By Jonathan Nelson
The Texas Legislature approached full stride this week as some of its most powerful committees began hearing testimony from state agencies and the public. The Senate Finance Committee took up Article II of the state budget, which contains funding for all agencies and programs that fall under Texas Health and Human Services. That includes Medicaid, CHIP, Healthy Texas Women, the Family Planning Program, services for the aging and those with disabilities, and much more. At roughly $80 billion for the biennium, Article II accounts for more than a third of total state expenditures.
Antonio Falcon, MD, of Rio Grande City, was the first TAFP member to address the committee on Wednesday morning, February 6, advocating for one of organized medicine’s top legislative priorities, the allocation of funding to ensure competitive and appropriate Medicaid payments. Those payment rates have not been increased in a meaningful or enduring manner in nearly two decades. Yet physician practice costs have increased by about 3 percent each year.
“I’m concerned about the future of medicine and would like for the committee to consider increased spending for physicians,” Falcon said. “I’m concerned because a third of us in the Valley are over the age of 65 now and are thinking about slowing down and retiring.”
About 80 percent of his practice is comprised of Medicaid and Medicare patients, and since current Medicaid rates often don’t even cover the cost of providing services, recruiting new physicians to communities like his is difficult, to say the least.
Low Medicaid rates discourage physicians from taking new Medicaid patients. In 2000, about 67 percent of Texas physicians accepted new Medicaid patients. TMA surveys show that today, less than half accept new patients. Many physicians participating in the program cap the number of Medicaid patients they will see, forcing many Medicaid patients to rely on the emergency room for care.
TAFP believes the state must revitalize our Medicaid physician network to ensure low-income Texans have timely access to vital and preventive health care services. We strongly support Medicaid as a vital piece of Texas’ health care safety net, but physician participation in Medicaid will continue to wither unless Texas implements competitive Medicaid payments.
Thomas Mueller, MD, of Columbus echoed Dr. Falcon’s testimony about Medicaid reimbursement, adding that poor payment rates make it hard for rural hospitals to keep their doors open.
“I’ve been in practice for 30 years and have seen the challenges of trying to recruit physicians to rural areas and keep hospitals open,” Mueller said.
He also laid out four of TAFP’s legislative priorities for improving access to women’s health services. He asked the committee to:
- Pursue federal authority to implement tailored health program benefits for eligible women of child bearing age that provides 12 months continuous coverage for preventive primary care and specialty care coverage including behavioral health services to women before and after pregnancy;
- Establish a process to automatically and seamlessly enroll young women into the Healthy Texas Women program when they lose children’s Medicaid or CHIP as a result of age;
- Ensure women losing CHIP perinatal coverage connect to the Family Planning Program to avoid gaps in preventive care; and
- Implement initiatives that improve early entry prenatal care, including a statewide campaign on the importance of prenatal care during the first trimester, expediting Medicaid eligibility and enrollment for pregnant women.
Emily Briggs, MD, of New Braunfels also focused her testimony on maternal health, imploring the committee to ensure women’s access to preventive primary and specialty care before and after pregnancy.
“Women’s lack of access to regular preventive primary and specialty care before and after pregnancy contributes to Texas’ high rates for poor maternal health outcomes,” she said, referencing the state’s September 2018 report on maternal morbidity and mortality. “Most of these issues are preventable and most of these happen after 61 days postpartum.”
She described the plight of one of her patients, who was dropped from Medicaid after her first delivery. “She was enrolled in Healthy Texas Women, which does provide screening but does not provide for care for those chronic issues,” Briggs said. “She returned to care for her next pregnancy because she got Medicaid again and I found out that she had obesity now, she had diabetes, she had all these complications that ended in a preterm delivery, including a lot of funding that was needed to provide care to her baby in the ICU. This is something we can help to prevent by encouraging that comprehensive care through the continuum of a woman’s life.”
Next week is another big week of legislative action as the House Appropriations Committee begins holding similar hearings on the budget. Thanks to these members who traveled to Austin to fight for patients and for family medicine. For information on how you can get involved in TAFP’s advocacy efforts this session, visit https://www.tafp.org/advocacy/get-involved.