The law [HB 2] requires that abortions—though not vasectomies—be performed in ambulatory surgical centers, hospital-like facilities that specialize in outpatient surgery. This provision goes into effect on September 1.
Ahead of this deadline, women's health care providers have raced to meet HB 2's burdensome requirements, spending millions of dollars and countless hours of fundraising and construction labor. Converting a medical facility into a full-blown ambulatory surgical facility can be very expensive. Texas has 114 pages of regulations governing ASCs, which mandate wide, gurney-accommodating hallways, larger operating rooms, and sterile ventilation. According to one Texas provider, it will cost them about $40,000 more each month to operate an ASC than it would a regular clinic.
Texas law has required all second-trimester abortions be performed in ASCs since 2003.
But most abortions by far are performed in the first trimester.
Many clinics closed their doors in the six months after HB 2 was signed because of other provisions in the law, especially one requiring that doctors performing abortions be required to have what physicians' organizations say are entirely unnecessary admitting privileges at nearby hospitals. Advocates of the provision say it was passed to ensure women's health and safety. But they engineered this specifically to shutter abortion clinics.
Texas isn't the only state where admitting privileges have been enacted, but so far it's the only one where the federal courts—in this case a panel of the Fifth Circuit Court of Appeals—has ruled in favor of the admitting privileges provisions. In Mississippi, a different panel of the Fifth Circuit Court ruled that the admitting privileges mandate there violated U.S. Supreme Court decisions barring undue burdens on women obtaining abortions because it would close down the state's only remaining clinic providing them. In Alabama, Wisconsin, and North Dakota, judges have also blocked such laws, at least temporarily. One of these is almost certain to wind up ruled on by the Supreme Court soon.
As with the admitting privileges laws, opponents of abortion clinics being required to outfit themselves as ambulatory surgical centers have included several physicians' organizations, including the American College of Obstetricians and Gynecologists. They have pointed out ASCs do not improve the level of abortion care and that doctors' offices provide all that is necessary to perform the procedure safely. That, of course, makes no nevermind to the forced birthers because ensuring abortions are safe isn't their objective.
As a consequence of the law, several groups have sought to raise money to build or buy ASCs. Planned Parenthood just opened a new, $6.1 million ASC in Dallas. It also plans to build another in San Antonio, the two eventually costing $13 million altogether. The Texas Women's Reproductive Health Initiative hopes to build two ASCs. But it is still trying to raise money.
Besides seeking funds for ASCs, groups are raising money to cover the costs of travel and accommodations for women who live more than 200 miles from the few clinics performing abortions that still are in operation. Since the state legislature chopped the state's family planning budget by two-thirds three years ago, they've also had to find tens of millions of dollars to subsidize preventive care for women (including annual exams, testing for sexually transmitted infections and cervical cancer screenings) for low-income women.
As always, affluent Texans seeking a legal abortion will find a way to get one inside or outside the state. While all women suffer from laws such as those passed in Texas, restrictions dating back to the first Hyde Amendment in 1977 that bars most Medicaid abortions have always contained a strong element of class war. Poor women get hurt the worst. That, too, makes no nevermind to the zealots who seek to impose their controls on them.