According to the Legislative Budget Board (LBB), the fiscal implications of SB 2695 are currently indeterminate due to a lack of available data regarding the number of students who would participate in the newly established Rural Admission Medical Program (RAMP). The bill requires public medical schools and other institutions of higher education to provide scholarships, stipends, faculty support, academic counseling, and program-specific administration, but without clear enrollment projections or cost thresholds, estimating a total program cost is not possible at this time.

However, a more concrete estimate was provided regarding the administration of the rural Advanced Practice Registered Nurse (APRN) delegation provisions of the bill. The Texas Medical Board (TMB) anticipates needing one additional full-time Program Specialist to support delegation agreement facilitation, data collection, and program evaluation. The total estimated cost to TMB for fiscal year 2026 is $111,516, with ongoing annual costs of approximately $101,516 thereafter. This includes salary, benefits, operational expenses, and a one-time technology cost of $10,000 for reporting functionality.

Importantly, under current law, the TMB is required to generate sufficient fee revenue to offset its appropriation and related costs. Therefore, despite the additional expenditures, no net fiscal impact to the state general revenue fund is anticipated from TMB's role in the bill. Similarly, the Legislative Budget Board projects no fiscal impact to local governments as a result of implementing the provisions in SB 2695.

SB 2695, also known as the Texas Critically Underserved Relief and Enhancement (CURE) Act, is a multifaceted proposal intended to address a significant public need: the shortage of healthcare providers in rural Texas counties. It does so by establishing two major programs. First, the bill creates the Rural Admission Medical Program (RAMP), a new state-managed educational pathway that offers scholarships, summer stipends, and guaranteed admission support to qualified students from rural counties. Second, it reforms the delegation framework governing advanced practice registered nurses (APRNs), eliminating supervisory fees and increasing delegation flexibility in rural areas.

While the overall policy goal—expanding access to healthcare in underserved communities—is worthwhile, the mechanism for achieving it raises serious structural concerns. Chief among them is the establishment of RAMP, a government-run scholarship and stipend program that would be funded through legislative appropriations and administered by a newly formed council with broad authority. This expansion increases the scope and function of state government by adding a new bureaucratic layer within higher education and medical training. It also initiates an indeterminate but potentially growing fiscal obligation for the state. According to the Legislative Budget Board, the cost of implementing and sustaining the RAMP program cannot be reliably estimated due to unknown participation levels and required institutional support.

This structure runs contrary to core limited-government principles. It uses taxpayer resources to subsidize the education of select individuals, imposes coordination obligations on public and private universities, and establishes a centralized selection and placement mechanism. These functions, while well-intentioned, exceed the appropriate scope of state involvement in workforce development. The existence of private scholarships, rural residency incentives, and nonprofit-supported pipeline programs suggests that similar outcomes could be achieved through voluntary, market-aligned initiatives, without long-term public funding commitments or administrative growth.

In contrast, the provisions addressing APRN delegation are directionally sound. They reduce regulatory barriers, enhance professional autonomy, and remove cost impediments that disproportionately affect rural service providers. These elements are consistent with the principles of deregulation, local autonomy, and market-based solutions. They directly expand the capacity for rural health delivery without increasing the size of government or the tax burden. They also place supervisory flexibility in the hands of physicians and nurses while retaining accountability through the Texas Medical Board’s oversight structure.

Because the bill combines overreach in one area with strong reforms in another, Texas Policy Research recommends that lawmakers vote NO on SB 2695 unless amended. In its current form, the bill expands government authority and spending through a publicly funded scholarship system that is difficult to scale or justify on constitutional, fiscal, or philosophical grounds. However, with amendments to remove or restructure the RAMP program—ideally shifting it toward a privately funded or hybrid model—the bill could become a strong example of effective, liberty-consistent policy aimed at improving rural healthcare access.

Until such amendments are adopted, the bill should not advance. A more restrained and focused version that maintains the APRN reforms and replaces RAMP with non-state-funded alternatives would merit a reevaluation.

• Individual Liberty: The bill expands individual opportunity for rural students and healthcare providers by opening new pathways to medical education and enabling APRNs to practice more freely in underserved areas. However, this increased liberty is delivered through government-directed programs, limiting true freedom of choice by tying benefits to bureaucratic structures and taxpayer funding. The net effect is targeted liberty for some, facilitated by broader state intervention.
• Personal Responsibility: The bill sets clear academic and professional expectations for student participants and rural APRNs, encouraging responsible behavior and performance. Yet, by subsidizing education through public scholarships and stipends, it shifts some of the personal cost and accountability onto taxpayers. This potentially undermines the incentive for individuals to seek private-sector or merit-based alternatives to achieve similar outcomes.
• Free Enterprise: By lifting restrictive regulations on APRNs, such as supervisory caps and delegation fees—the bill improves flexibility and efficiency in rural healthcare markets. These reforms support competition and reduce government interference in professional practice. However, the government-funded RAMP program distorts the education market by using public funds to influence admissions and career placement decisions that would otherwise be determined by supply, demand, and individual merit.
• Private Property Rights: The bill does not create any new restrictions or protections regarding property rights. It neither infringes upon nor enhances the ability of individuals or institutions to own, use, or control property. This principle is unaffected by the legislation.
• Limited Government: The bill expands the role of the state by creating a new administrative council, directing public universities to enter formal agreements, and authorizing taxpayer-funded medical scholarships and stipends. It also adds responsibilities to the Texas Medical Board, including oversight, data collection, and potential contracting with physicians. While some elements streamline regulation, the bill overall increases the scope and function of government, contrary to the principle of minimal state intervention.