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TAFP
is optimistic that the Legislature will address problems facing
patients and physicians, which threaten access to care for Texas
citizens. Here’s a rundown of TAFP’s legislative agenda.
Liability
reform: After a brief hiatus, physicians are experiencing
unprecedented and economically unsustainable increases in their
medical liability premiums. Liability reform will move on three
tracks. The first will focus on the adequacy and enforcement of tort
laws. Specific reforms that have been identified include a $250,000
cap on non-economic damages, collateral source rule, periodic
payments, and greater enforcement of the cost bond and expert witness
reports, to name a few.
The
other two tracks will focus on oversight of insurance underwriting and
claims practices, and reducing medical errors while assessing the
adequacy of professional discipline and oversight by the State Board
of Medical Examiners.
Managed
care reform: After substantial legislative progress in setting
legal standards for patient rights in managed care settings, much
legislative action is still required to restore some balance and
fairness to the operational business activities of the commercial
plans. TAFP will focus its efforts on three key areas of insurance
reform: prompt payment, standard contracts, and antitrust reform to
permit joint negotiations.
Medicaid:
For the past decade, the Texas Legislature has implemented a number of
sweeping changes to the state Medicaid program, including implementing
Medicaid managed care, increasing fraud and abuse detection and
prevention programs, and most recently, it enumerated $205 million in
cost-saving initiatives to make the program more efficient. In 2001,
the Legislature also enacted its largest Medicaid reimbursement
update, targeting new funds to primary care physicians. The goal of
each reform initiative has been the same: to reduce or contain costs
while improving access to care and ensuring a stable provider base.
Despite
provider increases in 2001, Medicaid reimbursement still lags far
behind Medicare and commercial payments. With the downturn in the
economy, more people are accessing the Medicaid and CHIP programs,
adding stress not only to the state budget, but physicians’ ability
to care for these patients. TAFP will strongly advocate for an
increase in Medicaid provider rates to help ensure a healthy provider
base. TAFP will also fight to streamline and simplify the Medicaid
program to remove some of its administrative complexity.
Immunizations:
Texas ranked last in the 2000 National Immunization Survey, an ongoing
study by the National Immunization Program at the Centers for Disease
Control and Prevention, which examines vaccination levels for children
19 through 35 months of age. TAFP will support efforts to educate the
public on the importance of a proper vaccination regimen. The academy
will try to strengthen the Vaccine for Children program through
physician education and improved vaccine distribution.
The
academy will also support legislation to improve the state’s
vaccination registry, ImmTrac, which is currently an opt-in system.
TAFP along with the Texas Pediatric Society, Texas Medical Association
and the Texas Academy of Internal Medicine will pursue changing the
registry to an opt-out system, where vaccination data for each child
goes into the database except when parents request their children’s
information not be listed.
Taxes:
In 1991 and again in 1997, the Legislature contemplated a massive
restructuring of Texas business taxes by removing or modifying the
local property tax and offsetting those revenues by extending the
corporate franchise tax to partnerships and sole proprietorships.
Given
the expected budget shortfall, restructuring the tax code will be
debated. TAFP will argue that health care services are profoundly
different from most other profitable services, since they are
third-party financed, price inelastic, and non-substitutable.
Physicians cannot by law or public policy pass along tax increases as
a cost of doing business. Moreover, consumers do not purchase illness
or injuries, and physicians, under penalty of law or legal and ethical
obligation, cannot refuse treatment for a patient in cases of
emergency.
New
district borders, many new faces and new leadership in both houses
make this session a challenging one, to say the least. But with one in
five Texans having no health insurance, two million Texans enrolled in
Medicaid and physicians dropping services, retiring early and closing
practices because they can’t make ends meet, the challenges facing
legislators are much greater than running the government.
The
ultimate question facing Texas, its government and its people is who
will care for our communities when the intricacies of business drive
physicians from being able to practice medicine. Without immediate
corrective action in the next legislative session on a number of
fronts, this crisis will only deepen in the months and years ahead,
leading us to a bleak and uncertain future.
As
long as we’re imagining our future, picture this: a health care
safety net strong enough to keep the least fortunate from fearing
illness and broad enough to provide preventive care instead of
requiring emergency care. A physician workforce that is free to focus
its energies on the practice of medicine instead of the business of
running a practice. Paradise or purgatory, health care decisions made
by legislators this session could go a long way toward shaping our
brave new world.
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