The Story of Texas House Bill 1676:
Insurance Coverage for Cognitive Rehabilitation
Carrie Morris
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Carrie Morris served for over 20 years in a variety of corporations as a technical writer/editor before retiring to work full-time in brain injury advocacy. For the past four years, she has served as Chair of the Texas Traumatic Brain Injury Advisory Council. Prior to that, she served for 14 months as a board member for the Brain Injury Association of Texas. In this capacity, she served on the Special Projects Committee and as Chair of Chapter Relations.

Carrie also operated BRAIN NET, the communication vehicle of the North Texas Brain Injury Resource And Information Network, Inc. (BRAIN), an acquired brain injury advocacy alliance based in the Dallas/Ft. Worth area. BRAIN NET is a very effective method for electronic dissemination of information useful to and affecting the lives of individuals with acquired brain injury and their families, professionals working with the community with brain injury and the general public.

Carrie and her husband, Don, live in North Richland Hills, Texas. They have three children, one of whom has traumatic brain injury as the result of a car crash. Carrie recently wrote a book about their son’s recovery from his catastrophic injury entitled, Detour, which will be published on the web next year.

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Exerpts from a letter dated February 12, 2001 in support of Article 21.530 by Fulbright,
O'Krent, Fulbright, Lurie, Smernoff, Thompson, & Nelson

At present, Texans who have suffered traumatic brain injuries receive very
inconsistent treatment for these injuries due to the fact that insurance carriers have no legal requirements to provide their insureds treatment for traumatic brain injury and acquired other brain impairment (due to brain illnesses). Although many policies cover rehabilitative services for traumatic brain injury, there is extreme variability from carrier to carrier as to which services are covered and how much therapy is allowed under their plans. Also, the degree to which services are considered medically necessary is highly variable from one insurance carrier to another. ...When insurance carriers pass the costs
of rehabilitative services to State agencies (via to the Texas Rehabilitation Commission) while maximizing profits, not only does the State suffer, but the individual insureds and their employers who pay health insurance premiums pay an undue cost while the insurance carriers reap profit from their neglect of this issue.

“Never doubt that a small group of thoughtful, committed citizens
can change the world. Indeed, it is the only thing that ever has.”

This profound statement by Margaret Mead was challenged, and proven, in 2001 by advocates for individuals with brain injury. During the 77th Texas legislative session, House Bill 1676 was introduced. Upon examination, the significance of this landmark legislation is obvious. Specifically, Section 2 of the bill prohibits exclusion of insurance
coverage for the following:

• Cognitive rehabilitation therapy

• Cognitive communication therapy

• Neurocognitive therapy and rehabilitation

• Neurobehavioral, neurophysiological, neuropsychological, and psychophysiological testing or treatment

• Neurofeedback therapy

• Remediation

• Post-acute transition services

• Community reintegration services necessary as a result of and related to an acquired brain injury

In addition, Section 3, states:

The commissioner by rule shall require the issuer of a health benefit plan to provide adequate training to personnel responsible for preauthorization of coverage or utilization review under the plan to prevent wrongful denial of coverage required under this article and to avoid confusion of medical benefits with mental health benefits.

House Bill 1676 was authored by Representative Lon Burnam (Fort Worth, Texas), co-authored by Representative Harryette Ehrhardt (Dallas, Texas), and sponsored by Senator Leticia Van de Putte (San Antonio, Texas). Texas Governor Rick Perry signed it on June 14, 2001, with an effective date of September 1, 2001.

While the statements above relate the relatively dry story of this bill, they don’t tell all of the story–the little bits and pieces of how it came about. I have been asked to share that story, from my perspective.The story of House Bill 1676, the “Brain Injury Insurance Bill,” begins very quietly in the late fall of 2000. Two events occur almost simultaneously by two small groups of advocates–neither aware of what the
other is doing.

In Dallas, the Brain Injury Collaborative of Greater Dallas concludes a meeting. One member casually asks another, “If there were just one thing you could change for survivors of brain injury, what would it be?” After several minutes of consideration, the mother of a son with brain injury answers, “Insurance!” There follows a discussion of insurance, what it doesn’t cover, and how desperately survivors of brain injury need specific coverage that is almost universally denied. Someone then asks, “How can this ever be changed?” The answer: “With a law.” Followed by another question: “How do you get such a law passed?” Response: “You have to know a legislator.” One member then speaks up: “My sister is a legislator.” General laughter – “Oh, sure.” “Right.” “Of course!” “No, she really is and she’ll help us. She’ll tell us how to do this.” “Well, get back to us and we’ll move on this.” Thus, the concept of House Bill 1676 is born.

