The Texas Legislature entered this session facing what appeared to be a fiscal crunch. The COVID-19 pandemic and the resulting recession looked like they would put a big dent in state revenues. In the end, that didn't happen, but the result was a mixed bag, particularly for health care.
The final version of Senate Bill 1, the budget for the 2022-2023 fiscal biennium, included total appropriations of roughly $248.5 billion, a decrease of 5.2% from the current cycle. Getting to that figure was no easy task for state Sen. Jane Nelson, R-Flower Mound, chair of the Senate Finance Committee.
"When we gaveled out last session, our economy was booming, and we had money in the bank, or so we thought," Nelson told her fellow senators as they prepared to vote on supplemental appropriations for the current fiscal cycle in late May.
Nelson had to work out that supplemental budget at the same time as she was working on the next budget, all while the pandemic and the recession cast doubts on the state's revenue projections.
"When I started working on this budget over a year ago, it was as if somebody had taken two boxes of jigsaw puzzles and thrown them up in the air, and all the pieces fell down, and we had to untangle it and put those jigsaw pieces together," Nelson said.
But the economy, and revenues, largely bounced back. The result was that Nelson was able to deliver on her top priorities. Fears of fresh, deep cuts turned out to be overblown.
"When we started this budget, I put forward four primary goals," Nelson said. "We're going to keep our commitment to education. We're going to fight the coronavirus and keep Texans healthy...Strengthen public safety and reignite our economy. And we are accomplishing those goals."
Nelson was not alone. Although there weren’t any huge increases, lawmakers’ fears of major cuts didn’t materialize, and the budget passed unanimously in the Senate — 31-0 — with just a few dissenting votes in the House, where it passed 142-6. And that’s before the allocation of nearly $16 billion in COVID-19 relief funds, which will be decided on during a special session in the fall.
Nelson was particularly proud of the appropriations for health care – she previously served as the long-time chair of the Senate Health and Human Services Committee before becoming the senate's chief budget writer. The two-year health care appropriation came to $34.2 billion, second only to public education as a share of the budget.
Among other facets, the budget includes some $8.4 billion for behavioral health funding spread out across 25 different agencies. That's an increase of about $300 million from the previous cycle.
"It's a very meaningful increase that will have a sizable impact on access to care in Texas," said Greg Hansch, executive director of the National Alliance of Mental Health Texas. "The funding increase will provide additional capacity in the in-patient care system which is sorely needed."
Some $50 million will go to in-patient psychiatric beds in Harris County. Other funding will go to finish construction of a 240-bed replacement campus of the Austin State Hospital, a 300-bed replacement campus of the San Antonio State Hospital, and the Kerrville State Hospital extension, as well as starting planning efforts for a new state hospital in the Dallas-Fort Worth area.
On Twitter, Republican lawmakers began circulating a graphic praising the budget’s passage, with a particular focus on the state’s allocation for health care.
This week, the Texas House officially approved #SB1, the state budget for the net biennium. SB1 is a balanced budget that stays well below all Constitutional spending limits while funding the needs of our growing state. #txlege pic.twitter.com/FVYHKsOmYX
— Geanie Morrison (@GeanieWMorrison) May 28, 2021
But some health care advocates say that’s misleading.
For example, the new budget provides extra funding for those battling severe disabilities. including an additional $76.9 million to address the interest lists for Medicaid Community Waiver Programs. That's a program designed to help people with severe disabilities receive care to continue to live at home, rather than being institutionalized.
But disability advocates say the funding is far short of what's needed. More than 166,000 Texans are on that waitlist. Dennis Borel, executive director for the Coalition of Texans with Disabilities, said that money is only enough to get about 1,500 people off the list.
"That waiting list, that guy at the end, if everyone stayed on it, it would take 200 years to get to the top,” Borel said. “So, what is keeping this (manageable)? Well, sadly enough, the life expectancy. People will die off before they ever reach the top.”
In practical terms, Borel explained, people adding their names – or the names of their disabled children – to the waitlist can expect to wait well over a decade to get the help they need. Texas currently has the longest waitlist of any state in the country.
"People who are getting off the wait list now have been on that waitlist for 17 years," Borel said. "And that speaks to how much attention has been given to this really important issue in the last 17 years by the Legislature, and the bottom line is simply not enough."
While the budget passed with strong bipartisan support, but that doesn't mean every lawmaker was happy with it. State Rep. Gene Wu, D-Houston, voted for the budget, saying that overall, it did more good than harm.
"There are a lot of our priorities that we wanted that weren't included," Wu said. "But there were also a lot of things like funding for higher education, funding for community colleges, funding for (Child Protective Services) that were included, and those were excellent additions."
But Wu had two major complaints. One was that the budget included some $1.1 billion for border security. That's a relatively modest increase over spending on border security in the previous budget cycle, but Wu said it's money that would have been better spent on other priorities. It’s money that would be largely wasted if it goes to a priority of Gov. Greg Abbott, building a wall on the Texas-Mexico border.
"Even if we take the $1.1 billion that's been added for border security, which is spread across multiple agencies...even if they spent all of that, that's still maybe building like 10, 20 miles,” Wu said. “It's, I think, a lot of posturing and bluster from somebody who wants to run for president in four years.”
Wu's larger complaint relates to emergency cuts taken out of the 2020-2021 budget cycle.
“In 2020, because of the pandemic, because all of a sudden things are going on with the economy, Gov. Abbott asked all government agencies except for education to take 5% voluntary cuts, with the understanding and the hope that those cuts would be restored in the 2021 budget,” Wu said. “Those cuts were not restored.”
When it came to Health and Human Services, the cuts fell particularly hard on the staff that enroll people for benefits – ranging from Medicaid and the Children’s Health Insurance Program to SNAP benefits, formerly known as food stamps.
That's at a time when the agencies have seen an increased demand for benefits because of the pandemic and the recession.
"We do see some effect already in that in terms of the processing time, the length of time between when people apply and when they get their benefits has gotten worse over the last 6-9 months," said Anne Dunkelberg, associate director for the public policy research group Every Texan.