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House of Public Health met on April 7 to consider a number of bills. This report covers HB 1535 (Klick), HB 4139 (Coleman), HB 2487 (Oliverson), HB 1280 (Capriglione), and HB 2337 (Klick).

This report is intended to give you an overview and highlight of the discussions on the various topics taken up. It is not a verbatim transcript of the discussions but is based upon what was audible or understandable to the observer and the desire to get details out as quickly as possible with few errors or omissions.

 

HB 1535 (Klick) – Relating to the medical use of low-THC cannabis by patients with certain medical conditions and the establishment of compassionate-use institutional review boards to evaluate and approve proposed research programs to study the medical use of low-THC cannabis in the treatment of certain patients

  • Klick – This bill proposes additional changes, 5 conditions include:
  • All cancers, not just terminal
  • Chronic pain remedies, that would otherwise be treated with an opioid
  • PTSD in veterans
  • Medical conditions in the research program
  • Debilitating medical conditions defined by Department of State Health Services
  • Creates a medical cannabis research program under HHSC
  • We have to find more data, with the data that has been found she feels as if they are well suited to participate in this research
  • Raised the THC limit for low THC cannabis from .5% to 5%, would enable treating physicians to find the best balance of cannabinoids for each patient

 

Dr. Craig DuBois, Neurologist – For

  • More oriented towards symptoms of pain than degree of pain
  • Believes that the ratios of CBD THC are very important, takes physician knowledge of the chemistry to truly understand; in favor of raising limit to 5%
  • Emphasizes that most patients are not interested in opioids and being in a “haze,” especially older patients

 

Dr. Mary Caire, Physical Medicine and Rehabilitation Specialist (Self) – For

  • Cannabinoid therapy has been shown to improve symptoms related to these conditions like no other substance has done before
  • Scientifically proven to have a profound impact on seizure disorders, pain, anxiety, and PTSD; current law only allows prescriptions to terminal patients with cancer
  • Reiterates in her experience medical cannabis is more effective at relieving these symptoms than other pharmaceuticals drugs
  • Medical cannabis is an alternative to dangerously addicted opioids that the vast majority of cancer patients face taking during some point of their treatment
  • Bill is a significant step in the right direction and will greatly improve the lives of all patients

 

Michael Thompson, Self – For

  • Explains his past surgeries and his time battling cancer, talks about the difficulty of opioids being the only remedy for chronic pain

 

Jason Walker, Self – On

  • Asks to remove the THC cap
  • Remove veterans from the bill, because he believes they will redefine what PTSD means and it will only apply to veterans, first responders, etc; claims that a lot of veteran PTSD comes from childhood trauma and it gets exacerbated when they go to combat
  • Concerned about TCUP, other states not adopting programs to parallel

 

Amanda Walker, Self – On

  • Husband of Jason Walker
  • Cannabis saved her husband’s life and is hoping for expansions on the THC limits

 

Davis Bass, Self – On

  • If this bill passes he will become a TCUP patient
  • Advocates for raising of THC limits, currently illegally managing his PTSD and needs the limit to be 20%
  • Oliverson – So because this bill is raising the limits of legality but not at the level you want, you would prefer to continually operate “in the shadows?”
  • I want to become a TCUP patient, because I want to use the TCUP medicine to see if it helps me. But my experience is, using 20% THC everyday instead of pills, is perfect
  • Oliverson – So your perspective is that you’re content to have the bill passed except the percentage content, but you don’t want to be carved out of the bill if it passes without the content you’re looking for?
  • Yes

 

Dr. Robert Marks, Pain Management Physician – For

  • Explains how senior citizens unknowingly break the law with taking a “summer in Colorado” and finding substitute substances
  • Advocates for increasing indications for what we’re talking about is great

 

