Ken Paxton, the Texas attorney general, sued in 2022 over federal guidance that hospitals must provide stabilizing abortion care in emergencies and won a ruling that kept it from being enforced in Texas; ProPublica has since identified pregnant Texas women who died without what experts said was appropriate emergency care. In 2024 he sued to stop the federal minimum-staffing rule for nursing homes, and a federal judge vacated it at his request in April 2025.
In July 2025 Paxton praised the One Big Beautiful Bill Act, which limits the payments Texas uses to fund hospital care and cuts federal Medicaid in rural Texas, where the Texas Hospital Association says many rural hospitals are already struggling to survive.
What It Cost: Texas Hospitals, Emergency Rooms and Nursing Homes Under Ken Paxton's Lawsuits and the Law He Praised
- Rural hospitals. The Texas Hospital Association reports that between 147 and 156 rural hospitals statewide are struggling to survive. Nearly 70% of Texas rural hospitals have cut services and 40% have closed their labor and delivery units, Texas Public Radio reported in October 2025.
- Hospital at risk. Public Citizen, a progressive watchdog group, lists Covenant Hospital Levelland among Texas hospitals at high risk of closing or cutting services under the law's Medicaid changes.
- Uninsured patients. KFF projects 480,000 more uninsured Texans in 2034 from the One Big Beautiful Bill Act alone.
- Emergency care. After Texas's abortion ban, the rate of sepsis shot up more than 50% for women hospitalized after losing a pregnancy in the second trimester, a 2025 ProPublica analysis found.
- Nursing home residents. Texas had 87,711 residents in certified nursing facilities in KFF's most recent count, the residents the staffing rule Paxton sued over was meant to protect.
Ken Paxton's Lawsuits Over Hospital Emergency Care and Nursing-Home Staffing, and the Hospital Cuts He Praised
- Paxton Won a 2022 Lawsuit That Kept Federal Emergency-Care Guidance for Pregnant Patients Out of Texas Hospitals. On July 14, 2022, Ken Paxton sued the Biden administration over guidance telling hospitals that federal emergency-care law protects doctors who perform an abortion to stabilize a patient, saying it would "transform every emergency room in the country into a walk-in abortion clinic." A federal judge sided with him in August 2022, and the Fifth Circuit affirmed the decision in January 2024; after Trump took office, his administration dropped the suit and rescinded the EMTALA guidance in June 2025. ProPublica has identified Tierra Walker and at least two other pregnant Texas women who died without what experts said was appropriate emergency care, among them Josseli Barnica, who waited 40 hours at a Houston hospital while losing her pregnancy and died days later of sepsis.
- Paxton Sued to End the Nursing-Home Staffing Rule in 2024, and the Law He Praised Bars It Until 2034. On August 14, 2024, Ken Paxton sued the Biden Administration to stop a new Centers for Medicare and Medicaid Services rule setting minimum staffing levels for nursing homes, and in April 2025 a federal judge granted Attorney General Paxton's request to vacate it. The rule would have required 3.48 hours per resident, per day of total nurse staffing. KFF found that only about 1 in 5 nursing facilities met the now-overturned minimum, and the Consumer Voice, an advocacy group for residents, says the rule was estimated to save 13,000 lives annually. The One Big Beautiful Bill Act, which Paxton praised in July 2025, then barred the federal health department from enforcing the rule through September 30, 2034.
- Paxton Praised a Law That Will Lower Payments to Texas Hospitals From 2028. Ken Paxton posted on July 1, 2025 that the Senate-passed bill was "One step closer to massive tax cuts," and on July 3, 2025 that "President Trump's Big Beautiful Bill is HISTORIC legislation." The law limits the provider taxes and state-directed payments that states use to fund hospital and nursing-home care, limits KFF counts as $340 billion of its federal Medicaid savings. Starting January 1, 2028, payment rates for hospital services will decrease in at least 37 states with directed payments that exceed the new limits, KFF found, and Texas hospital directed payments carry about $3.5 billion a year in federal spending above those limits.
- The Law Paxton Praised Cuts About $4 Billion From Rural Texas Medicaid. The law Ken Paxton praised created a $50 billion rural health fund that could offset a little over a third (37%) of the $137 billion it takes from rural Medicaid nationwide, by KFF's estimate. In rural Texas the ten-year cut is about $4.0 billion, and the administration limited states to using 15% of federal funding awarded for payments to providers such as hospitals.
Frequently Asked Questions About Ken Paxton on Texas hospitals and Medicaid
Does the rural health fund make up for the Big Beautiful Bill's Medicaid cuts in Texas?
No. Ken Paxton praised a law whose rural fund KFF says will not make up the difference: "these funds will not offset reductions in federal Medicaid support." Texas received $281 million in the fund's first year, and its award per rural resident is the lowest of any state, with awards ranging from $66 (Texas) to $6,305 (Rhode Island).
Did Ken Paxton sue to stop nursing home staffing requirements?
Yes. Ken Paxton sued in August 2024 to stop the federal rule that set minimum nurse and aide staffing in nursing homes that take Medicare and Medicaid, and a federal judge in Texas vacated the rule in April 2025. His office's announcement said the rule "could force rural nursing homes to shut down"; KFF found most homes did not meet the standard the rule set.
What did Ken Paxton's emergency abortion lawsuit mean for Texas hospitals?
Ken Paxton's 2022 win kept federal emergency-care guidance from being enforced in Texas hospitals, and ProPublica reported that it also gave Idaho's ban "a lifeline" in court. Once Idaho could enforce its ban, St. Luke's, Idaho's largest hospital system, said it had to airlift six patients out of the state for abortions in three months.
Last updated: 2026-10-25