Cook Health Care Bill Repeals Most Texas Abortion Limits

The text as introduced · 4,235 words

By: Cook, Eckhardt
S.B. No. 2768

A BILL TO BE ENTITLED

AN ACT

relating to certain health care services, increasing access to

health care, and repealing or replacing medically unnecessary and

outdated health care restrictions.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

ARTICLE 1. GENERAL PROVISIONS

SECTION 1.01. This Act may be cited as the Health Freedom

for Texans Act.

SECTION 1.02. The legislature finds that:

(1) comprehensive reproductive health care, including

safe abortion care and health care services for transgender and

gender-nonconforming persons, is a vital component of a person's

overall health and of their social and economic equality;

(2) abortion is one of the safest medical procedures

in the United States, as demonstrated by available data, including

from the Centers for Disease Control and Prevention, showing

abortion has a more than 99 percent safety record;

(3) any regulation of medical care must have a

legitimate and verifiable purpose and advance the goals of

improving the quality of care and increasing access to care;

(4) according to the American College of Obstetricians

and Gynecologists, American Medical Association, American Academy

of Family Physicians, and American Osteopathic Association,

"access to high-quality, evidence-based abortion care should not be

limited by laws enacted under the guise of patient safety but that,

in fact, [cause] harm"; and

(5) the almost complete abortion ban and the onerous

restrictions enacted in this state based on pretextual reasons are

a systematic attempt to eliminate access to safe and necessary

medical care.

ARTICLE 2. INCREASING ACCESS TO HEALTH CARE

SECTION 2.01. Section 32.003, Family Code, is amended by

amending Subsection (a) and adding Subsection (g) to read as

follows:

(a) A child may consent to medical, dental, psychological,

and surgical treatment for the child by a licensed physician or

dentist if the child:

(1) is on active duty with the armed services of the

United States of America;

(2) is:

(A) 16 years of age or older and resides separate

and apart from the child's parents, managing conservator, or

guardian, with or without the consent of the parents, managing

conservator, or guardian and regardless of the duration of the

residence; and

(B) managing the child's own financial affairs,

regardless of the source of the income;

(3) consents to the diagnosis and treatment of an

infectious, contagious, or communicable disease that is required by

law or a rule to be reported by the licensed physician or dentist to

a local health officer or the [ Texas ] Department of State Health

Services , including all diseases within the scope of Section

81.041, Health and Safety Code;

(4) is unmarried and pregnant and consents to

hospital, medical, or surgical treatment[ , other than abortion, ]

related to the pregnancy;

(5) consents to examination and treatment for drug or

chemical addiction, drug or chemical dependency, or any other

condition directly related to drug or chemical use;

(6) is unmarried, is the parent of a child, and has

actual custody of the [ his or her ] child and consents to medical,

dental, psychological, or surgical treatment for the child; [ or ]

(7) is serving a term of confinement in a facility

operated by or under contract with the Texas Department of Criminal

Justice ; or

(8) consents to a contraception-related examination

or medical treatment [ , unless the treatment would constitute a

prohibited practice under Section 164.052(a)(19), Occupations

Code ].

(g) In this section, "contraception" means any reversible

method of preventing pregnancy that is approved by the United

States Food and Drug Administration.

SECTION 2.02. Section 501.065, Government Code, is amended

to read as follows:

Sec. 501.065. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL,

AND SURGICAL TREATMENT. An inmate who is younger than 18 years of

age and is confined in a facility operated by or under contract with

the department may, in accordance with procedures established by

the department, consent to medical, dental, psychological, and

surgical treatment for the inmate by a licensed health care

practitioner, or a person under the direction of a licensed health

care practitioner[ , unless the treatment would constitute a

prohibited practice under Section 164.052(a)(19), Occupations

Code ].

SECTION 2.03. Section 62.151, Health and Safety Code, is

amended by amending Subsection (c) and adding Subsections (h) and

(i) to read as follows:

(c) In modifying the plan, the executive commissioner shall

ensure that primary and preventive health benefits [ do not ] include

reproductive services, such as contraception, abortion services,

[ other than ] prenatal care , and care related to diseases,

illnesses, or abnormalities related to the reproductive system.