Chase Bearden, Coalition of Texans with Disabilities – For

  • Claims current THC cap even at 5% is an issue and needs to be higher
  • Advocates that the THC limits not only be for veterans, but for anyone with disorders and PTSD
  • Zwiener – Under the current law, the limit is the percentage of THC in the product, correct?
  • Yes, by weight so you can have so much THC but you need that extra weight, so it’ll be filler
  • Zwiener – So there’s not a limit on the amount of product you can take with the amount of THC, but a limit on the percentage in the product?
  • Yes

 

John David Carrasco, Cannilive, Inc – For

  • Believes there needs to be more work that needs to be done to be able to address and create solutions on research with cannabinoids

 

Lisa Sewell, Self – For

  • Concerned about this bill not including HIV, aids, or wasting syndrome
  • Includes veterans with PTSD which she desperately supports
  • Does not include parental protection, concerned as she does not want to break the law

 

Dr. Manda Hall, DSHS – Resource

  • No questions asked

 

Patrick Pope, Self – For

  • Gives instances where marijuana has cured cancer and significantly sped up the recovery process for patients
  • Asks to consider raising the cap on THC limits, especially for veterans

 

Charles Sewell, Self – For

  • Claims that he depends on cannabis to stay alive
  • Compiled a notebook on how cannabis benefits HIV and AIDS
  • Asks for the committee to consider HIV and aids on this bill

 

Gregory Fowler, Self – Neutral

  • Concerned about the list off qualifying conditions on this bill
  • Claims how medical cannabis has changed his daughter’s life, and how including Tourette syndrome in the bill would impact her life greatly

 

Dr. Elias Jackson, Vyripharm Enterprises – For

  • Offering an amendment to this bill, adding a bit of language in reference to certification of these products can cure all the issues
  • Advocate for veterans and organizations that want to remove the THC cap, but in order to do that we have to include a certification program within this bill
  • By addition of TRACEtrack and certification for public health language there is a win/win across the board including:
  • DPS will have more transparency in their law enforcement
  • Lawmakers will have more informed information as you begin to make decisions
  • You have the ability now to give the data to those proposed review boards as they begin to look at research
  • From an economic standpoint, you get to capture the potential or predicted revenues for the state
  • For compassionate cultivation and all legal growers/dispensaries, by adding TRACEtrack certification language you make your product the best in the nation

 

Shawn Meredith, Self – For

  • Describes drastic side effects prescription pharmaceuticals
  • Would like this bill to offer more room for doctors to determine who is eligible/doses/methods of administration

 

Eric Espinoza, DFW NORML – For

  • Claims THC is a vital part of his medication
  • Was able to compete as an amateur bodybuilder with the help of cannabis

 

Estella Castro, Self – For

  • Requests that the committee consider the THC cap be removed
  • Describes the process of her not qualifying for the TCUP program

 

Jesse Williams, Self – For

  • Believes that we should lift the THC cap, understands that it most likely won’t happen this session
  • Speaks about transitioning from a percentage-based program to a dosage based programs

 

Arianne Williams, Self – For

  • PTSD affects more than just veterans and the bill should reflect this
  • Patient protections need to be added in this bill
  • Believes the THC cap is counterintuitive and can possibly cause more symptoms
  • Guerra – What did you mean by “job protection” and “retaliation?”
  • There’s a stigma around this passing claiming it is just “about getting high” and is federally illegal, so there is uncomfortability and a prejudice in workplaces

 

Karen Reeves, Self – For

  • Explains her use of cannabis
  • Speaks on how beneficial medical cannabis can be for everyone

 

HB 1535 left pending

 

HB 4139 (Coleman) Relating to the Office for Health Equity

  • Coleman – This bill changes the way we look at disparities by using the term health equity
  • Reestablishes office that looks at morbidity and mortality based on region
  • Office will conduct research of health disparities on COVID-19

 

Octavio Martinez, Hogg Foundation for Mental Health – For

  • Believes that the establishment of the office of health equity is crucial to addressing the health inequities affecting Texas communities
  • Structural inequities are evident with people of color
  • Recommends Texas create an office of health equity within HHSC to correct inequities currently in the system

