Looking Ahead

The 90th Texas Legislature convenes in January 2027

As one of its founding principles, TSGE has long worked to raise awareness about the risk of colorectal cancer and emphasize the importance of colon health with lawmakers and members of the public.

One prominent outcome of these efforts is the Texas Colorectal Cancer Treatment Initiative, a state-funded program that provides dedicated funding to treat colorectal cancer for uninsured and underinsured Texans at up to 200% of the federal poverty level. With the general appropriations bill (SB 1) passed and on its way to Governor Abbott’s desk, I’m pleased to report that the Texas Society for Gastroenterology and Endoscopy was successful in securing an additional $10 million to fund the program through the 2026–2027 biennium.

We strongly advocated for this funding with members of the House Appropriations and Senate Finance Committees, and seeing it approved in both chambers’ budgets is a testament to the impact of persistent advocacy. This investment also supports gastroenterologists and oncology providers by giving them the resources to care for vulnerable populations.

This session, budget writers also directed the Health and Human Services Commission (HHSC) to evaluate the feasibility of using a Section 1115 Demonstration Waiver, or a similar federal funding option, to fund early screening and treatment for colorectal cancer among uninsured and underinsured Texans. Securing a dependable source of federal funding would be transformative for the Texas Colorectal Cancer Treatment Initiative, offering improved budget certainty in future cycles and maximizing the state’s investment through matching federal funds.

HHSC is required to present its recommendations and findings to the Legislative Budget Board and the Office of the Governor by September 1, 2026.

The state budget (SB 1) also significantly increased funding for Graduate Medical Education (GME) in Texas. The budget allocated a total of $304.4 million for GME expansion, including $282.4 million from General Revenue Funds — $71.3 million more than in the previous biennium — and $22.0 million from the Permanent Fund Supporting Graduate Medical Education.

These investments aim to maintain a 1.1-to-1 ratio of residency positions to medical school graduates in Texas, with the goal of retaining more of the state’s medical graduates to treat patients here at home. The Family Medicine Residency Program also received increased funding, raising per-resident support to $15,000 annually to enhance primary care training and encourage entry into family medicine, especially in underserved areas.

The “Make Texas Healthy Again” bill (SB 25), introduced by Sen. Lois Kolkhorst (R-Brenham) and Rep. Lacey Hull (R-Houston), represents a comprehensive effort to enhance public health through education, regulatory reform and institutional accountability. The bill addresses growing concerns about chronic diseases linked to poor nutrition and sedentary lifestyles through primary physical education, higher education curricula, food labeling, and the establishment of a state nutrition advisory body.

SB 25 requires students in pre-kindergarten through eighth grade to participate in at least 30 minutes of moderate to vigorous physical activity each day, reflecting the state’s dedication to addressing childhood obesity and related health problems, including a host of serious gastrointestinal disorders.

In higher education, SB 25 stipulates that all health-related institutions develop nutrition curricula based on guidelines from the newly established Texas Nutrition Advisory Committee. Texas medical students and allied health professionals will be required to complete this curriculum, ensuring future providers understand the role nutrition plays in disease prevention and management — and are better prepared to advise patients on dietary choices.

Perhaps most significantly, SB 25 introduces labeling requirements for food manufacturers to include a warning label on products containing artificial colors, additives or chemicals banned in other countries, increasing consumer awareness and reducing consumption of ultra-processed foods.

By promoting physical activity, enhancing nutrition education and increasing transparency in food labeling, SB 25 lays the foundation for a healthier population and a potential reduction in the prevalence of gastrointestinal diseases. For TSGE, these measures align with preventive healthcare goals and offer an opportunity to engage in broader public health initiatives aimed at improving digestive health outcomes across Texas.

In what became one of the most challenging fights of the legislative session, Rep. Drew Darby (R-San Angelo) filed HB 3794, a sweeping scope-of-practice expansion bill that would grant nurse practitioners, nurse anesthetists, nurse midwives and clinical nurse specialists full independent practice authority without the supervision or delegation of a licensed physician.

Under the provisions of the bill, APRNs would have full authority to evaluate patients, diagnose conditions, order tests, prescribe treatments including controlled substances, and serve as a patient’s primary care provider — all without physician involvement. The bill even redefines “nursing” to include medical diagnosis and prescribing, effectively authorizing APRNs to practice medicine without a license.