Meanwhile, 25 miles away on the fringes of the Metroplex, Frances Lou Newman and I are spending hours a day on the telephone, planning the infrastructure of a new brain injury advocacy alliance specifically for the Dallas/Fort Worth Metroplex. We conceptualize an alliance of people with brain injuries, family members and professionals to address practical issues of everyday challenges faced by people with acquired brain injuries and their caregivers. The seeds for the creation of the Brain Injury Resource And Information Network (BRAIN) are being planted.

The two groups maintain separate paths for months, each vaguely aware of the other, but intent on a purpose. Several members of the Collaborative write a draft of a bill prohibiting exclusion of cognitive rehabilitation benefits for survivors of brain injury.
In January 2001, when the 77th legislative session opens, Representative Lon Burnam agrees to author the bill. His staff rewrites the bill to meet insurance standards and
files it in mid-February. Representative Harryette Ehrhardt co-authors the bill.

When the bill is filed, the BRAIN organizers decide to create a brain injury alliance and work toward what we perceive to be the greater good of all Texans with brain injury: insurance coverage for cognitive rehabilitation services. We begin working with other groups and individuals on the bill to revolutionize services for individuals with brain injury in Texas–services desperately needed by hundreds of thousands of people.

HINTS FOR SUCCESSFUL LOBBYING EFFORTS FOR BRAIN INJURY LEGISLATION

After HB 1676 was passed, this information was compiled by Ralphana Barnes and shared with others who wrote seeking help in writing successful legislation for their own state.

We were fortunate to have successfully passed legislation in Texas, which prohibits insurance companies from excluding coverage for cognitive therapy as a medical necessity for brain injury survivors and requires training in the understanding of brain injury for pre-certification personnel who are responsible for approval of insurance claims within our state.

In the hope that our experience might assist other states in legislation benefiting brain injury survivors, we have written a few suggestions learned. Hopefully these suggestions will be helpful whether the choice is to promote legislation that involves insurance reform, better prevention laws (bike helmets, etc.) state funding (i.e., for rehab centers), or education (both public and private schools).

• Meet with several groups within your state to define the single most important issue you’d like to address within the legislature.
- Make your appeal as simple as possible.
- Clearly document your reasons for the request.
- Keep your aim as broad as possible (i.e., don’t ask for legislation for TBI if you really mean acquired brain injury).
- Specify that you are not requesting coverage for everything so you won’t scare the opposition too much.
- Find a representative and/or senator to file your bill.

• If yours is a bicameral body consider joint filing in both houses simultaneously.

• Locate a representative or senator who is a member of the committee to which your bill will be referred (in Texas, the House of Representatives refers all bills dealing with insurance reform to the Insurance Committee).

• Especially seek the support of someone from the more conservative, far right members of your legislative body. You will likely have the support of your progressive members.

• Find members of your legislative body who have a personal interest in brain injury and contact them for their early involvement. These folks will make the difference between “foot dragging” and fast movement in various committees as your bill travels through the many steps along the way to the governor’s office for signing into law.

- Seek those that have carried similar legislation.
- Request their lobbying support.
- Ask their advice about other legislators and committee chairs.

• Get a respected group of people who will be able to make calls to legislators and who might be willing to go to the Capitol to testify. With a little determination, you’ll locate these important people who ALSO have a personal connection with brain injury or whose institutions are very interested in this legislation (i.e., the Chancellor of your Medical School). Seek people whose name (and money) will have clout with the elected official, for example:

- Chairs of hospital boards
- Directors of the Boards of Governors of area medical schools
- Members of various associations, i.e., American Psychological Association, CEOs of rehabilitation centers, AMA officials
- Recognized state physicians
- Well known names in research, education, politics

• Most importantly, locate a coalition of caregivers and associations of several types of brain injury groups and create an effective means of frequent electronic communication with them. These individuals were the fast acting e-mail voice of the grass roots effort that created success within the passage of our bill in Texas. Examples include:

- Your state and local brain injury associations
- Support groups such as TBI, cerebral palsy, shaken baby, brain abscess, stroke, brain tumor, multiple sclerosis, hypoxia, meningitis, etc.

• Take advantage of media coverage in several areas of your state.
- Find local human-interest stories in the home-towns of the legislators.
- Involve your most articulate caregivers and survivors.

