PPOs may come under more regulatory scrutiny from the Texas Department of Insurance. Proposals being floated would require PPOs operating in Texas to have a certificate of authority and allow the TDI to act against plans engaging in illegal practices. HMOs are more highly regulated in Texas than PPOs, but PPOs make up a much larger part of the market. At the same time, Texas physicians are lobbying for tighter regulations of so-called "silent" PPOs that sell, resell or lease physician contracts without physician authorization.
Texas' first 3-share plan became active July 1, extending health benefits to small businesses in Galveston County. Under the 3-share model, employers, employees and an outside source such as an endowment or local government share the cost of health plan premiums. On the IT front, one-third of physicians responding to a Texas Medical Association survey in 2007 said they use electronic medical records, up from 27 percent in 2005.