Proposition 12 Produces Healthy Benefits

Texas' 2003 medical liability reforms have kept their promises. The landmark law and accompanying constitutional amendment have assured good Texas physicians they can take on the most complicated illnesses and serious injuries without fear of facing a groundless lawsuit in return, and attracted record numbers of new physicians to the state. 

Improving access to medical care is critically important to all Texans.  

  • This is especially true for children, pregnant women, the aged, the poor, those in an emergent condition and those in rural Texas.

Charity care has greatly increased since the passage of the 2003 reforms.

  • Charity care rendered by Texas hospitals rose 24-percent in the six years following the passage of lawsuit reform as the state's non-profit hospitals saw their charity care costs increase 36-percent. But for the 2003 reforms, this $594 million increase in charity care expenses would have left many Texas hospitals with the stark choice of turning away charity care patients or closing their doors altogether.

  House Bill 4 (the 2003 medical liability reforms) has a track record of improving access to medical care.  

  • 2001: Texas licensed 2,088 new doctors, the fewest in a decade.
  • 2012: Texas licensed 3,630 new doctors, the highest number of any year on record.
  • The Texas physician workforce has outpaced population growth every year since 2007.
  • Overall, Texas has enjoyed a 61 percent greater growth rate in newly licensed physicians in the past four years compared to the four years preceding reforms.
  • Since 2003, Texas has added 5,800 more physicians with in-state licenses than can be accounted for by population growth.
  •  During the crisis years Texas fell to 41st nationally in patient care physicians per capita. Since 2006, the state has climbed into a tie for 24th (Source: U.S. Department of Health and Human Services). 
  • Using the most conservative figure available, Texas has added enough direct patient care physicians since 2003 to provide 10.5 million more patient visits this year than likely would have occurred without liability reform.
  • Texas received a record, 4,253 new applications for licensure in 2012.
  • The Texas Medical Board has received 88% more applications for new licenses in the past four years than in the four years preceding reform.
  • The ranks of high risk specialists have grown more than twice as fast as the state’s population.
  • Pediatric sub-specialists have grown ten times faster than the state’s population.
  • The number of geriatricians has more than doubled.
  • Amarillo, Texas lost 28 physicians in the two years preceding reforms. Since reforms, Amarillo has gained 75 physicians.
  • 28,000 new physicians have been licensed in Texas since Sept. 1, 2003.

UPDATE: Fiscal Year 2012:

Texas is attracting more new doctors than ever. TMB reported 3,630 newly licensed physicians for FY 2012 (which ended Aug. 31) —the highest # ever!   There were 4,253 medical license applications, also a new record; 43% of the applications were processed in 10 days or less.

About 2 out of 3 (73.5%) new physicians are graduates of medical schools outside Texas. Overall, 42.1% (1,528) were graduates from other states or Canada, 31.4% (1,139) from other countries, and 26.5% (963) from Texas. This is the 2nd highest number ever of newly licensed from other states (but near the peak number in 2008 when 1,540 were licensed). And it’s the highest-ever number of international medical graduates, 1,139! (Note:  the latter may have been influenced by SB 189 which as of Sept. 1, requires non-citizen IMGs seeking initial licensure in Texas to practice 3 years in an underserved community. It has been predicted that this new practice obligation will begin to have a chilling effect on IMGs interested in practicing in Texas. It’s possible that some IMGs were motivated to apply for licensure to get ahead of the implementation of this law.)

Since Prop. 12, Texas has licensed more than 28,000 new physicians.  In the 9 years since Prop. 12, we have added an average of 3,135 newly licensed each year.  This average is 772 more than the average of 2,363 per year for the 9 years before the passage of Prop. 12, a gain of 33% in the annual average.

For the past three years, the pace was even higher, averaging about 3500 newly licensed each year.   

Number Licensed Fiscal Year 2012

   Texas Schools  








Number of Medical License Applications FY 2012



Physician growth is not limited to metro Texas.

  • The ranks of rural obstetricians have grown nearly three times faster than the state’s rural population.
  • Since 2003, thirty-five rural Texas counties have added at least one obstetrician, including sixteen counties that previously had none.
  • Forty-six counties that did not have an emergency medicine physician now do. Thirty-nine of those counties are rural.
  • Fifteen counties that did not have a cardiologist now do. Fourteen of those counties are rural.
  • Fifty-one counties have seen a net gain in orthopedic surgeons since 2003. Seven counties that did not have an orthopedic surgeon in 2003 now do. Fifteen of the counties that have added an orthopedist are rural.
  • Twenty-four rural counties added at least one general surgeon and eleven counties added their first general surgeon.
  • Four Texas counties added their first neurosurgeon and two of those counties are rural.

 The Coastal Bend has been beneficiaries of those gains.

  • During the past nine years Nueces County has added 29 emergency medicine physicians, 16 pediatric specialists, 6 kidney specialists, 5 pediatricians, and 5 cardiologists.
  • Bee and Aransas counties did not have an emergency medicine physician at the passage of reforms eight years ago.  They now do. 

Premiums are stable and declining.

  • All major physician liability carriers in Texas have cut their rates since the passage of the reforms by more than 30 percent.
  • Nearly half the doctors insured in the Texas commercial market have seen their premiums slashed more than 50 percent.
  • Thirty-four rate cuts have occurred in Texas since the passage of the 2003 landmark reforms.

Reductions in premiums since the passage of Prop. 12 and respective savings:

  • Texas doctors have received, on average, a 46.24% reduction in their liability premiums since 2003 resulting in $1.9 billion in reduced premiums. Premium reductions include both rate cuts and dividends. This number does not include premium reductions for hospitals and nursing homes.

Claims and lawsuits in most Texas counties have been cut in half.

Harris County Medical Liability Lawsuits

-2001: 441       -2004:  204       -2007: 217
-2002: 550       -2005:   256       -2008: 219
-2003: 795*       -2006: 248       -2009: 198
-2010: 234       -2011: 221       -2012:   199
          -2013 (through July) 125          

*Denotes rush to the court house to beat effective date of new laws.

Competition in the Health Care Liability Market is Increasing,

Since the passage of the 2003 reforms, Texas has added:

  • Four new admitted, rate-regulated carriers: Advocate MD of the Southwest, Medicus Insurance Company, Medical Liability Insurance Company of America and the Physicians Insurance  Company.
  • Thirty-eight risk retention groups, captives, surplus lines and other unregulated insurers.

Hospital Savings

  • Texas hospitals are collectively saving roughly $100 million a year on their liability premiums.
  • Hospitals have re-invested their liability savings into new technology, patient care, patient safety and have increased charity care by more than a half billion dollars annually. Without reforms and the attendant liability savings, these achievements would have been impossible.

Changing Texas' proven reforms will hurt access to medical care.  

  • CHRISTUS Spohns' Westside Corpus Christi clinic serving the indigent and its Diabetes Excellence Program are funded by the hospital's medical liability savings. Take away the savings and the programs are seriously jeopardized.
  • Kelsey-Seybold Clinic in Houston is using its liability savings to fund an electronic medical record. This electronic medical record will eliminate sources of medical error due to illegibility, monitor for medication allergies and alert the prescribing physician about drug interactions. It also allows results to be graphed to show doctor and patient trends over time and will reduce the cost of health care through more efficient handling of medical information. This electronic medical record investment would not be possible without the savings achieved by medical liability reform.

Updated Aug. 28, 2013

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