(h) Subject to Subsection (i), the child health plan must

provide as covered benefits prescription contraceptive drugs or

devices approved by the United States Food and Drug Administration.

(i) The child health plan shall provide as covered benefits

prescription contraceptive drugs or devices for an enrolled child

17 years of age or younger for the purpose of primary and preventive

reproductive health care if the prescribing health care provider

receives written consent for the prescription from:

(1) the enrolled child's parent, guardian, or managing

conservator; or

(2) the enrolled child or other adult if authorized

under Section 32.001 or 32.003, Family Code, for the prescription

or dispensing of the contraceptive drug or device.

SECTION 2.04. Section 171.002(1), Health and Safety Code,

is amended to read as follows:

(1) "Abortion" means an act or procedure performed

after pregnancy has been medically verified and with the intent to

cause the termination of a pregnancy other than for the purpose of

either the birth of a live fetus or the removal of a dead fetus. The

term does not include birth control devices or oral contraceptives

[ has the meaning assigned by Section 245.002 ].

SECTION 2.05. Subtitle H, Title 2, Health and Safety Code,

is amended by adding Chapter 174 to read as follows:

CHAPTER 174. REPRODUCTIVE AUTONOMY

Sec. 174.001. INTERNET WEBSITE ON REPRODUCTIVE RIGHTS AND

RELATED RESOURCES. (a) The commission shall develop and maintain a

web page on the commission's Internet website with information on

the rights of an individual in this state to:

(1) obtain an abortion or related health care services

in this state;

(2) receive treatment for a miscarriage or an ectopic

pregnancy;

(3) access telemedicine medical services or

telehealth services for an abortion; and

(4) self-manage an abortion.

(b) The information required under Subsection (a) must be

printed in each of the five most spoken languages in this state.

SECTION 2.06. Section 32.024, Human Resources Code, is

amended by amending Subsections (e) and (l-1) to read as follows:

(e) Except as provided by Section 32.03118, the [ The ]

commission may not authorize the provision of any service to any

person under the program unless federal matching funds are

available to pay the cost of the service.

(l-1) The commission shall continue to provide medical

assistance to an individual [ a woman ] who is eligible for medical

assistance for pregnant individuals [ women ] for a period of not

less than 24 [ :

[ (1) six months following the date the woman delivers

or experiences an involuntary miscarriage; and

[ (2) 12 ] months that begins on the last day of the

individual's [ woman's ] pregnancy and ends on the last day of the

month in which the 24-month [ 12-month ] period ends [ in accordance

with Section 1902(e)(16), Social Security Act (42 U.S.C. Section

1396a(e)(16)) ].

SECTION 2.07. Subchapter B, Chapter 32, Human Resources

Code, is amended by adding Section 32.03118 to read as follows:

Sec. 32.03118. REIMBURSEMENT FOR CERTAIN REPRODUCTIVE

HEALTH SERVICES. (a) Regardless of whether federal matching funds

are available to pay the cost of the services, the commission shall

ensure that medical assistance reimbursement is provided for the

provision of the following services to medical assistance

recipients:

(1) abortion services;

(2) forms of contraception approved by the United

States Food and Drug Administration, including the insertion and

removal of devices; and

(3) voluntary sterilization, including vasectomies.

(b) The commission shall ensure that abortion,

contraception, and sterilization services are provided in

accordance with applicable state and federal law.

(c) Notwithstanding any other law, abortion, contraception,

and sterilization services provided under the medical assistance

program may not be subject to:

(1) a cost-sharing requirement, including a

deductible or coinsurance;

(2) utilization review;

(3) a prior authorization or step-therapy

requirement; or

(4) any restrictions on or delays in coverage.

SECTION 2.08. Chapter 32, Human Resources Code, is amended

by adding Subchapter H to read as follows:

SUBCHAPTER H. EXPANSION OF ELIGIBILITY FOR MEDICAL ASSISTANCE

Sec. 32.351. EXPANDED ELIGIBILITY FOR MEDICAL ASSISTANCE

UNDER PATIENT PROTECTION AND AFFORDABLE CARE ACT. (a)

Notwithstanding any other law, the commission shall provide medical

assistance to all individuals who apply for that assistance and for

whom federal matching funds are available under the Patient

Protection and Affordable Care Act (Pub. L. No. 111-148), as

amended by the Health Care and Education Reconciliation Act of 2010

(Pub. L. No. 111-152), to provide that assistance.

