Texas Legislative Update

February 2023

As the 2023 legislature continues to get organized, committees are being named and bills are being filed at a rate almost too rapid to count. With the legislature convening for only 140 days every other year to conduct the state’s business, each and every day seems critical the process. But with rules in place that delay the start of consideration of policymaking bills, it is a reminder that there is only one thing the legislature MUST accomplish – developing a budget to operate the state for the next two years. The amount of money available for the state to spend is at an all-time high and healthcare spending is a significant and important component of that budget creation process -- one that TCEP participates in closely to improve the delivery of emergency medicine on behalf of patients.

Healthcare cost to the State of Texas is one of the largest items in the state’s budget and is always a significant challenge to lawmakers who must develop ways to improve outcomes in the midst of rising costs of medical services for indigent and disabled citizens, state employees/retirees and other wards of the state. Both the Texas House and Senate have proposed initial budgets that would spend nearly $289 billion in state and federal funds during the next two-year cycle, the most ever in history. Incredibly, due to spending limits and fund balance requirements, appropriators are leaving more than $50 billion in available funds unspent in this budget.

Much of the additional spending will focus on non-healthcare related items like property tax relief, infrastructure investment and pay raises for state employees, while some of the priorities could have indirect benefits for TCEP members. For example, increased spending for broadband infrastructure in the state will impact technological opportunities to increase the delivery of emergency care to rural and indigent parts of the state that face additional medical challenges. And investment in the state’s electricity grid can insure better healthy outcomes during storms and natural disasters that frequently impact communities in this state.

The additional budgetary spending should also include important increased spending that will directly impact TCEP members and their practices. One example of this is addressing the staffing shortages and other issues creating a problem with overcrowding and “boarding” in emergency departments across the state. Both the proposed House and Senate budgets have funding increases for the Physician Education Loan Repayment Program, raising the amount to spend to address retention from $1 million dollars per year to $28 million over the next two years. Another example of increased spending is the state committing to funding the fees for provider participation in the Prescription Monitoring Program (PMP) instead of forcing the providers to pay the fees themselves (See more detail in Sidebar).

Finally, there has already been considerable discussion around funding for mental health issues early in this legislative session, and much of these discussions have centered around funding for additional resources for those suffering from mental health and substance abuse as a way to address societal issues including homelessness and increased crime. While there has not been much detail around how this funding will manifest, the increased scrutiny around these issues is an important development in making them a key priority for budget writers in 2023.

It is important to note that formulating a budget is one of many parts of the dynamic that makes up the legislative session in Texas. But passing a balanced budget is the only constitutional obligation legislators are required to meet when they come to Austin, and a duty that can have far-ranging impacts on the citizens of this state. So TCEP will continue to make it a priority for our members and the patients for whom you provide care.