1. 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

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

3. 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

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

5. 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)

6. 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

7. 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

8. 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

9. Graduate Medical Education Funding
2013
$14.25M – created 100 new first-year positions in 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

10. 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

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

12. 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%

13. 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%

14. 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

15. 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

16. Resources Who Represents Me?
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
Find your legislators’ offices in the Capitol 16

17. 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

18. 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 levels by phasing in these increases over the next three biennia.
Increase the GME rate for formula funding for the biennium by an additional 34.77%, which was the committee’s requested level for
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)

19. UTMB Hospital Formula
For 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. 

20. 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

21. $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.

22. Questions? 22