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TSGE Legislative Update December 2024

 Meet the New Boss, Same as the Old Boss?

As TSGE prepares its agenda and priorities for the 89th Texas Legislature, we do so amid a contentious leadership fight in the Texas House over who will hold the Speaker's gavel in January. 

Since the conclusion of the 2023 session, two-term Republican House Speaker Dade Phelan (R-Beaumont) has endured withering hostility from the Republican Party's base of conservative grassroots voters and activists. This enmity concerns primary around Phelan's decision to initiate impeachment proceedings against firebrand Attorney General Ken Paxton and his somewhat obstinate defense of the longstanding, bipartisan practice of appointing members of the minority party to committee chairmanships and other leadership roles in the Texas House. 

After a contentious primary contest in which several well-funded conservative challengers unseated moderate Republican incumbents - a fate Phelan himself only narrowly escaped - a significant challenge to the Speaker's position seemed all bet inevitable. Faced with this reality, Phelan ultimately decided to step aside rather than face the prospect of a contentious and potentially unsuccessful effort to hold on to power. 

Phalen's decision to withdraw has set off a battle for control within the Republican caucus, highlighting key differences between various party factions as they work to determine who will lead the chamber in the next legislative session. At the time of this writing, the leading Speaker candidates are Rep. Dustin Burrows (R-Lubbock) and Rep. David Cook (R-Mansfield).

Burrows, who leads the powerful House Calendars Committee, promotes himself as something of a consensus builder in the Texas House. A close friend and political ally of Speaker Phelan, Burrows has continued Phelan's bipartisan approach to governing by seeking the backing of both Republicans and Democrats in his campaign for Speaker. Perhaps unsurprisingly, Burrow's bipartisan strategy and refusal to rule out Democratic committee chairmanships have invited much of the same conservative backlash faced by Phelan. 

Cook, on the other hand, has publicly called for an end to the practice of appointing Democratic committee chairs and claims that he has earned the support of a majority of Republican Caucus members (though, importantly, not a majority of House members) in his campaign for Speaker. Cook also highlights endorsements from prominent Republican leaders like Lieutenant Governor Dan Patrick and Attorney General Ken Paxton, who stress the importance of having a House Speaker capable of advancing a conservative agenda without Democratic cooperation. 

Regardless of who ultimately emerges to lead the Texas House in the next session, the results of the House Speaker's race can be sure to impact the legislative priorities of the Texas Society of Gastroenterology and Endoscopy. The next Speaker will not only have a strong hand in shaping the broad policy agenda for the Texas House but will also be able to select new chairs to lead the key committees that affect the practice of medicine, including the House Committees on Public Health, Insurance, Human Services, and Appropriations. 

Ensuring Patient Safety in Colorectal Cancer Screening

The Texas Society of Gastroenterology and Endoscopy is actively engaged in a critical patient safety issue involving health insurers' sending unsolicited stool DNA tests, like Cologuard, directly to patients without their prior knowledge or consent. By failing to consider patients' individual medical histories, this practice risks compromising both patient safety and the doctor-patient relationship. 

Stool DNA tests may serve as valuable screening tools for average-risk individuals facing colorectal cancer, yet they are unsuitable for those at high risk or exhibiting symptoms. Research by Texas Digestive Disease Consultants indicated that 36% of these tests were wrongly prescribed, which can result in consequences like postponed colonoscopies, misdiagnoses, and misplaced confidence. Worryingly, almost a third of patients who received negative stool DNA results were later diagnosed with pre-cancerous adenomas during follow-up assessments. 

TSGE has formally raised these concerns with the Texas Department of Insurance and is helping patients affected by this issue file formal complaints with the Texas Medical Board regarding prescription treatments being provided without an adequate physician assessment. We will continue to advocate for adherence to established clinical guidelines and emphasize that colonoscopy remains the gold standard for the screening and prevention of colorectal cancer. 

Preserving Access to Remicade for Gastroenterology Patients 

 Blue Cross Blue Shield of Texas recently introduced a contentious policy proposal that would reclassify Remicade and unbranded infliximab as non-preferred medications, a change that would profoundly impact patient access to these vital treatments. 

In our official communication with BCBS, TSGE expressed apprehensions regarding the negative implications of this policy on patient care, including delays in treatment, interruptions to established gastrointestinal infusion services, and heightened financial burdens on patients and healthcare providers. The organization emphasized the importance of specialized GI care infusion centers in management conditions like inflammatory bowel disease (IBD), where prompt and accurate treatment is essential to prevent worsening symptoms and the need for expensive emergency care. 

Following advocacy efforts from TSGE and other stakeholders, BCBS has subsequently overturned its decision, affirming that Remicade will remain a preferred medication. This results emphasizes the significance of collective advocacy in safeguarding patient care and ensuring affordable access to effective treatments. TSGE will continue to monitor similar policy proposals from health care plans and amplify the voices of gastroenterology professionals and their patients. 

Texas Gastroenterology Day at the Capitol: March 4, 2025

Please join us on Tuesday, March 4, for Texas Gastroenterology Day at the State Capitol! 

As in previous legislative sessions, TSGE's official advocacy day will coincide with the Texas Medical Association's "First Tuesday" event (don't forget to wear your white coat!), which provides participants with a unique opportunity to engage directly with lawmakers and discuss the policy issues that matter most to your practice and your patients. 

No policy expertise is necessary to participate. The TSGE lobby team will provide talking points and background information on our full legislative agenda, including prior authorization reform, continued funding support for the Texas Colorectal Cancer Initiative, and other identified priorities. 

For more details or to sign up for Texas Gastroenterology Day at the State Capitol, please contact TSGE Executive Director Ky Camero at ky@cameroams.com. We'll see you in Austin!