Texas is trying to limit public money from going to abortion providers. Some fear other health services could get cut.

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Texas lawmakers' latest move to block public money from going to abortion providers and their affiliates is creating a murky picture for the future of women’s health care and some community health programs in Texas. That includes some services unrelated to abortion and reproductive health, like sharing information about sexual health on college campuses or helping local governments prevent disease outbreaks.

Senate Bill 22, which goes into effect Sept. 1, prohibits government entities from providing anything of value to an abortion clinic or an affiliate, even if the money isn’t explicitly for abortions or the clinic doesn’t perform the procedure. Proponents of the law authored by Sen. Donna Campbell, R-New Braunfels, say it’s an effort to protect taxpayers' funds from going to entities associated with abortions.

"Abortion providers unnaturally end the lives of almost 60,000 of our tiniest and vulnerable Texans every year,” Campbell said in a statement April 1. “That fact alone should make them ineligible to receive tax dollars.”

Campbell declined an interview through a spokesperson, but she said during the session that abortion providers should be cut off from all government subsidies.

But it’s not necessarily just tax dollars that the clinics are losing. The bill prohibits any “taxpayer resource transactions,” a term with such a broad definition that opponents fear they won’t be able to hand out condoms or conduct HIV tests on community college campuses.

“The most damaging aspect of this is the limbo that this creates for programs all over the state,” said Autumn Keiser, director of communications and marketing for Planned Parenthood of Greater Texas. “I think it’s going to be a process of a long period of time to continue to find the best ways to keep local communities healthy and safe.”

Campbell and other lawmakers say the state’s Healthy Texas Women program will fill any gaps left by abortion providers or affiliates after they lose local government assistance or partnership. But the success of that program has been questioned since it was launched in 2011, leaving many doubtful of its ability to bolster access to health services after this latest cut.

“That’s laughable,” Rep. Donna Howard, D-Austin, said when asked if the state-funded clinics would be effective in providing care to women.

The latest in years of cuts

Since 2011, the state has taken several steps to cut funding to abortion providers, actions that abortion rights groups say have already hurt community health. That year, state leaders decided to exclude abortion providers from receiving funds from the federal Medicaid women’s health program. In response, federal officials dropped Texas from the program, and the state began funding women’s health itself.

Also in 2011, the Legislature cut funding for family planning. Nearly 25% of Texas health clinics then closed, according to a 2014 study. The study also found that the number of organizations offering long-acting contraception, like intrauterine devices, fell from 71% to 46% the following year.

In June 2015, the state banned Planned Parenthood from participating in the Breast and Cervical Cancer Services program, stopping counties like Tarrant from providing $15,000 grants to Planned Parenthood of Greater Texas for cervical dysplasia services, a process that detects early cervical cancer. According to Tarrant County officials, that funding contract has since gone to North Texas Area Community Health Centers, which does not perform abortions.

But the new law cuts abortion providers and affiliates off from any governmental benefit. In South Texas, the law could mean the end of partnering with Planned Parenthood for public health services.

Mara Posada, director of public affairs at Planned Parenthood South Texas, pointed to an example from several years ago, when Cameron County partnered with Planned Parenthood to educate residents in hard-to-reach neighborhoods about the Zika virus.

During this year’s legislative session, Sen. José Rodríguez, D-El Paso, proposed an amendment to SB 22 that would have allowed municipalities to contract with Planned Parenthood to address public health crises like Zika, HIV and sexually transmitted disease outbreaks, but it was ultimately shot down.

“What we're the most concerned about is what impact this will have on any future work or future partnerships that we may want to have or that the local governments may need to do,” Posada said. “The public health concerns, we don't know what those are yet. We didn't know that the Zika virus was going to be such an issue, such a crisis when it was.”

El Paso doesn’t have any formal contracts with abortion providers, but until recently, it provided its newly reopened Planned Parenthood clinic with free condoms.

Since SB 22 was passed, the health department decided to halt that practice.

