1. The University of Texas Medical Branch The 83 rd Legislative Session and UTMB Ben G. Raimer, MD, MA, FAAP Senior Vice President Health Policy and Legislative Affairs December 9, 2013

2. Working Together to Work Wonders Highlights Most encouraging legislative sessions in years Speaker Straus’ leadership Democrats operating in the minority Strong freshman class Breakout of largely adult behavior 2

3. Working Together to Work Wonders The Big Picture Budget Water Fund Transportation Fund South Texas Medical School Tuition Revenue Bonds GME Campus Carry Physician Education Loan Repayment CPRIT Reform Medicaid Reform 3 Photo credit: Texas Tribune

4. Working Together to Work Wonders No Medicaid Expansion in Texas Medicaid costs too much-- uses up too much of the state budget; inefficient and ineffective health care system imposed on states by feds VS Not expanding Medicaid costs too much-- lost federal funds, lost human capital, increased costs to local governments and providers; inefficiencies and ineffectiveness due more to state choices in Medicaid policy, not federal Medicaid Expansion: The Discussion 4

5. Working Together to Work Wonders Eliminates the requirement for onsite physician supervision and allows doctors to delegate drug and durable medical device prescribing authority to an advanced practice nurse or physician assistant Increases from four to seven the number of advanced practice registered nurses or physician assistants to whom a physician can delegate prescriptive authority Improves coordination between the Texas Medical Board and the Board of Nursing and Board of Physician Assistants Allows physicians to delegate prescribing authority to APRNs and PAs for certain controlled substances in hospitals and hospice settings SB 406 Scope of Practice 5

6. Working Together to Work Wonders UTMB’s Legislative Priorities - Outcomes Growth in formula funding to support: $24.5M o Education of health workforce needed for Texas, now and in the future, including undergraduate and graduate medicine, nursing, health professions, and biomedical research o Necessary infrastructure o Research critical to solving the health problems of the state and nation Continuation of 2012-2013 levels of funding for the Health System and existing special items with a new Hospital Formula: $10M New Exceptional Item funding for: NONE o Vaccine development o Regenerative medicine o Emerging infectious disease research TRB funding for Inter-professional Education Building: NONE Release of TRB debt service for new Jennie Sealy Hospital: $11M Correctional Health Care funding: $48.1M 6

7. Working Together to Work Wonders UTMB Historic Funding 7 1.Base adjustment after Hurricane Ike; does not include $150 million TRB debt service or $150 million Ike Match 2.Reduction of 16.65% from prior biennium primarily in hospital General Revenue funds 3.Does not include $11.4 million increase in Higher Education Group Insurance (HEGI) for UTMB.

8. Working Together to Work Wonders Tuition Revenue Bond Formula Funding Hospital Formula UTMB’s Legislative Priorities - 84 th Session 8

9. Working Together to Work Wonders 9 Texas’ Future Leadership Governor o Governor Rick Perry is not seeking reelection o Attorney General Greg Abbott is the front runner to replace him but only leads Senator Wendy Davis by single digits in early polling Lieutenant Governor David Dewhurst Announced Challengers in 2014 o Land Commissioner Jerry Patterson o Agriculture Commissioner Todd Staples o Senator Dan Patrick o Senator Leticia Van de Putte Speaker of the House Joe Straus

10. Working Together to Work Wonders State Comptroller o Susan Combs will not run again o Debra Medina o Sen. Glenn Hegar o Rep. Harvey Hilderbran o Raul Torres Land Commissioner o George Prescott Bush Attorney General o Rep. Dan Branch o Railroad Commissioner Barry Smitherman o Senator Ken Paxton Other Political Changes 10

11. Working Together to Work Wonders Senator Larry Taylor Representative Greg Bonnen Representative Craig Eiland (retiring after 20 years of service) o Loss of 17 th most senior person in House o Loss of powerful member of insurance committee o Possible candidates: -Judge Susan Criss (D) -Wayne Faircloth (R) -Bob Senter (R) -Growing list of others Local Delegation Changes 11

12. Working Together to Work Wonders Advocacy What you can do to advocate for your patients, for your profession and your school: o Be involved with your professional society o Visit your State Representative and Senator o Know the issues and stay informed HPLA Web Site: www.utmb.edu/hpla o Click on “Resources” o Look up your home geopolitical district o Review the Health Policy Briefs o Ben’s Blog 12

13. Working Together to Work Wonders Questions? 13