Texas has one of the strictest abortion restrictions in the country, banning abortion in nearly all situations with very limited exceptions. Since the near-total ban went into effect, several women in the state have shared stories and filed lawsuits, saying that they were denied critical care while experiencing pregnancy complications. On March 14, one of the lawmakers behind the state’s restrictive abortion laws introduced a bill seeking to clarify medical exceptions.
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But some abortion-rights advocates and legal experts say the bill won’t do what it claims to, and even worry that it could open the door to prosecuting pregnant people and people who help patients access abortions.
Here’s what to know.
What is current Texas law?
The only exception to Texas’ abortion ban is if a person is experiencing a “life-threatening” medical emergency “that places the female at risk of death or poses a serious risk of substantial impairment of a major bodily function.” But the current version of the law does not get more specific than that. Doctors have said that the near-total ban causes confusion over when they can provide treatment in urgent situations, leading to care delays or denials.
However, there is specificity over the potential severe penalties for doctors who are found to have violated the state’s ban: up to $100,000 in fines, 99 years in prison, and losing their medical license.
In the fall of 2024, ProPublica reported that three Texas women died after they didn’t receive appropriate care while experiencing miscarriages.
What is the new proposed bill, SB 31?
Republican state Sen. Bryan Hughes—who has previously said that exceptions to the state’s near-total ban are “plenty clear”—said during a Senate committee hearing on March 27 that there have been “reports that some doctors and some hospitals are not following the law,” meaning that they have denied necessary medical care. He said he recently introduced a bill, SB 31, in order to “remove any excuse from a doctor or a hospital” from treating a patient experiencing medical emergencies. Republican Texas Rep. Charlie Geren has filed the same bill in the House. (Neither Hughes’s nor Geren’s office responded to a request for comment on this story.)
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The bill doesn’t expand abortion access in the state, but removes language from the state’s laws that requires a pregnant person to be experiencing a “life-threatening” condition for a doctor to provide care. The bill adds that it “does not require a physician to delay, alter or withhold medical treatment provided to a pregnant female if doing so would create a greater risk of the pregnant female’s death; or substantial impairment of a major bodily function of the pregnant female.” It says that a patient’s emergency “need not be imminent or irreversible” for a doctor to provide care. It specifies that ectopic pregnancies are considered exceptions to the state’s near-total abortion ban, but doesn’t include exceptions for fetal anomalies, rape, or incest.
The bill also includes language that instructs the State Bar of Texas and the Texas Medical Board to hold education sessions for lawyers and doctors about the medical exceptions to the state’s ban.
Why is it controversial?
The bill has received some rare bipartisan support, as well as support from both anti-abortion groups and some medical organizations, including the Texas Medical Association. Dr. Julie Ayala, an ob-gyn who practices in Texas, testified during the Senate committee hearing on March 27 on behalf of the Texas Medical Association that she believes “this bill will clear up confusion” and “save women’s lives.”
But other abortion rights advocates, doctors, and legal experts say the bill won’t do what it claims.
“It’s an attempt to add some clarity, but I think the underlying reasons that we’re seeing what we’re seeing with denials to care aren’t really changed in the bill,” says Mary Ziegler, a professor at the University of California, Davis School of Law with expertise in abortion. While the bill specifies some situations in which abortion is permitted, “pregnancy is complicated, so there are a lot of other scenarios that aren’t going to be enumerated in the bill where physicians aren’t going to know what to do,” Ziegler says.
The bill also doesn’t remove the severe penalties for doctors who are found to have violated the state’s near-total ban—one of the reasons “we’re seeing physicians refuse to provide care,” Ziegler says.
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Samantha Casiano, an advocate for the reproductive rights advocacy nonprofit Free & Just, also criticized the bill. Casiano, who lives in Texas, was forced to carry her baby to term even after doctors told her at 20 weeks of pregnancy that her baby had anencephaly, a fatal birth defect, and wouldn’t survive. Her baby died four hours after being born. Casiano was one of the plaintiffs in the lawsuit Zurawski v. State of Texas that was brought by the Center for Reproductive Rights and made national headlines for challenging Texas’ abortion ban. The Texas Supreme Court ruled against the women at the heart of the lawsuit in May 2024, refusing to clarify the exceptions to the state’s abortion ban.