• Court the staffs of key legislators.
- Maintain close relationship with the assistants of the persons sponsoring your bill.
- Stay ever vigilant in your contact with them.

Legislators, even those with different ideologies, have a special relationship with one another. If some of your spokespersons are legislative colleagues whose daughter or grandson is a brain injury survivor or whose mother or husband is a success story, their
personal testimony is tremendously helpful. Their treating team of doctors and therapists will make excellent lobbyists because the legislator will make certain their story is heard.

Our bill passed because of the recent brain injury experience of representatives and senators – both liberal and conservative – who testified of their successful cognitive treatment provided without the insurance coverage. These members represented the full political spectrum of our state government. Their personal involvement was the key to preventing stalled or bottlenecked legislation.

We wish each state the best of luck in efforts to support the needs of the brain injury survivors and their caregivers throughout our nation. Share with us your success stories, please.

In addition to the Collaborative and BRAIN, other individuals and interested parties become involved. We quickly merge into a very small, loosely organized group of zealous advocates. We learn that the chances of getting our bill passed are slim to none, with strong emphasis on none. In Texas, the legislature meets every two years, for approximately five months. Bills usually take at least three sessions to pass. So we are looking at six years of hard work. We are not organized. We are not a Political Action Committee. We have never held a meeting. We don’t even have a name for our group. Most of us have never actually met each other. We meet by e-mail, then by telephone. We have no funding–not one penny. The non-professionals of the group are all individuals with brain injury or family members of individuals with brain injury. It is common knowledge that by the end of the second year following a brain injury, a family is usually financially devastated. So, there is no hope of finding any funding unless an outside source can be identified and there is no time to identify such a source. What can a small group of exhausted, broke advocates do? Remember Margaret Mead, that’s what! “Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has.”

In our zeal to create a grassroots movement, we contact everyone we know who is actively involved in brain injury advocacy. After a flurry of e-mails and phone calls, we realize that our effort, as sincere as it is, has succeeded only in stirring up the same handful of persons already involved. This is going to be very difficult . . . but not impossible. We remain neither organized nor disorganized. We just keep on moving forward. Communication among the advocates is the key. Ralphana Barnes (Rep. Harryette Ehrhardt’s sister and a member of the Collaborative) works closely with Les Breeding, Chief of Staff for Representative Burnam. She passes his directives to everyone else and each of us communicates on an individual basis with our own list of advocates. Lou and I decide it’s time to think electronically. Any other method is too difficult and time consuming. E-mail costs nothing and has a very long reach. At this time, I am a board member of the Brain Injury Association of Texas and serve as Chair of Chapter Relations. I maintain close contact with facilitators of about a dozen support groups across Texas. I have also recently been elected Chair of the Texas Traumatic Brain Injury Advisory Council. In these positions, I communicate with about 150 advocates by email and meet more with each meeting I attend. So Lou and I decide to combine our e-mail lists and utilize the combined list on behalf of this bill. We send an initial e-mail concerning House Bill 1676 to the combined list of advocates. We receive an overwhelming positive response and requests to be added to the list pour in. The list almost doubles overnight. Is this how to create a grassroots movement? Time will tell. I never dream that this movement will assume a life of its own and consume mine for months to come.

In the Texas legislature, a bill must be read three times. House Bill 1676 is read the first time on February 14, 2001, and the historical journey begins. The bill is referred to the Insurance Committee. No one in the 1676 group knows anything whatsoever about legislative activity. We don’t know the torturous route by which bills travel through the legislature. We don’t know about committees, or calendars, or amendments, or fiscal notes, or engrossment, but we know about public hearings and testimony. So, we prepare for what we know. We prepare to testify.

The first public hearing, before the Insurance Committee, is on March 26, 2001. Six or eight individuals have prepared testimony. Our testimonies are coordinated. Parents, spouses, and medical professionals-each is testifying on a different topic concerning brain injury, so there will be no repetition. A “Faces of Brain Injury” book has been prepared. It has 22 color photographs of individuals with brain injury; from a tiny baby girl holding her mother’s finger (who looks asleep but who is in a coma due to trauma at birth), to young children who have survived Shaken Baby Syndrome, to in-utero drug exposure and brain trauma, to teenagers injured during sports and accidents or illnesses, to adults who survived medical conditions or assault. The photographs tell their own story; a strong story that tears at the heart. The book also contains the National Institutes of Health (NIH) Consensus Statement on Rehabilitation of Persons with Traumatic Brain Injury. Strong opposition is expected from the insurance industry.

