A Texas bill to clarify exceptions to the state's abortion ban clears a key hurdle after rocky path

AUSTIN, Texas — Texas lawmakers advanced a bill Wednesday to clarify medical exceptions under one of the most restrictive abortion bans in the U.S., putting the GOP-backed proposal on the brink of reaching Republican Gov. Greg Abbott's desk.

The changes would not expand abortion access in Texas or list specific medical exceptions under the state's near-total ban, which took effect in 2022 and only allows for an abortion to save the life of the mother. It also would not include exceptions for cases of rape or incest.

But the proposal is still a pivot for Texas Republicans, who for years have defended the ban as written in the face of legal challenges and pleas for clarity from medical providers. Democrats, meanwhile, have called the bill a positive step but also faced criticism from some abortion-rights allies who raised doubts about what, if any, impact it will have.

The bill passed 129-6 and needs only a final procedural vote before reaching Abbott, who has signaled support for the measure. Lawmakers debated for nearly an hour as Republican state Rep. Charlie Geren, a co-author of the bill, fielded questions from several conservative legislators who expressed concerns that it would expand abortion access.

"We do not want women to die of medical emergencies during their pregnancies,'' Geren said.

The bill would specify that doctors cannot face criminal charges for performing an abortion in a medical emergency that causes major bodily impairment. It also defines a ''life-threatening'' condition as one capable of causing death.

Similar near-total abortion bans across the country have faced numerous legal challenges and criticism from medical professionals who have said that medical exceptions are too vague.

Moves to clarify medical exceptions

Lawmakers in at least nine states with abortion bans have sought to change or clarify medical exceptions that allow doctors to perform an abortion if the mother's life is at risk since Roe v. Wade was overturned in 2022, according to the Guttmacher Institute, a research organization that supports abortion rights.

Supporters of these bills have said they have the potential to save lives. Critics, including some abortion rights groups, have questioned whether they make state abortion laws easier to understand.

In Kentucky, Democratic Gov. Andy Beshear earlier this year vetoed a bill that GOP lawmakers touted as bringing clarity to that state's near-total abortion ban, saying it would not protect pregnant women. Republican lawmakers later overrode his veto.

Last year, South Dakota released a video for physicians that outlined examples of acceptable medical emergencies that received criticism from abortion rights supporters for not being specific enough.

''I think these bills are trying to get at the reality that exceptions are really hard to comply with," said Kimya Forouzan, principal state policy adviser at the Guttmacher Institute.

Still, Texas Republican Sen. Bryan Hughes, an architect of the state's abortion ban, said the new bill's goal is to avoid confusion among doctors.

''One of the most important things we want to do is to make sure that doctors and hospitals and the hospital lawyers are trained on what the law is,'' Hughes said.

Navigating exceptions under bans

In 2024, the Texas Supreme Court ruled against a group of women who say they were denied an abortion after experiencing serious pregnancy complications that threatened their lives and fertility. The court ruled that the state's laws were clear in allowing doctors to perform an abortion to save the life of the mother.

Dr. Austin Dennard, a Dallas OB-GYN, was part of the lawsuit and testified how the state's near-total ban put her health at risk after her fetus was diagnosed with a fatal condition. She eventually left Texas for an abortion.

Dennard's feelings are mixed about the bill, which does not list specific medical conditions or include fatal fetal anomalies as exceptions.

''What is broadly now known among practicing physicians in Texas is that abortions are illegal,'' said Dennard. ''Undoing that broad understanding is going to be difficult.''

Texas' efforts underscore the challenges abortion opponents have had to navigate regarding medical exceptions, said Mary Ziegler, a professor at the University of California, Davis School of Law and a historian of abortion politics in the U.S.

Judges have put enforcement of Utah's abortion ban on hold in a case over exceptions, for example, and they struck down two Oklahoma bans over medical exceptions – though most abortions in that state remain illegal.

For abortion opponents, Ziegler said, it's tricky to craft legislation that does two different things.

''Can you provide clear guidance as to when medical intervention is justified without providing physicians discretion to provide abortions they don't think are emergencies?'' Ziegler said.

Texas may advance other anti-abortion laws

Texas' ban prohibits nearly all abortions, except to save the life of the mother, and doctors can be fined up to $100,000 and face up to 99 years in prison if convicted of performing an abortion illegally.

On Wednesday, the House passed a bill that prohibits Texas municipalities from providing individuals resources to access an abortion outside of the state.

Texas Republicans are also advancing efforts to make it a civil offense to mail, deliver or manufacture abortion pills, expanding on a 2021 law that allows private individuals to sue others whom they suspect are helping a woman obtain an abortion.

Attorney General Ken Paxton's office has filed criminal charges against a midwife for allegedly providing illegal abortions and is also suing a New York doctor for prescribing abortion pills to a Texas woman.

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Associated Press writer Geoff Mulvihill in Cherry Hill, New Jersey, contributed to this report.

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Lathan is a corps member for The Associated Press/Report for America Statehouse News Initiative. Report for America is a nonprofit national service program that places journalists in local newsrooms to report on undercovered issues.