amount of money Texas receives from the federal government depends on the amount of money that Texas commits to CHIP. The 76th Legislature will determine the eligibility level for CHIP, which may be set as high as 200 percent of the federal poverty level, and the appropriate level of funding.
The Children's Health Insurance Program will help to reduce the number of uninsured children, but the burden of providing health care to uninsured adults and the remaining uninsured children will continue to fall on the health care "safety net" described above. The "safety net" provides an estimated $3 billion of uncompensated care each year, but as the number of uninsured continues to grow, so will the strain on the "safety net." The 76th Legislature must address this issue, because the "safety net" is burdened to the point where it is in serious jeopardy of breaking.
In recognition of this concern, Speaker Laney charged the House Subcommittee on Indigent Health Care to perform a comprehensive review of the health care "safety net" and report to the 76th Legislature recommendations for its improvement. In general, the subcommittee found that the "safety net" is not spending that $3 billion in the most effective and efficient manner possible--in fact, the subcommittee found the "safety net" to be fragmented, unorganized and uncoordinated. The subcommittee developed more than 20 specific policy options to maximize the efficiency of the current system, and proposed the commitment of additional public resources to state and local governments to assure the long-term viability of the "safety net" for the uninsured.
Public Health Issues for the 76th Legislature
By Representative Dianne
White Delisi
Vice Chair, House Appropriations
Committee
Member, House Public Health
Committee
The
face of public health is changing in Texas. Many health issues affect the
lives of Texans, and, as legislators, we strive to improve the health of
our citizens. In the next legislative session, I will address two important
issues relating to public health.
Public health, or the lack of it, has the potential to affect every person in Texas. Public health is the provision of population-based services geared towards protecting the health of the public as a whole. These services include disease surveillance, outbreak management, prevention activities, and education.
Based on the committee's recommendations, the public health bill will outline essential public health services. I believe that once Texans are aware of the impact that public health has on their lives, they will support the opportunity to create or maintain a public health entity. In addition, as communities become aware of the benefits of a strong, local public health presence, I hope to see a strengthening of the relationships between private health organizations and public health entities.
2. Cardiovascular Disease
In October, the House Public Health Committee heard the report from the House Subcommittee on Cardiovascular Disease. The subcommittee, which worked with the members of the Texas Coalition on Cardiovascular Disease, ascertained that cardiovascular disease (CVD) is not only the number one killer in the nation, but also in Texas. CVD is also the number one financial drain on health care resources nationally and in Texas. The subcommittee concluded its report by finding that primary and secondary prevention can reduce the rate of CVD and stroke, but that resources for research, education, prevention, and treatment are insufficient and uncoordinated. The subcommittee stated that coordination at the statewide level is needed to provide access of information to all Texans, to coordinate research and evaluate outcomes of programs.
I will be filing legislation that creates a CVD forum. The forum will include experts in the prevention, treatment, research and education of CVD and stroke, as well as patients and families whose lives have been affected by CVD or stroke. The forum would promote education; coordinate activities with other groups; provide guidance to the public and private sector; help communities in developing comprehensive prevention efforts; develop recommendations for care and treatment; and create a database to help extrapolate information about CVD. In addition, the forum will develop outcome measures to evaluate the effectiveness of its initiatives. Lastly, I will support efforts to educate teaching agencies and school districts on the long-term benefits of a public school curriculum that includes physical education, nutrition, and health education and how each relate to CVD and stroke.
I see promise in the future for the health of Texans. In this next session, I hope there will be major steps in addressing public health needs and creating a commitment to the health and welfare of our citizens.
Health Insurance, Kids, and the State
By Representative Kyle Janek
Member, House Public Health
Committee
Recent
data has indicated that as many as 1.3 million Texas children are not covered
under either public or private health insurance. As the start of the 76th
Legislature looms, state lawmakers will confront this number in an effort
to make children's health insurance more affordable for parents.