 

Keven Cokley, Researcher & Analyst at UT – On

  • Speaks about addressing heath inequities
  • Neighborhoods that were historically subjected to redlining practices also tend to hold more negative health outcomes
  • Communities of color are having an increase in suicides and metal health issues in the past year

 

HB 4139 left pending

 

HB 2487 (Oliverson) Relating to the required disclosure by hospitals of prices for hospital services and items; providing administrative penalties

  • Oliverson – 70% of healthcare services are shoppable, can be scheduled in advance
  • Goal of the bill is by lowering prices, we have to know what the prices are in advance of getting the services so you can shop around

 

Charles Miller, Texas 2036 – For

  • Making prices transparent is a crucial way in lessening costs
  • Study was shown from 2014-2028 employee sponsored health care costs, 74% of increase during that time was due to prices alone
  • By reducing price variation and maintain quality, employers and Texans will see a lower healthcare cost
  • Encourage there be a more meaningful penalty to insure greater compliance with no absurd costs

 

Cameron Duncan, Texas Hospital Association – For

  • Main issue is that this bill would require hospitals to disclose the rates of their independent contractor physicians, creates complications
  • Hospitals have a fundamental problem with disclosing their rates
  • Says increasing fines and penalties is unlikely to increase compliance
  • Smith – What is the problem with hospitals disclosing their rates?
  • We’re talking about negotiated rates between a payer and the hospital (no issue with disclosing out of pocket costs for patients), our concern that the disclosure of these negotiated rates is going to lead to uniformity in payment. Not going to be passed off positively with the consumer
  • Smith – Why wouldn’t it?
  • Anticipates that the payer would go and reduce their rates in the light of decreases in payments to hospitals and physicians, there’s just no guarantee
  • Smith – So this bill goes behind the sticker price and provides the details of how much you all are being reimbursed for the service?
  • Yes
  • Collier – Do negotiations of group performance play into different rates for different health insurance companies?
  • Yes
  • Collier – What rate would you be willing to share?
  • What the consumer will be paying for the service
  • Collier – If they’re self-paid, would you be willing to show what you charge a self-paid patient?
  • Absolutely
  • Zwiener – What is the long term effect of pushing this? Could you follow up with all of us on what this will really mean for patients long term?
  • We’d be glad to, but I think the fear is it’ll lead to the mass underfunding of healthcare in the state

 

HB 2487 left pending

 

HB 1280 (Capriglione) Relating to the prohibition of abortion;  providing a civil penalty; creating a criminal offense