(b) The executive commissioner shall adopt rules regarding

the provision of medical assistance as required by this section.

Sec. 32.352. ANNUAL REPORT ON EXPANDED ELIGIBILITY FOR

MEDICAL ASSISTANCE. Not later than December 1 of each year, the

commission shall report to the governor, the lieutenant governor,

the speaker of the house of representatives, and the standing

committees of the senate and the house of representatives having

primary jurisdiction over the medical assistance program on the

effects of expanding eligibility for medical assistance under

Section 32.351, including the effects on:

(1) the number of individuals in this state who do not

have health benefits coverage;

(2) state health care costs, including costs relating

to programs funded with money appropriated out of the general

revenue fund;

(3) local health care costs; and

(4) charity care and uncompensated care costs for

hospitals.

SECTION 2.09. The heading to Chapter 1218, Insurance Code,

is amended to read as follows:

CHAPTER 1218. COVERAGE FOR REPRODUCTIVE HEALTH SERVICES

[ ELECTIVE ABORTION; PROHIBITIONS AND REQUIREMENTS ]

SECTION 2.10. Sections 1218.001 and 1218.004, Insurance

Code, are amended to read as follows:

Sec. 1218.001. DEFINITIONS [ DEFINITION ]. In this chapter :

(1) "Abortion" has the meaning assigned [ , "elective

abortion" means an abortion, as defined ] by Section [ 245.002,

Health and Safety Code, other than an abortion performed due to a

medical emergency as defined by Section ] 171.002, Health and Safety

Code.

(2) "Effective pain and anxiety management" means

evidence-based pain and anxiety management, including prescription

antianxiety medication, local anesthesia, topical anesthetic,

paracervical block, and minimal and moderate sedation.

Sec. 1218.004. COVERAGE REQUIRED [ BY HEALTH BENEFIT

PLAN ]. (a) A health benefit plan shall [ may ] provide coverage for

abortion services, all forms of contraception approved by the

United States Food and Drug Administration including the insertion

and removal of devices and counseling on and provision of effective

pain and anxiety management for the insertion or removal of

devices, and voluntary sterilization including vasectomies, in

accordance with applicable state and federal law.

(b) Coverage required under this section is not subject to

[ elective abortion only if ]:

(1) a cost-sharing requirement, including a

deductible or coinsurance [ the coverage is provided to an enrollee

separately from other health benefit plan coverage offered by the

health benefit plan issuer ];

(2) utilization review [ the enrollee pays the premium

for coverage for elective abortion separately from, and in addition

to, the premium for other health benefit plan coverage, if any ];

[ and ]

(3) a prior authorization or step-therapy requirement;

or

(4) any restrictions on or delays in coverage [ the

enrollee provides a signature for coverage for elective abortion,

separately and distinct from the signature required for other

health benefit plan coverage, if any, provided to the enrollee by

the health benefit plan issuer ].

(c) This section controls over Subchapter C, Chapter 1369,

to the extent of any conflict.

SECTION 2.11. Section 1369.1031(c), Insurance Code, is

amended to read as follows:

(c) A health benefit plan that provides benefits for a

prescription contraceptive drug must provide for an enrollee to

obtain up to[ :

[ (1) a three-month supply of the covered prescription

contraceptive drug at one time the first time the enrollee obtains

the drug; and

[ (2) ] a 12-month supply of the covered prescription

contraceptive drug at one time each [ subsequent ] time the enrollee

obtains the [ same ] drug, regardless of whether the enrollee was

enrolled in the health benefit plan the first time the enrollee

obtained the drug.

