HB 2154

House Bill 2154, having been voted out of the House Public Health Committee a few weeks ago, was on the floor of the Texas House Friday. The bill would increase funding for a program that pays down student loans for doctors in exchange for a term of service practicing in a federally designated health professional shortage area. The funding increase would come from a $25 surcharge on medical licenses, so the cost to taxpayers, and the rest of the state budget, would be zero.

According to the bill’s sponsor, Al Edwards (D- Houston) the bill “is going to help solve a lot of problems we have with general practitioners in rural areas. We have a shortage of general practitioners. It helps put doctors in your areas, members.”

The first thing that happens is that Edwards introduces an amendment. The amendment increases the surcharge cost to $35. This is because the fiscal note (an estimate of how much money the state would spend or save if the bill became law) for the original bill implied that the General Revenue fund would lose $10 of revenue on each medical license. The $10 increase is to offset that estimated loss and protect the bill from a point of order (a procedural move to kill a bill or an amendment before it comes to a vote).

The Chair hears no objections; the amendment is adopted.

Then there is some congregating at the dais, where a microphone picks up some laughter about someone trying to sub a 20-page bill for a 2-page bill.

Another amendment, this time by Veronica Gonzales (D- McAllen). This amendment would require recipients of loan repayment money to practice in a health professional shortage area. It also establishes maximum repayment amounts based on length of service. The former requirement is already built in to the program, making this one redundant. The latter authority, to increase payments to doctors, also already exists.

Nevertheless, Edwards initially opposed the amendment, believing that the legislation would cover the whole state, not merely the shortage areas. This is just a semantic slip up, though, because the overwhelming majority of the state is a shortage area. The map right below shows, in dark green, the counties that are designated primary care shortage areas. The light green counties have a partial designation.


Edwards withdraws his motion to table the amendment and the amendment is adopted.

Now Warren Chisum (R- Pampa) has an amendment. This amendment produced the laughter at the dais a few minutes before. Chisum had introduced HB 1876, which would have discontinued all the individual health-related loan repayment programs and replaced them with one big one, to be funded with a change in how smokeless tobacco is taxed. For whatever reason Chisum’s bill has not come up for a hearing (perhaps because he was an ally of the previous, divisive House Speaker Tom Craddick, though this is pure authorial speculation). Chisum’s amendment would strike the entire, 2-page bill and replace it with the almost 20 pages of HB 1876 text.

Charlie Geren (R- Fort Worth) calls a point of order, because the amendment is not germane to the original bill

The House Speaker sustains the point of order.

Chisum raises a parliamentary inquiry, asking the Speaker to clarify the mechanics of trying to appeal the ruling. (The scene briefly recalled the much tenser and ultimately explosive confrontation between Speaker Craddick and Jim Dunnam near the end of the previous legislative session.) Chisum explained later that this was just a move to distract from the filing of his next amendment.

Chisum’s next amendment just grafts the funding mechanism from HB 1876, the change in smokeless tobacco tax assessment, onto HB 2154.

Geren initially calls another point of order (“it has the same problems as the last one did”) but a minute later temporarily withdraws the objection.

Edwards asks to postpone a ruling on the point of order, and further consideration of the bill, until Monday.