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Members of the Texas Legislature sit on panels discussing health care and taxes at the Texas Tribune Preview of the 2023 Legislative Session on December 8, 2022. An archive and overview can be found here.

This report is intended to give you an overview and highlight of 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.

 

Panel on Health Care

Moderated by Eleanor Klibanoff, The Texas Tribune

Representative Donna Howard

Representative Steve Allison

Representative Nicole Collier

  1. What can and should the Lege focus on this session to get our healthcare systems off life support?
  • Howard- If you don’t have coverage, you don’t have access; expanding Medicaid should be something we should embrace on a bipartisan basis; number one thing to do in this session
  • Allison- Access is critical in all factors, mental health major issue; need to address Medicaid expansion but problem of not having enough physicians and providers and need to attract them and increase the reimbursement rate
  • Collier- Agree, need reimbursement and adequacy of the network; stress plays a role on overall health so job, childcare, access to healthy foods play into health
  1. Can you talk about why workplace violence for nurses is important to you Rep Howard?
  • Howard- Common in hospital settings, come to agreement with TMA, THA, and TNA on legislation to give more emphasis to making sure the policy committees for this are working and have interventions available
  1. Rep. Allison, what appealed to you and party members in the Live Well Texas program?
  • Allison- Increase in reimbursement rate is the starting point to address problem; may become more attractive to put in a wellness incentive and provide rulemaking authority for that to be a requirement; job incentive or requirement also
  • Collier- If we’re going to put parameters in place er have to think about how it actually works on the ground; questions compliance requirement
  1. Rep. Collier, what are the odds of getting a year of post-partum Medicaid?
  • Collier- Disappointed in HHS report without distinguishing rates between race and ethnicity, don’t think they are finished; access to 12 months is vital, better compliance when there is coverage for that time; feel confident we can get the 12 months
  • Howard- Maternal mortality and morbidity review committee had this as number one recommendation, also at national level
  • Howard- Everyone on pregnancy Medicaid program in March of 2020 is still getting covered; should look at if it has changed health outcomes and asked agency to help us determine; able to space pregnancies with this Medicaid coverage
  • Allison- Outcomes is what we are really after, 12 months is no brainer; optimistic this will happen this session
  1. Texas has above national average maternal mortality numbers; Rep. Howard, can you talk about the delay on that report?
  • Howard- Review committee are meeting tomorrow; currently don’t have actual report even though it was required on September 1; have no ability to enforce things with part time legislature
  • Howard- Information on obstetric hemorrhaging review and protocol to have hospitals prepared to intervene with best practices has made huge differences in outcomes; obstetric hemorrhage in black women went up, only population that this rose for
  • Howard- Built in racial disparity factor in this report; whole point is to keep moms alive and healthy so need this information to know what kind of policies will give this outcome
  • Collier- Released report but had to dig to find it on website; a lot of it says we will update, and it needs to be final
  1. What actions would you like to see?
  • Collier- Need to see what they found to make adjustments in system before recommending action; hearing from stakeholders and providers too; need funding
  1. Rep Allison, do you view maternal mortality as an area of bipartisan collaboration?
  • Absolutely, it’s in everyone’s best interest; should use surplus on this and extend coverage to 12 months
  1. Rep. Howard, what are you predicting in the report with reduced abortion access?
  • Howard- Keep track at state level the complications of having an abortion; majority of abortions to those who already have children; those with limited means will be ones that will have more babies
  • Howard- Expecting an increased number of births on Medicaid; need to support the moms and babies by funding programs for healthy births; want to double money for federally qualified health centers, need mobile clinics and telehealth and medicine
  • Collier- Texas not ready for economic consequences of what are about to see; need to make sure behavioral and mental health programs in place; foster system already ruled by a court to be dangerous, need to do more
  • Allison- Alternatives to abortion provision from last session needs to be explored and enhanced; the more we can do there the better
  • Howard- Part of metrics have been handing out pamphlets; it’s an unaccountable program without medically accurate info that is used to get pregnant people to not have an abortion; not actual medical facilities and dollars could be more effective in healthcare system
  • Howard- Need to look at what already exists in social service delivery programs and get people into these programs with evidence based outcomes; evidence of misappropriated funds in alternatives to abortion program
  • Collier- Don’t have healthcare professionals running these facilities; need contraception built into any family planning program
  • Allison- Agree with you; should have these
  1. Rep. Allison, are you interested in having Lege adding a rape and incest exception to abortion ban?
  • Allison- Open to that being considered; need a full hearing and discussion to see the pros and cons
  • Howard- Requirement for reporting to get abortion could retraumatize survivors; how do we make it less bad
  1. Rep. Allison, as you mentioned Lt. Gov. wouldn’t even say he was considering this; where do you think the conversation in terms of tightening laws in your party may go?
  • Allison- Don’t see bills that go in that direction being passed and believe we should have full hearings and discussions
  1. What do you think would feel like a victory for mental health this session?
  • Collier- Done a good job of reducing stigma and need to keep that going and grow education; need funding in every area, schools, churches, need to think outside the box
  • Allison- Have structures in place but not enough; need funding for additional facilities especially in rural areas and telemedicine which is broadband sensitive; increasing suicide rates
  • Howard- Have 7 M Texans without broadband connectivity; need different types of facilities and goes back to not having enough providers

