Now that Ebola is officially gone from Texas, media attention on the state’s public health system has subsided. But that might not last long, because the newly elected Republican Legislature could be bringing big changes to the state’s department of Health and Human Services.
Today, the Texas Sunset Advisory Commission will begin hearing public testimony on the state’s Health and Human Services Commission (HHSC). The hearing will discuss recommendations for the future of the agency, and it could foreshadow major changes to come in the 2015 legislative session.
In Texas, most state agencies in Texas have what’s called a “sunset” provision in the legislation that enables them, specifying that they will be abolished, or “sunsetted” within a certain amount of time–unless they are continued by the Legislature. The Sunset Advisory Commission is a legislative agency that reviews other state agencies and determines whether they should continue or be abolished, and also makes general recommendations for improving their operations, making them more efficient and effective, saving taxpayer money, and more.
The way the Sunset Commission works is as follows:
- -Sunset staff analyze an agency’s performance and write a report recommending areas for improvement.
- -Once the report is published, the recommendations go before the Sunset commission, which is made up of 5 senators, 5 representatives, 2 members of the public. Sunset staff, agency staff, and the public testify in hearings.
- -The Commission adopts or rejects the recommendations in the report.
- -The adopted recommendations are made into a bill that goes through the legislative process, considered by the full Legislature.
During legislative consideration of the bills that come out of Sunset recommendations, the sunset provision functions as a poison pill–if the Legislature cannot pass a new bill, the agency will automatically expire and must start winding down operations. Often, the Legislature works around this by passing bills extending the date for the agency, while ignoring the problems and recommendations themselves.
Agencies generally come under consideration once every 12 years. The current commission is heavily Republican, with 4 out of 5 senators and 3 out of 5 representatives being members of the GOP. This year, it’s the HHSC’s turn for review, for the first time since 1998. It’s also the first time the HHSC has come under review since the passage of HB 2292 in 2003, which consolidated the Health and Human Services system from 12 agencies into 5: the HHSC, Department of Aging and Disability Services (DADS), Department of State Health Services (DSHS), Department of Assistive and Rehabilitative Services (DARS), and the Department of Family and Protective Services (DFPS).
Suffice it to say, this review is a pretty big deal.
The Sunset Advisory Commission’s report on the HHSC, along with hearing material, was released earlier this month, and it contains several recommendations for how the system should be restructured. Of the 15 issues the Sunset Commission made recommendations on, there are a few that have been gaining prominence due to their potential to impact the HHSC system.
First, they recommend that the Health and Human Services system be consolidated from five agencies into one. According to Sunset, consolidation would save the state money (the five agencies received $34.5 billion combined in public funding in fiscal year 2013 — 58% was from federal funding and 42% from the state), as well as increase efficiency.
Next, the Sunset Commission heavily criticized the state’s approach to women’s health. While the report doesn’t touch on the most controversial issues (i.e. HB 2), it does criticize the system of health care delivery that has emerged as a result of Republicans slashing funding for women’s health services. When the Republican Legislature cut Planned Parenthood out of funding women’s health programs in Texas, 76 clinics were forced to close, and the state has had to find new ways to restore services. The result has been a fragmented system that is increasingly difficult for the state to navigate.
Sunset also called out the mismanagement of the HHSC’s Office of Inspector General, which is supposed to combat waste, fraud, and abuse in Medicaid and other HHSC programs. Not only did Sunset criticize the office’s lack of structure and guidelines, and its fraud hearing process, they also expressed concerns about accountability. As the report points out, “, the inspector general’s gubernatorial appointment and OIG’s creation as a division of HHSC raise questions about the inspector general’s accountability to the governor versus the executive commissioner.”
Finally, Sunset recommends removing all of HHSC’s advisory committees from statute. There are 35 HHSC advisory committees in statute, and Sunset recommends taking them out to remove restrictions and make management more efficient. While this isn’t as incendiary as some of the other recommendations, it could have important ramifications. Many stakeholders, and the public at large, could lose their ability to be involved and give feedback to the agency if the committees disappear.
The big question now is what the Republican legislature will do with Sunset’s recommendations–and the results may not be pretty.
The Sunset review of HHSC gives Republicans in the Legislature to opportunity to do away with the state’s health and human services infrastructure entirely. Fortunately, it’s unlikely this will be the case–the state does still need an agency to administer federal programs like Medicaid, SNAP (food stamps), and Temporary Assistance for Needy Families (TANF). But under the guise of consolidation, the Legislature could make some serious cuts, leaving vulnerable Texans even worse off than they are now. Given the agencies’ large size and massive budgets, along with Texas’ generally terrible record on providing health services, it’s clear that Republicans will do their best to dismantle the state’s health infrastructure even more.
Another issue that could emerge is that of Medicaid expansion. Sunset bills are generally thought of as tools for improving government, and not addressing policy questions– the Sunset Commission didn’t address Medicaid expansion in its report. But once the bill goes to the full Legislature, it’s entirely possible that one of the new right-wing extremists elected this year could take the opportunity to add Medicaid expansion to the bill. It falls under the general scope of HHSC, and one of the freshman Tea Party legislators could try to use the Sunset bill to prove their anti-Obama chops by adding a provision against Medicaid expansion.
It’s very likely that the Legislature will consolidate the various HHSC agencies into one mega-agency, a move that those who work with vulnerable populations oppose. As Eileen Garcia, CEO of the nonprofit organization Texans Care for Children, said in a statement (emphasis added):
“We all agree on the importance of efficiency in our programs to investigate child abuse, ensure babies are healthy, provide services to Texans with disabilities, and carry out other health and human services functions. However, burying existing agencies within another layer of bureaucracy at this point would divert attention away from fixing the real problems identified by Sunset, disrupt services for children and families, and create new inefficiencies. At this time, we oppose consolidating the agencies into a single mega-agency. …We want improved coordination, but we’ve seen in the past that making staff from different programs sit next to each other and use the same letterhead isn’t the way to make them work together.”
Whatever the Legislature ends up doing, it’s clear that HHSC will not be the same as we know it after this session. The discussion of Texas’ health and human services infrastructure will almost certainly be one of the biggest issues of the upcoming legislative session. Now that Texans have placed the future of health and human services in the hands of one of the most extreme right-wing Legislatures to date, public assistance programs, Medicaid, women’s health, and mental health will probably not come out of the session unscathed.
This year, vital programs for millions of Texans will be at risk. Though the election is over, the fight certainly is not. It’s up to Democrats to speak out, otherwise Texas’ future looks bleak indeed.