Speaker Tom Craddick recently entrusted me with chairmanship of the House Committee on Public Health. I am grateful for the opportunity, as this committee works on issues of importance to the health care of all Texans. The matters my committee will review are of particular importance to the residents of Bell County due to our extraordinary health care infrastructure. It is a big responsibility and I am ready to get to work.


Many people may not realize it, but one dollar out of four in our state budget goes to operate just one federal program: Medicaid. In our current two-year budget cycle, Medicaid spending from all sources of funds is around $29 billion. According to the Legislative Budget Board, Texas' expenditures on Medicaid from all sources of funds have grown 90 percent from fiscal year 1994 through 2003.


This growing price-tag is why lawmakers spent so much time in the 2003 regular session working on both reforming the state's health and human services programs and streamlining the bureaucracy that administers them. Some landmark reforms were adopted, but the work has to continue in the current session.


The challenge facing all lawmakers will be to control costs while still ensuring that those with honest needs receive quality care.


I will be authoring major legislation on this topic and let me say up front that there is no one magic bullet to fix everything. It is more like a lot of small things that, taken together, add up to major improvements.


One item that simply must be addressed is the state's inability to assemble the data collected in the Medicaid program into something truly useful to health care providers, patients, and lawmakers. In many ways, we are all somewhat flying blind when it comes to knowing what works best as far as improving health outcomes for our dollars.


It is critical that we integrate better information technology into all of our Medical programs, to include Medicaid. I have already filed legislation to try to spur this along and will explore it more fully in my Medicaid bill.


Another area where large amounts of money go towards an expenditure that everyone agrees is bad policy is inappropriate emergency room use. It costs us all a fortune, runs emergency room staffs ragged, and is not the best way to treat the patient that doesn't need it.


The Legislative Budget Board estimates that curbing unnecessary emergency room use could save $164 million in our next biennial budget. I have several strategies for improving the situation that will be in my legislation.


I want to see Texas try an innovative program called Doctor on Call that lets Medicaid patients call a hotline anytime to speak to a physician about their symptoms. The doctor walks them through how to evaluate their problem and make an informed decision on whether they need to go to an emergency room. A recent pilot program in South Carolina saw a 13 to 14 percent reduction in emergency room visits.


Another idea I want to try is offering an "after-hours bonus" to doctors and clinics that stay open late to provide a more cost-effective alternative to the emergency room.


I also see promise in targeting those who go to an emergency room more than three times within six months with information on how to find a primary care physician. The private sector has already tried this strategy for emergency room "frequent flyers" and the results have been worthwhile. One Texas hospital saw a 40 percent reduction in emergency room visits from those they assisted with the information.


Of course, while the state will do a number of incremental reforms under the current set of federal rules for Medicaid, our opportunity for truly major reform will be through the flexibility to create a program that works best for our state. We need to remain focused on continually seeking this freedom from the federal government. When it comes to health care, one size really doesn't fit all.