Family medicine tallies significant victories for patients and communities in the 89th Texas Legislature

The 89th Texas Legislature adjourned its regular session on June 2, 2025, and gaveled back in for a special session on July 21. In a regular session that was focused largely on items not related to health care, TAFP and its coalition partners were able to secure significant wins for patients and communities across the state.

A member of TAFP’s advocacy team, Helen Kent Davis has written an extensive overview of the session from the perspective of family medicine and public health entitled “The 89th Texas Legislature: A Summary from the Texas Academy of Family Physicians.” The document contains a bonus section on the predicted effects of Congress’s passage of H.R. 1, the so-called “One Big Beautiful Bill Act,” on the health care industry.

Here are some highlights from the session.

The budget

Unlike some recent legislative sessions, lawmakers convened in January with a sizeable budget surplus and a rosy fiscal forecast. They passed a $338 billion budget including state and federal funds for the next two years, $5 billion more than the current biennial budget. Some of that new funding will go to upgrade the state’s aging eligibility system for Medicaid, the Children’s Health Insurance Program, and the Supplemental Nutrition Assistance Program. About $160 million in new spending will go to support programs to improve rural health, including much-needed help for rural hospitals.

Women’s health program funding remained stable as lawmakers maintained spending levels for the Healthy Texas Women program, the Breast and Cervical Cancer Screening Program, and the Family Planning Program. As a steering committee member of the Texas Women’s Healthcare Coalition, TAFP fought for programs and initiatives designed to address Texas’ maternal mortality and morbidity crisis, and to increase access to maternity care.

Family medicine obstetrics fellowships

In what amounts to a major win for rural communities across the state, budget writers included $5 million to “support the development or expansion and administration of family medicine obstetrics postgraduate training grant programs and to support the salaries and benefits of the training physicians.” The Texas Higher Education Coordinating Board will administer the funds and establish rules to guide institutions in the creation and expansion of the fellowships.

After participating in the publication of the “2025 Rural Texas Maternal Health Rescue Plan” last fall, TAFP began calling for the creation of obstetrics fellowships for family doctors to increase access to maternity care in rural Texas. According to the March of Dimes, 47% of Texas counties are “maternity care deserts” — meaning they lack obstetrical services entirely — compared to 33% of counties nationally. The Robert Graham Center says family physicians deliver babies in more than 40% of U.S. counties, and they are the sole maternity care clinicians in 16% of maternity care deserts across the country.

TAFP believes family doctors can play an important role in increasing access to maternity care for rural Texans, but more training opportunities are needed. For family physician residents seeking additional maternity and women’s health care training, there are only five FMOB fellowships available in Texas and only 48 fellowships in the country. By establishing the new Family Medicine Obstetrics Postgraduate Training Grant Program, the Legislature has given family medicine the opportunity to help struggling communities.

Primary care and rural physician workforce funding

The Legislature opted to stay the course on a raft of programs designed to recruit and train primary care physicians and to encourage more to practice in rural and underserved communities. Funding for these five programs remained unchanged from the current biennium.

The Family Practice Residency Program

The FPRP is a strategy in the budget under the Texas Higher Education Coordinating Board designed to increase access to primary care by providing direct funding to family medicine residency programs. The program, which has suffered from inconsistent funding in past sessions, maintained funding at $16.5 million for the coming biennium.

The Physician Education Loan Repayment Program

The PELRP pays up to $180,000 of student loans for physicians who agree to practice in a Health Professional Shortage Area in Texas for four consecutive years. The program will receive $35.5 million for the biennium.

The Texas Primary Care Preceptorship Program

The TPCPP aims to increase student interest in primary care by placing first- and second-year medical students in primary care practices for two- to four-week rotations. Its funding will stay at $4.85 million for the biennium.

The Rural Resident Physician Grant Program

The RRPGP awards grants for the creation of new graduate medical education positions in rural and nonmetropolitan areas. The program was established in 2024 and will get $3 million for its second biennium.

The Joint Admission Medical Program

JAMP seeks to recruit economically disadvantaged undergraduate and high school students to pursue careers in medicine by offering scholarships, internships, mentorship, and other support. Its funding held steady at $11.7 million for the biennium.

Other key legislation

Expansion of value-based primary care

House Bill 2254, which reforms outdated insurance laws that block value-based care models in many employer-based health plans, made it through the session and is awaiting the governor’s signature. TAFP and a coalition of health plans, business and employer groups, and primary care organizations worked to bring this issue to the Legislature. H.B. 2254 allows employers and primary care physicians to enter value-based contracts with innovative payment models like advanced primary care and direct primary care that could improve patient outcomes and lower health care costs.

The Life of the Mother Act

Lawmakers in both houses passed Senate Bill 31, the so-called Life of the Mother Act, with broad majorities. The bill should provide pregnant women, physicians, and hospitals a common understanding of what constitutes a medically necessary exception to Texas’ abortion ban, allowing physicians to perform the procedure when needed to save a mother’s life or prevent serious medical harm.

Scope of practice

As expected, the house of medicine faced numerous attempts by nonphysician providers to expand their scope of practice. Once again, TAFP and other physician organizations succeeded in defeating the measures. This session’s biggest threat was S.B. 3055, which would have given advanced practice registered nurses, or APRNs, independent authority to diagnose and treat patients — which is by definition the practice of medicine — without collaborating with physicians.

In written testimony to the Senate State Affairs Committee, TAFP President Lindsay Botsford, MD, MBA, laid out the Academy’s concerns with the legislation. “Rather than another debate regarding physician versus nurse credentials, the Academy urges lawmakers to consider ways to strengthen the entire primary care network, including APRNs, by redoubling efforts to promote team-based care — the only model that can achieve our mutual goals to increase access, improve health outcomes, and constrain health care costs,” she concluded. The bill did not make it out of committee.

Stay tuned …

The current 30-day special session called by Gov. Abbott is focused on legislation in response to the recent floods in Central Texas, regulation of THC products, the redrawing of the state’s congressional districts, and a number of conservative-backed proposals that failed to pass during the regular session. Of interest to family physicians, lawmakers will likely consider legislation to restrict the manufacturing and distribution of abortion medications. TAFP will continue to advocate for family doctors, their practices, and their patients, and as always, keep an eye on your inbox for the latest news in TAFP News Now.

Your Academy extends a huge “thank you” to all members who participated this session, either by testifying, or writing and calling your representatives, or by serving as Physician of the Day. Your effort, your voices, and your membership led to TAFP’s successful advocacy.