TSGE Legislative Update - May 2025 

While we continue to monitor numerous other bills and budget items not listed below, these items represent a more immediate concern due to their progress through the legislature thus far. 

  

I'm excited to report that both the House and Senate versions of the 2024-25 state budget have now passed their respective chambers with a $10 million appropriation to fund the Texas Colorectal Cancer Treatment Initiative for the next two years. As you know, this program will provide dedicated funding to treat colorectal cancer for uninsured and underinsured Texans (up to 200% of the federal poverty level). 

  

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 providing them with the resources to care for vulnerable populations. 

  

The 89th Texas Legislature marks my 18th year as either a lobbyist or staffer at the Texas Capitol, and I regret to report that this session's fight over independent practice for APRNs is the most aggressive attempt at scope expansion I've witnessed during that time. 

  

HB 3794 proposes a sweeping expansion of the scope of practice for Advanced Practice Registered Nurses (APRNs) in Texas. If enacted, HB 3794 would grant nurse practitioners, nurse anesthetists, nurse midwives, and clinical nurse specialists full independent practice authority, thereby eliminating the need for physician supervision or delegation agreements. The bill even redefines "nursing" to include medical diagnosis and prescribing, effectively authorizing APRNs to practice medicine without a license. 

 

Under this bill, APRNs could evaluate patients, diagnose conditions, order tests, prescribe treatments (including controlled substances), and serve as a patient's primary care provider - all without physician involvement. It also introduces a "payment parity" provision for state health programs, preventing physicians from billing for oversight unless they directly see the patient. This would treat APRN care as equivalent to physician care in reimbursement, significantly diminishing the value of physician oversight. 

  

To state the obvious - HB 3794 represents a direct threat to 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 this team, physician oversight is critical for complex decision-making, diagnosing nuanced conditions, and managing complications. Removing that oversight, especially in a specialty like gastroenterology, raises serious safety concerns. 

  

On April 14, HB 3794 was heard on the House Public Health Committee amid hours of intense debate. TSGE joined a board coalition of medical specialty societies in forceful opposition during that hearing. The room was filled with physicians in white coats testifying that patient access can be improved without sacrificing quality. 

  

On Wednesday (4/30), we received word that the House Public Health Committee was planning to hold a vote on HB 3794 the following day. The other members of the physician lobby team and I spent the day leading up to the vote engaged in a pitched battle with the nursing lobbyists, working to shore up opposition to the bill and prevent the nurses from flipping the votes of any members of the House Public Health Committee. In the final hours before the vote, it seemed that wherever we went, the nursing lobby had either just been there or would be there soon. As we chased each other around the Capitol counting and recounting the votes, both the nurses and physicians felt confident that the votes were on their side. Someone was going to be wrong. 

  

At 1:00 p.m., Chairman VanDeaver gaveled the House Public Health Committee to order in a crowded meeting room behind the House chamber. After voting on several dozen bills, they got to HB 3794. At the moment of truth, the Chairman finally acknowledged that the bill did not have the votes needed to pass and chose to leave HB 3794 pending rather than forcing a vote that seemed doomed to fail 4-9. 

  

As of now, HB 3794 remains stuck in committee, and our efforts remain focused on ensuring it does not advance between now and May 12, the final day for House Bills to be reported out of committee. 

  

On the other side of the rotunda Thursday (5/1), the Senate Committee on State Affairs was busy hearing its own version of the APRN scope expansion bill, SB 3055, by Senator Mayes Middleton of Galveston.

  

In a hearing that lasted from morning until night, dozens of physicians from across the state took their turn testifying in opposition to the unsupervised practice of nurses in Texas. They highlighted the potential harm to patient safety and outlined the substantial differences in educational and clinical experience between nurses and physicians. After many hours of testimony, the bill was left pending without a vote. 

  

As with HB 3794, we continue to monitor SB 3055's progress closely and are prepared for the chair's eventual call for a vote in the closing weeks of the session. Our message is simple: Texas should expand access by building on physician-led teams, not dismantling them. We support measures to provide care in rural and underserved areas, but handing over unsupervised medical practice to nonphysicians is not the answer. 

  

HB 138 would establish a Health Impact, Cost, and Coverage Analysis Program (HICCAP) at UT Health Science Center in Houston to evaluate new insurance benefit mandates proposed in the Texas Legislature. Before voting on a mandate, the Legislature would received a HICCAP report estimating costs, coverage impacts, and utilization. You'll recall that this was one of the bills we advocated against during TSGE Capitol Advocacy Day on March 4. 

  

In response to physician concerns, the House Insurance Committee adopted a substitute that requires more balanced evaluations, including patient outcomes and public health impacts. It mandates the use of Texas' all-payer claims database and peer-reviewed literature and allows both chairs and vice-chairs to request analyses. Conflict-of-interest policies were also added. 

  

Despite these revisions, TMA, THA, and other patient and physician groups continue to oppose HB 138 based on the belief that this analysis could still be misused to prioritize insurance company profits over patient care. The HICCAP analysis process might be used to delay and ultimately kill future patient protections, such as cancer screening mandates or access to newer therapies. 

  

On Thursday (May 1), HB 138 passed the Texas House and is now heading to the Texas Senate, where it is expected to be heard in the Senate Committee on Health and Human Services next week. 

  

HB 139 (authored by House Insurance Committee Chairman Jay Dean) would allow insurers to offer "Employer Choice" health plans that are exempt from most state insurance mandates and consumer protection laws. These plans could legally exclude essential benefits and safeguards, including coverage mandates, surprise billing protections, prompt-pay requirements, and networking adequacy standards. Other critical patient protections - such as continuity-of-care provisions, appeal rights, and prior authorization reforms - would also not apply. 

  

The bill's stated goal is to reduce premiums by easing regulations. However, it is more likely to expose Texas patients to unexpected medical costs, narrow networks, and insurance denials for necessary care, such as cancer screenings and, importantly, specialist care. Lower premiums means little if plans leave patients with massive out-of-pocket expenses. 

  

The bill's broad exemptions also create legal uncertainty regarding with consumer rights remain intact, raising concerns about future litigation and regulatory confusion. The widespread adoption of these "barebones" health insurance plans could erode broader health insurance standards and significantly undermine patient faith in the health care system's ability to provide adequate medical care without financially crushing denials and exclusions. 

  

On April 4, despite vocal opposition from physician groups and patient advocates, HB 139 was voted out of the House Insurance Committee. We continue to urge lawmakers to reject this bill and preserve the integrity of patient protections in Texas health insurance law. As of this writing, we have been successful in blocking it from a floor vote in the Texas House. If HB 139 does not receive a favorable floor vote by May 15, the bill will be considered dead.