TMA Legislative Priorities Gain Traction as Key Deadline Nears
By Emma Freer

Texas House bills must clear the lower chamber by May 11 – or face a likely death this session. In the runup to this deadline, the Texas Medical Association is working furiously to ensure medicine’s priority legislation clears this hurdle without getting snagged in House and Senate wrangling over school vouchers and property tax relief.  

“We’re getting to that crunch time of session,” TMA Chief Lobbyist Clayton Stewart said, adding that legislation can move much faster in the Senate, passing in days rather than weeks.  

This is also the time when TMA will call on members to take a simple but important action to make sure medicine’s voice is heard: Respond to a TMA Action Alert when it hits your inbox. These are prepared messages from TMA asking legislators to stop or pass a bill that take two clicks to send. Visit TMA's Grassroots Action Center to get educated and armed ahead of time. 

Here’s a digest of what’s happening with the budget process, scope-expansion attempts, insurance legislation, and public health bills. 

Budget update

Two key physician-legislators – Rep. Greg Bonnen, MD (R-Friendswood), and Sen. Charles Schwertner, MD (R-Georgetown) – were appointed to serve on the conference committee tasked with reconciling the House and Senate versions of record-breaking budgets.  

TMA lobbyists are working with these and other lawmakers to preserve gains made in House Bill 1, which includes increased funding for targeted Medicaid physician payment adjustments, graduate medical education, and tobacco prevention efforts. Senate Bill 1 has gains for medicine as well, but also prioritizes school vouchers.   

As the two chambers hash out their differences, TMA is also on guard that wins like House Bill 12 – which would extend continuous coverage for postpartum women to 12 months – don’t get ignored. The bill cleared the House on April 21 and now lies in the hands of the Senate. 

Neither chamber has opted to touch the state’s record-high Economic Stabilization Fund, commonly referred to as the Rainy Day Fund.  

Scope defense 

Meanwhile, TMA advocacy has strongly opposed the most concerning scope-expansion legislation.  

As of this writing, neither Senate Bill 1700 nor House Bill 4071 – both of which would remove physician oversight of the health care team by allowing advanced practice registered nurses (APRNs) to practice independently – has been heard in committee. Similarly, House Bill 4404 – which would create an interstate compact for APRN licensure that supersedes Texas’ restrictions against nurse independent practice – has been bottled up in committee after an April 17 hearing. 

Over the next week, TMA is working to block the following legislation from getting to the House or Senate floor: 

• House Bill 2553, which would allow physical therapists to treat patients for 20 days without a physician referral. 
• House Bill 1105, which would allow pharmacists to administer vaccines down to age 3.  
• Senate Bill 730, which would allow podiatrists to access hospital privileges.  
• House Bill 724 and its companion, Senate Bill 161, which would prevent the Texas Medical Board (TMB) from issuing cease-and-desist letters to nonphysician practitioners who venture into the practice of medicine.  
• Senate Bill 666, which would restrict TMB’s complaint process, weaken its disciplinary authority, and increase its operating costs.  

Insurance wins

On the insurance front, the House passed two key TMA-backed bills: House Bill 3359, which would promote adherence to the state’s network adequacy rules by putting them into statute, and House Bill 4343, which would bolster Texas’ 2021 “gold-card” law. At least two other House bills related to prior authorization reform also are moving in the right direction as the May 11 cutoff nears.  

Also, House Bill 1726, which would ensure payment parity for telehealth visits, is on its way to the House floor.  

After languishing in committee, two bad insurance bills are dead or close to it thanks to TMA advocacy: House Bill 633, which threatened to amplify health plans’ already-considerably market power by capping physician payments at the lowest contracted rate for many services; and House Bill 1001, which purports to offer Texans slightly more affordable health insurance premiums by reducing the value of that coverage and gutting certain consumer protections.  

TMA is also battling the following legislation: 

• Senate Bill 1581 and House Bill 2403, both of which would favor health plans at the expense of patients and physicians in their establishment of a Texas Health Insurance Mandate Advisory Committee to analyze bills imposing new regulations on health plans. SB 1581 recently passed the Senate; TMA hopes to stall HB 2403 in the House.  
• House Bill 3351, which would undo physician protections in health plans’ ranking and tiering programs.  
• House Bill 2414, which would allow health plans to steer patients to so-called “low-cost” physicians or other health professionals, regardless of quality. 
• House Bill 1973, which would require physicians to give patients an itemized billing statement before collecting any payment and impose a fine for noncompliance.  

Public health progress

Finally, TMA welcomes the forward progress on certain public-health legislation, including a bill to tax e-cigarettes. Other legislation addressing youth social media use and medical records privacy include: 

• House Bill 18, which would help protect children from social media’s ills. The bill passed the Texas House on April 27 and now heads to the Senate. 
• Senate Bill 1467, which would modify sensitive medical test disclosures under federal rules to protect patient privacy. The bill passed the Senate on April 24 and lies with the House Public Health Committee.  

Concerns remain about the following bills after they cleared their respective committees:  

• Senate Bill 177, which would redefine informed consent, putting employers, patients, and physicians at risk.  
• House Bill 44, which would kick physicians out of Medicaid or the Children’s Health Insurance Program for having a discriminatory vaccination policy. 
• House Bill 3468, which would add penalties and other burdens that complicate physicians’ ability to release patients’ medical records.  

Read testimonies by TMA physician advocates during the current session in TMA’s advocacy center.