TMA Urges House Committee to Bolster Border Care Access
By Emma Freer

With 30 years of experience practicing primary care medicine in the Rio Grande Valley, Edinburg internist and Texas Medical Association President E. Linda Villarreal, MD, has unique insight into the region’s health care needs and how state lawmakers can build on previous legislation to address them.

Drawing on that firsthand knowledge, Dr. Villarreal submitted written testimony to the Texas House Public Health Committee and testified in person on Tuesday when the committee met to discuss health care access along the Texas-Mexico border.

“We recognize that Texas has many competing needs and priorities, and we encourage your focus on the international border region of this great state,” she wrote in her submitted testimony.

In the five-page letter, Dr. Villarreal laid out some of the most pressing health care challenges along the border, where more than 3 million Texans live and work, including:

• Poverty, food insecurity, and environmental hazards that contribute to higher rates of chronic disease and poor health outcomes;
• Lower health coverage rates than the state as a whole, which not only correlate with health care access issues but also hurt the region’s ability to attract and retain physicians;
• Acute shortages of physicians and other health care professionals;
• Inadequate funding for public health infrastructure, surveillance, and infectious disease response, which if addressed can help prevent outbreaks, school and business closures, and undue burden on the health care system; and
• Broadband access problems, which are especially acute in rural areas and can impede health care access.

Despite these entrenched challenges, Dr. Villarreal applauded the recent passage of three TMA-backed bills that help improve health care access along the border. House Bill 133 by Rep. Toni Rose (D-Dallas)  extended Medicaid postpartum coverage to six months; House Bill 2658 by Rep. James Frank (R-Wichita Falls) eliminated the eligibility red tape that caused many eligible children to lose their Medicaid coverage; and House Bill 5 by Rep. Trent Ashby (R-Lufkin) created a state broadband development office, which will in turn create a program to award financial incentives for broadband expansion.

But more action is needed to ensure health care access in the region, which serves as a gateway for trade and pathogens into the rest of Texas. In the letter, Dr. Villarreal encouraged committee members to:

• Work with TMA to further expand health care coverage and access;
• Extend the Texas Medicaid 1115 Transformation Waiver, which protects the financial stability of border hospitals and public health care institutions;
• Use any waiver funding to increase Medicaid physician payments, which have barely budged in nearly two decades, and innovative value-based payment models, which provide “cost-effective primary and specialty care outside of a more costly acute care setting”;
• Make further improvements to the state’s technical infrastructure to expand access to telemedicine and facilitate the timely exchange of health information; and
• Continue to focus COVID-19 vaccine distribution to physicians in private practice, whose long-term relationships with patients can help address vaccine hesitancy.

During her in-person testimony Tuesday morning, Dr. Villarreal once again emphasized the impact of the social determinants of health, such as food insecurity and income level, on border health. She noted the outsized impact those factors can have on a person’s overall health.

“Access to care: No transportation, can’t get there,” she told the committee. “No food, can’t eat. No money for drugs, can’t treat those chronic diseases that affect all of us. Statewide, 25% of Texans lack coverage. That is a category that none of us should be proud of.”

A video recording of the committee meeting can be found on the Texas House of Representatives website.