  • Capriglione – Performing an abortion will be a second-degree felony, unless the unborn dies then it is first degree
  • The person performing the abortion will be subject to a civil penalty not less than $100,000 for each violation
  • Contingency, when Supreme Court does appeal Roe v. Wade, the state will immediately follow
  • Collier – How did you come up with the $100,000? What made you choose that number?
  • We wanted there to be a significant penalty, and we feel that $100,000 was significant
  • Collier – I think $500,000 is significant too, so this is if Roe v. Wade –
  • Right, so this is a contingency that upon Supreme Court overturning the Roe v. Wade precedent, then it would make it clear in Texas law that Texas statute would follow this new precedent
  • Collier – So there would be criminal and civil penalties against the one person?
  • If the Supreme Court were too overturn the precedent it would be against the law, so this would automatically put this into law what the penalties are upon that ruling
  • Collier – So both the doctor and the patient would be subject to civil and criminal penalties?
  • The doctor would be subject to $100,000, the pregnant women who the abortion is performed on would not be subject to criminal prosecution or civil liability, just for the doctor
  • Zwiener – What exceptions are written in this legislation at the moment?
  • In this one, there is none
  • Zwiener – Is there an exception for the life of the parent being in danger?
  • No exception, setting a contingent on what the Supreme Court says
  • Zwiener – If the Supreme Court did overturn Roe v. Wade, we as the state would have more latitude in regulating abortion care, is that correct?
  • That’s what this bill intends to do
  • Zwiener – So theoretically, we can set the parameters instead of waiting for the Supreme Court?
  • That’s what this bill intends to do
  • Zwiener – I understand, but if overturned what does the law in Texas look like? Would there be an exception for the life of the parent being in danger?
  • As of now, there is no exception for that
  • Zwiener – So if I got pregnant again and my doctor believed my life was in danger if I carried that pregnancy to term and this was in effect, would I be able to get a life saving abortion here in the state of Texas?
  • If it was against the law to have an abortion in the county because of the Supreme Court overturning its precedent, then it would be illegal. Pretty optimistic in the Supreme Court’s makeup of the bill
  • Zwiener – Why do you think It doesn’t make sense to carve out situations where the mother’s life is in danger?
  • I’m happy to work with experts who believe whatever the best thing to do is. I don’t believe abortion is healthcare or a service
  • Zwiener – So just to clarify, your understanding of the situation has no consideration for the mother’s life in danger?
  • I will let other people answer this question, I don’t think abortion should be justified
  • Zwiener – Does this bill as currently written create an exception for situations of rape or incest?
    • No
  • Allison – In page 2 of the bill –
  • I’m sorry, there is an exception for the risk of harm to the mother, not for rape/incest
  • Zwiener – I see that the life-threatening physical conditions specifically excludes mental health treatment, could you explain your thinking on that?
  • Obviously, we want to limit the total number of exceptions, so we want to make those exceptions in cases only where there is direct, physical harm

 

Spotlight on Public Testimony on HB 1280

Below is a spotlight on comments from the roughly 30 witnesses testifying on the bill

 

Paul Linton, Texas Alliance for Life – For

  • Bill would restore legal protection to unborn children upon the Supreme Court decision
  • Bill would ensure that Texas would have a law in place to prohibit abortion upon the overruling of Roe v. Wade without having to enact new law
  • The pregnant women who the abortion is performed on would not be subject to criminal prosecution or civil liability, consistent with uniform practice in Texas
  • Texas Controlled Substances Act automatically adopts the classification of drugs by the attorney general of the US under the federal controlled substances act to determine what’s illegal in Texas
  • Issue of Notice is provided by this bill and states that the prohibition will go into effect on the 30th day after the Supreme Court overrules wholly or in part Roe v. Wade

 

Amelia Fulbright, Self – Against

  • Legislation is attempting to bring a sectarian religious view into law, which is not unconstitutional and not Christian
  • Should focus on expanded healthcare, increased access to birth control, more sex education, and economic opportunity for women

 

Kyleen Wright, Texans For Life – Against

  • Sees abortion as unnecessary as there is an extensive network of pregnancy health centers to help mothers and their children
  • Bill continues the legislature’s work to protect preborn life by working in coordination with the courts
  • If any one of the 15 State Heartbeat Bans is upheld, Texas will automatically benefit
  • Bill declines to criminalize women
  • Describes the bill as an abortion ban that will work

 

Caroline Duble, Avow – Against

  • Says this ban is a political stunt that would ban abortions in Texas with very few exceptions
  • Forcing someone to carry an unwanted pregnancy against their will is shown to increase suicidal thoughts
  • Bill bans abortions even in the case of rape/incest, inability to get an abortion may force a person to stay in contact with abusive partners potentially causing the child harm
  • Bill is rooted in coercion and control, projecting certain beliefs onto others
  • Focus should be on getting much needed healthcare to Texans during a global pandemic and public heath crisis
  • Collier – Does this bill provide for a mechanism for the doctor to prove that their abortion services fell within the exception? This seems like arrest first, ask questions later bill, is that how you read it?
  • Yes, that’s how we read it
  • Collier – Who would bring the claim against the doctor and raise those charges and how would the doctor show it fell within that exception?
  • Great question, I think the bill raises a lot legal concerns and situations
  • Collier – If Roe v. Wade was abolished, are there currently any other statutes that would penalize a doctor who performed an abortion that was deemed to be illegal by the US Supreme Court?
  • I’m not the best person to answer that specific legal question
  • Collier – The first offense someone is facing a second degree felony of 2-20 years with a fine of $10,000, is this your understanding of the bill?
  • Yes, that’s my understanding
  • Collier – A first degree felony, that could get up to life in prison? Is that your understanding?
  • Yes