We have sent information about the hearing via e-mail to all advocates, with a plea that they attend to support those who are testifying. It is, however, very difficult for individuals with brain injury and their family members to attend meetings, so no one expects a good attendance. The 1676 group travels to Austin for the hearing. We wait all day. The tension builds but…so does the attendance. By the time testimony on 1676 is called early in the evening, the attendance is so great the group is moved to another room. Even then, there is not enough room for everyone in the larger room, and folks spill out into the hall. Everyone wants to testify. Some of the 1676 group who have prepared testimony relinquish his/her right to testify so that those who have arrived unexpectedly may testify, instead. The testimony goes on for hours. There is such excitement and so many people attending that the governor sends an aide to inquire what is going on. The aide reports that the brain injury bill is creating a lot of excitement. There is strong grassroots support. Twenty-four people testify in support of the bill. One person, representing the Texas Association of Life and Health Insurers, testifies against the bill. Everyone returns home empowered. For many, this is our first experience with legislative activity. We now believe we can do this.

Testimony before the committee results in the bill being sent to the Calendar Committee. Another lesson is now learned in legislative activity: 90% of pending bills die in Calendars. Now, more than ever, is when grassroots support is absolutely necessary. But we can do this. Our e-mail list is growing daily. Many organizations are contacting us, advising us that they are forwarding our Legislative Alerts to their entire membership. We are receiving e-mails from surrounding states, supporting our position. We receive
e-mails from Texans living out of state. They want to participate also. We become more organized. We develop a template for our Legislative Alerts. They are organized
in a format that provides an update of the current situation, what specific action is needed, the names of committee members and the contact information for each member (district number, capitol and district phone numbers, fax number, e-mail address), and a sample phone message. Background information about the bill is provided at the end of the Alert for those receiving it for the first time. If we want readers to contact their own legislator(s), we provide the Texas capitol URL for their information. We ensure they feel part of this enterprise. This is a grassroots effort and each of us is an important component of it.

We broadcast a Legislative Alert advising readers to contact members of the Calendar Committee urging them to schedule the bill to be heard on the House floor. Readers are urged to contact each member of the Committee and to ask friends, family and co-workers to do the same. Will our bill become part of the 90% death toll? Not due to lack of effort on our part! I receive more requests to be added to the e-mail list. Two days later-two days!-the bill is placed on the General State Calendar. Let’s talk grassroots support! The 1676 group prepares for the second reading of the bill on April 26, 2001. This is a very important date and requires a lot of preparation. A Legislative Alert sets the stage. Advocates are asked to contact his/her representative on April 25th and 26th and urge him/her to vote for the bill.

Representatives Burnam and Ehrhardt plan the day very carefully. Approximately 20 advocates arrive in Austin by 8:00 a.m. We meet the representatives’ staff members for some quick training in how to influence representatives. We are given a supply
of colored flyers–one-page explanations of House Bill 1676–what it is, why it is needed, who will benefit. We are given a supply of self-adhesive badges in bright colors, printed with “I Support HB 1676.” We are stationed in parallel lines on either side of each entrance to the House and told to waylay anyone burdened with a huge briefcase. We are to introduce ourselves, trot along beside them, tell them about the bill, stuff the flyer into their already full hands, slap the badge on their shoulder, and urge them to vote for our bill. And we have to do all of this within a few feet because we cannot cross the threshold into the House. Then, we are to return to our place in the line and wait for the next representative to cross our path. I hide behind a column because I am uncomfortable doing something like this and just can’t seem to get started. Representative Ehrhardt discovers me and pushes me out in front of a man and hisses, “There’s one–do it!” So I do. The first one is very difficult–I stammer and stutter, but get the flyer in his hand and the badge on his shoulder. Soon, I am stalking anyone who vaguely resembles a representative and if he or she is not a legislator, I talk to them anyway. Soon, lots of people are milling around in the hall wearing badges. There are hundreds of people crammed into the hall, all talking at the top of their lungs, all trying to influence someone to do something. It is a madhouse; it is exhausting; it is exhilarating.

