Record State Budget Opens Door for Health Care Investment
By Emma Freer

The 88th Texas Legislature kicked off earlier this month, and the Texas Medical Association is already tracking nearly 700 bills, including promising proposals to reduce prior authorization requirements and concerning ones regarding scope expansion.  

But state lawmakers’ first and only constitutional mandate is to pass a budget for the 2024-25 biennium, and TMA is hard at work identifying opportunities as those hearings get underway in the coming weeks.

Paving the path toward possible investment in the state’s health care infrastructure, the legislature will have a record $188.2 billion for general-purpose spending, up 26.3% from the 2022-23 biennium thanks in part to a $32.7 billion surplus. Although Texas state leadership has indicated its top spending priorities are local property tax relief and improving the power grid, leaders also have signaled support for some new health care spending in line with TMA’s legislative goals. 

For instance, House Speaker Dade Phelan (R-Beaumont) announced last March the formation of a Health Select Committee on Health Care Reform, the members of which were tasked during the interim period with identifying ways to expand access among Texans to affordable, high-quality health care.  

More recently, state leaders – including Gov. Greg Abbott, Lt. Gov. Dan Patrick, and Comptroller Glenn Hegar – have cited broadband expansion as one potential option for spending surplus dollars. TMA has advocated strongly for broadband expansion in recent sessions, pointing to the necessity of such infrastructure for continued telehealth usage and increased access to care in rural communities.  

Early budget bills from both the House and the Senate also increase funding for the Texas Health and Human Services Commission, although one of budget-makers’ first tasks will be to shore up the state’s estimated $3.7 billion Medicaid deficit from the 2022-23 biennium.  

In addition to addressing this shortfall, TMA would like to see the legislature extend continuous coverage for postpartum women to 12 months, which TMA lobbyist Caitlin Flanders says is “one of the top priorities for TMA.” 

The budget bills, which total 2,034 pages, also include funding for licensing fees related to Texas’ prescription monitoring program (PMP) and for additional graduate medical education (GME) residency positions, both issues at the forefront of TMA’s advocacy. 

Physicians are required by state law to check a patient’s prescribing history using the PMP before prescribing opioids and other controlled substances. Physicians don’t have to pay to access the PMP, but they do have to pay fees to keep their electronic health record integrated with the program.  

Michelle Romero, TMA associate vice president of public affairs, says these fees amount to an unfunded mandate and have long been a thorn in physicians’ sides, one that potentially could be removed by the legislation.  

Similarly, Texas medical schools are doing their part to educate more physicians, but a dearth of GME residency positions means some graduates must leave the state for training elsewhere, decreasing their likelihood of returning to Texas to practice. TMA prioritizes GME expansion because it protects the state’s investment in medical education and helps alleviate Texas’ physician workforce shortage.  

Comptroller Hegar attributed the budget windfall to a constellation of unprecedented factors during a biennial revenue estimate presentation on Jan. 9. They include the ongoing COVID-19 pandemic; skyrocketing inflation, which has contributed to state sales tax revenue; and the Russian war in Ukraine, which has driven up oil prices. 

“We are unlikely to have an opportunity like this again,” he said. “This budgeting session is truly a once-in-a-lifetime session.”