 

 

Public Questions

  1. Another side to abortion that wasn’t discussed; disregard for expectant mothers with terminal abnormal pregnancies and those mothers don’t have a choice; is that on the table?
  • Howard- Looking at that issue and working with physicians to clarify language that has ambiguity; physicians having to wait until women start dying to terminate and women having to carry a nonviable fetus to term and causing trauma
  • Allison- Don’t believe that was the intent of bill; extends to concern for miscarriage and DNC; confident it will be addressed and clarified
  1. Kirk Watson concerned about childcare; do you any information to share about childcare?
  • Collier- Programs within Texas Unemployment Commission that fund access to childcare; have RISE program; need to shore up programs and open to suggestions on making childcare more affordable and accessible
  1. Abstinence only sex education currently; will there be provision to talk to students about how sex education actually functions? Concern with new policies restricting abortion
  • Howard- Have abstinence plus programs but a lot of districts don’t have any sex education; challenge with the environment we are in right now with classification of parental rights
  • Howard- Trying to have age-appropriate information that could be used for healthy social behavior and need to do more but will be difficult in upcoming session

Q.Mediator- Trying to get the state to add contraceptive coverage to children’s health program?

  • Howard- One of only two states in program that don’t reimburse for contraception; fiscally responsible to reimburse and hoping to get through this time
  1. What was the justification to eliminate dollars designated for mental health services and how will you structure legislation to make sure these cuts will never happen again?
  • Howard-It’s a net zero impact; the money was taken out then replaced with other money; another issue of executive authority with Gov. and the legislature being part-time
  1. Curious if Lege has plan to circumvent Gov. Abbot if the Lege wants to approve Medicaid expansion?
  • Allison- If we can move toward increased reimbursement rate and wellness incentive, we move closer to my party accepting that; President Biden had incentive of addition $5 B over the next two years if we expand Medicaid, don’t know if it’s still on the table
  1. What can Lege do to allow small employers and non-profits to band together and purchase commercial insurance?
  • Howard- Would like to see the Tricare model expanded
  • Allison- Moved in that direction last section; think Rep. Oliverson is working on more in that area

 