After the session starts, most of the 1676 group return to their respective careers, but Lou, Toni Wiley (a member of the Collaborative), and I decide to take advantage of being in the Capitol to distribute more flyers. So we take the remainder of the flyers and start walking. We distribute flyers for hours. We walk until we can’t walk any more. We finally stop to rest in Representative Burnam’s office. While we are there, a call comes from the floor of the House. The bill is being voted on. Two amendments have already been passed, but there is now a snag. A very powerful legislator is insisting on an amendment. He wants to discuss the terminology of the bill with a neuropsychologist. It just so happens that Lou knows the telephone number of the neuropsychologist who helped write the original draft of the bill and knows that he will be in his office at this particular hour, as he mentioned it to her this morning while we were waiting to distribute flyers and badges. The appropriate telephonic connections are made and the representative receives the information he wants. We breathe a little easier.

Moments later, another snag. Les Breeding relays the information that the same legislator doesn’t like the term “traumatic” and wants another term, less defining, less broad. We look at each other; then, one of us suggests, “How about ‘acquired’?” Les relays the term to the representative, who decides that it is acceptable. The bill will be amended to read “acquired brain injury” rather than “traumatic brain injury”. We hold our collective breath. We simply can’t believe it. Rather than narrowing the scope of the bill, as intended, the scope has just been broadened significantly. Surely, someone will realize this and this amendment will be canceled. This startling development, plus our aching feet, makes us decide to start home. For the next four hours, we maintain telephonic contact with Representative Burnam’s office, hoping that the bill will be passed before we get back to Ft. Worth. It passes unanimously, as amended, late that night,
but we don’t know it until the next day. What a victory! Cognitive rehabilitation benefits for acquired brain injury.

The barrage of Legislative Alerts keeps activity at a high level. The entire state of Texas seems to be pulsing with activity regarding the bill. My phone never stops ringing, an achievement, considering that I never seem to get off of e-mail. By the end of the second
reading, I am in almost constant contact with most of the other individuals and groups working on the bill. Many of them have shared their e-mail lists with me and many of the recipients of the Alerts have thanked us for eliminating some of the duplication.

The bill is read the third and final time on April 30, 2001. It passes. The bill has passed, unanimously, unopposed, through all committees and the House of Representatives and it passed with exclusion of coverage prohibited for acquired brain injury. By now, we are
a strong, grassroots movement, yet to encounter any significant opposition.Senator Leticia Van de Putte sponsors House Bill 1676. The next step is for the bill to be read on the floor of the Senate. However, the Senate works differently from the House. Bills are not read until two-thirds of the senators indicate they will vote in favor of the bill. We must have twenty-one votes to have our bill read. We send another Legislative Alert asking advocates to contact their senators and urge them to indicate they would vote in favor of HB 1676. It doesn’t take long. HB 1676 is read the first time in the Senate on May 2, 2001, and referred to the Business & Commerce Committee.

A Legislative Alert immediately announces that fact and provides the names and contact information of members of that Committee to advocates, but there is a critical time frame for this action. The bill is set to be reviewed by the Committee on May 8th. The final day the Committee will hear a bill is May 10th. Unless the bill is passed by the Committee on May 10th, it will all be over for this legislative session and it will be two years–two
long years–before we will have another opportunity to try again. The Alert requests that advocates contact Committee members and urge them to vote the bill out of Committee by May 10th. They are requested to contact their senator and ask him/her to contact Committee members with the same request. They are further urged to contact their representative and persuade him/her to contact members of the Committee. Lastly, they are encouraged to ask neighbors, friends, and co-workers to make contacts also. Two days-if ever we prove grassroots support, it has to be now! And prove it, we do!

The Business & Commerce Committee does not actually take testimony concerning the bill until 8:00 a.m. on May 10th, but we’re ready and we move quickly. Two professionals take the red-eye to Austin to testify for the bill. Five other individuals attend and register for the bill, but do not testify. This group includes a member of the Texas Medical Association and a member of the Association of American Physicians and Surgeons. We now expect to be absolutely stomped by the insurance lobbyists. But our opponent is a single individual who registers his opposition, but he does not testify.
He represents the Texas Association of Business and Chambers of Commerce.

Where are the insurance lobbyists? Earlier in the session, I’ve been told by a lobbyist representing another industry that the insurance lobbyists refer to us as “a couple of moms who are clueless about what they are doing and don’t have a cent–how much damage can they do?” So the insurance lobbyists haven’t been concerned. Perhaps they should have been, because the bill is voted out of Committee on May 11th and sent to the Local and Uncontested Calendar. This is yet another victory because the Local and Uncontested Calendar is voted on as a whole, not as individual bills. House Bill 1676 is read the second and third time as part of the Local and Uncontested Calendar and passes the Senate on May 22, 2001, the last day the Senate is in session. House Bill 1676 has passed, unanimously, unopposed. It is signed in the House and the Senate on May 24, 2001. WE DID IT!

