TMA’s Top Legislative Priorities: Improve Women's Health and Clarify Abortion Exceptions
By Jessica Ridge

Priority: Improve funding and supportive services that ensure healthy outcomes for women, mothers, and babies; and get clarity on exceptions to the state’s abortion laws so physicians can safely treat pregnant women in crisis while protecting the patient-physician relationship from criminalization. 

Background: The Texas Medical Association made big strides last session, securing a hard-won waiver extending Medicaid postpartum coverage to one year and expanding access to other women’s health care through the Healthy Texas Women (HTW) and Family Planning Program, for instance.  

But Texas still struggles to ensure timely access to women’s health care in the face of subpar maternal outcomes and the potential loss of a federal waiver that funds HTW. (See “Enhanced Medical Payments and Coverage,” page 17.) The Texas Maternal Mortality and Morbidity Review Committee’s 2024 report found 80% of pregnancy-related deaths were preventable, with disproportionately higher rates among Black, Hispanic, and non-White women.  

And physicians continue to struggle with application of the narrow medical exceptions under Texas’ trigger law and other abortion statutes, which physicians worry put them in legally precarious waters when the treatment of a pregnancy complication involves terminating the pregnancy. The trigger law banned most abortions in the state following the U.S. Supreme Court’s reversal of Roe v. Wade, although the statute and its related regulations allow for an exception to the ban if the mother faces a “life-threatening physical condition aggravated by, caused by, or arising from a pregnancy” and is at risk of death or “substantial impairment of a major bodily function” if the abortion is not performed. 

TMA advocacy last session helped ease some of the liability threat surrounding ectopic pregnancies and premature rupture of the membrane. And in June 2024, the Texas Medical Board followed up with new rules.  

In a November 2024 press release, TMB President Sherif Zaafran, MD, said its rules “provide that when addressing a condition that is or may become emergent in nature, a physician is not required to wait to provide medical care until that mother’s life is in immediate danger or her major bodily function is at immediate risk. This clarification is consistent with the leading opinion of the Texas Supreme Court on this matter.” 

That same press release highlighted Texas Health and Human Services data from August 2022 to June 2024 showing 119 documented instances of care provided under the state’s abortion exceptions, “and to date, no physician has had disciplinary action taken against them by the Texas Medical Board for their medical intervention in these cases,” Dr. Zaafran said. 

Denton gynecologist Joseph Valenti, MD, called the progress Texas made to expand women’s health care “a wonderful step forward and long overdue and badly needed.” 

But the chair of TMA’s Board of Trustees questions whether such initiatives go far enough, especially for patients in the 46.5% of Texas counties lacking an obstetrician, according to March of Dimes.  

And despite TMB’s guidance on abortion, without statutory changes from the legislature itself, Dr. Valenti anticipates further fraying of access to such care because of what he describes as competing and conflicting provisions under Texas’ labyrinth of abortion statutes. 

Reiterating TMA testimony during TMB’s rulemaking process, Dr. Valenti says physicians like him still struggle to understand when they can provide medically necessary abortion-related care in compliance with Texas’ overlapping and complicated laws. TMA also remains concerned that the effect of TMB’s rules remains unclear in a criminal or civil liability context.  

“Physicians find themselves in an untenable situation,” Dr. Valenti said. If on the one hand, they are unable to appropriately treat a pregnant woman with complications for fear of liability, “you may be committing medical malpractice,” he said. On the other hand, if physicians do proceed with treatment, “you may be committing [acts subjecting you to potential] civil and criminal [liability].”  

Those fears were revealed in a Manatt October 2024 assessment of the impact of abortion restrictions on the Texas physician workforce and its pipeline, says Deborah Fuller, MD, secretary of the TMA Women Physicians Section and president of the Dallas County Medical Society. The obstetrician-gynecologist cited the responses of the 447 Texas OB-gyns and 47 resident physicians surveyed, which showed: 

• 76% believe they cannot practice medicine according to best practices; 

• 60% fear legal repercussions from practicing according  

to evidence-based medicine; 

• 44% indicated they’ve thought about or have already changed how or where they practice as a direct result of the state’s abortion restrictions; and 

• 29% do not feel they have a clear understanding of Texas’ abortion laws. 

Solutions: In response, TMA this session will continue to seek legislative improvements to Texas’ life-of-the-mother exemptions, for which there is bipartisan interest, says TMA Chief Lobbyist Clayton Stewart.  

“This is about allowing physicians in these very difficult situations to use their medical judgment to provide medically necessary care,” he said. “TMA still believes a legislative solution is needed.” 

Some of the legislative remedies to help physicians and patients navigate such challenging terrain may include, for instance, strengthening and clarifying the life-of-the-mother exemptions; removing private citizens’ civil litigation incentive; and eliciting exceptions for fatal fetal abnormalities. 

And to promote women and babies receiving the care they need during and beyond pregnancy, TMA plans to pursue funding and support for: 

• Texas’ multidisciplinary programs that work to improve maternal outcomes and disparities, including the Maternal Mortality and Morbidity Review Committee, Texas Alliance for Innovation on Maternal Health, and Texas Collaborative for Healthy Mothers and Babies.  

• Mobile women’s health units and congenital syphilis prevention (See “Enhancing Awareness,” page 30.). 

• Behavioral health care for mothers and children, including perinatal and maternal depression  

screening via PeriPAN, and social media protections via health technology use. 

“We have taken an oath,” Dr. Fuller said. “We have to support our patients.”