Shaping the next era of healthcare reform

This summer, our nation marked 250 years of American independence, a milestone that invites reflection not only on the freedoms we have secured, but also on the work that remains. Building a healthcare system that is accessible, accountable, and affordable is very much part of that unfinished work.

History tells us that major healthcare reform comes in cycles. Roughly every 12 to 15 years, policymakers reshape some aspect of the system. Medicare and Medicaid expanded coverage to seniors and low-income Americans in 1965. The Employee Retirement Income Security Act, or ERISA, and managed care transformed employer-sponsored insurance in the 1970s and 1980s. The Health Insurance Portability and Accountability Act, or HIPAA, and the Balanced Budget Act reshaped payment and coverage rules in the 1990s. The State Children’s Health Insurance Program expanded coverage for children, followed by Medicare Part D and the modern Medicare Advantage program. The Affordable Care Act then dramatically reduced the number of uninsured Americans, while largely leaving unresolved the more difficult question of why healthcare costs continue to rise.

Today, as we are approaching the end of that latest reform cycle, healthcare affordability has emerged as one of the defining policy issues facing Texas and the nation. Patients, employers, and taxpayers are no longer asking only whether they have coverage, they are asking whether that coverage is affordable, whether it provides value, and why the cost of care continues to climb. For the first time in years, policymakers are listening.

That makes this legislative interim one of the most consequential in recent memory.

TAFP has spent the past several months ensuring that family physicians are at the center of these conversations. The Academy provided testimony before both the Texas House Select Committee on Healthcare Affordability and the Senate Health and Human Services Committee to help frame the issue of rising costs as a structural problem rather than simply a reimbursement issue. TAFP highlighted the market forces driving costs higher, including hospital consolidation, site-of-service payment disparities that reward care delivered in more expensive settings, facility fees attached to routine services, and growing payer market concentration that places increasing pressure on independent physician practices.

The Academy also emphasized the administrative burdens that consume physician time and practice resources every day, including prior authorization, credentialing delays, and regulatory complexity, even as physician payment has remained essentially flat.

Across both hearings, TAFP consistently advanced three priorities: increasing price transparency, restoring competition through market reforms, and strengthening the primary care workforce. The Academy discussed practical policy solutions including site-neutral payment policies, limits on unnecessary facility fees, restrictions on anti-competitive contracting practices, prior authorization reform, streamlined credentialing, and support for innovative models such as direct primary care and subscription-based practices.

Underlying every recommendation was a simple but powerful message: family medicine remains the most effective and affordable entry point into the healthcare system, and strong primary care remains one of the best long-term strategies for improving health while controlling costs.

At the same time, TAFP continues to lead efforts to address Texas’ rural maternal health crisis. Alongside Texas A&M’s Rural and Community Health Institute, Texas Health Institute, and numerous partner organizations, the Academy co-convened the Rural Texas Maternal Health Rescue Plan, a statewide blueprint focused on rebuilding maternity care in rural communities. Recommendations include improving Medicaid reimbursement, expanding workforce pipelines, and supporting innovative models such as family medicine-obstetrics.

The evidence behind all this work has never been stronger. The Texas Health Institute and the Texas Primary Care Consortium recently released Primary Care in Texas: A System at a Crossroads — the most comprehensive statewide assessment of primary care’s structural condition in years. The report’s central conclusion is one that family physicians have long understood from the exam room: primary care in Texas is neither failing nor fully secure. It is indispensable and increasingly vulnerable — not for lack of effort or innovation, but because of a persistent misalignment between what primary care is expected to do and how it is financed, measured, and supported. These findings give lawmakers a clear, data-driven roadmap, and they give TAFP exactly the kind of evidence base needed to make the case for structural reform in 2027.

None of this progress happens through a single hearing or one legislative session. Meaningful reform requires years of education, relationship building, and persistent advocacy. Every committee hearing, every legislative meeting, and every physician who shares their experience helps policymakers better understand how decades of misaligned incentives have shaped today’s healthcare system — and how family medicine can help build a better one.

As we prepare for the 2027 legislative session, the opportunity before us is significant. Family physicians occupy a unique position in healthcare, seeing firsthand how rising costs affect patients, families, employers, and communities. By remaining engaged with TAFP’s advocacy efforts, you help ensure that those real-world experiences continue to shape the policies that will define the next chapter of healthcare reform in Texas.