A bill becomes law unless the governor vetoes it, but it gains strength if the
governor signs it. Governor Rick Perry signs House Bill 1676 on June 14, 2001.
The signing of the bill is a special occasion, with some of the advocates invited as witnesses.

A few weeks later, a group of advocates drive from the Dallas/Ft. Worth area to Austin. We take a home-cooked lunch to Representative Lon Burnam and his staff. We sit in his office and reminisce about the bill–the way things came about; the day the call came from the House floor, wanting another word to replace “traumatic” and we suggested “acquired;” the ups and downs of the hearings (mostly ups); the pressures of keeping the grassroots movement alive; the exhilaration of the session. We talk about the next session and what we might accomplish. Representative Burnam says, “I don’t know what ya’ll want to do in 2003, but whatever it is, I want to author that bill!”

How did we do it? Over the course of four months, many organizations, groups and individuals worked tirelessly to shepherd this landmark bill through the Texas legislature. It seemed to fall on my lot to send Legislative Alerts. Many people sent e-mails; I sent 22 Alerts, which were shared, and forwarded by most advocates to many, many others. One recipient, alone, told me he forwarded the Alerts to his e-mail list of 22,000. I’ve often wondered just how many people we eventually reached. During the April 25th and 26th push to get the bill through the critical second reading in the House, I was told by House operators that we closed down the switchboard on both days because we flooded them with calls. We had asked advocates to contact Governor Perry. When I called, one of his aides sounded so tired that I asked if they had received a lot of calls about HB 1676. He said, “Yes, Ma’am, we’ve never had anything like this before.” I admitted to being one of the motivators of the calls and asked if he thought the calls should be curtailed. He replied, “No, Ma’am. This is our job and the governor wants to hear from folks. We just weren’t prepared for this.” Perhaps when another bill about brain injury benefits reaches the governor’s desk, his staff will prepare for an onslaught of calls because I suspect there will be one.

The success belongs to all of the advocates who worked so long and so hard to make this landmark bill a victory for Texans with brain injury. The success does not belong to one individual, one group, or one organization. Each one of us who wrote an e-mail, made a phone call, sent a fax, or shared the vision with someone else owns a little piece of House Bill 1676. We can all feel pride in what we accomplished and we all know that we can do it again, and we will!

In addition to the legacy of House Bill 1676, we have several items to remind
us of the power of grassroots. Three 16” x 24” Texas flags were made and signed by advocates who participated in the grassroots movement. The signatures were collected during a “House Bill 1676 Back Slappin’ Party” at the 2001 Brain Injury Association of Texas conference. The flags were presented to Representatives Burnam and Ehrhardt and Senator Van de Putte in a gesture of appreciation for their hard work in supporting Texans with brain injury. During remarks following presentation of the flags, Representative Ehrhardt said, “This is not how you pass a bill–this is how you pass a miracle!”

In 2002, a quilt was constructed of small 4” squares of red, white, and blue, with an outline of the State of Texas in contrasting color. Hundreds of signatures were collected from all over the State of Texas–from support group members, from conference attendees, through e-mail, through word of mouth. Some people simply signed their name; some added the name of their city; some tried to tell their story on the little square. There was no rhyme or reason to the color or number of squares when people signed. They chose the color they preferred and signed as they wished. Yet, when the final squares were counted, there was exactly the same number of each color. What type of quilt could be made with three colors of equal number? A Texas flag, of course. So, a House Bill 1676 Texas flag quilt was designed, bearing witness to the power of grassroots support, witness to empowerment, witness to what a “small group of thoughtful, committed citizens” can accomplish.

We never did organize. We never held a meeting. We never chose a name for our organization because we never had an organization. We never collected a penny. I still haven’t met many of the people I talk with by phone or e-mail, but we all know each other well now and we are very much in contact. We were successful in getting HB 2019, establishing the Texas Traumatic Brain Injury Advisory Council, passed in the 2003 session and signed by the governor. Again, this success was against all odds, because the 2003 session was largely devoted to passage of HB 2292, which completely reorganized the vast Texas health and human services enterprise, abolishing approximately 1000 boards, councils, and committees. Now, we have plans for the next legislative session, beginning in January 2005. We’ve learned how strong grassroots are.

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