Legislative Update & Communicating Your Political Views February 17, 2017 UTMB Faculty Senate Legislative Update & Communicating Your Political Views Ben G. Raimer, MD, MA, FAAP Professor and Senior Vice President Health Policy & Legislative Affairs The University of Texas Medical Branch

Texas Government Refresher Executive Leadership Governor – power to appoint and veto Lt. Governor – legislative and budget power Speaker – legislative and budget power House - 150 members including Speaker Senate - 31 members plus Lt. Governor

Texas House after the 2016 Election All 150 members of the House were up for election Only 47 incumbents faced general election opposition Very few competitive races Democrats picked up five seats 95 Republicans and 55 Democrats 22 new members Speaker Straus unanimously reelected to 5th term

House Committee Chairs Appropriations – Rep. John Zerwas (R) - Katy Public Health – Rep. Four Price (R) - Amarillo Higher Education – Rep. J. M. Lozano (R) - Kingsville

Texas Senate after the 2016 Election Senate party makeup unchanged 20 Republicans and 11 Democrats Three new members: Bryan Hughes (R-Mineola)  Borris Miles (D-Houston)  Dawn Buckingham (R-Lakeway)

Senate Committee Chairs Finance – Sen. Jane Nelson (R) – Flower Mound Health & Human Services – Sen. Charles Schwertner (R) – Georgetown Education – Sen. Larry Taylor (R) -- Friendswood Higher Education – Sen. Kel Seliger (R) – Amarillo

Health Professionals in the Legislature Sen. Dawn Buckingham (R) – Lakeway* Sen. Donna Campbell (R) – New Braunfels Sen. Charles Schwertner (R) – Georgetown* Rep. Greg Bonnen (R) – Friendswood* Rep. Tom Oliverson (R) – Houston Rep. J.D. Sheffield (R) – Gatesville Rep. John Zerwas (R) – Katy Rep. Donna Howard (D) - Austin *UTMB SOM Alumni Dr. Greg Bonnen with UTMB medical students

Major Issues Public School Finance Reform CPS / Foster Care System Mental Health Private School Choice Transgender Bathrooms Sanctuary Cities / Border Security Property & Franchise Tax Reductions Higher Education / HRI Funding

Graduate Medical Education Funding 2013 $14.25M – created 100 new first-year positions in 2014 and 2015 2015 $53M – created and sustained hundreds of new residency training slots $300M – established permanent endowment to continue supporting GME 2017 SB1: $44.1M

The State Budget Picture Downturn in oil & gas industry Sales tax collections down Sales taxes make up 58% of state revenues Comptroller: $104.9B available for budget $11.9B in Rainy Day Fund 4% budget reduction for state agencies

House and Senate Budget Proposals $108B vs $103B Special Items House budget reduces them Senate budget eliminates them

FY16/17 Special Item Appropriation vs HB1 Decrease % Decrease Primary Care $9,600,000 $3,552,000 $6,048,000 63.0% Bio. Contain. Unit $8,200,000 $7,790,000 $410,000 5.0% Indigent Care $5,300,000 $1,955,000 $3,345,000 63.1% AHEC $2,900,000 $1,076,000 $1,824,000 62.9% Home Dialysis $2,800,000 $1,026,000 $1,774,000 63.4% Inst. Enhancement $397,000 $153,000 $244,000 61.4% Total $29,197,000 $15,552,000 $13,645,000 46.7%

FY16/17 Appropriation vs HB1 and SB1 Article III Article II Total Decrease % Decrease FY16/17 Appropriation $566,170,000 $9,800,000 $575,970,000 - HB1 $549,000,000 $878,000 $549,878,000 $26,092,000 4.5% SB1 $533,000,000 $533,878,000 $42,092,000 7.3%

UTMB’s FY18-19 Legislative Appropriations Request Restoration of reductions and Special Items HB1 - $26M SB1 - $42M Conversion of existing health system funding to a hospital formula to provide stability Growth in formula funding

UTMB Student TMA-AMA Trip Agenda 10:00 – Introduction to the Texas House; photos with Bonnen and Faircloth 12:00 – Introduction to the Texas Senate; photos with Buckingham and Schwartner 12:30 - Presentation of “Old Red” Print to Senator Dawn Buckingham (UTMB graduate) GE.5 (Ground floor, east side, room 5 of main capitol) 1:30 - Visits with members and/or staff (each student should visit their hometown state representative and senator) Schedule ahead of time! 4:00 - Walk to TMA Auditorium (SW corner of 15th and Guadalupe) to hear speakers related to Health Policy w/Q&A session (Bonnen, Fuller, Cardas, 5:00 - BBQ and Drinks 15

