Rachel Landon says she doesn't make much money as an actor, but she's been able to get birth control, gynecological exams and other health screenings at her local Planned Parenthood in Houston as part of the Women's Health Program, which provides care for low-income women.
Now, though she'll either have to leave the program or find a new doctor because Texas no longer wants to allow tax dollars to go toward clinics affiliated with abortion providers or advocates.
"These people trying to shut this down never met me, never met any of these other women," Landon, 29, told ABCNews.com. She said that since it's difficult to find a doctor she trusts, she stuck with Planned Parenthood after starting to go there in college. "Losing that not only hurts me financially, but it hurts me as a Texan on a personal level."
Planned Parenthood will face a judge on Friday in Texas, trying to overturn a massive defunding of the family planning nonprofit in the state. They say they're not the only ones suffering. Women like Landon are left scrambling for new doctors, and even non-Planned Parenthood clinics find themselves at a crossroads.
When Texas Gov. Rick Perry announced his "Initiatives to Protect Life" on Dec. 11 in Houston, he said there was a difference between women's health and protecting the rights of abortion providers. He said state legislators were obligated to make every day of the upcoming 140-day session count toward protecting Texas' "most vulnerable citizens."
"The ideal world is a world without abortion," Perry said, calling for the Supreme Court's decision in Roe v. Wade to be overturned. "Until then, however, we will continue to pass laws to ensure abortions are as rare as possible under existing law."
From 2007 through 2012, the Women's Health Program got 90 percent of its funding from Medicare, but that all changed when state lawmakers decided to exclude Planned Parenthood and other clinics affiliated with abortion advocacy.
Federal officials decided the state rule was illegal because it interfered with a woman's right to choose her own doctor. They gave Texans a choice: allow Planned Parenthood to be part of the Women's Health Program or lose federal funding. In response, Texas launched a new Women's Health Program that only uses state funds and excludes Planned Parenthood. The changes went into effect Jan. 1.
"The ignorance, I think, that is so rampant among the legislative community is mind boggling," said Regina Rogoff, the Executive Director of the People's Community Clinic, an independent family planning provider in Austin.
Planned Parenthood performed 333,964 abortions in 2011, amounting to 3 percent of the services the organization offered nationwide that year, according to its annual report, which was released Jan. 4. During the year, it reported it served about 4.5 million people for sexually transmitted disease testing and treatments, 3.4 million people for contraception services, 1.3 million for cancer screening and prevention, and 1.2 million women for pregnancy tests and prenatal care.
"It seems very skewed, the idea that every woman going in there is getting an abortion," Landon said. "That's not what it's about at all."
Rogoff said she once promised herself she would never use the word "family planning," because many such clinics offer full blood panels and other medical help in addition to standard well-woman exams.
"'Family planning' becomes kind of a red herring for people who are upset about abortion," she said.
Rogoff's clinic has not been cut from the state-funded Women's Health Program, but she said she's not sure it will continue to participate because Texas has targeted any organization that might refer a patient to an abortion provider.
"The idea the state is putting a gag order on what physicians can say to a patient is just offensive," she said. "We are sorely tempted to entirely withdraw from this program to avoid giving the appearance that we support it."
But abandoning patients in need would be terrible, Rogoff said, calling her clinic's predicament a "conundrum." Her clinic already lost $526,000 in 2011 because Texas redistributed federal Title X family planning funds, she said.
Texas does not prohibit health care providers in the Women's Health Program from referring women to abortion clinics, said state Department of Health and Human Services spokeswoman Linda Edwards Gockel. The provider can tell the patient where she can get an abortion and give her a phone number, for example, but the provider can't help the patient set up her appointment, arrange travel or negotiate a fee reduction, according to the Women's Health Program rules that were finalized in October.
Planned Parenthood has said that 48,000 of the 110,000 patients in the Women's Health Program used its clinics. A survey released Tuesday by the Texas Health and Human Services Commission, in contrast, found that Planned Parenthood served 80,127 women in fiscal 2012, but concluded that the state now has enough eligible providers to serve 147,512 patients and can therefore handle the influx.
Patients displaced by the Planned Parenthood and abortion-affiliated clinic bans can go to TexasWomensHealth.org to find Women's Health Program-eligible clinics.
"We believe the state misrepresented the level of provider participation," Rogoff said. "They say they have these thousands of providers [to take on the displaced Planned Parenthood patients], but we're listed six times, and we're not taking new patients except for a limited number of teens."
A search for services in ZIP code 78722, part of Austin, yielded four entries for the "Peoples Community Clinic "at a few different addresses plus two more entries at the same address for individual doctors there. But the clinic is just one organization, and it's at capacity, Rogoff said.
The Texas Department of Health and Human Services is aware that the website has some redundancies, but its internal system tracks providers by a single provider number, Edwards Gockel said. The Women's Health Program has 3,500 providers with unique ID numbers, she said.
Patricio Gonzales, CEO of Planned Parenthood Association of Hidalgo County, near the Texas-Mexico border, said he had to lay off half of his staff and close four of the eight Planned Parenthood clinics in the area last year because of the first round of funding cuts in September 2011. Now, he doesn't know what to expect, but said he hopes to continue to serve his remaining 4,900 patients after the Jan. 11 hearing.
"I'm very apprehensive about my clients," Gonzales said. "Who's going to take care of them?"
He said his patients are stressed, asking why they have to stop seeing the doctors who have taken care of them for years because the state doesn't like that their clinic is affiliated with a national organization that supports legal abortion. He said he expects many of them will go without care because of the hassle.
"There's a 1-800 number for people to call so that they can ask somebody else to do the legwork for them," Edwards Gockel said, adding that every caller has been successfully matched with a new provider. About 3,000 people called in November, 2,700 people called in December, and 1,000 people called in the first week of January, she said.
The remaining Hidalgo County Planned Parenthoods will stay open as they try to either help patients find new providers or help them find other programs or grants so that they don't have to leave. The clinics have offered discounted services for patients who are waiting to see whether the ban will be reversed.
Some clinics that aren't losing funding say they're still unhappy with Texas.
The Legacy Community Clinic in Houston was not affected by any of the new family planning rules, but spokesperson Randall Ellis said it has seen an uptick in patients since 2011, when the "well-thought-out and coordinated attack" began with Title X fund rearranging that hurt some clinics.
"We are able to absorb the additional administrative costs and jump through hoops," Ellis said. "When looking at smaller providers in rural areas of the state, they don't have the resources to absorb the changes. Therefore, access is cut off for women in places where there is already limited access."
"For me, it's an issue of priority," he said. "The state has to decide whether they want to make women's health a priority for the state of Texas or not."
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