His allies say he protects women and children. His record on their health care says otherwise.
He sued to strike down the Affordable Care Act, fought a woman’s court-approved abortion, voted against children’s CHIP coverage, and his office offered one day in jail in a child sex-abuse case.
An outside group backing Paxton claims he protects women and children, pointing to a sex-trafficking prosecution.
Source: Television ad, Sept. 2026 · The Texas TribuneWhat the record shows
Paxton led the multistate lawsuit to strike down the entire Affordable Care Act, including its protections for pre-existing conditions and its maternity coverage requirements; the U.S. Supreme Court dismissed it in 2021. 08 09 In 2023 he went to court to stop a pregnant woman’s court-approved abortion after her fetus was diagnosed with a fatal condition, and he won a case blocking federal guidance on emergency-room abortions in Texas. 02 03 04
In September 2026, with about $10 billion in Medicaid payments to Texas hospitals withheld and hospitals warning that maternity wards and newborn intensive care units were at risk, Paxton said nothing, though he had sued the Biden administration over a similar threat in 2023. 10
In a child sex-abuse case his office took over, the defendant pleaded to misdemeanors after a hung jury. An appeals court found the evidence did not reasonably support his office’s case for closing a midwife’s clinics. 01 06
As a state legislator, he voted against the 2007 bill restoring 12-month CHIP eligibility for children, against the 2009 CHIP buy-in bill, for 2011 budget amendments moving money out of family planning, for the 2011 budget that cut state family-planning funding by $73.6 million, and against the 2013 state equal-pay bill. The votes are listed below with journal citations.
The record behind this
- Supreme Court throws out Paxton’s suit to strike down the Affordable Care Act
Texas led states arguing the entire law was invalid. A federal judge agreed in 2018; the Supreme Court ruled 7–2 that the plaintiffs lacked standing, leaving the law in place.
- Paxton threatens hospitals to stop Kate Cox’s court-approved abortion
A judge had ruled that Cox, whose fetus had a fatal condition, could end her pregnancy. The Texas Supreme Court paused the order and later ruled against her; she left the state for the procedure.
- Paxton’s office charges a midwife under the abortion ban
Midwife Maria Rojas and an employee were charged with illegal performance of an abortion. The charges are pending.
- New York court rejects Paxton’s bid to punish an out-of-state doctor
The judge ruled the doctor’s services were protected by New York’s shield law.
- Court finds Paxton’s evidence didn’t support closing the midwife’s clinics
The court found the evidence did “not reasonably support” the claim that abortions were performed there, noting reliance on an anonymous email.
- Paxton investigates the nation’s pediatricians over childhood vaccines during a measles outbreak
The American Academy of Pediatrics said its recommendations are rooted in decades of science and noted more than 750 measles cases in Texas. His office has announced no findings.
- Paxton silent as $10 billion in Texas hospital Medicaid payments is withheld
Hospitals warned that newborn intensive care units and maternity wards are at risk. Paxton sued the Biden administration over a similar threat in 2023, but has not sued or commented on the Trump administration’s action.
- Family of a pregnant woman who died sues Paxton, blaming the abortion ban he enforces
Tierra Walker, 37, was 20 weeks pregnant when she died of preeclampsia in December 2024. Her family says she asked for an abortion and was refused. These are allegations; no court has ruled.
The votes behind this
- Voted against restoring 12-month CHIP health coverage for childrenHB 109: Restoring 12-month CHIP eligibility and outreach. Passed House 128–17; he also voted against the final version, adopted 134–14. Became law.
- Voted against letting families buy CHIP coverage for their childrenHB 2962: CHIP eligibility changes and a CHIP “buy-in” option. Passed House 87–55; died in the Senate.
- Voted twice to move money out of family-planning servicesHB 1, Amendments 49 and 54: Budget amendments moving money out of family planning. Both adopted (96–6 and 104–37).
- Voted for the budget that cut state family-planning funding by $73.6 millionHB 1: General Appropriations Act, 2012–13 state budget. Passed; conference report adopted 97–53.
- Voted to bar clinics affiliated with abortion providers from the Women’s Health ProgramSB 7: Health and human services omnibus, including Women’s Health Program restrictions. Passed; conference report adopted 96–48.
- Voted against the Texas equal-pay billHB 950: State equal-pay bill (filing deadline for pay-discrimination claims). Passed Senate 16–15; vetoed by Gov. Rick Perry.
Response
His office said it would appeal the midwife-clinic ruling to the Texas Supreme Court. 06 In the Waco case, prosecutors said the child wanted to move on. 01
Sources
- 01Inside Ken Paxton’s plea deal for a child sex abuse caseThe Texas Tribune · May 19, 2026
- 02Texas Supreme Court temporarily halts ruling allowing Dallas woman to get an abortionThe Texas Tribune · Dec. 8, 2023
- 03Texas Supreme Court blocks order allowing abortion; woman who sought it leaves stateThe Texas Tribune · Dec. 11, 2023
- 04Supreme Court declines to hear Biden appeal in Texas emergency room abortion disputeNBC News · Oct. 7, 2024
- 05Houston-area midwife arrested for allegedly performing illegal abortionsThe Texas Tribune · March 17, 2025
- 06Ruling overturns closure of Texas midwife’s clinicsThe Texas Tribune · July 23, 2026
- 07New York tosses Ken Paxton challenge in abortion pills caseThe Texas Tribune · Oct. 31, 2025
- 08California v. Texas, No. 19-840 (opinion)Supreme Court of the United States · June 17, 2021
- 09What is the California v. Texas lawsuit?healthinsurance.org · June 17, 2021
- 10Ken Paxton quiet about Texas’ $10B Medicaid cutThe Texas Tribune · Sept. 4, 2026
- 11Lawsuit blames Texas abortion ban for San Antonio woman’s deathThe Texas Tribune · Sept. 16, 2026
- 12Texas AG Ken Paxton investigates American Academy of Pediatrics over childhood vaccine recommendationsKPRC 2 (Click2Houston) · Aug. 5, 2026