By and large, these are the children of the "working poor." Their parents make too much to qualify for Medicaid, but still not enough to pay the premiums, which may run two or three thousand dollars a year. As the welfare reforms of recent years take root and the economy does well, we are seeing more parents move off welfare rolls and into this category. This is certainly a good thing, and we should try to help these folks stay off welfare.
It is important to note that not having health insurance does not mean these children do not get care. A safety net exists in the form of county hospital districts, which are supported by local property taxes; the generosity of physicians and hospitals who provide services without compensation; and higher costs passed along to those who do have insurance. Unfortunately, one common way for these kids to be seen is through the emergency room, often once they have gotten really sick. Those with insurance are more apt to seek care early, when care is more cost effective.
In August of 1997, Congress passed legislation that would give states federal grants to subsidize health insurance to those children whose families are between 100% and 200% of the federal poverty level. These Children's Health Insurance Plan (CHIP) grants require states to put up some money of their own in exchange for matching funds. For Texas this means roughly $1 in state money can get $3 in federal funds. In the meantime, two state House committees and a state Senate committee have been meeting to develop a plan for implementation, and in November voted on some recommendations for consideration by the full Legislature. Developed with the input of the Commissioner of Health and Human Services and the Governor's office, here are the recommendations:
I. The Legislature should authorize and fund a state-designed CHIP plan providing health insurance coverage to eligible children consistent with the intent of the law and within available funding ($151 million).
II. The Legislature should authorize the Health and Human Services Commission and the Texas Department of Health to begin implementation of a state-designed CHIP plan with an administrative and benefits structure materially similar to the recommendation of the health and human services agencies with the goal of providing health insurance to children in families with incomes from 100% to 200% FPL.
III. During the interim between the 76th and 77th Regular Sessions, and while implementing CHIP coverage to children, the Health and Human Services Commission and the Texas Department of Health should undertake a comprehensive examination of and make recommendations to the 77th Legislature concerning various CHIP implementation issues including: comprehensive data requiring initial CHIP administrative issues and utilization and participation rates; expected and realized levels of Medicaid spillover; levels of crowd-out and the potential impact of crowd-out at higher income levels; optimal levels of cost-sharing sufficient to "ramp" individuals into Texas Healthy Kids or private insurance markets at higher income levels; the feasibility of providing CHIP coverage through employer-sponsored arrangements; the feasibility of enrollment through Community-Based Organizations (CBO's); and the feasibility of providing CHIP-related coverage to adult family members.
IV. The Legislature should create a joint legislative oversight committee to monitor implementation of CHIP. The Health and Human Services Commission and the Texas Department of Health should report quarterly on program progress and utilization of appropriated CHIP funding.
A few points are worth highlighting:
Making Health Care Information Available to Consumers
By Representative Glen Maxey
Member, House Public Health
Committee
I
have always been a strong proponent of providing consumers with as many
tools as possible when they are making decisions about their health care.
During the 74th session, Senator Jerry Patterson and I passed House Bill
1048 which created the Texas Health Care Information Council. The Council
recently published an HMO "report card" and will release cost information
from hospitals in the spring. The release of health care cost and quality
information benefits all stakeholders in the health care system. In addition
to consumers, employers can make more informed decisions when choosing
providers with the availability of such data. Researchers and policy makers
also need this information in order to better understand the evolving health
care needs of Texas. Health care providers, themselves, will use such information
to market their services to consumers and employers and survive in an increasingly
competitive field.
This session, I hope to put additional information into the hands of consumers in order that they can be even more savvy about their health care choices. Choosing a competent doctor to perform surgery, to deliver a child or simply finding one whose bedside manner you are comfortable with can be one of life's most important decisions. Unfortunately, the information consumers need to make educated decisions about prospective physicians is not readily available. My physician profile bill will provide for the release of malpractice payouts, disciplinary records and any criminal history. Modeled after a Massachusetts law that went into effect in 1996, the legislation will also list education, honors and awards, hospital affiliations, specialties, whether the physician offers translation services, and their participation in Medicaid. True, some of this information is available to the public, but only to those determined enough to comb through court records and licensing board summaries or spend time on the phone hunting down physician backgrounds. Consumers will be able to call the Board of Medical Examiners on a toll-free hot line and get profiles faxed or mailed to them. Hospitals, managed care organizations, and malpractice insurers will also be interested in the information. Eventually, I hope the profiles will be available on the web.
