Last month, we reported on the possibility of the Republican-controlled Texas Legislature bringing big changes to the state’s health and human services infrastructure. Now, it looks like those changes will be moving forward.
For those who may not remember, this year the Texas Health and Human Services Commission (HHSC) is up for review by the Sunset Advisory Commission for the first time in 12 years. The Sunset Commission is a legislative agency that reviews other state agencies and determines whether they should continue, and also makes general recommendations for improving their operations. The last time HHSC was under review in 2003, it was consolidated from 12 agencies down to 5. This year, the Sunset Commission has recommended consolidating those 5 agencies down to 1.
The Sunset Commission’s recommendations are released in a public report, which then goes before a legislative panel, comprised of 5 senators, 5 representatives, and 2 members of the public. The current panel is heavily Republican, reflecting the composition of the current Legislature, with 7 Republicans and only 3 Democrats.
On Wednesday, the Sunset Commission voted unanimously to approve the recommendation to consolidate the 5 HHSC agencies into one “mega-agency.” As the Texas Tribune reported, in accordance with Sunset’s recommendations, the new agency would have 7 divisions:
- – Medical and social services
– State institutions and facilities
– Family and protective services
– Public health services
– Regulatory services
– Centralized services
– Inspector general
At the hearing on Wednesday, Senator Jane Nelson (R-Flower Mound), who co-chairs the Sunset Commission, said that she believes the consolidation is a promising step forward, stating that, “This reorganization … will better serve our most vulnerable citizens and will create one front door for Texans who are seeking services.”
Senator Charles Schwertner, R-Georgetown, who chairs the Senate Committee on Health and Human Services, noted, “This consolidation does present a monumental change to the delivery of health care services in the state.” He also acknowledged that the transition would not be easy, but nonetheless supported it moving forward.
Advocates for the vulnerable populations most affected by consolidating HHSC were not so enthusiastic, however. Eileen Garcia, CEO of the advocacy group Texans Care for Children expressed disappointment at the Sunset Commission’s actions. In a statement, she pointed out, “Asking officials to spend their time building a new bureaucratic system will distract them from delivering basic services to families and implementing Sunset’s other recommendations to improve efficiency.”
Other advocates have noted that a mega-agency would be “unwieldy,” and would make it more difficult to dedicate time to the populations who need it.
These stakeholders are doing their best to have a say in the process as it moves forward, but the consolidation of HHSC nonetheless has the possibility for drastic consequences. The next step is for these recommendations to go before the full Legislature, putting the future of Texas’s social safety net in the hands of one of the most conservative Legislatures in decades. Conservative Texas legislators do not exactly have the best track record when it comes to protecting social safety net programs, and it is unlikely that things like women’s health, mental health, and Medicaid will come out of the session unscathed. The HHSC review gives the newly-elected Tea Party legislators the perfect opportunity to slash government programs, and it’s likely that they’ll make the most of it.
Members of the public do have the opportunity to have a say in the process. The Sunset Commission is accepting written comments until December 15.
If the Legislature approves consolidating HHSC, the health commissioner would be required to submit a plan for the transition by December 2015. It remains to be seen how the future of HHSC will unfold, but in as little as a year from now, Texans could be facing an entirely new health and human services landscape.