Texas Abortion Providers Get A Win, But The Damage May Be Done

Last year, Planned Parenthood of Greater Texas opened an ambulatory surgery center inside its new administrative building in Fort Worth that would adhere to the strict abortion requirements established by House Bill 2, a piece of state legislation that mandated that the procedure only be offered in these hospital-lite outpatient facilities. It also required that providers have admitting privileges at a hospital within 30 miles.

The Greater Texas chapter, which includes Planned Parenthoods in Central and North Texas, opened the center partly as a safeguard in case the Supreme Court upheld the law. But on Monday, the high court struck it down in a 5 to 3 vote, increasing the likelihood that similar laws it parented in other states—Louisiana, Wisconsin, Alabama, Oklahoma, Kansas—will also lose their teeth.

“I believe in pessimism because you’re never disappointed,” said Kelly Hart, the organization’s senior director of government relations and public policy. “For Planned Parenthood of Greater Texas, we have three facilities that perform abortions that were fully compliant. We were prepared to weather the storm regardless of how it went.”

And two of those came in the wake of the law. In addition to the Fort Worth facility, Planned Parenthood purchased an ambulatory surgery center in South Dallas in 2014 and began offering abortions there. These are capital-intensive operations; after HB2’s enactment in September 2014, more than half of the state’s 41 abortion clinics shuttered as either a result of a lack of money for the surgery center upgrades or because there was not a hospital within 30 miles. Had the law stuck, the number left open would’ve plunged further—no more than eight total, all in the big cities: one in Austin, two in Dallas, one in Fort Worth, two in Houston and one or possibly two in San Antonio.

But Hart notes that, in some ways, the damage has been done. It’s now been three years since the law was enacted. It’s wrecked the organization’s infrastructure for facilities that provide abortions. Clinics have lost their leases and many staffers have left for other jobs. And should Planned Parenthood and its ilk choose to reopen the shuttered facilities, they’ll have to undergo the relicensing process. Little is immediate beyond the abrupt halting of the state’s mandates. As such, Hart says, the organization’s executives are still parsing the law. When reached by phone Monday morning, Hart herself hadn’t had a chance to read the full ruling. But this line was particularly striking to her: “In the face of no threat to women’s health, Texas seeks to force women to travel long distances to get abortion in crammed-to-capacity superfacilities.”

“The vast majority (of abortion clinics) are east of Interstate 35. We’ve maintained that your ability to access any type of healthcare should not depend on your ZIP code,” she said. “While we’re super thrilled the court has recognized the rights and dignity of women, it doesn’t change the fact that far too many women are still left without the availability for care.”

HB2 came just two years after the Legislature gutted funding for Planned Parenthood, booting it out of the state’s program for women’s health. The closures began in earnest in 2011, well before the abortion law, as many struggled to have the funds to keep the doors open. More than 80 clinics shuttered. Planned Parenthood and other women’s health providers were already staggering when the punch from HB2 connected.

The independent abortion provider Whole Woman’s Health brought the suit that climbed to the high court. And its CEO, Amy Hagstrom Miller, has said that it will certainly take time to reopen the clinics, and even that is not guaranteed. As The Texas Observer reported, Miller said during a call Monday that “We have the go-ahead to open clinics, but the process to actually undertake that is going to take some time.”

“This win doesn’t mean the struggle is over,” she wrote in a blog post after the ruling. “First, clinics don’t reopen overnight. We have a daunting task ahead of us to determine whether and how we can reopen our health centers that were forced to shut their doors over the past several years. Renewing leases, hiring staff, and working with communities that we previously served to help us re-open for care.”

Also interesting: In addition to finding that the law would put an “undue burden” on women outside the state’s urban centers seeking an abortion, the ruling also puts the onus on states to prove the claims it makes in defending new restrictions that purportedly improve the health and safety of a set of patients. In Justice Stephen Breyer’s majority opinion, he writes “we have found nothing in Texas’ record evidence that shows that, compared to prior law (which required a “working arrangement” with a doctor with admitting privileges), the new law advanced Texas’ legitimate interest in protecting women’s health.”

Nevertheless, Texas lawmakers are already pledging to pursue anti-abortion legislation in the next session. Rep. Jonathan Stickland, R-Bedford, told The Texas Tribune he expects “an absolute onslaught of pro-life legislation.” Lt. Gov. Dan Patrick tweeted that he “will remain committed to protecting women’s health and safety,” elaborating on Facebook “that the Texas Senate will continue to work to protect women’s health in the next legislative session.”

Attorney General Ken Paxton, meanwhile, called the decision “exceedingly unfortunate.”

Posted in Hospitals, News, Public Health.