BY John Hawkins, President and CEO, THA
After this year’s regular session of the Texas Legislature adjourned in June, I wrote that – in my experience, at least – there had never been a legislative session like it before.
Now that we’re about to close the final chapter of 2025, I can safely apply that truth on a broader scale: for Texas hospitals, there’s never been a year like this before.
From another intense legislative session to repeated high-stakes negotiations over health care policy in Washington, D.C. – not to mention the nation’s longest-ever federal government shutdown – the Texas Hospital Association and its advocates never really got to breathe, take a beat or stop and smell our state’s proverbial yellow roses. I don’t mind telling you it’s been a trying year for hospitals – but a rewarding one, and a reminder of how powerful and driven our industry can be to effect positive change and preserve bedrock elements of our health care system.
Roughly the first half of THA’s 2025 was defined by nonstop, fluidly evolving advocacy needs on both the state and federal levels. The state legislative session kicked off on Jan. 14; six days later, the second Trump administration began, and negotiations on congressional Republicans’ planned major budget reconciliation measure soon kicked into high gear. The ensuing months tested THA’s mettle, and we passed.
In Austin, we realized an outsized legislative achievement with the Life of the Mother Act, which clarified the exception to Texas’ abortion ban and outlined the circumstances under which a physician may terminate a pregnancy in a medical emergency. Among other big wins during session, we secured more funding for Texas’ trauma and emergency medical services account; convinced lawmakers to maintain budget funding for nearly all existing priorities while boosting key areas of Medicaid; and successfully defended hospital facility fees and vaccines against new legislative attacks.
All those battles were waged at the same time we successfully worked to protect Texas’ safety-net hospitals in the congressional reconciliation measure, which eventually became widely known as the One Big Beautiful Bill Act (OBBBA). During talks on that bill, Texas’ method of financing the nonfederal share of Medicaid became a talking point – and a potential source of major cuts that could have strained our safety net. But our tireless advocacy succeeded in averting disaster, as lawmakers grandfathered in multiple key tenets of Texas Medicaid financing. In the closing days of negotiations before OBBBA was signed into law on July 4, our advocacy protected approximately $10 billion of state Medicaid funding.
From there, developments in both capital cities offered little respite. Here in Austin, the Texas Legislature reconvened for a pair of special sessions. During the second one that wrapped up early in September, we successfully earned a blanket exemption for hospitals from a new ban on “abortion-inducing” drugs, making the case that hospitals need access to these medications for legitimate gynecological purposes. We also fought to exempt public hospitals from the state’s new “bathroom bill” that requires separating changing areas by biological sex, a heavy lift for many patient care spaces – such as emergency rooms – that separate patients with privacy curtains. Although we didn’t get the exemption we sought, the author of the bill stated on the Senate floor that he doesn’t believe the legislation applies to hospital emergency departments and other clinical spaces.
Since then, the wildest winds of this year are probably as fresh in your mind as in ours. Beginning Oct. 1, the government shutdown lasted 43 days and – despite our fervent prevention efforts – marked the lapsing of several vital federal programs for our hospitals, including two payment programs for rural hospitals and the hospital-at-home program. These programs, like our federal government itself, are now funded through Jan. 30, 2026, and long-delayed cuts to Medicaid Disproportionate Share Hospitals are once again postponed through that date.
Meanwhile, however, one of the major sticking points that caused the shutdown – the Dec. 31 expiration of enhanced premium tax credits (EPTC) for the federal Health Insurance Marketplace – remains unresolved at this writing. In calling for the renewal of EPTC, we’re in lockstep not only with our friends in the hospital industry, but also with the Texas Medical Association and the Texas Association of Health Plans, which is why all three of us recently stood as one in an op-ed on the topic.
In the spirit of the holidays, THA is hoping for an end-of-year gift from Congress on the EPTC front. In addition to preserving coverage for perhaps millions of Texans, it would tie a bow on a year where our industry’s advocates had to push themselves to every limit. It would also – hopefully – help set up Texas hospitals for something we all want: a less chaotic 2026. Candidly – as rewarding as it was to learn how much we could do at once – our industry will need calmer waters to advance and thrive next year and beyond.