SECTION 2.12. Section 164.052(a), Occupations Code, is

amended to read as follows:

(a) A physician or an applicant for a license to practice

medicine commits a prohibited practice if that person:

(1) submits to the board a false or misleading

statement, document, or certificate in an application for a

license;

(2) presents to the board a license, certificate, or

diploma that was illegally or fraudulently obtained;

(3) commits fraud or deception in taking or passing an

examination;

(4) uses alcohol or drugs in an intemperate manner

that, in the board's opinion, could endanger a patient's life;

(5) commits unprofessional or dishonorable conduct

that is likely to deceive or defraud the public, as provided by

Section 164.053, or injure the public;

(6) uses an advertising statement that is false,

misleading, or deceptive;

(7) advertises professional superiority or the

performance of professional service in a superior manner if that

advertising is not readily subject to verification;

(8) purchases, sells, barters, or uses, or offers to

purchase, sell, barter, or use, a medical degree, license,

certificate, or diploma, or a transcript of a license, certificate,

or diploma in or incident to an application to the board for a

license to practice medicine;

(9) alters, with fraudulent intent, a medical license,

certificate, or diploma, or a transcript of a medical license,

certificate, or diploma;

(10) uses a medical license, certificate, or diploma,

or a transcript of a medical license, certificate, or diploma that

has been:

(A) fraudulently purchased or issued;

(B) counterfeited; or

(C) materially altered;

(11) impersonates or acts as proxy for another person

in an examination required by this subtitle for a medical license;

(12) engages in conduct that subverts or attempts to

subvert an examination process required by this subtitle for a

medical license;

(13) impersonates a physician or permits another to

use the person's license or certificate to practice medicine in

this state;

(14) directly or indirectly employs a person whose

license to practice medicine has been suspended, canceled, or

revoked;

(15) associates in the practice of medicine with a

person:

(A) whose license to practice medicine has been

suspended, canceled, or revoked; or

(B) who has been convicted of the unlawful

practice of medicine in this state or elsewhere;

(16) [ performs or procures a criminal abortion, aids

or abets in the procuring of a criminal abortion, attempts to

perform or procure a criminal abortion, or attempts to aid or abet

the performance or procurement of a criminal abortion;

[ (17) ] directly or indirectly aids or abets the

practice of medicine by a person, partnership, association, or

corporation that is not licensed to practice medicine by the board;

(17) [ (18) performs an abortion on a woman who is

pregnant with a viable unborn child during the third trimester of

the pregnancy unless:

[ (A) the abortion is necessary to prevent the

death of the woman;

[ (B) the viable unborn child has a severe,

irreversible brain impairment; or

[ (C) the woman is diagnosed with a significant

likelihood of suffering imminent severe, irreversible brain damage

or imminent severe, irreversible paralysis;

[ (19) performs an abortion on an unemancipated minor

without the written consent of the child's parent, managing

conservator, or legal guardian or without a court order, as

provided by Section 33.003 or 33.004, Family Code, unless the

abortion is necessary due to a medical emergency, as defined by

Section 171.002, Health and Safety Code;

[ (20) otherwise performs an abortion on an

unemancipated minor in violation of Chapter 33, Family Code;

[ (21) performs or induces or attempts to perform or

induce an abortion in violation of Subchapter C, F, or G, Chapter

171, Health and Safety Code;

[ (22) ] in complying with the procedures outlined in

Sections 166.045 and 166.046, Health and Safety Code, wilfully

fails to make a reasonable effort to transfer a patient to a

physician who is willing to comply with a directive; or

(18) [ (23) ] performs or delegates to another

individual the performance of a pelvic examination on an

anesthetized or unconscious patient in violation of Section

167A.002, Health and Safety Code[ ; or

[ (24) performs a gender transitioning or gender

reassignment procedure or treatment in violation of Section

161.702, Health and Safety Code ].

ARTICLE 3. CONFORMING AMENDMENTS

SECTION 3.01. Section 161.006(b), Family Code, is amended

to read as follows:

(b) In this code, "abortion" has the meaning assigned by

Section 171.002 [ 245.002 ], Health and Safety Code.

SECTION 3.02. Section 266.010(a), Family Code, is amended

to read as follows:

(a) A foster child who is at least 16 years of age may

consent to the provision of medical care[ , except as provided by

Chapter 33, ] if the court with continuing jurisdiction determines

that the child has the capacity to consent to medical care. If the

child provides consent by signing a consent form, the form must be

written in language the child can understand.