“There is absolutely no reason we should not be working together to fight STDs and community health problems,” said El Paso City Council member Alexsandra Annello.

Could college programs be at risk?

SB 22 could also impact public health programming on college campuses, where students are a historically underserved population.

After a 2018 study from the University of Texas found that nearly 70% of women at community colleges weren’t getting their preferred method of birth control, Planned Parenthood of Greater Texas started outreach on campuses across the state, Keiser said.

But it’s unclear whether that program, or any of Planned Parenthood’s many Texas student clubs, will be able to continue to operate under the new law.

“Will we still be able to come onto community college campuses, which ultimately is a health care need?” Keiser said. “It’s not necessarily financial, but it is still an exchange of resources and time between Planned Parenthood as a public partnership.”

Howard said she expects the legislation to impact college programming in more than a dozen counties.

“There are counties with pop-up clinics on community college campuses that provide HIV testing, that provide contraceptives and screenings,” Howard said. “And these are in jeopardy now, which is really disappointing.”

The main point of contention for bill advocates was a “sweetheart rent deal” between the city of Austin and an east side Planned Parenthood clinic. Last fall, the city renewed its $1-per-year rental contract with the organization for another 20 years.

While SB 22 won’t do anything to close the Austin clinic (the legislation doesn’t work retroactively), it will prevent other cities from penning similar deals with abortion clinics.

It’s good timing for abortion opponents, who are concerned about Planned Parenthood’s further expansion into West Texas.

“We believe they would love to have the financial help of a city or hospital district or county in West Texas,” said Joe Pojman, president of Texas Alliance for Life. “But that's not going to be possible now, because of SB 22.”

While abortion opponents say the bill is aimed at cutting off funding, they are also unsure about how the legislation could impact nonfinancial partnerships.

But they disagree with the notion that it will decrease access to contraception, cancer screenings and other health care provided by clinics that don’t perform abortions.

“It's crying wolf,” Pojman said. “Absolutely untrue.”

He and other abortion opponents say that any services lost by cutting off taxpayer funds to Planned Parenthood and others will be supplemented by providers in the state’s Healthy Texas Women program.

Healthy Texas Women was created to replace the Medicaid women’s health program, but some have questioned its effectiveness.

In fiscal year 2017, the program boasted 5,342 primary providers, which are medical offices that provide annual women’s health examinations and can prescribe contraceptive drugs and devices. But the Texas Observer found that nearly half of those providers saw zero patients in the program, and of the 2,900 who did see patients, 700 saw only one.

The most recent report from Texas Health and Human Services found that primary providers billing through the state-funded program had fallen to 2,161 in fiscal year 2018.

“So to think that we can continue to say we're going to meet this need with the Healthy Texas Women's program is really disingenuous at best,” Howard said.

Navigating a path forward

Howard is among several opponents who have taken issue with the broad language of the law, which they see as a potential legal tool for anyone who wants to target abortion clinics or their affiliates.

“It just provides multiple avenues for litigation,” Howard said. “Which seems to be what the real intention is here, to get things tied up in court, to keep eroding the ability of Planned Parenthood to provide services in communities.”

Clinics and educators will spend the next months trying to figure out a plan forward, so that they can continue to provide services to Texas women.

For communities like El Paso, which recently regained its Planned Parenthood clinic after nearly five years without it, the legislation feels like a major blow, Annello said.

“I just think this is an attack on women, an attack on our community, which is majority brown women, and on poor women,” she said. “It’s a step backwards in our health and our success.”

But Rebecca Parma, with Texas Right to Life, said the organization doesn’t want taxpayers to feel their conscience is being violated because the funds are going to an entity that provides abortions.

“Even if the funds are technically going to a Planned Parenthood to provide other services like certain treatments or contraception or tests, it's still going to an entity where those funds are fungible and can be used to benefit those abortion providers and their affiliates,” she said.

Correction: A previous version of this story misstated the political affiliation of state Rep. Donna Howard of Austin. She is a Democrat.

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