The U.S. Supreme Court ruled 5 to 3 Monday that two provisions of a Texas omnibus anti-choice law, the admitting privileges and ambulatory surgical center requirements, are unconstitutional. The Court’s ruling nullifies the two provisions, which directly led to several abortion clinics in the state either closing or ceasing to provide abortion services.
However, the Supreme Court’s decision striking down parts of Texas HB 2 is just the first step to restoring access to reproductive health care in the state: Most of the state’s clinics that have been forced to close will not be able to immediately reopen, if they reopen at all.
Prior to the passage of HB 2 there were 41 facilities in Texas that offered abortion services. Since that time, there have been 19 facilities that closed and another four that stopped providing abortion services.
Whole Woman’s Health, the plaintiff in the Supreme Court case, was one of several abortion providers affected after the passage of HB 2 in 2013.
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The family of clinics was forced to close two facilities in Beaumont and Austin.
The Whole Woman’s Health clinic in McAllen shuttered but reopened after a court decision, and another Whole Woman’s Health clinic in Fort Worth was forced to close but reopened after the clinic’s physician obtained the admitting privileges required by the law.
However, other clinics “likely won’t reopen,” the Associated Press reported Monday.
Among the 19 facilities that closed in the state, at least eight have been sold and reopened by other businesses or organizations. Another facility, Abortion Advantage in Dallas, was demolished. Some of the facilities that closed are still owned by the abortion providers, but it’s unclear at this point how many may consider reopening.
For those facilities that may want to resume providing abortion services, there are several hurdles to jump through first. Clinics will need to rehire staff, re-purchase medical equipment and supplies, and find physicians who provide abortion care. This last obstacle may be one of the more difficult ones to overcome, as the number of physicians who provide abortion care in Texas has declined.
Prior to the implementation of HB 2, there were 48 physicians who provided abortion care across the state. While some physicians stopped providing abortion services because they could not gain admitting privileges, other physicians stopped providing services for reasons including retirement, illness, or personal circumstances.
There currently are 28 physicians with admitting privileges who are providing abortion care in Texas, according a study by the Texas Policy Evaluation Project.
Heather Busby, executive director NARAL Pro-Choice Texas, told Rewire in a phone interview that while the Supreme Court’s decision is a victory for reproductive rights, the damage to reproductive health care in Texas cannot be easily undone.
“You can’t fix a broken system overnight,” Busby said. “You may have to completely re-staff. You may have to find another facility. You also have the other challenge of getting licensed by the state, and this is Texas.”
Texas has grown “particularly hostile on the administrative side,” and currently licensed facilities are reporting an increasing number of surprise inspections and state inspectors are being “unduly harsh,” according to Busby.
“I’m sure Texas is not going to be bending over backwards to provide licenses to abortion providers,” Busby said.
Perhaps the most significant obstacle that clinics may face will be meeting all of the requirements required to obtain a license to provide abortion services from the Texas Department of State Health Services (DSHS).
An application for an abortion facility must be submitted to the DSHS “no earlier than 90 calendar days prior to the projected opening date of the facility,” and a $5,000 license fee must be submitted with the application. The license fee is not refundable.
The licensing process includes an onsite survey by officials from the DSHS, who will review clinical records, facility policies and procedures, quality assurance activities, and personnel records, as well as conduct interviews with staff. The process of obtaining a license can take as long as a year.
“It’s going to be a long process for sure; it’s not going to be overnight,” Busby said.