Life of the Mother Act Captures House Committee, Physician Input

With less than two months left in the regular session, one of the Texas Medical Association’s top 10 legislative priorities captured significant attention in a lengthy House Public Health Committee hearing as it considered a bill providing crucial clarification for Texas physicians caring for pregnant women in medical emergencies, with a trio of physicians providing essential perspective on the bill.  

The committee heard House Bill 44, dubbed the Life of the Mother Act, which leaves the current Texas prohibition against abortion intact while offering clarity on medical emergency exceptions covering threats to the mother’s life or major bodily functions. TMA supports the bill and its companion Senate Bill 31, with the goal of helping to restore the ability of physicians to act quickly – alleviating the fear of prosecution – to save the life of the mother. 

TMA Board of Trustees Chair Joseph Valenti, MD, said he’s encouraged by what he characterized as “movement on this issue.”  

“There has been a lot of uncertainty on the part of physicians on how to manage cases,” the Denton obstetrician-gynecologist said. “The bill helps to clarify that to some extent. This is a step in the right direction.”  

Specifically, HB 44 would:  

• Confirm that the burden of proof in criminal prosecutions on the medical emergency exceptions rests with the state and not the physician; 

• Remove the term “life-threatening” in the Chapter 170A medical emergency exception to clarify treatment of a non-lethal risk of impairment of a major bodily function; 

• Confirm that, at a minimum, physicians treating ectopic pregnancies and spontaneous abortions (i.e. actions that are not abortions) are always exercising reasonable medical judgment; 

• Conform the definition of “medical emergency” used in abortion laws to match the medical emergency exception of Chapter 170A, so hospitals and doctors are only working with one “medical emergency” standard across the abortion laws; 

• Clarify the definition of “ectopic pregnancy;” 

• Clarify that communications between physicians, hospital administrators and lawyers to help understand and navigate the medical emergency exception are not considered “aiding and abetting;” and 

• Include a requirement that the appropriate agencies create or approve certain education for lawyers and doctors to better understand Texas’ abortion laws. 

Several TMA physicians offered testimony in support of the measure, building on prior testimony in support of SB 31, heard with little fanfare in the Senate Committee on State Affairs on March 27.  

By contrast, TMA physicians delivered remarks and fielded a range of questions from committee members in the opening panel of a six-hour session on HB 44, alongside Texas Hospital Association and Texas Civil Justice League representatives. 

TMA Chief Lobbyist Clayton Stewart said the hearing on what he described as a “very important bill” was the welcome result of legislative discussions “over the past two sessions coming to a head.”  

Elaborating on that in his testimony, TMA Council on Legislation Chair and radiologist Zeke Silva, MD, said, “TMA has been very vocal for the past three years regarding confusion on how physicians can treat a mother-to-be with pregnancy complications without the fear of breaking the law and going to jail,” calling HB 44 “tremendously helpful. As physicians, it is vital for us to be able to exercise our reasonable medical judgment depending upon a given circumstance and to act within the standard of care. Pregnant women deserve that standard of care as much as any patient.” 

Dr. Silva also voiced TMA’s support for the continuing medical and legal education provisions in the bill, which he called “critical in making sure awareness of this new law is conveyed to those engaged in these critical situations.” 

Amid Texas’ web of existing abortion laws, “this bill presents a thoughtful, necessary step in protecting the health and well-being of women in Texas,” Dallas OB-gyn Deborah Fuller, MD, added in her testimony. “I also believe it will go a long way into making OB-gyns believe they can practice evidence-based medicine in Texas and thus improve our ability to keep and recruit high quality OB-gyns and to train and retain these residents in Texas.”  

Committee member Rep. Ann Johnson (D-Houston) thanked testifying physicians from the dais for their prescient input.  

“When I see your white coats, I think about that patient care room in that space where I have the ability to sit with you and seek counsel,” she said. "Your oath is to do no harm.”  

Bookending the hearing with physician support, San Antonio OB-gyn Nichole Van de Putte, MD, provided additional testimony later in the day.  

“It is imperative that pregnancy complications that pose threat to maternal life and serious threat to bodily function are treated expeditiously,” she said.  

As of this writing, both HB 44 and SB 31 remained pending in their respective committees.    

Priority: Prior auth 

Meanwhile, in addition to gearing up in opposition against House Bill 3794, a nurse scope expansion bill set to be heard April 14, TMA also voiced support for three bills improving prior authorization and continues to analyze the state budget bill following its unusually swift passage by the House.  

Across the two chambers, TMA stood strong for prior authorization reforms that would lighten burdens on practice burdens and improve timely access to care.  

“We’re chipping away any way we can,” TMA lobbyist Ben Wright said. 

House Bill 3812, championed by one of the original gold-card law authors Rep. Greg Bonnen, MD, aims to comprehensively improve upon the 2021 landmark legislation to work as intended, and, significantly, defines utilization review as the practice of medicine, placing it under Texas Medical Board authority.  

“HB 3812 is the fix we need,” Austin oncologist Debra Patt, MD, told the House Insurance Committee. “It streamlines eligibility, improves transparency, and enhances state oversight.” 

The Senate Health and Human Services Committee also heard a pair of additional prior auth reform bills still pending, for which TMA testified in support:  

• Senate Bill 1380 would prevent insurers from requiring prior authorization for a range of services including emergency care, primary care, outpatient mental health care treatment, certain cancer treatments, and pediatric hospice services. It would also prevent prior authorizations for chronic health condition treatments from expiring unless standard treatment for that condition changes.  

• Senate Bill 547 would require insurers to notify the Texas Department of Insurance (TDI) about changes in the prior authorization exemption status of a physician under the gold card law and establish a TDI-maintained database tracking those exemptions.  

Budget matters

As this story went to press, the House on April 11 dove into a marathon floor debate on the budget bill already approved by the Texas Senate. After garnering unusually swift approval by the House, the budget now heads into the closed-door reconciliation process, where the two chambers will hash out any differences. 

TMA is analyzing the bill to ensure the maintenance of items funding Health and Human Services Commission programs, including Healthy Texas Women, mobile breast and cervical cancer screenings, mobile stroke units, and Medicaid enrollment, plus a handful of medicine-friendly amendments including:  

• A 5% Medicaid rate increase for physicians in health professional shortage areas;  

• A one-year training program for unmatched graduate medical students; and 

• A stipend for physician preceptors in community-based settings. 

Continue to read Texas Medicine Today for coverage and show support by registering for the final First Tuesdays at the Capitol event on May 6.