Rural access-to-care shortages. Health care market consolidation. Artificial intelligence (AI) in medicine.
Amid these and other concerns on physicians’ and lawmakers’ minds, the Texas Medical Association is entering the 2025 legislative session not only with the lofty goals of ensuring patients have access to care and physician practices can stay viable and autonomous in providing it – but with concrete solutions to make that happen.
Those goals undergird TMA’s top 10 priorities for the upcoming session starting on Jan. 14. (See “TMA’s Top 10 Legislative Priorities,” page 16).
Coming off of a busy interim session, medicine already has made headway in bending lawmakers’ ears to its message, having testified on everything from scope of practice and insurance to public health funding and AI. To further amplify its multi-faceted advocacy, TMA also will be collaborating with organizations like the Texas Public Health Coalition and the new Texas Coalition for Patients on public health and insurance issues.
“My ultimate goal for this session is to educate our legislators to make sure that all Texans have physician-led health care,” TMA President G. Ray Callas, MD, said. “Every Texan deserves to have access to health care. We know for a fact that if we can create a system that allows for access to physician leadership and oversight, we can make Texans healthier.”
As it did for the first time in 2023, TMA’s Council on Legislation once again culled its legislative priorities from the many issues the association tracks each session with input from its councils and committees, explains council chair Zeke Silva, MD. That list does not mean TMA won’t have its radar up for other items likely to impact medicine.
But TMA leaders say it does allow TMA to focus its efforts during what is likely to be a lively session marked by a house speaker race that, as of this writing, had yet to be decided, and numerous new faces following a successful election for medicine-endorsed candidates. Among other friends of medicine, the Texas Legislature collectively still has five physicians in the House and Senate.
But Dr. Silva says TMA’s biggest partner this session will be physicians themselves.
“When you’re an association like TMA, and you represent a profession with the kind of credibility that medicine has, with the level of accountability and responsibility that we have to patients, it really creates for us the opportunity to discuss with lawmakers from a position of strength,” the San Antonio radiologist said.
“As complex as this system is, and as complex as the lawmaking and the regulatory processes are, at the most foundational level, we’re physicians, and the patient trusts that position. TMA will always be the voice for that relationship and the voice for that position, and that is always going to be our differentiator,” Dr. Silva emphasized.
Last session, TMA monitored more than 2,000 bills related to health care out of the approximate 12,000 filed. TMA leaders anticipate legislators could file even more bills in the upcoming session.
“We’re going to have a larger freshman class coming into the House, so there’s probably a lot of eagerness to file a lot of legislation for constituents,” said Clayton Stewart, TMA vice president of legislative affairs.
Republicans incrementally grew their majority in both chambers via November’s elections. The Texas House of Representatives now holds 88 Republicans and 62 Democrats, while the Texas Senate comprises 20 Republicans and 11 Democrats.
On the one hand, changes in the legislature’s makeup plus an undetermined speaker race could mean committee shakeups where TMA has had longstanding allies, Mr. Stewart said. On the other hand, some of those shifts may bode well for TMA’s aims to “keep medicine competitive,” he added – in bolstering practice viability and reducing insurance burdens, for instance – as lawmakers themselves look for ways to reduce health care costs while making care more accessible.
Dr. Callas is also optimistic Texas’ economic strength could open the door for historically challenging items like much-needed Medicaid funding to help physicians care for patients in a state with the highest amount of uninsured residents in the nation at 4.3 million.
As of this writing, the comptroller had projected yet a $21 billion surplus in Texas’ coffers for the 2026-27 cycle.
Although medicine will be competing with other interests, including those declared by state leadership – such as the Medicaid shortfall, property tax relief, schools, and the border – “it’s a lot easier ask to try to make Texans healthier if we have a budgetary surplus,” Dr. Callas said.
He also praised the Texas Legislature’s ongoing investments in public health and graduate medical education (GME) in recent sessions, which TMA will build upon, the latter of which has enabled the state to meet and begin to exceed its target ratio of 1.1 GME slots for every medical school graduate.
“Where we’re finally getting traction is, the legislature understands that if we can fund and put physicians in rural communities and create rural health physician leadership, we’re going to make Texas healthier,” he said.
As evidenced by a two-day hearing during the interim, access to care is also top of mind for lawmakers, and with nonphysicians upping their arguments for scope expansions, TMA is primed for scope creep to again emerge as medicine’s primary legislative priority.
Mr. Stewart says lawmakers have been open to TMA’s solutions to protect patients from harmful and costly scope expansions and to bolster existing policies that continue to attract physicians to Texas in record numbers.
“There is interest in everything we’re doing to build the pipeline.”
