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Even After Their Court Victory, Texas Abortion Clinics Face A Long Road To Rebuilding And Reopening

Abortion rights activists, from left, Ravina Daphtary of Philadelphia, Morgan Hopkins of Boston, and Alison Turkos of New York City, rejoice in front of the Supreme Court in Washington, Monday, June 27, 2016, as the justices struck down the strict Texas anti-abortion restriction law known as HB2. Other cases are to follow on guns, and public corruption. (AP Photo/J. Scott Applewhite)
Abortion rights activists, from left, Ravina Daphtary of Philadelphia, Morgan Hopkins of Boston, and Alison Turkos of New York City, rejoice in front of the Supreme Court in Washington, Monday, June 27, 2016, as the justices struck down the strict Texas anti-abortion restriction law known as HB2. Other cases are to follow on guns, and public corruption. (AP Photo/J. Scott Applewhite)

What will it take to rebuild Texas’ reproductive heath care infrastructure?

It’s a question that’s very much on the minds of abortion providers and reproductive health advocates as they consider how to move forward following last week’s landmark Supreme Court ruling on abortion. The decision struck down two key provisions of HB 2, a sweeping anti-abortion law that threatened to reduce the number of abortion clinics in Texas to about nine.

While the court’s ruling prevented the number of Texas’ abortion clinics from shrinking to the single digits, providers caution that it won’t be easy –- or cheap –- to restore the full scope of abortion access that existed before the law went into effect.

“That rebuilding is not something that is going to happen overnight,” Amy Hagstrom Miller, the lead plaintiff in the case and president of one of the state’s largest abortion providers, Whole Woman’s Health, told ThinkProgress. The legislation caused two of Whole Women’s Health five Texas clinics to shut down, and Hagstrom Miller expects that reopening the remaining clinics will be expensive. “A lot of us have gone through a lot of disruption over the last three years and we don’t necessarily have the resources to say boom! I’m going to reopen tomorrow,” she noted.

Amy Hagstrom Miller, founder of Whole Woman’s Health, a Texas women’s health clinic that provides abortions, rejoices as she leaves the Supreme Court in Washington, Monday, June 27, 2016, as the justices struck down the strict Texas anti-abortion restriction law known as HB2. The justices voted 5–3 in favor of Texas clinics that had argued the regulations were a thinly veiled attempt to make it harder for women to get an abortion in the nation’s second-most populous state. The case is Whole Woman’s Health v. Hellerstedt. (AP Photo/J. Scott Applewhite)
Amy Hagstrom Miller, founder of Whole Woman’s Health, a Texas women’s health clinic that provides abortions, rejoices as she leaves the Supreme Court in Washington, Monday, June 27, 2016, as the justices struck down the strict Texas anti-abortion restriction law known as HB2. The justices voted 5–3 in favor of Texas clinics that had argued the regulations were a thinly veiled attempt to make it harder for women to get an abortion in the nation’s second-most populous state. The case is Whole Woman’s Health v. Hellerstedt. (AP Photo/J. Scott Applewhite)

The shuttered clinics will likely have to navigate a series of logistical and financial hurdles before they are able to reopen their doors. Many of the clinics that shut down after the bill was signed have since sold their buildings or let go of their leases in the spaces they operated in. The clinics that closed will also have to reapply for licenses from the state to perform abortions, hire staff, raise money for new medicine, medical supplies and equipment, and obtain liability and malpractice insurance. Moreover, the process of applying for an abortion license from the state could be a tedious one; it took nearly a year for the Reproductive Services clinic in El Paso to earn a new license from the state after it was allowed to reopen by court order.

In total, the rebuilding process could cost clinics up to $200,000, Hagstrom Miller estimated.

“And that’s not including purchasing the property,” she explained. “If you decide you want to buy the building or you have to pay a year’s lease up front, 200,000 is just the ballpark that’s just for medical supplies, equipment, staff training, insurances, and that kind of thing that you’d have to line up.”

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HB 2, signed into law in 2013 by then-governor Rick Perry, placed strict regulations on abortion providers and clinics. The provisions in HB 2 — also known as “Targeted Regulation of Abortion Providers,” or TRAP laws — required that abortion providers have difficult-to-obtain credentialing requirements, also known as “admitting privileges,” from local hospitals, and stipulated that abortion clinics comply with the costly regulations imposed on “ambulatory surgical centers.” Before the legislation was enacted, there were more than 40 licensed abortion clinics throughout the state of Texas. After the admitting privileges requirement went into effect in October 2013, the number of abortion clinics in the state decreased by nearly 50 percent. Had the law been upheld, it’s estimated that at least 30 of the state’s 40 abortion clinics would have shut down.

The question at the center of the court’s decision focused on a precedent set in Planned Parenthood v. Casey, a landmark 1992 Supreme Court abortion case, that prohibited states from placing an “undue burden” on a woman’s ability to obtain an abortion. In his majority opinion, Justice Breyer wrote that the provisions of HB 2 violated the prohibitions on undue burden established in Casey.

A medical operating room is seen during a tour at Whole Woman’s Health of San Antonio, Tuesday, Feb. 9, 2016, in San Antonio. (AP Photo/Eric Gay)
A medical operating room is seen during a tour at Whole Woman’s Health of San Antonio, Tuesday, Feb. 9, 2016, in San Antonio. (AP Photo/Eric Gay)

“We conclude that neither of these provisions offers medical benefits sufficient to justify the burdens upon access that each imposes,” Breyer wrote. “Each places a substantial obstacle in the path of women seeking a previability abortion, each constitutes an undue burden on abortion access, and each violates the federal Constitution.”

While last week’s decision did add more depth to the Court’s vague definition of “undue burden,” reproductive health advocates insist the battle is far from over — and say some aspects of their work may actually get more difficult now that the justices have concluded the lengthy legal battle over Texas’ law.

Hagstrom Miller and others say it’s hard to guess what abortion opponents will do next, but expect that lawmakers and anti-abortion advocates will continue to develop new strategies to enact barriers to accessing abortion clinics.

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Dr. Willie Parker, an abortion provider in the South and chair of Physicians for Reproductive Health, said the Court’s decision is likely to galvanize abortion opponents, and may actually lead to a resurgence of protest and harassment of abortion providers. “They are embracing the notion that those of us who do this work do so quietly and don’t want our neighbors to know, so there’s an effort to shame us,” Parker said, noting that a group of anti-abortion picketers came to his apartment the Sunday before the hearing.

Over the past five years, politicians have enacted more than 280 abortion restrictions throughout the country, accounting for more than a quarter of all abortion restrictions passed since the court’s ruling on Roe v. Wade more than four decades ago. In Texas alone, these restrictions include a 20-week abortion ban and limits on medication abortion. Other states require mandatory counseling sessions and lengthy waiting periods for women seeking abortions.

“I think it’s lofty to describe what happened [last week] as a victory,” Parker remarked. “We held ground.”