Scope, Insurance, Vaccine Battles Ramp Up in Session’s Final Weeks as Women’s Health Bills Progress
By Emma Freer

With just 17 days until “sine die,” the adjournment of the regular state legislative session, the Texas Medical Association has been mounting a tough defense against problematic bills related to scope-of-practice expansion, insurance practices, and COVID-19 vaccine requirements. There’s good news, too, as several measures to expand access to women’s reproductive health care move through the legislative process, after years of physician advocacy. 

Scope creep containment 

Preventing scope creep is TMA’s top legislative priority this session. Although the association has successfully beat back several bad bills, one bill still stands out at this late stage for its potential to corrode established patient protections.  

Senate Bill 666 would restrict the Texas Medical Board’s (TMB’s) complaint process, weaken its disciplinary authority, and increase its operating costs. The legislation recently passed the Senate, so TMA lobbyists are focused on battling it in the House. 

Fortunately, TMA advocacy killed the only scope-related legislation to make it to the House floor: House Bill 2553 would have given patients direct access to a physical therapist without a physician referral for 20 business days, up from 15. This bill failed by a wide margin on May 8 in a huge win for medicine. 

Two other concerning scope measures are all but dead:  

• House Bill 724 and its companion, Senate Bill 161, would prevent TMB from issuing cease-and-desist letters to nonphysicians practitioners who venture into the practice of medicine.  
• House Bill 1767, would allow podiatrists to access hospital privileges, regardless of medical staff decision-making. 

Insurance update

In the insurance category, TMA is battling several pieces of problematic legislation that jeopardize patient safety and physician protections, including: 

• Senate Bill 490 and its companion, House Bill 1973 would require patients be given an itemized billing statement before any payment is collected. TMA lobbyists fought for amendments removing individual physicians from this bill, which the House passed and with which the Senate must concur before it heads to Gov. Greg Abbott’s desk.  
• House Bill 2414 would allow health plans to steer patients to physicians or other health professionals of their choosing, regardless of quality. The House Insurance Committee voted in favor of HB 2414, teeing up its May 2 passage out of the House and into the Senate.  
• House Bill 3351would undo physician protections in health plans’ ranking and tiering programs. Following its May 9 passage in the House, the bill now lies with the Senate.   

Public health pushback

TMA continues to oppose two concerning public health bills that would have far-reaching consequences beyond the COVID-19 vaccine mandates they purport to legislate. 

• Senate Bill 177 and its companion, House Bill 81, would redefine informed consent, putting employers, patients, and physicians at risk. Although TMA lobbyists kept HB 81 from the House floor, they remain concerned about SB 177, which passed the Senate and the House Public Health Committee. It’s now pending a hearing on the House floor. 
• House Bill 44 would kick physicians out of Medicaid and the Children’s Health Insurance Program for having a “discriminatory” vaccination policy, such as requiring patients to be vaccinated against certain diseases. The Senate Health and Human Services Committee heard HB 44 on May 10, following its passage out of the House, but left it pending. 

TMA also is pushing legislation related to federal medical privacy rules, including Senate Bill 1467, which would modify sensitive medical test disclosures under the federal rules to protect patients.  

Dallas oncologist David Gerber, MD, testified on behalf of TMA in support of SB 1467 before the House Public Health Committee on May 8. He told lawmakers the bill would help prevent potentially traumatic situations, such as when one of his patients learned of a cancer diagnosis from an automatic patient portal notification while reading a bedtime story to a toddler.  

“We are not seeking to withhold important information from patients,” Dr. Gerber said. “Rather, we are seeking to deliver the information the best way we can.”  

SB 1467, having passed the Senate and the House Public Health Committee, was scheduled for a hearing on the House floor on May 12 as of this writing. 

Finally, Senate Bill 415 awaits Governor Abbott’s signature – its last step to becoming law – after passing both chambers. The bill builds on state rules regarding the number of human trafficking-related CME physicians must take.   

Women’s health wins 

On the budget front, TMA lobbyists continue to work to preserve health care gains – including critical investments in women’s reproductive and pediatric health care – in the House version as the two chambers reconcile their competing bills. 

TMA, along with four state specialty societies and the Texas Public Health Coalition, recently sent a letter to the conference committee members tasked with this reconciliation process, reiterating its budget priorities. They include: 

• Increasing Medicaid physician payments for women’s reproductive and certain pediatric services; 
• Tripling rural hospital maternal health add-on payments from $500 to $1,500 to help preserve local access to these services;  
• Expanding mobile women’s preventive health care clinics in rural and underserved communities; and 
• Broadening eligibility for the Medicaid Breast and Cervical Cancer Program to 250% of the federal poverty level, up from 200%.  

TMA lobbyist Caitlin Flanders says these budget items are especially important in the wake of the June 2022 U.S. Supreme Court decision in Dobbs v. Jackson Women’s Health Organization regarding abortion. The decision triggered additional restrictions under state law and is expected to lead to an increase in pregnancies and young children. 

In other positive news, the Senate Health and Human Services Committee recently passed House Bill 916, which would require health plans to provide a 12-month supply of a covered prescription contraceptive drug, up from a 90-day supply. HB 916 passed the House in mid-April.  

The same Senate committee is expected to hear House Bill 12, which would extend continuous Medicaid coverage for postpartum women for 12 months, although as of this writing, a date hasn’t been set.  

Find all the testimonies by TMA physician advocates during the current session in TMA’s Advocacy Center.