How Republicans Won the Fight Over Abortion in Texas

Tough state restrictions will likely have the state down to its final six abortion clinics by September.

Texas State Sen. Wendy David (D) speaks at the National Press Club August 5, 2013 in Washington, DC.
National Journal
Sophie Novack
March 5, 2014, 8 p.m.

Two abor­tion clin­ics in Texas are clos­ing, bring­ing the state’s total down to 20 as abor­tion pro­viders struggle to stay open un­der new state laws.

The two clin­ics — loc­ated in Mc­Al­len and Beau­mont — are the last re­main­ing pro­viders in rur­al areas. Those that re­main are clustered in ma­jor cit­ies, leav­ing low-in­come wo­men in rur­al Texas without nearby ac­cess to abor­tion.

More clos­ures are likely to fol­low: Un­der House Bill 2, an an­ti­abor­tion bill passed last Novem­ber, all clin­ics are re­quired to close by Sept. 1, 2014, un­less they have on-site am­bu­lat­ory sur­gic­al cen­ters. Of the 20 re­main­ing clin­ics, only six meet that stand­ard and are likely to re­main open.

There were 44 abor­tion clin­ics in Texas in 2011.

House Bill 2 — the most re­strict­ive in a re­cent wave of state-level an­ti­abor­tion laws — gained na­tion­al at­ten­tion last sum­mer when Demo­crat­ic state Sen. Wendy Dav­is fili­bustered the bill for 11 hours. It nev­er­the­less passed the Le­gis­lature shortly after dur­ing a second spe­cial ses­sion called by Re­pub­lic­an Gov. Rick Perry in Ju­ly 2013.

Along with the sur­gic­al-cen­ter clin­ic re­quire­ment, the bill bans abor­tions after 20 weeks; bans med­ic­al abor­tions after sev­en weeks and re­quires wo­men to vis­it the clin­ic four sep­ar­ate times to com­plete the pro­ced­ure (one vis­it for a sono­gram, a second and third for doses of a drug, and a fourth for a fol­low-up); and re­quires all phys­i­cians con­duct­ing the pro­ced­ure to have hos­pit­al ad­mit­ting priv­ileges with­in a 30 mile ra­di­us.

The first three pro­vi­sions went in­to ef­fect Nov. 1, for­cing a wave of clin­ics to close im­me­di­ately. The sur­gic­al-cen­ter re­quire­ment will go in­to ef­fect Sept. 1.

The two clin­ics whose clos­ings were an­nounced this week are op­er­ated by Whole Wo­man’s Health. Mc­Al­len stopped provid­ing abor­tions in Novem­ber when the bill went in­to ef­fect, while Beau­mont ceased pro­ced­ures a week and a half ago. Both have tech­nic­ally re­mained open while the own­er tried to find a solu­tion.

Com­pany CEO Amy Hag­strom Miller says the med­ic­al-abor­tion lim­it­a­tion has been the hard­est part of the law for pa­tients, but ad­mit­ting priv­ileges and ASC re­quire­ments have been most dif­fi­cult for clin­ics.

“I’ve been a little more stub­born or a little more stu­pid,” she told Na­tion­al Journ­al. “I’ve tried to keep them open and lost a lot money.”

Neither clin­ic has an ASC, and Hag­strom Miller says she doesn’t have the budget or pa­tients to build a mul­ti­mil­lion-dol­lar cen­ter. The Beau­mont clin­ic does cur­rently have a phys­i­cian that has hos­pit­al ad­mit­ting priv­ileges, but he is 75 years old and try­ing to re­tire. At­tempt­ing to get hos­pit­al ad­mit­ting priv­ileges has proven a fruit­less pro­cess; the stigma against abor­tion is too great in Texas, and Hag­strom Miller has not been able to get re­sponses from any doc­tors or hos­pit­als, des­pite call­ing them all. 

“I have trouble get­ting a vendor for bottled wa­ter,” she says.

Both Beau­mont and Mc­Al­len are bor­der com­munit­ies with pre­dom­in­antly low-in­come res­id­ents. Ac­cord­ing to data from Whole Wo­man’s Health, 22 per­cent of the Beau­mont pop­u­la­tion is be­low the fed­er­al poverty level. Pa­tients at this clin­ic are 40 per­cent Afric­an-Amer­ic­an, largely single and un­in­sured, and between 19 and 35 years old. The fa­cil­ity sees 1,200 pa­tients each year.

In the Mc­Al­len com­munity, just over 27 per­cent of res­id­ents are be­low the poverty level, and only 15 per­cent have in­sur­ance. Clin­ic pa­tients are largely His­pan­ic, mar­ried, un­in­sured, and about 30 years of age. The clin­ic sees 1,700 pa­tients an­nu­ally.

Beau­mont is the only abor­tion fa­cil­ity between Hou­s­ton and New Or­leans. The next closest is in Hou­s­ton, which is 90 miles away.

Mc­Al­len is cur­rently the only abor­tion pro­vider re­main­ing in the Rio Grande Val­ley. The closest al­tern­at­ive is in Cor­pus Christi, 150 miles away, but this clin­ic lacks an ASC, and faces clos­ure in Septem­ber. The next closest is in San Ant­o­nio, which is 230 miles away.

The dif­fi­culty in trav­el­ling these dis­tances — an im­possib­il­ity for many wo­men who lack the fund­ing to do so — is com­poun­ded by the fact that Texas law re­quires mul­tiple vis­its for a single pro­ced­ure. A 2011 law re­quires wo­men to see the doc­tor twice — first for an ul­tra­sound, and again for the abor­tion. This dis­pro­por­tion­ately af­fects rur­al clin­ics, which of­ten fly in phys­i­cians who don’t live in the area. For some wo­men in these areas, need­ing to cross the bor­der adds an ad­di­tion­al obstacle.

Hag­strom Miller says wo­men who have the means to travel will, but wo­men who don’t will try to find oth­er ways to ter­min­ate their preg­nancy.

“The law didn’t do any­thing to pre­vent need,” she says. “Un­der any kind of pro­hib­i­tion like this, you’ll see clandes­tine op­er­a­tions come up — the need is still there.”

Ad­voc­ates of H.B.2 main­tain it is be­ne­fi­cial to wo­men’s health, by hold­ing pro­viders to high­er stand­ards. “This is an im­port­ant day for those who sup­port life and for those who sup­port the health of Texas wo­men,” Perry said upon sign­ing the bill in­to law.

Op­pon­ents ar­gue it is purely polit­ic­al. A law­suit filed by Planned Par­ent­hood, the Amer­ic­an Civil Liber­ties Uni­on, the Cen­ter for Re­pro­duct­ive Rights, and a Texas law firm chal­lenged the ad­mit­ting priv­ileges pro­vi­sion of the law, say­ing it re­stricts ac­cess and en­dangers wo­men’s health. Whole Wo­man’s Health is in­volved in the law­suit. An in­junc­tion was ori­gin­ally gran­ted that would stop the pro­vi­sion from go­ing in­to ef­fect, but it was ap­pealed by the state. The case is cur­rently held in the 5th Cir­cuit Court, with a rul­ing ex­pec­ted any day.

However, even if law­suits against the bill are suc­cess­ful, it could be very dif­fi­cult to re­open clin­ics once they have already been closed.

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