To state the obvious, HB 3794 represents a direct threat to the Texas physician-led care model and, more importantly, to patient safety. Gastroenterologists and other specialists recognize that complex medical conditions require a team approach, and while nurses and advanced practitioners are vital members of that team, physician oversight is critical for complex decision-making, diagnosing nuanced conditions and managing complications.

On April 14, HB 3794 was called before the House Committee on Public Health in a contentious hearing marked by hours of intense debate. TSGE joined a broad coalition of physician groups and medical societies in opposing the bill, asserting that patient access can be improved without compromising quality of care. The bill was initially left pending.

Two weeks later, Chairman Gary VanDeaver (R-Texarkana) announced the committee would vote on HB 3794 the following day. The physician lobby team scrambled ahead of the vote in a pitched battle with the nursing lobbyists, hoping to solidify opposition and prevent any votes from swaying. As we navigated the Capitol, counting and recounting votes, lobbyists on both sides seemed convinced the votes were in their favor.

At the appointed time, Chairman VanDeaver called the committee to order in a packed meeting room behind the House chamber. After addressing several dozen unrelated bills, they reached HB 3794 — and at the moment of truth, the chairman seemed to acknowledge that the bill lacked sufficient support, and chose to leave it pending rather than risk a vote he felt was sure to fail.

That same day, across the Capitol rotunda, the Senate Committee on State Affairs heard its own version of the APRN scope expansion, SB 3055 by Sen. Mayes Middleton (R-Galveston). In a hearing that lasted from morning until night, dozens of physicians from across the state testified in opposition, highlighting the potential harm to patient safety and the substantial differences in educational and clinical experience between nurses and physicians. That bill was also left pending without a vote.

In the end, our efforts to stop HB 3794 and SB 3055 were successful, as neither was called for a vote or advanced out of committee. Our message to lawmakers remains clear: Texas should expand access by building on physician-led teams, not dismantling them. We support measures to provide care to rural and underserved areas, but handing unsupervised medical practice to nonphysicians is not a responsible solution.

House Insurance Committee Chairman Jay Dean (R-Longview) filed HB 138 to establish the Health Impact, Cost, and Coverage Analysis Program (HICCAP) at the UT Health Science Center in Houston to evaluate new insurance benefit mandates proposed by the Legislature. Before voting on legislation that would mandate additional coverage benefits, legislators would receive an HICCAP report estimating costs, coverage impacts and utilization.

In response to concerns raised by the Texas Medical Association, the Texas Hospital Association, TSGE and other physician groups, the House Insurance Committee adopted a substitute bill requiring more balanced evaluations — including the potential for improved patient outcomes and public health impacts. It mandates the use of the Texas all-payer claims database and peer-reviewed literature, allows both chairs and vice-chairs to request analyses, and adds conflict-of-interest policies.

The revised HB 138 passed the Texas House 141–3 and the Texas Senate 31–0.

The 89th Legislature also saw concerted efforts by the health insurance lobby to allow health plans to offer limited “Employer Choice of Benefits” plans exempt from most state insurance mandates and consumer protections.

Authored by House Insurance Committee Chairman Jay Dean (R-Longview), HB 139 would have allowed health plans to legally exclude essential state-mandated benefits and safeguards, including coverage mandates, surprise billing protections, prompt-pay requirements and network adequacy standards. Other critical patient protections — continuity of care provisions, appeal rights and prior authorization reforms — would also not have applied.

While the stated goal of HB 139 was to lower premiums by easing regulations, the bill was more likely to expose Texas patients to unexpected medical costs, narrow networks and insurance denials for necessary care such as cancer screenings and specialist visits. Widespread adoption of these “barebones” plans could erode broader insurance standards and undermine patient confidence. Lower premiums mean little if health plans leave patients on the hook for massive out-of-pocket expenses.

On April 4, despite vocal opposition from physician groups and patient advocates, HB 139 was voted out of the House Insurance Committee 6–3. TSGE, TMA, THA and other physician groups succeeded in delaying a floor vote for nearly a month, but the bill was ultimately scheduled for May 15, the final day for House bills to be heard.

The physician lobby team and allies spent days in a full-court press, expressing opposition to all 150 members of the Texas House. In the end our efforts proved successful: Rep. Dean was forced to acknowledge the bill lacked the support to pass, and withdrew HB 139 before it could be voted down.