Resources Who Represents Me? http://www.fyi.legis.state.tx.us/Home.aspx Enter your home address Look up Capitol phone number for State Rep. and Sen. Try to schedule time to meet between 1:30 - 3:30 Texas Tribune Interactive Capitol Map https://www.texastribune.org/directory/offices/ Find your legislators’ offices in the Capitol 16

Talking With Your Legislator Introduce yourself Name Hometown School Class Year Thank them for past support Focus on your major interests Personal stories about your educational experience Plans on practicing in the future Be Brief (5 minutes or less) 17

UTMB’s Legislative Appropriations Request Conversion of existing health system funding to a hospital formula to provide future stability for planning and growth Restoration of selected special items by priority Growth in formula funding Exceptional Item UTMB supports THECB HRI Formula Advisory Committee recommendation to increase funding for the HRI formulas. Restore the rates for all formulas, except for Graduate Medical Education (GME), back to the 2000-01 levels by phasing in these increases over the next three biennia. Increase the GME rate for formula funding for the 2018-19 biennium by an additional 34.77%, which was the committee’s requested level for 2016-17. Creation of a hospital formula for existing health system funding – no additional funding requested Exceptional item for Excellence in Infectious Disease Research, Treatment and Biosafety Training (total $34.15M for FY18/19)

UTMB Hospital Formula For 2018-19 UTMB seeks to convert its existing Health System appropriation into a new health systems operations formula. UTMB is not requesting increased funding for the health system. Proposed formula would be based on the number of trauma, primary care, diabetes, heart, psychiatry and telemedicine patients served in Texas in 2016. In FY 2016, UTMB incurred more than 700,000 patient encounters in the proposed categories, of which over 600,000 were primary care patients. Proposed Health system appropriation includes strategy D.1.1 Medical Branch Hospitals ($147,374,603/year), E.1.1. Chronic Home Dialysis ($1,400,159/year – current appropriated amount but proposed to be reduced as part of 4%) and E.1.4. Support for Indigent Care ($2,666,658/year – current appropriated amount but proposed to be reduced as part of 4%) Proposal would add a new strategy i.e. – A.1.7. Health System Operations $151,441,420/year in FY18/19. Based on patients described FY16 est. 769,000 creating a rate of $196.93/case for FY18 and FY19. Creation of hospital formula would also require new rider language in Art. III special provisions to define UTMB’s formula. If asked about the amounts used in the $151,441,420 number - the proposed Rider Language Change on Page 106 of the LAR and includes the FY16/17 appropriated amounts for Chronic Home Dialysis Center and Support for Indigent Care before the 4% reduction  was taken from these two items.  We excluded from the 4% calculation, only for purpose of the rider language, because these items would now be part of a formula and formula strategies were excluded from the 4% reduction calculation. 

Impact of Reductions UTMB acknowledges the current economic challenges facing Texas and will work with state leaders to be a responsible and efficient steward of state resources Proposed reductions equates to a loss of $26.3 million in the House Budget and $47 million in the Senate Budget for the FY18/19 biennium from UTMB’s Article III funding: UTMB request restoration of selected priority items that are deemed vital to the support of medical education, the health of the public, and the continued growth of Texas’ fight against emerging infectious diseases Cuts to these programs would adversely impact the health of Texans, decrease the ability to train new physicians, and limit our ability as a state to recruit and train new health care providers. UTMB is also impacted by reductions made elsewhere in the State’s budget – i.e. Art. II HHSC Indigent Health Care Reimbursement in the amount of $8.9 million 8th consecutive year to post a positive margin Reductions to Special Items over the biennium: Institutional Enhancement $(243,968) Chronic Home Dialysis Center $(1,719,380) Primary Care Physician Services $(5,948,028) East Texas Area Health Education Centers $(1,802,004) Support for Indigent Care $(3,274,626) $8.9M Article II reduction Reduction of Three Share funding in TDI’s budget $(3.2M) – total funding for all three-share programs

$12M Trans-Texas Vaccine Institute New Special Item: Excellence in Infectious Disease Research, Treatment and Biosafety – $12.0 M $12M Trans-Texas Vaccine Institute Create an institute to support projects that expedite the development and production of vaccines for the most significant 21st century diseases, namely chronic infectious and non-infectious diseases. The institute will bring research, development and production entities together to maximize the impact of expertise found throughout Texas' higher education community. UTMB is recognized internationally as the leader in infectious disease research and is home to the Galveston National Laboratory, a state-of-the-art facility built to study emerging infectious diseases, develop medical countermeasures and prepare for public health emergencies. This new special item will allow UTMB to enhance current research and develop treatments for emerging infectious diseases that are threatening Texas and the U.S. This request will enable UTMB to ensure world-class operations of its bio-containment treatment facility, provide biosafety training to research staff and Texas healthcare professionals, support essential maintenance and operations for the Galveston National Laboratory (GNL), and partner with other leading Texas research and health institutions to create the Trans-Texas Vaccine Institute.

Questions? 22