Shelton G. Hopkins, MD
President's Page

DCMS and the Texas Legislature

When this is published in the Dallas Medical Journal, the biennial spasm that is our Texas Legislature will have completed its session (unless the governor calls a special session during the summer). But the Legislature will be back again in 20 months, so I want to talk about how DCMS and TMA work to influence the legislative process.

Although the political views of our membership vary substantially, when it comes to specific issues to support or oppose in Austin, physicians’ opinion almost are unanimous. I have heard from several colleagues that they hesitate to participate in the formal lobbying efforts of DCMS or TMA because they disagree with TMA’s overall political leanings — which some see as right and others contend are left. I have yet to see those basic philosophical differences cause the implosion of efforts to maintain Medicaid payments or the number of GME (Graduate Medical Education) slots, for example. Support for the Patient Protection and Affordable Care Act may be divided on the national level, but at the state level, we have to learn the best ways to live with the system as it is. The bottom line is that your presence is wanted and needed next go-round in Austin, whether you are a Tea Partier or think that Obama is too far to the right.

DCMS tries to influence legislation in two ways: directly, through personal contacts with lawmakers and participation in First Tuesdays, and indirectly, through our participation in TMA. Tracy Casto is our Director of Public Affairs and Advocacy. She oversees and organizes our efforts in Austin, and is allied with the TMA lobbyists. During the legislative interim, she is busy vetting local potential legislative candidates and developing relationships with them as well as between them and our membership.

Our own political action committee, HealthPAC, is medicine’s voice in Dallas. It focuses on races for the Dallas County Commissioners Court (because of its control over the Parkland Health & Hospital System budget) and local judicial posts. Our voice in Austin is led by the DCMS Legislative Affairs Committee, which comprises those physicians willing to take time to push medicine’s views in the Legislature. They do not create policy or write bills (or take state legislators on yacht trips to the Caribbean — or even to Lake Ray Hubbard).

The main way we try to get our ideas across to legislators is through our participation in TMA. Our interaction with TMA is complex. It starts with the DCMS delegation to the annual meetings, where the House of Delegates considers resolutions that provide guidance to the Council on Legislation and to the TMA lobbying team. To have more influence on the TMA, a county medical society must have its members elected or appointed to TMA councils and committees (i.e., it requires politikin’). The bodies that have the greatest connection to the Legislature are the Council on Legislation and the Council on Socioeconomics. This year we are fortunate to have DCMS members Dan McCoy, MD, as COL chairman and Chris Crow, MD, MBA, as COS chairman. As you might imagine, the Council on Legislation members do not rest during the legislative session. That council is the one where the rubber meets the road during this part of the biennium, and it meets throughout the year during scheduled TMA meetings. At this time of the biennium, the council communicates via conference calls at least weekly and sometimes multiple times a day.

The determination of medicine’s position on a bill often is not clear-cut. One must remember that a bill we may have supported in committee may have been changed significantly by the time it reaches the House or Senate. This can happen very fast. Thus, instructions of principle may no longer be easily applied, and even specific instructions may no longer be pertinent. Snap decisions must be made that are consistent with the general view of the TMA as interpreted by the councils and the lobby team.

The TMA lobbying team works in the Division of Advocacy and is headed by Darren Whitehurst. He has four additional lobbyists in his division as well as access to the director of TEXPAC (TMA Political Action Committee) and the TEXPAC staff. At times, additional lobbyists are hired to work on specific issues. On many issues, we work with specialty groups and business interests and form coalitions, such as TAPA (Texas Alliance for Patient Access) regarding tort reform and the Texas Public Health Coalition for smoking limits). Our lobby team is widely recognized as one of the most effective teams in Austin, and they say that a physician connection to a legislator, especially as a treating physician, is their most effective tool.

A few physicians serve in the Legislature, and TEXPAC worked hard for their election. They have their own issues and goals, but in general they see the problems much as we do. They can strongly influence the legislative process, but they, too, have their limits. The formation of coalitions is crucial, as is maintaining comity among friends and potential friends.

The political dance that is our Q2Y legislative session is a thing of wonder and, sometimes, horror, but mostly of hard work by knowledgeable, dedicated people. Our voice in Austin can include you. Next time around, join in.

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