The 77th Texas Legislative Session will be remembered as one of the most divisive and partisan in recent history. Much of the tension can be blamed on redistricting. Even though legislators couldn’t agree on a final redistricting plan, this task and the political gerrymandering surrounding it dictated the mood and events of the session.

As new census data indicate, rapid growth along the Interstate 35 corridor and the continued migratory trend toward urban areas across the state could mean, in a post-redistricting session, a loss of as many as 15 rural House seats. Recognizing the probable loss of influence at the Statehouse, the majority of which will be in areas west of IH-35, rural legislators were determined to address the needs of rural Texas this session.

Legislators focused on the usual big-picture issues for rural areas—economic development, transportation, and high-speed telecommunications infrastructure—but health care topped the list. Many officials have witnessed hospital closings and other effects caused by the 1997 Balanced Budget Act and they understood that access to quality health care is as important to rural community development as roads or new businesses. These legislators backed their words with action, passing several bills and appropriating funds to address the health care concerns of rural Texas. 

Putting the money where their mouths are

It’s unclear whether legislators are big music fans, but if they heard any song this session, it was the beating drums from rural and border physicians regarding low Medicaid reimbursement rates. Organized medicine beat the drum and legislators began moving to the rhythm.

Though already mentioned, it bears repeating that health providers should see rate increases from the $197 million allocated in Senate Bill 1, the general appropriations bill. To improve recruitment and retention of rural and border physicians, the appropriations act specifically targets primary care providers who practice in those areas as the chief beneficiaries of these rate increases. A methodology will be developed to provide a “bonus” payment for high volume Medicaid providers. The funds allocated for physicians and providers will be targeted toward Early Periodic Screening Diagnosis and Treatment program and selected primary care codes with the goal of promoting preventive care.

This appropriation has been a long time coming and it’s a giant step toward supporting the sagging physician infrastructure in rural areas. Legislators, both urban and rural, heard the music and they responded.

The rural 7-11 or a big whale

The convenience store has become a staple of our society for no other reason than it provides one-stop shopping for basic goods. Rural legislators, including Speaker Pete Laney, D-Hale Center, and Rep. Warren Chisum, R-Pampa, recognized the value of such a strategy for rural Texas and as a result they drafted House Bill 7. This legislation creates a new one-stop state agency for rural communities, the Office of Rural and Community Affairs.

ORCA, no not the big whale, includes something for everyone in rural Texas, and it packs a punch—$80 million in federal community development block grants. This money can be used for a variety of rural community development projects, like health care, transportation, economic development, telecommunications and education. The Center for Rural Health Initiatives is scheduled to be absorbed by ORCA as it becomes fully operational over the next two years. The new office will preserve programs now administered by CRHI. Unfortunately, a line item veto by Gov. Rick Perry reduced start-up funding for ORCA by $1 million.

Now, the rest of the story

The 77th Texas Legislature may be remembered as partisan, but it will also be remembered as far-sighted in terms of addressing access to quality health care in rural and underserved areas. Several bills were passed this session designed to recruit and retain physicians and other health care professionals, as well as to provide needed physician relief services.

One colorful rural representative, who recognized that most rural physicians were either raised in the country or they married someone who was, believed that “what Texas needed to address the rural physician shortage is a dating service.” The Legislature stopped short of passing this legislation, but the following is an overview of the bills that did pass and have been signed by the governor.

HB 2421 (Rep. Hawley, D-Portland/ Sen. Madla, D-San Antonio) creates a pilot program to create a competitive grant to a Texas medical school to prepare more students for rural medical practice. This TAFP-supported legislation will partner CRHI/ORCA with a participating medical school to identify potential applicants, sponsor financial aid and mentor rural high school students who are interested in practicing medicine. Additionally, a rural elective curriculum will be developed by a medical school to encourage those students to return to a rural area.

SB 940 (Sen. Bivins, R-Amarillo) establishes the Joint Admission Medical Program to increase minority medical school enrollment. This program will create an internship for qualified undergraduate students in hopes the experience will encourage them to pursue careers in medicine. In an effort to have more representative medical school enrollment, both geographically and demographically, the bill requires medical schools to reserve 10 percent of student slots for economically disadvantaged students. Students will be placed under a contract in order to receive financial assistance. This contract will require them to maintain a certain grade point average and complete the courses or repay the loans.

HB 1018 (Rep. Hardcastle, R-Vernon/Sen. Haywood, R-Wichita Falls) requires the State Board of Medical Examiners to expedite the applications for medical licensure for those individuals who express their intention to practice in rural areas.

SB 126 (Sen. Madla/ Rep. Turner, D-Voss) creates a $5 million endowment for a loan repayment program for licensed health professionals other than physicians, who contract to serve in rural areas. It will be based on the existing, and very successful, physician loan repayment program. Legislators have recognized that not only is it difficult to recruit physicians to rural areas, it’s also difficult to recruit nurses, pharmacists, radiological technologists and others.

SB 115 (Sen. Madla/Rep. Hawley) creates a rural foundation (5.01 c.3) within the CRHI to assist rural communities and health professionals raise money for local projects. The new foundation will provide grant writing assistance for funds available through governmental entities, foundations and other sources to fund local rural health projects.

SB 1394 (Sen. Fraser, R-Horseshoe Bay/Rep. Hawley) is authorizing legislation for the TAFP-supported Rural Community Health Systems, which was created by the Legislature in 1997. This bill allows the RCHS to create a pilot project to determine the effectiveness of exclusive provider networks in the delivery of rural Medicaid.     

The one that got away

SB 516 (Rep. Hawley/Sen. Madla) Perry struck down the Physician Relief Services Act late on the last day for the governor to sign or veto legislation. SB 516 would have created a locum tenens program administered through CRHI/ORCA. Over the last decade, similar legislation has been introduced on no less than three separate occasions and this legislation was developed through an interim study charged by the previous legislature.

The program would have allowed CRHI/ORCA to recruit and coordinate relief services for practicing rural primary care physicians at an affordable rate. A provision of the bill authorized the use of fully licensed third-year residents as relieving physicians in hopes the program would increase their exposure to rural medicine.

Clearly, TAFP is disappointed that Perry chose to veto this important rural health legislation. TAFP believes that the lack of available physician relief services is a real-life problem facing physicians and thus patients in rural areas. This legislation would have provided services to rural physicians and patients and helped increase exposure to the physicians of tomorrow. TAFP will continue to work with the CRHI/ORCA and other stakeholders toward these important goals.