On Guard for the Patient-Physician Relationship: 2023 Legislative Preview
By Amy Lynn Sorrel Texas Medicine January 2023

Illustrations by Don Friesen 

A pandemic wind-down, a U.S. Supreme Court ruling, a possible recession, a national surprise-billing law. The 2023 Texas legislative session is one shaping up to be defined by a host of federal forces, some of them potentially contentious.  

Nevertheless, the House of Medicine stands steadfast in its legislative priorities. At the heart of the Texas Medical Association’s agenda for this session: protecting the practice of medicine and the patient-physician relationship, whether from criminalization, interference from insurers and other nonmedical entities, or public health threats. 

“We’re vigilant, we’re motivated, and we’re going to be working on issues of importance to physicians and to patients’ health and well-being,” said Tilden Childs, MD, chair of TMA’s Council on Legislation. “We want to work with legislators to accomplish the best possible results for the patient-physician relationship.” 

TMA President Gary Floyd, MD, acknowledges the practice of medicine in Texas has been complicated by recent major events, namely the U.S. Supreme Court ruling in Dobbs v. Jackson Women’s Health Organization regarding abortion, and state investigations over gender-affirming care. Those frustrations may be compounded by the fact that practices have been under economic and morale pressures from a nearly three-year-long pandemic, and of late, a set of federal regulations that could undermine health plan accountability even at the state level.  

While some of those developments may seem discouraging, divisive, even polarizing, Dr. Floyd urges physicians as he did in his inaugural speech as TMA president with advice that still rings true for the legislative session. 

“Physicians have probably experienced more pushback than ever before, more questioning. That’s frustrating, and it’s disheartening. But allowing issues to divide us compounds that pushback. That’s why we have to pull together and push back against all the entities that try to get between physicians and our patients. That includes hospitals, insurance companies, government, all the above.” 

With that aim in mind, the Council on Legislation culled a top-10 list of legislative priorities from the many issues TMA tracks every session, narrowing down to “those areas that we see this session of great importance for medicine and for the physician-patient relationship,” Dr. Childs explained. 

That doesn’t mean issues that did not make the list will get overlooked. TMA tracks as many as 2,000 health care-related bills each session, and those that hit TMA’s radar will get the appropriate attention, says TMA Vice President of Public Affairs Clayton Stewart. 

But considering only 25% of all bills filed actually become law, he emphasizes it’s the legislature that determines legislative priorities, not TMA, so medicine’s list could shift as the session evolves.  

Physicians will recognize TMA’s 2023 legislative priorities represent some issues that are familiar from previous sessions and likely will remain so into future sessions – something TMA leaders attribute to a successful offense in building upon prior accomplishments, and a laudable defense in preventing any chipping away of those advancements. 

“We’re here to continue working on what we want to accomplish, recognizing well where we’ve been in the past. In some ways, Texas has already been a leader in the country in getting some of these issues taken care of,” Dr. Childs said.   

Texas’ landmark gold-card legislation, for instance, is among those TMA priorities that center on areas of opportunity this session. That law has paved the way for additional prior authorization reforms. Meanwhile, during interim hearings throughout the summer, the establishment of a House Select Committee on Health Care Reform and a Senate Special Committee to Protect All Texans (in response to the Uvalde shooting) has opened the door for discussions to improve maternal and behavioral health care coverage for women and children.  

And in light of the Dobbs decision, state agencies and lawmakers are looking more closely at funding women’s health services and targeted increases in pediatric Medicaid payments, Mr. Stewart says. 

Although Texas’ $27 billion surplus appears to be a big pot of opportunity, he tempers that excitement with a reminder that many hands will be out, and lawmakers typically tap into those funds for one-time expenditures versus ongoing expenses like health care. In a time of inflation, Texas lawmakers also are expected to prioritize tax-reducing measures – a goal Lt. Gov. Dan Patrick announced at press time in his 2023 legislative priorities.   

TMA’s other legislative goals, however, involve a game plan to safeguard medicine’s gains when it comes to stopping scope of practice expansions, preserving medical liability reforms, upholding a fair surprise-billing dispute process, and protecting state vaccine laws.  

And all of TMA’s legislative successes depend on the strength of grassroots advocacy by physicians, whether testifying at the Capitol; advocating in their own districts; or helping to educate lawmakers on sensitive medical topics, the benefits of medical liability reform, or how the health care team functions.  

Physician involvement is especially important when discussing “the realities of care and how we provide care” for certain populations, said John Carlo, MD, a member of the TMA Board of Trustees and past Council on Legislation chair. (See “Eight Simple Ways to Get Involved in TMA Advocacy,” page 17.) 

When it comes to advocacy, Texas’ five physician legislators also are a major asset to the House of Medicine. (See “Meet Texas’ Physician Legislators,” page 25.) 

 Following the November 2022 election, the makeup of the Texas Legislature largely mirrors that of the 2021 session with 86 Republicans and 64 Democrats in the House; and 19 Republicans and 12 Democrats in the Senate. Candidates endorsed by TEXPAC, TMA’s nonpartisan political arm, won 141 out of 142 races, with medicine picking up one physician lawmaker in the House to add to its list of allies to help communicate and advance physicians’ interests. (Former Sen. Dawn Buckingham, MD (R-Lakeway) won her race for Texas land commissioner.)  

And the more physician voices the legislature hears from, the better, says Sen. Charles Schwertner, MD (R-Georgetown). 

In the face of “ever-increasing” challenges to the practice of medicine, “physicians need to be engaged,” he said. “They’re in probably the most highly regulated profession in the nation; not just regulation of the profession but also payment by governmental entities. … It is extremely important that they understand if they’re not active participants in the [legislative] process and trying to help fashion a future of their profession, then someone’s going to fashion it for you, and you’re probably not going to like it.”  

Rep. Tom Oliverson, MD (R-Cypress), added the health care reform hearings he participated in revealed “broad support from members on that committee that they really want to see patients and providers be the main drivers in the conversations about health care. I heard a lot of conversations about how there are far too many middlemen, or middle-people, and they are the ones who end up driving up the cost significantly. Whether they’re insurers, whether they’re facilities, whether they’re PBMs (pharmacy benefit managers) – whatever they are. But these barriers between provider and patient are not good for our health care system.” 

The Top 10

Legislative Priority #1: Scope of Practice Encroachments, Graduate Medical Education Funding
Legislative Priority #2: Women's Reproductive Health 
Legislative Priority #3: Medicaid Payment Increases
Legislative Priority #4: Medicaid Coverage for Women and Children 
Legislative Priority #5: Medical Liability Reforms
Legislative Priority #6: Physician Autonomy, Corporate Practice Protections
Legislative Priority #7: Prior Authorization Reforms
Legislative Priority #8: ImmTrac2 Modernization
Legislative Priority #9: Network Adequacy, Surprise Billing 
Legislative Priority #10: E-Cigarette Regulation and Taxation