2025 Legislative Wrap-Up: Harmful Insurance Bills Defeated by Physician Advocacy
By Alisa Pierce Texas Medicine September 2025

The association also had help from a coalition it built of more than 30 state and national medical, pharmacy, and patient advocacy organizations in killing its top target: House Bill 139. That bill sought to establish a new type of “employer choice of benefits” (ECOB) health plan exempt from a long list of TMA-backed patient and physician protections won over the years, including state: 

• Minimum mandated benefits and network adequacy requirements;  
• Utilization review laws and the 2021 gold-carding prior authorization law;   
• Prompt-pay legislation; and 
• Rules surrounding transparency in ranking and tiering. 

TMA Council on Legislation Chair Zeke Silva, MD, warned the consequences of the bill could have set a dangerous precedent for future legislation. 

“Imagine Texas passes a law that requires health plans to cover a specific medication for a specific condition, for example,” Dr. Silva told Texas Medicine. “The new plans would have been exempted from doing so, leading to more work for physicians and a lack of necessary care for patients.” 

Additionally, the bill would have allowed ECOB plans to be exempted from a litany of other state patient and physician protection laws – all despite the fact nothing in the bill required ECOB health plans be offered at a lower premium.  

Similarly, TMA defeated legislation sought by commercial health plans that would have created a new definition of and enforcement mechanisms surrounding health care fraud, despite the fact Texas already has laws and multiple enforcement vehicles in place against bad actors.  

House Bill 4012 would have created new criminal and civil penalties against physicians for potential good-faith billing disagreements, as well as a new False Claims Act-like “whistleblower” statute that would have applied to the commercial market. 

“Fraud should be prosecuted – but this bill targets physicians broadly, not just bad actors. It expands authority without accountability … and oversight without insurer transparency,” Dr. Silva testified during the session. 

Although HB 139 and HB 4012 died this session, they are likely to be pursued next legislative session, putting medicine on guard for yet another battle against aggressive insurer tactics.  

In a proactive win, TMA succeeded in a multi-session effort to pass legislation addressing some of the shortfalls and inconsistencies among payers in the intended implementation of Texas’ landmark “gold-card” prior authorization exemption law, which have led to fewer than 4% of physicians qualifying. 

Under the 2021 bill, physicians are eligible for an exemption from an insurer’s prior authorization requirements for a particular service if they receive approvals on at least 90% of their requests during the timeframe set forth in the law.   

However, House Bill 3812 by Reps. Greg Bonnen, MD (R-Friendswood), Tom Oliverson, MD (R-Tomball), and Venton Jones (D-Dallas) brings to bear some of the fixes TMA sought during early rulemaking to streamline eligibility, improve transparency, and enhance state oversight by:  

• Extending the evaluation period from six to 12 months;  
• Codifying the minimum threshold of five services to qualify during that time; 
• Expanding the data to be used in an exemption evaluation; and 
• Requiring HMOs and insurers to submit annual written reports on certain gold-card data to the Texas Department of Insurance. 

“The big frustration I’ve had as a surgeon is the weaponization of the prior auth process by the insurers against patients, resulting in delayed care and denied care,” Representative Bonnen told Texas Medicine. “We took a huge step forward when we asked for the first prior authorization bill, and as with so much of what we do, you inevitably come back to make improvements.”