Panel on Taxes

Moderated by Joshua Fechter, The Texas Tribune

Senator Paul Bettencourt

Senator Sarah Eckhardt

  1. What is left to do in terms of property taxes?
  • Bettencourt- Average homestead tax bill in Travis County is actually down this year; passed SB 8 which allowed people to get credit for their homestead exemption when they first buy homes
  • Eckhardt- High property taxes due to no income tax; even without 2019 changes in property taxes, the percentage of property tax bills compared to income for average Texan is below 5%; reason bill is down in Travis County is because of growth
  • Eckhardt- Need to buy down property tax with a different sustainable funding source
  • Bettencourt- Gives examples of property tax rates and values, school buydown will be over $5 B in the biennium allowing bottom floor tax rates to come down
  • Eckhardt- Looking at combined state and local property tax per capita, we are 40 something according to the Tax Institute; state pays less and less every year; examples of local governments picking up more and more of the cost of state services
  • Eckhardt- Should have state structurally fund statewide needs
  • Bettencourt- Don’t want to get nearer to a state property tax system; have taken decent steps to solve a big problem
  1. Does tax bill continue decreasing over the long term? What does the Lege need to do?
  • Bettencourt- Automatic reduction on school taxes will continue to be compressed; trying to set up automatic system that allows for more buydown
  • Eckhardt- If we can take surplus and invest in broadband, transportation, education, and healthcare that could help a people a lot
  • Bettencourt- Everything can be appealed to the public now; key part of this reform is top-down guidelines and going to public is needed
  1. Gov. Abbott says he wants to use half of the surplus on property tax relief and Lt. Gov. said state couldn’t do that without busting constitutional spending limit and proposed other options; Are Gov. and Lt. Gov. at odds here?
  • Bettencourt- Slightly different path; Lt. Gov. proposal of raising homestead and business exemption still in billions and could trigger constitutional cap
  • Eckhardt- Just a game of chicken; other statewide leaders like Hegar are saying we should be investing in infrastructure including water and Speaker Phelan said we should look at transportation infrastructure
  • Eckhardt- Good suggestions from TTARA where state can have biggest impact
  • Eckhardt- Should increase base rate and index it so state’s contribution to public education doesn’t erode every year; increase homestead exemption under school property taxes; lowering percentage increase that could occur annually off appraisal, but slightly concerned about that because it should be for all types of property
  • Bettencourt- Self-correcting features in market; will have billions applied to property tax relief but can’t tell you at this time
  • Eckhardt- Lt. Gov. said he didn’t want to bust cap but would look to referenda on issues other than the cap
  • Bettencourt- Federal subsidies for renewables create different game; need more base load and think public would vote for something like that
  • Eckhardt- We need to be agnostic on energy source
  1. What forms does this property tax issue take?
  • Bettencourt- Can have constitutional amendment, put it before voters, and Gov. can’t veto that, example of property tax relief propositions
  1. Where will focus be for property tax exemptions?
  • Bettencourt- Big fan of tax rate compression because doesn’t matter if you own or rent; can increase business exemptions
  • Eckhardt- For affordable housing, only mechanism is a flat dollar homestead exemption; percentage homestead exemption benefits wealthier people more; have bill for flat dollar homestead exemption
  • Eckhardt- State puts in almost zero to affordable housing
  1. Is there any feeling that the Lege would want to play a greater role in the affordability crisis?
  • Bettencourt- Had an interim charge from the Gov.; need to look at top-down guidelines; 5,000-foot cap for affordable housing in Austin is anti-market reality
  • Bettencourt- Need third party review with length of time it takes cities and counties to get permits out; example of County Line Barbecue hiring issues and costs
  1. Saying its possible the state comes in?
  • Bettencourt- Possible the state does some top-down guidelines; example of Houston with 1,400 ft zoning affordable housing
  • Eckhardt- If state were to pay its fair share, that would be the biggest property tax relief; can’t waste surplus bickering over zoning in city of Austin; difference between state and local responsibilities

 

Public Questions

  1. Would you consider supporting a bill that would create a mechanism to provide state matching funds to have a county funded spay neuter program for low-income people?
  • Eckhardt- Animal control predominately funded by city and county entities; suggest we take a look at public health contribution levels at the state compared to how much is being paid for by cities and counties
  1. Have a lot of fast growth cities in the greater Austin area and face unique challenges; Lege interested in assistance to make sure infrastructure keeps up with growing population?
  • Bettencourt- Some federal money for any lead line issues; transportation and water infrastructure; think there will be interest in that
  • Eckhardt- If we have to wait for voter approval for debt it will be lager
  • Discussion of CO use and misuse
  • Eckhardt- Gives examples of Cos being used well
  1. from moderator- Speaker and Lt. Gov. set aside $3 B in federal stimulus for potential property tax relief; is that still on the table?
  • Bettencourt- Yes
  1. How will areas like Killen be effected by this? Tax base is already deeply impacted by 65 plus and disabled veteran exemption?
  • Bettencourt- Will be looking at that issue with Senator Flores
  • Eckhardt- When you increase those exemptions and have a revenue cap that means a drastic reduction in city and county coffers so suggest that with this one-time money we buy increments for that local community and reset to higher over 65 and disabled exemption
  1. Texas Coalition of Veteran Organizations has worked on addressing the disabled veteran exemption in areas of state with high population and continue to work to try to come up formulas and ideas to make sure impact is not disproportionate; hope to do this upcoming session
  • Bettencourt- Think spending caps are there for a good reason
  • Eckhardt- Let’s find a structural long term sustainable solution to property taxes; must include state paying fair share for infrastructure and statewide concerns