Since its inception two years ago, the physician profiling program in Massachusetts has proven to be enormously popular with consumers. The Board of Registration in Medicine, which manages the program, has received approximately 80,000 phone requests and its web site has received over 1.5 million hits. Despite some initial concerns in the medical community regarding the program, the profiling has had no measurable effect on malpractice claims and there has been no increase in complaints against doctors. Physician profiling laws have been passed in 13 other states and in addition to Texas, and two more are considering it.
My office has worked closely with the Board of Medical Examiners and the Texas Medical Association to ensure that the profiles are presented in an objective manner. The Board will place each record in the context of the physician's specialty to help consumers evaluate the profiles by medical industry norms. For example, malpractice claims of individual doctors will be compared with the average number of lawsuits lodged against a particular type of specialist.
Genetic Discoveries Raise Wide Range of Issues
By Representative Brian McCall
Chair, House State Affairs
Subcommittee on Genetics
The
intensity of the debate about who should have access to genetic information
is growing rapidly, affecting such areas as medical malpractice, employment,
education, family, and criminal justice legislation. Not only are privacy
rights a major concern, but laws regulating research and testing facilities
are, as well. Based on current state activity, it is clear that the controversy
surrounding genetic issues will be considered in legislatures and the courts
for years to come.
The House State Affairs Subcommittee studied a wide array of issues this interim relating to genetics. Topics ranged from cloning to genetic testing, but perhaps the most interesting portion of the study dealt with the forecasting of events likely to arise from future applications of the science itself. Since the discovery of DNA the field of genetics has evolved into big business and has led to medical and legal advances which have improved the quality of life for millions. As the tremendous growth in bio-technology and genetics research promises to provide a wealth of benefits to society, it also threatens to have grave social consequences for Texans in all walks of life. It was critical that the subcommittee identify the legal, ethical and social issues surfacing through advancements in health care and sciences so that the legislature can predict and prevent problems through changes in policy, behavior or both.
Cloning captured the world's attention on February 23, 1997, when a short article announced the first successful cloning of an adult mammal. This amazing occurrence raised numerous ethical issues, questions, concerns and alarms. Naturally, the chief ethical issue raised in most commentaries is whether under any circumstances it could be morally acceptable to apply the cloning techniques to humans. I anticipate that anti-cloning legislation will be introduced next session and may spark a spirited debate on the moral and social implications surrounding this highly charged issue.
Developments in genetics and reproductive technologies have come close to enabling parents to select for eugenic possibilities. Ultimately, parents may be able to choose which traits they want and do not want their child to possess. Eugenic developments are in their infancy and have not, to this date, been a significant reality (except in sex selection). This is an issue that will likely be explored in subsequent legislative sessions. However, genetic information relating to natural parents, adoptive parents or adoptee children might be of great interest in adoption proceedings and could have adverse ramifications for the child if protections aren't adequately addressed.
Once lawyers understand how useful genetic information can be in creating a case, the impact on the courts could be enormous. We can anticipate the use of bio-technology in almost every area of the law. For example, in personal injury cases, projecting lifespans for settlements will no longer be necessary since more exact lifespans particular to the individual could be ordered. In addition, genetic markers for personality predispositions (anger, aggression) could be considered in criminal cases. Civil Rights laws could be modified to take into account inherited genomic characteristics. And in family law disease predisposition could affect custody decisions.
In the very near future,
genetics and bio-technology will affect each of our lives in ways that
we can not predict today. It is our responsibility as legislators to prepare
and provide the citizens of Texas with the knowledge and tools to address
these issues as they arise. There is much evidence that suggests that the
Texas economy will benefit greatly by attracting and promoting bio-technology
research and development in this state. State leaders must oversee this
growth by having policies in place to meet those advancements and at the
same time, have protections in place that provide protections and safeguards
against any misapplication of the science.