AUSTIN, May 30 – Lawmakers successfully triumphed over the powerful tobacco lobby to pass a bill that will use monies from taxes levied on smokeless tobacco to assist physicians in repaying their school loans.

House Bill 2154, by state Rep. Al Edwards, D-Houston, would revamp the Texas Physician Education Loan Repayment Program. Currently, the state forgives up to $45,000 of a medical graduate's loans if he or she practices in a shortage area. Most physicians graduate with more than $160,000 in school loans, however.

In order to qualify family practitioners would have to serve in areas designated as medically underserved for a minimum of four years, and in turn would qualify for more than $150,000 in loan repayment.

“Physicians and health centers consider House Bill 2154 to be the most significant legislation to pass in decades because of its potential to bring basic medical care to millions of Texans in the border region and underserved communities of our state,” said Tom Banning, chief executive officer of the Texas Academy of Family Physicians (TAFP).

“Within four years, Texas will have 900 new physicians serving communities in need. Texas established the nation’s first physician loan repayment program and will once again serve as a national model for recruiting and retaining physicians to serve in our medically underserved communities.”
 
Funding for the program will come from closing a loophole in the taxing of smokeless tobacco. State Sen. Juan “Chuy” Hinojosa, D-McAllen, is the Senate sponsor of the bill and said more than $100 million could be raised by plugging the loophole. 

“The way we pay for that is that we changed the way we tax smokeless tobacco from an ad valorum unit approach to a weight based approach and that would raise approximately $105 million,” he said.

Edwards applauded passage of the bill as something that would not only benefit his district, in inner city Houston, but could also bode very well for the border.

“You got deprived areas like the border (and) they will be taken care of more,” he said. “They’ll probably get more than others but that’s not going to change folks from going to inner cities or urban cities at the same time.”

That said, however, Edwards added the state a whole would benefit and that was the intent of his bill.

“You got people that are sick whether they live in the district or not. If they are sick they are sick,” he said. “We can’t be so shortsighted to come up and say, ‘Oh, if this is not just so much for my district then I am not going to do it.’ They can’t be because our indigent (people) and our elderly and our sick people are all over the state and you just can’t do a bill just for your district.”

The smokeless tobacco tax would also fund provide for tax breaks for small businesses, which Edwards said would be another step forward for the state.

The Texas Association of Community Health Centers (TACHC) joined TAFP in praising the passage of the bill.

“The legislation was carefully crafted to solve a very real problem in Texas. This is an incredibly important measure,” said TACHC Executive Director Jose Camacho.
 
“Our centers desperately need and are counting on this legislation to provide us with primary care physicians to serve in our clinics, located in Health Professional Shortage Areas. The impact of this legislation will felt from our rural areas to our border communities.”

Both Banning and Camacho said the measure had many legislative champions, including Edwards, Hinojosa, Sen. Steve Ogden, R-Bryan, and Reps. Warren Chisum, R-Pampa, Sylvester Turner, D-Houston, Richard Peña Raymond, D-Laredo, and Veronica Gonzales, D-McAllen.

The medical importance of this is underscored by the statistics for physicians working in medically underserved areas:
 
* The national average is 81 primary care physicians for every 100,000 people. Texas averages 68 for every 100,000 people.
 
* By 2015, Texas will need more than 4,500 additional primary care physicians and other providers to care for the state’s underserved population, predicted to be 5.3 million people.
 
* More than half of Texas’ counties need more primary care physicians. 114 counties do not meet the national standard of one physician for every 3,500 people.
 
The eventual passage of the Edwards-Hinojosa legislation preceded many twists and turns at the state Capitol. Chisum had filed legislation – House Bill 1876 - to create a healthcare access fund to recruit health care providers to medically-underserved areas and fund federally-qualified health centers. Gonzales was a joint author.

The Chisum-Gonzales legislation faced a lot of opposition from lobbyists working for the tobacco industry. It was only after a successful amendment by Gonzales to Edwards’ bill that Chisum’s proposals were deemed sufficiently “germane” to Edwards’ bill. Once Chisum’s bill was grafted onto Edwards’ bill, the measure really had momentum and a funding mechanism to make it work.

“This legislation would open the doors for health care providers to work in medically-underserved areas by giving them a financially viable career choice,” Gonzales said. “Texas faces a shortage of physicians and other health care providers all over the state, especially along the border and in rural areas.”

Before the bill passed on Friday, Hinojosa said he was on “high alert” because he said someone with close ties to the tobacco lobby had an obvious and vested interest in blocking the bill.

He said the bill wasn’t time stamped when it was originally delivered and asked his staff to contact the office of House Speaker Joe Straus. A spokesperson in Straus’ office said the bill could have been one of hundreds that were literally carted over to the House from the Senate on Wednesday and was delayed because of the sheer volume of bills being worked before the session’s end.

Edwards said that because of the incentives offered to small businesses, he was certain the bill would be signed into law by Gov. Rick Perry.