SECTION 3.03. Section 419.909(c), Government Code, is

amended to read as follows:

(c) This section does not apply to state agency personnel

who conduct a life safety code survey of a building or facility in

connection with determining whether to issue or renew a license

under Chapter 142, 241, 242, 243, 244, [ 245, ] 247, 248, 251, 252,

464, 466, or 577, Health and Safety Code, or Chapter 103, Human

Resources Code.

SECTION 3.04. Section 32.046(e), Health and Safety Code, is

amended to read as follows:

(e) For purposes of this section, "postpartum depression"

means a disorder in which an individual [ a woman ] experiences

moderate to severe depression following a pregnancy, regardless of

whether the pregnancy resulted in birth, or an abortion [ act ]

defined by Section 171.002 [ 245.002(1) ].

SECTION 3.05. Section 170.001(1), Health and Safety Code,

is amended to read as follows:

(1) "Abortion" has the meaning assigned by Section

171.002 [ 245.002 ].

SECTION 3.06. Section 241.011, Health and Safety Code, is

amended to read as follows:

Sec. 241.011. HUMAN TRAFFICKING SIGNS REQUIRED. (a) An

emergency department of a hospital shall display separate signs, in

English and Spanish, side by side in accordance with this section in

each restroom and patient consulting room. The signs must include

the following information:

(1) no person, including an individual's parents, may

force any individual to have an abortion;

(2) it is illegal for a person to force an individual

to engage in sexual acts;

(3) an individual who needs help may call or text a

state or national organization that assists victims of human

trafficking and forced abortions; and

(4) the toll-free number of an organization described

by Subdivision (3) [ that comply with Section 245.025 as if the

hospital is an abortion facility ].

(b) In addition to the information required under

Subsection (a), the sign must include the contact information for

reporting suspicious activity to the Department of Public Safety.

(c) Signs required under this section must be at least 8-1/2

by 11 inches in size and displayed in a conspicuous manner clearly

visible to the public and employees of a hospital. The notice must

cover at least four-fifths of the sign.

(d) The executive commissioner shall adopt rules as

necessary to implement and enforce this section.

SECTION 3.07. Section 248.003, Health and Safety Code, is

amended to read as follows:

Sec. 248.003. EXEMPTIONS. This chapter does not apply to:

(1) a home and community support services agency

required to be licensed under Chapter 142;

(2) a person required to be licensed under Chapter 241

(Texas Hospital Licensing Law);

(3) an institution required to be licensed under

Chapter 242;

(4) an ambulatory surgical center required to be

licensed under Chapter 243 (Texas Ambulatory Surgical Center

Licensing Act);

(5) a birthing center required to be licensed under

Chapter 244 (Texas Birthing Center Licensing Act);

(6) [ a facility required to be licensed under Chapter

245 (Texas Abortion Facility Reporting and Licensing Act);

[ (7) ] a general residential operation, foster group

home, foster home, and child-placing agency, for children in foster

care or other residential care who are under the conservatorship of

the Department of Family and Protective Services; or

(7) [ (8) ] a person providing medical or nursing care

or services under a license or permit issued under other state law.

ARTICLE 4. REPEALER; TRANSITIONS; CONFLICTS; EFFECTIVE DATE

SECTION 4.01. The following provisions are repealed:

(1) Section 30.022, Civil Practice and Remedies Code;

(2) Subchapter L, Chapter 74, Civil Practice and

Remedies Code;

(3) Section 38.063(e-1), Education Code;

(4) Chapter 33, Family Code;

(5) Section 151.002, Family Code;

(6) Section 311.036, Government Code;

(7) Chapter 2273, Government Code;

(8) Section 32.005, Health and Safety Code;

(9) Chapter 54, Health and Safety Code, as added by

Chapter 1033 (S.B. 24), Acts of the 88th Legislature, Regular

Session, 2023;

(10) Section 62.151(g), Health and Safety Code;

(11) Subchapter X, Chapter 161, Health and Safety

Code, as added by Chapter 335 (S.B. 14), Acts of the 88th

Legislature, Regular Session, 2023;