“Nothing in [SB 31] would’ve helped my situation at all,” Casiano says. “I’m just so upset that I felt like from 20 weeks to 32 weeks, I was basically a walking coffin for my daughter until I had to give birth, and then she had to suffer and be in agony. So where in that [bill] does that help my situation, or families and mothers like me? It was really upsetting and disappointing to read it.”
Dr. Austin Dennard is an ob-gyn practicing in Texas who joined the Zurawski v. State of Texas lawsuit after she was forced to travel out of state to receive care when she learned that her baby had anencephaly. Dennard says that while she believes some of the people behind the bill had good intentions, she doesn’t think the bill “is going to make a lick of difference in the real practicality of practicing medicine.” She says the bill’s language is still very confusing, even to reproductive rights lawyers she’s spoken with, adding that “exceptions don’t work” to ensure access to care.
As for the education sessions about the medical exceptions, Dennard questions who would be creating that guidance, and if it would be coming from anti-abortion sources.
“It’s extremely disappointing to me, and if anyone is celebrating, I think that they are extremely naive to think that these individuals actually really want to make a change,” says Dennard, who is an advocate for Free & Just. “It feels like a political publicity movement rather than [a] true desire to help people.”
A cracked-open “door” to further restrictions
Advocates and experts also point out that SB 31 amends a 1925 law predating Roe v. Wade. The 1925 law bans abortion and penalizes anyone who “furnishes the means for procuring an abortion,” with the possibility of up to five years in prison. Texas Attorney General Ken Paxton had previously tried to enforce the 1925 law after the U.S. Supreme Court overturned Roe, but a federal judge blocked the move in 2023. Now, advocates and experts worry that the bill could “open the door” to the 1925 law being used to prosecute abortion patients, as well as people and groups who help patients access care, such as through abortion funds.
“If there is even a sliver of [a] chance that that bill could open the door to that 1925 criminalization of women and people that help you get an abortion, we have to be concerned,” says Kaitlyn Kash, a Free & Just advocate. Kash was forced to travel out of Texas to receive an abortion after learning that her baby had severe skeletal dysplasia, which impacts bone and cartilage growth, and that her baby likely wouldn’t survive.
Texas is also considering a separate bill that would allow authorities to charge people who obtain abortions with homicide, making it one of at least 10 states that have introduced bills for the 2025 legislative session that open the door for penalizing patients—a growing trend since the U.S. Supreme Court overturned Roe.
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According to Ziegler, SB 31 carves out some situations that wouldn’t be considered “aiding and abetting” an abortion, but in doing so, leaves open the possibility that other situations would be. “It’s sort of a similar dynamic to what you see with the exceptions,” Ziegler says. “There’s some clarity in a few narrow situations, and then a lot of gray area and threat of prosecution in most others.” She adds that Hughes has also introduced another bill, SB 2880, which—among other attempts to crack down on abortion—would expand who could be penalized for “aiding and abetting” abortions, including people who pay for or reimburse the costs associated with obtaining an abortion.
Amanda Zurawski, the lead plaintiff in the Zurawski v. State of Texas lawsuit, was denied an abortion after experiencing a complication called preterm pre-labor rupture of membranes (PPROM) because doctors said they detected fetal cardiac activity. A few days later, she developed sepsis, a life-threatening condition. Doctors performed an emergency induction abortion, and she had to spend several days in the ICU.
Zurawski, now a Free & Just advocate, criticized SB 31 for attempting to create “blanket rules over every single pregnancy in the state of Texas, because no two are the same.”
“I like to believe—I think I have to believe—that the intent of this bill is not malicious,” she says, but she adds that Texas officials have attempted to penalize people providing access to abortion care. The Texas Attorney General’s office recently announced that it had filed criminal charges against a midwife and medical assistant, accusing them of illegally providing abortions in Texas.
Dennard says she has received pressure from some people behind the bill and other physicians who disagree with her to support it. While some doctors and legal experts have said that the clarity would make “modest but not meaningless” changes and could save some lives, advocates say they don’t believe it will work.
“We shouldn’t be begging for scraps,” Kash says.”You don’t legislate medicine.”
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