Texas Legislature clarifies when doctors can perform life-saving abortions

Sign up for The Brief, The Texas Tribune’s daily newsletter that keeps readers up to speed on the most essential Texas news.

---

A bill clarifying when doctors can perform abortions under Texas’ near-total ban will now go to Gov. Greg Abbott’s desk after the House approved the bill with wide bipartisan support. Despite some concerns raised by conservative Republicans, the narrow bill does not expand abortion access, but rather aims to ensure pregnant patients can get life-saving medical care.

Bill sponsor Rep. Charlie Geren, a Republican from Fort Worth, stressed that this was not a “choice bill,” but rather an attempt to ensure the existing limits of the law are “clear, consistent, fair and understandable.”

“We do not want women to die from medical emergencies during their pregnancy,” Geren said before a preliminary vote Wednesday. “We don’t want women’s lives to be destroyed because their bodies have been seriously impaired.”

Texas banned all abortions three years ago, with a narrow exception that allows doctors to terminate a pregnancy only to save a pregnant patient’s life. Immediately, doctors and legal experts warned that this exception was too narrow and vaguely written, and the penalties too severe, to ensure that women could get life-saving care.

That has proven true in many cases. Dozens of women have come forward with stories of medically necessary abortions delayed or denied, and at least three women have died as a result of these laws. Faced with these stories, Republican lawmakers have conceded that the language of the law might need some clearing up.

Senate Bill 31, also called the Life of the Mother Act, aligns language among the state’s abortion laws, codifies court rulings and requires education for doctors and lawyers on the nuances of the law. It passed the House 134-4 on Thursday.

The bill was tightly negotiated among lobbyists for doctors and hospitals, anti-abortion groups and Republican lawmakers, including Sen. Bryan Hughes of Mineola, who authored the bill, and Geren.

“These groups don’t always see eye to eye,” Geren said. “But in this case, they worked together to ensure pregnant women with pregnancy complications get appropriate and timely care.”

Clarification, or promoting abortion?

In the Senate, Republicans threw their support behind the bill, while Democrats pushed back on its narrowness, noting that Texas law still does not allow abortions in cases of rape, incest or lethal fetal anomalies.

“The folks who are working on this fix are, from my perspective, the folks who have created the problem,” said Houston Sen. Molly Cook. “Over the past four years, we've watched women suffer and die, and this bill is the confirmation that we all agree that something is broken in Texas.”

In the House, however, the bill faced headwinds from the right, as conservative Republicans rallied to the idea that this bill would allow doctors to resume elective abortions. Rep. Brent Money, a Greenville Republican, said he believed the laws were clear as written but there had been “malicious interpretations” by pro-abortion doctors.

“People that want to promote abortion have tried to make it murky what our current law is,” Money said. “And so my question is to you, is this law written to ensure that malicious actors won't be able to find loopholes to allow abortions that would not be allowed under our current law?”

Geren touted his own perfect record of voting for every anti-abortion measure that’s come before the House in his long career, and assured Money and his fellow conservatives that this was not an end-run around the laws.

“We are in no way promoting abortion on this,” Geren said, adding later that if a doctor were to abuse this clarification, they could face 99 years in prison and “they would deserve it.”

Many anti-abortion Republican women rallied to Geren’s side, including Rep. Shelby Slawson, a Stephenville Republican who carried the bill in 2021 that led to Texas banning nearly all abortions. She framed this bill as just codifying the Legislature’s original intent to protect the live’s of pregnant women. They took the mic to offer up examples of times doctors should be allowed to terminate a pregnancy - in cases of cancer diagnoses, kidney failure, premature membrane rupture, ectopic pregnancies.

But still, some Republicans were not appeased. On Wednesday, Rep. Briscoe Cain, a Deer Park lawyer who has been involved in some of the state’s most contentious abortion litigation, asked Geren if “more or less babies will die” as a result of this bill. Geren conceded that by affirming that doctors can perform abortions to save a woman’s life, it was possible more babies would die, although he noted that many women were traveling out-of-state to get the same medical care they were denied in Texas. When he returned before the final vote Thursday, Geren corrected himself, saying this would not increase the number of abortions, as these were abortions that were already permitted under the law.

Rep. Brian Harrison, a Midlothian Republican, said he was “alarmed” to hear Geren’s comments, and said it was the “height of irresponsibility to tinker with these pro-life protections that have already saved countless lives.”

Some doctors groups, including the Texas chapter of the American College of Obstetricians and Gynecologists, have criticized the bill for not going far enough to protect doctors and the patients they treat. Others say these changes will be sufficient to free doctors to perform medically necessary abortions without fear of lengthy prison sentences and massive fines.

Texas Hospital Association president John Hawkins said in a statement that the bill’s passage is "a great step forward for Texas women and health care.”

“We’re grateful we were able to move past the politics to find common ground,” Hawkins said. “Lawmakers followed through on input from patients, hospitals and physicians to strengthen and clarify laws to better protect moms. Once finalized, this will have an immediate and positive impact, helping us provide life-saving care to pregnant women in distress.”

Despite the back-and-forth between Republican factions over the bill, it passed with overwhelming bipartisan support, with just six Republicans, including Harrison, voting no. Ten Republicans, including Cain and Money, declined to vote on the measure.

The House also approved Senate Bill 33 on Thursday, which prohibits a city or county from using taxpayer dollars to pay for abortion-related expenses. The bill is aimed at Austin and San Antonio, where city officials have allocated budget dollars to support abortion funds that help pay for people to travel to abortion clinics out-of-state. Despite efforts from Democrats to kill the bill on procedural grounds, it passed 87-58.

Disclosure: Texas Hospital Association has been a financial supporter of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune's journalism. Find a complete list of them here.

---

First round of TribFest speakers announced! Pulitzer Prize-winning columnist Maureen Dowd; U.S. Rep. Tony Gonzales, R-San Antonio; Fort Worth Mayor Mattie Parker; U.S. Sen. Adam Schiff, D-California; and U.S. Rep. Jasmine Crockett, D-Dallas are taking the stage Nov. 13–15 in Austin. Get your tickets today!