(12) Chapter 170A, Health and Safety Code;

(13) Sections 171.002(2), (3), and (4), Health and

Safety Code;

(14) Section 171.0031, Health and Safety Code;

(15) Section 171.004, Health and Safety Code;

(16) Section 171.005, Health and Safety Code;

(17) Section 171.006, Health and Safety Code, as added

by Chapter 4 (H.B. 13), Acts of the 85th Legislature, First Called

Session, 2017;

(18) Section 171.006, Health and Safety Code, as added

by Chapter 9 (H.B. 215), Acts of the 85th Legislature, First Called

Session, 2017;

(19) Section 171.008, Health and Safety Code;

(20) Section 171.012, Health and Safety Code;

(21) Section 171.0121, Health and Safety Code;

(22) Section 171.0122, Health and Safety Code;

(23) Section 171.0123, Health and Safety Code;

(24) Section 171.0124, Health and Safety Code;

(25) Section 171.013, Health and Safety Code;

(26) Section 171.014, Health and Safety Code;

(27) Section 171.015, Health and Safety Code;

(28) Section 171.016, Health and Safety Code;

(29) Section 171.017, Health and Safety Code;

(30) Section 171.018, Health and Safety Code;

(31) Subchapters C, D, E, F, G, and H, Chapter 171,

Health and Safety Code;

(32) Section 241.007, Health and Safety Code;

(33) Section 243.017, Health and Safety Code;

(34) Chapter 245, Health and Safety Code;

(35) Section 285.202, Health and Safety Code;

(36) Chapter 697, Health and Safety Code;

(37) Section 32.024(c-1), Human Resources Code;

(38) Section 32.024(pp), Human Resources Code, as

added by Chapter 335 (S.B. 14), Acts of the 88th Legislature,

Regular Session, 2023;

(39) Section 1218.003, Insurance Code;

(40) Section 1218.005, Insurance Code;

(41) Section 1218.006, Insurance Code;

(42) Subtitle M, Title 8, Insurance Code;

(43) Chapter 103, Occupations Code;

(44) Section 111.005(c), Occupations Code;

(45) Section 164.055, Occupations Code;

(46) Section 164.0551, Occupations Code;

(47) Section 164.0552, Occupations Code;

(48) Section 9.35, Penal Code; and

(49) Chapter 6-1/2, Title 71, Revised Statutes.

SECTION 4.02. If before implementing any provision of this

Act a state agency determines that a waiver or authorization from a

federal agency is necessary for implementation of that provision,

the agency affected by the provision shall request the waiver or

authorization and may delay implementing that provision until the

waiver or authorization is granted.

SECTION 4.03. (a) Section 32.351, Human Resources Code, as

added by this Act, applies only to an initial determination or

recertification of eligibility of an individual for medical

assistance under Chapter 32, Human Resources Code, made on or after

the date the section is implemented, regardless of the date the

individual applied for that assistance.

(b) As soon as possible after the effective date of this

Act, the executive commissioner of the Health and Human Services

Commission shall take all necessary actions to expand eligibility

for medical assistance under Chapter 32, Human Resources Code, in

accordance with Section 32.351, Human Resources Code, as added by

this Act, including notifying appropriate federal agencies of that

expanded eligibility.

SECTION 4.04. Chapter 1218, Insurance Code, as amended by

this Act, applies only to a health benefit plan delivered, issued

for delivery, or renewed on or after January 1, 2026. A health

benefit plan delivered, issued for delivery, or renewed before

January 1, 2026, is governed by the law as it existed immediately

before the effective date of this Act, and that law is continued in

effect for that purpose.

SECTION 4.05. The changes in law made by this Act apply only

to health care services provided on or after the effective date of

this Act. Health care services provided before the effective date

of this Act are governed by the law applicable to those services

immediately before the effective date of this Act, and that law is

continued in effect for that purpose.

SECTION 4.06. To the extent of any conflict, this Act

prevails over another Act of the 89th Legislature, Regular Session,

2025, relating to nonsubstantive additions to and corrections in

enacted codes.

SECTION 4.07. This Act takes effect September 1, 2025.