That pipeline is robust as is Texas’ nation-leading population growth. The Texas Medical Board issued 7,610 medical licenses in 2024, up 550 or 7.8% from 2023, setting yet another record. And according to a TMA analysis of U.S. Health Resources and Services Administration data, adding just 80 primary care physicians to the workforce in the right places could remove all health professional shortage area designations.
Especially at a time when physician practices are challenged by consolidation and vertical integration in health care, among other intrusive forces, TMA also will be on guard against bills that could infringe on practice viability, physicians’ medical decision-making, and patient care.
According to the Physicians Advocacy Institute, 73% of Texas physicians are now employed, whether by hospitals or other types of corporate entities that physicians worry may not have patients’ best interests at heart.
Meanwhile, the complex interaction between the 2022 U.S. Supreme Court ruling in Dobbs v. Jackson Women’s Health Organization and Texas’ overlapping abortion laws and regulations continues to generate fear and confusion among physicians treating patients with pregnancy complications.
Regarding Texas’ life-of-the-mother exception, “there’s got to be some sort of clarification,” said J. Timothy Parker, MD, a Denison obstetrician-gynecologist and vice chair of TMA’s Council on Legislation. “You can’t have a blanket statement and expect to cover every [medical] situation.”
Thanks to the significant victories medicine scored in the 2024 election, however, “we will have a lot of open doors and people to talk to,” Mr. Stewart said.
TEXPAC, TMA’s bipartisan political arm, endorsed 140 candidates running in the general election for U.S. Congress, the Texas House, and Texas Senate – and 139 of them won.
That leaves Texas with five physician legislators: Rep. Greg Bonnen, MD; Rep. Suleman Lalani, MD; Rep. Tom Oliverson, MD; Sen. Donna Campbell, MD; and Sen. Charles Schwertner, MD.
Dr. Silva says the legislative session always provides an opportunity to build new relationships and showcase TMA’s expertise on myriad topics, whether through testimony or in-person lawmaker visits. For example, through testimony delivered to Texas House and Senate committees in the months-long lead up to the session, TMA was able to bring medicine’s perspective to typically business-related topics like noncompete agreements and AI.
With the latter, for instance, “lawmakers are really focused on not just what those opportunities are for innovation, but they’re very focused, for the right reasons, on what the risks are to those technologies,” he said. “And it’s not just health care. It’s across all industries. It’s television and film, it’s law, it’s insurance, and it’s vehicle safety.”
TEXPAC Director Brianna Menard says medicine’s work of educating lawmakers, new and established, gets underway even before voters cast their ballots.
“Candidates often reach out to us to gain a deeper understanding of the health care priorities affecting Texans,” she said. “In our meetings, we discuss the unique health care challenges we’re working to address and are available to answer questions about the policy issues impacting Texas physicians and patients.”
Ms. Menard sees the arrival of 32 first-term legislators as a “huge opportunity” for TMA.
“We just continue to build relationships,” she said. “Those are folks who maybe aren’t super familiar with medicine yet, or don’t have that direct experience with us, and that’s why we love working with freshmen and trying to give them our perspective.”
TMA encourages its member physicians to get involved in advocacy efforts, and provides different avenues for participating, for those who can invest as little as a few minutes or as much as a few days. (See “Six Ways to Get Involved in TMA Advocacy,” page 14.)
First Tuesdays at the Capitol – launched in 2003 and spearheaded by the TMA Alliance, TMA’s massive volunteer force of physicians and their spouses – provides an opportunity for physicians to come to Austin on the first Tuesday of each month the legislature is in session, circulate with other physicians to meet with legislators and their staff members, and make their voices heard. (See “2025 First Tuesdays at the Capitol: The Family of Medicine Needs You,” page 26.)
“Sometimes physicians aren’t aware that they can advocate for medicine,” said Jenny Shepherd, TMA Alliance president. “They aren’t aware that they need to advocate for medicine and tell their stories. Statistics might get the issue noticed, but it’s the stories that will get the vote.”
Mr. Stewart adds First Tuesdays is often where physicians get their start in TMA advocacy and then bridge to participation in TMA councils and committees.
Dr. Parker has been involved in the so-called “white coat invasion” – which attracts as many as 300 physicians and medical students at a time – since its inception and is encouraged by a trend he’s seen in recent years: younger physicians and medical students getting involved and learning more about TMA’s advocacy in the process.
Recalling how he’s evolved from his first attempts at interacting with legislators, Dr. Parker asserts the work TMA Alliance does coordinating First Tuesdays enables physicians to more confidently talk to their representatives and senators.
“You don’t have to be bashful,” he advises physicians. “If you feel strongly enough about a certain issue, please come down to Austin and testify, because that’s important.”