Dr. Feyi Obamehinti: Inside the Texas Diabetes Council: What Worked, What Didn’t, and What Should Change

Estimated Time to Read: 7 minutes

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Editor’s Note: The following guest commentary reflects the views and opinions of the author alone and does not necessarily represent the official views of Texas Policy Research, its staff, board, or affiliated organizations. Guest submissions are lightly edited for grammar, formatting, clarity, and length while preserving the author’s voice and arguments.

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Most Texans have no idea how the state’s advisory councils actually work. They appear in news stories occasionally, get referenced in legislative debates, and are mentioned in agency announcements — but the day-to-day work of these entities, the impact they have on legislation that becomes law, and the structural limits on what they can do are mostly invisible to the public they serve.

I served for five years on the Texas Diabetes Council, including two as its Chair. From that vantage point, I want to share three things: what made the Council effective, where it could improve, and one specific policy change that would help advisory councils across Texas do more for the Texans they’re meant to serve.

First, the scale of the problem the Council exists to address. The American Diabetes Association reports that more than 40 million Americans live with diabetes, and the Centers for Disease Control and Prevention estimates that approximately 2,972,000 Texas adults — roughly 12 percent of the adult population — have been diagnosed. The serious consequences of the disease include heart disease, stroke, amputation, end-stage kidney disease, blindness, and death. Not all 50 states have organized statewide advocacy to address this epidemic. Texas does — through a council that works closely with the Legislature and state agencies on diabetes education and treatment.

What Worked

The most tangible measure of the Council’s effectiveness is its legislative record. During my tenure, the Council supported a series of bills that became law — bills that have directly improved how Texans with diabetes access care and manage their conditions:

• Senate Bill 827: Capped insulin copays at $25 per prescription for a 30-day supply.
• House Bill 18: Established a prescription drug savings program for Texans without health benefit plan coverage.
• HB 4: Expanded the use of telehealth services for Texas patients, including for chronic disease management.
• HB 133: Extended postpartum Medicaid coverage for new mothers from two months to six months, a meaningful change for women managing gestational and Type 2 diabetes after pregnancy.
• HB 1935: Authorized pharmacists to dispense a 30-day emergency supply of insulin when specific criteria are met, preventing dangerous lapses for patients who cannot immediately reach a prescriber.
• HB 2509: Expanded graduate medical education for podiatric medicine in Texas, addressing a workforce gap that disproportionately affects diabetic patients who need specialized foot care.
• HB 3459: Streamlined prior authorization requirements and removed administrative barriers between patients and the care their physicians have prescribed.

All legislation listed above was considered in the 87th Legislative Session (2021)

The Council didn’t draft these bills, and we didn’t pass them. Legislators did. But the Council provided technical input, lent the credibility of medical and patient expertise to public testimony, and helped ensure that what made it into law actually addressed the real problems Texans with diabetes face.

Three structural factors made this kind of impact possible. First, members of the Council are appointed by the Governor and bring genuine subject-matter expertise — physicians, diabetes educators, patient advocates, and public health professionals all working from a shared mission. Second, the Council’s structure allowed both advocacy organizations and clinical professionals to engage with members through workgroup discussions before formal council meetings, which meant the conversations that shaped Council positions were substantive long before they became official. Third, the Council operates under the support and oversight of the Texas Department of State Health Services (DSHS), which handles logistics — meeting space, expense processing, regulatory compliance — that would otherwise consume volunteer members’ limited time.

One particular achievement during my tenure deserves more attention than it has received. The Council collaborated with the Texas Education Agency on a comprehensive revision of the K-12 health education curriculum standards — the first substantive revision since 1998. The updated standards, which took effect across Texas public schools in the 2022-2023 school year, brought health education into alignment with current medical understanding of chronic disease prevention, including the metabolic and lifestyle factors that drive Type 2 diabetes. Most Texans have no idea this work happened or that the Diabetes Council helped shape it.

What Didn’t Work

Despite the Council’s legislative effectiveness, one persistent weakness limited our reach: we could not consistently hear directly from the Texans we were meant to serve.

We made repeated efforts to conduct community listening sessions and focus groups with diabetic Texans across the state — to learn directly what care barriers, costs, and challenges they faced in their daily lives. A handful of patients and family members occasionally attended Council meetings in Austin to share their stories. But the number of Texans we reached through these means was minute compared to the millions of Texans living with diabetes. The structural reality was that our most affected constituents were largely absent from the deliberations meant to serve them.

The reason wasn’t lack of will. It was the way state advisory councils are structured. Chapter 660 of the Texas Government Code governs travel and operating expense reimbursement for state board and commission members, which in practical terms means that any official Council activity outside formally scheduled meetings requires DSHS coordination, approval, and resource allocation. The agency’s support of the Council is real and necessary — without it, organizing the routine business of a statewide advisory body would be impossible — but the same framework that makes Council operations possible also constrains members from independently organizing the kind of grassroots community engagement that would have given us a fuller picture of Texans’ real experiences with diabetes care.

What Should Change

The policy change I would recommend is targeted and specific: Texas should provide a framework allowing advisory council members, with appropriate guardrails, to conduct community listening sessions and focus groups within their constituent regions without requiring full agency coordination for each event. This would not displace agency oversight of formal Council business — it would supplement it, by allowing the people closest to Texans on the ground to bring constituent voices into the policy conversation directly.

The benefit would be a true two-way dialogue. Today, Council members carry information and recommendations to the Legislature and to state agencies. With this change, they could also carry the unfiltered concerns of Texans back into the Council’s deliberations and into the State Plan Priorities that reach the Legislature. The work of advisory councils would become more representative of the Texans they are meant to serve — and the legislation that results would be better for it.

The Texas Diabetes Council does important work. So do the dozens of other appointed advisory councils across state government, many of which face the same structural limitations. A targeted reform allowing meaningful constituent engagement would strengthen all of them — and would give Texans a more direct line into the policy decisions that affect their lives.

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