 

Shannon Jaquette, Texas Catholic Conference of Bishops – For

  • Bill puts in place a trigger that makes sure “Texas will return to its roots at protecting life from conception” by passing a total ban on abortion effective as soon as allowed

 

Joe Pojman, Texas Alliance for Life – For

  • In 2019, there were roughly 57,000 reported abortions in Texas, only 10% were estimated before a heartbeat was detected
  • States that we have an obligation to protect all unborn children and believes this HB will do just that

 

HB 1280 left pending

 

HB 2337 (Klick) Relating to the regulation of drug-induced abortion procedures, providers, and facilities; providing criminal penalties

  • Klick – Would continue the current prohibition of any abortion inducing drug being provided via carrier, delivery, or mail service
  • Bill sets the penalty for intentionally, knowingly, recklessly violating this act, is a state jail felony

 

Spotlight on Public Testimony for HB 2337

Andrea Reyes, Deeds not Words – Against

  • Prohibiting abortion will negatively impact not only women but also low income, BIPOC, trans, and sexual assault providers
  • Believes this is a direct target on marginalized communities because a medication or self-managed abortion are sometimes the only viable options for some
  • This bills violates a person’s autonomy and deciding how someone has an essential healthcare procedure, extremely controlling bill

 

Amy O’Donnell, Texas Alliance for Life – For

  • Drug induced abortions are the second most common method of abortion making up 40% of abortions in Texas, result in a 4x higher complication rate for women than surgical abortions
  • Emphasizes being pro-life while also being pro-woman

 

Shannon Jaquette, Texas Catholic Conference of Bishops – For

  • Emphasizes no abortion is safe
  • Will codify in Texas statute the current FDA risk evaluation and mitigation strategy known as REMS
  • Any federal deregulation of abortion inducing drugs will gut the protection in Texas, resulting in an increase in complications of this type of abortion
  • Effort to remove these regulations is an attempt by the abortion industry to characterize the decision to end a pregnancy is no more consequential than taking an antibiotic to cure an infection
  • Offers greater protection and respect for the lives of the women seeking abortion
  • Coleman – Is the morning after pill considered a chemical abortion?
  • No, it is not

 

Johnathan Saenz, Texas Values – For

  • Important to make sure we have these commonsense measures in place
  • We have the ability to handle these things on own at the state level and not have to look and see what the federal government does
  • Extremely valuable to have someone meet with a doctor
  • Zwiener – So you hear stories that people are prescribed medication without an exam?
    • Yes, also hear that women are left to deal with this issue on their own
  • Zwiener – Without doctor examining them in the first place or after taking medication?
    • Both
  • Zwiener – What do you see as the safety advantage of Texas deviating from FDA guidelines?
    • State will be in the position to continue to have guidelines for the state and not see federal guideline deviations
  • Zwiener – Current admin has not changed guidelines yet, current timeline is 70 days
    • Key is “yet,” concerned about what they’re doing moving forward
  • Zwiener – If the previous admin had 70 days, what is the reason for 49?
    • To make sure we don’t see a significant change with a new admin and for state to be in control of guidelines
  • Zwiener – Do you think it would be a good idea to pin guidelines to what they were at the end of the Trump admin?
    • What do you mean by pin? Supports bill as written