If health care issues weren’t at the top of the legislative priority list already, Gov. Perry put them there this week with his State of the State Address. He unveiled a proposed initiative called “Healthier Texas” that aims to redirect hundreds of millions of federal Medicaid dollars to create an insurance premium assistance program for workers earning less than 200 percent of the federal poverty level, and he plans to do it without spending any of the state’s general revenue funds.

The governor’s plan is to sell the state lottery to private interests for an estimated $14 billion, then divide the proceeds into three trust funds. $8.3 billion would go into a trust for education and $3 billion would go into a trust to fund cancer research. The remaining $2.7 billion would be used to establish the premium assistance program through what the governor calls the Uninsured Partnership Trust Fund. Interest earned in the fund would be matched with Medicaid Disproportionate Share Hospital funds and used to help qualifying uninsured workers buy into employer-sponsored health plans or purchase private insurance.

Many questions surround the proposal. First, the plan depends on finding a buyer for the lottery and getting top dollar for it. Two states are currently trying to sell their lotteries and others are considering the option, which is why the governor says Texas must act fast before the market becomes saturated. The plan also depends on the trust fund investments earning an average annual return of 9 percent. If they fall below expectations, will the state make up the difference or will the programs be under-funded?

Both House Speaker Tom Craddick and Lt. Gov. David Dewhurst are noncommittal on the sale of the lottery. A contingent of anti-gambling legislators don’t like the idea of turning the lottery over to a private company, and then there’s the question of whether it’s a good deal to trade away an asset that generates $1 billion each year for a one-time $14 billion lump sum payment.

TAFP fights for increased Medicaid rates

The governor also submitted his proposed budget to the Legislature on Tuesday, which includes an adjustment to Medicaid reimbursement back to 2003 levels. This action would restore the 2.5-percent cut enacted in that year but would do little if anything to increase physician participation in the program. TAFP past president and AAFP board member Roland Goertz, M.D., of Waco, testified before the Senate Finance Committee on Wednesday that only 38 percent of Texas physicians accept new Medicaid patients, a number that continues to drop. He told the committee that Medicaid currently pays about $47 for an average office visit, meaning a 2.5-percent hike would equate to a little more than a dollar. “It may be a step in the right direction, but it’s so modest that I’m not sure what difference it will make,” he said.

In addition to the restoration of the cut, TAFP has called for a 10-percent increase in Medicaid rates in both 2008 and 2009 to bring reimbursement for the program in line with Medicare. Check out the Primary Care Coalition’s issue brief on Medicaid and CHIP for more on TAFP’s proposal.

Measures taken to support graduate medical education

This week, Eugene Stokes, M.D., chairman of the Primary Care Coalition, sent two letters to the House and Senate committees urging lawmakers to invest in Medicaid and CHIP and family medicine graduate medical education. In the letter sent to the Senate Finance Committee, Stokes laid out the Primary Care Coalition’s Medicaid and CHIP budget priorities, which include promoting the “medical home model,” increasing provider reimbursement, increasing enrollment and access for Texas children, and restore graduate medical education payments to aid in training future family physicians.

The letter sent to both the Senate Finance Committee and House Committee on Appropriations focused strictly on boosting graduate medical education to avoid the worsening of the current primary care physician shortage. The three initiatives for investing in graduate medical education included increasing funding for family practice residency programs and primary care residency programs, maximizing funding for primary care preceptorship program, and expanding the state Physician Education Loan Repayment program.

Two TAFP members, Roland Goertz, M.D., and Joane Baumer, M.D., appeared before the committees in support of graduate medical education. Goertz explained to the House Committee on Appropriations that Texas has experienced a decline in primary care physicians over the past four years and remains below the national average for physicians per capita. Fixing the decline, Goertz said, would require restoring graduate medical education funding to pre-2003 levels to aid in the training of primary care physicians.

Goertz used talking points from TAFP’s latest one-page issue brief, a policy initative highlighting major health care issues. Find the Graduate Medical Education and Physician Workforce issue brief on TAFP’s Web site.

Lawmakers focus on public health

Now that committees can hear debate on bills, more public health issues are making their way onto the table and TAFP is doing its part to make sure they are heard. As one of 13 member organizations of the Texas Public Health Coalition, the Academy filed a letter with the Senate Finance Committee detailing the importance of and rationale behind addressing public health issues such as immunizations, health promotion and chronic disease prevention, and women and children’s health services. These issues and more are sure to come up in the next few weeks.

Senate Bill 60, named the booster seat bill, would require children to be secured in a child passenger safety seat until they are 8 years old unless they exceed four feet nine inches in height. Authored by Sen. Judith Zaffirini, D-Laredo, the booster seat bill was unanimously voted out of the Senate Transportation and Homeland Security Committee and recommended for the Local and Uncontested Calendar. Its House companion, HB 118, by Rep. Fred Brown, R-Bryan, was heard in the House Committee on Transportation and is now pending.

Senate Bill 368 proposes a statewide smoking ban in public places, which would include all indoor workplaces, public buildings, restaurants and bars. Its author, Sen. Rodney Ellis, D-Houston, cited the bill as a public health initiative, making the connection between secondhand smoke and lung cancer, heart disease, low birth weight and chronic lung ailments.

Another major public concern mentioned by Gov. Rick Perry in his State of the State address, the rising rate of obesity in Texas, has spurred several bills.

Sen. Jane Nelson, R-Lewisville, filed Senate Bill 530 to bring 30 minutes of “moderate or vigorous” daily physical education back for students in grades K-8 and require biannual fitness assessments for students in grades K-12. Using the data collected by the fitness assessments, the Texas Education Agency would analyze any correlations between physical health and academic success. Currently, elementary students must have 135 minutes of physical education per week and middle school students must have physical education twice a week.

Sen. Eddie Lucio, Jr., D-Brownsville, filed Senate Bill 73 to develop an interagency obesity council, public awareness campaigns and research to identify methods the state can combat obesity, especially in vulnerable segments of the population.

Thanks to these Physicians of the Day

Thanks to the physicians who volunteered their time to serve at the Capitol as Physicians of the Day. This week’s physicians were: Justin Bartos, M.D., of North Richland Hills; Beverly Nuckols, M.D., of New Braunfels; John Egerton, M.D., and Judith Egerton, M.D., of Austin; and John Whitham, M.D., of Corpus Christi. For more information on participating in the Physician of the Day program, contact Kate McCann at TAFP.