By Lindsey Byman, The Texas Tribune.

On Sept. 30, Planned Parenthood’s Gulf Coast branch in Houston, which ran the organization’s largest clinic in the country, shuttered to merge with another affiliate.

Anti-abortion groups celebrated this shutdown, saying they were one step closer to pushing the health care provider from the state and, eventually, the nation.

Officials with Planned Parenthood Gulf Coast said the move — which involved closing down two Houston clinics and passing four others to Planned Parenthood Greater Texas — was a strategy to remain in Texas.

“It’s about consolidating resources to meet the moment and continue care where it’s needed most,” said Melaney Linton, who ran the Gulf Coast operation, in a statement to The Texas Tribune. Last year, Planned Parenthood Gulf Coast reported a $6 million net loss.

Over more than a decade of the Texas Legislature booting Planned Parenthood from various funding programs, the organization has slashed its number of clinics by more than half, merged affiliates and unveiled online services. In Texas, Planned Parenthood now operates 29 clinics plus telehealth.

With no access to public funding currently, the state’s affiliates lean on donors, their parent organization and private insurance.

This year, the federal government took a note from Texas’ playbook and barred Planned Parenthood affiliates nationwide from accessing Medicaid reimbursements. The Planned Parenthood Federation of America said it might have to shutter nearly 200 health centers as a result — almost two-thirds of its clinics.

“Planned Parenthood has already been defunded in Texas. We've already done it,” said Amy O’Donnell of Texas Alliance for Life. “We applaud the federal government and the Trump administration for going after that at a federal level.”

Before Texas cut off Planned Parenthood from most of its Medicaid funding in 2013, Planned Parenthood’s affiliates provided reproductive care, including contraception and testing and treatment for sexually transmitted infections, to just under 50,000 patients in one of the state’s government-subsidized women’s health programs — about 40%.

Planned Parenthood often lands in political crosshairs because it’s associated with abortion care, which anti-abortion groups say is the nonprofit’s priority and the provider group denies.

After cutting ties with Planned Parenthood, the Texas Legislature has funneled money into a patchwork of programs that distribute state and federal funds for women’s health: Healthy Texas Women, the Family Planning Program and the Breast and Cervical Cancer Services program.

Those programs served 290,000 women in 2023, while Texas’ remaining two Planned Parenthood affiliates — Greater Texas, which runs clinics from Houston to Lubbock, and South Texas with clinics in San Antonio and the Rio Grande Valley — saw more than 130,000 patients that year.

Anti-abortion advocates say Texas’ services render Planned Parenthood obsolete. While enrollment in these programs remains high, some reproductive rights researchers say Texas’ attempts to remodel its programs without the prominent provider have reduced access to care for low-income Texans, particularly among medically underserved communities. They say Texas still needs the nonprofit source of reproductive care.

“Other health care providers in the area just were not able to step in and serve the Planned Parenthood patients who lost access to Planned Parenthood as a health care provider,” said Kari White, executive and scientific director of Texas-based Resound Research for Reproductive Health, which examines policies that affect reproductive autonomy. “It may be that we see something similar happen in other communities across the country.”

Texas’ Planned Parenthood has repeatedly consolidated 

The beginning of the end of government funding for Texas’ Planned Parenthood can be traced back to 2011. The Texas Legislature dealt the affiliates a major blow by cutting the state's family planning budget by two thirds. Specialized family planning providers, including Planned Parenthood, were placed at the bottom of the remaining funding.

Of the 82 family planning clinics that closed the next year, about a third were Planned Parenthood.

“That was the first big, significant loss of funding for Planned Parenthood health centers,” said Sarah Wheat of Planned Parenthood Greater Texas, which operates 22 clinics in the state.

Also that year came another crippling cut. Texas lost roughly $30 million in annual federal funding because officials tried to exclude Planned Parenthood and other health providers whose services include abortion from federal Medicaid money. After the Obama administration rejected the request and Texas pulled out of the federal program, Texas created its own subsidized women’s health program and cut off Planned Parenthood starting in 2013.

Over the next few years, Texas continued to whittle away at Planned Parenthood’s funding, denying the clinics of all Medicaid reimbursements , regardless of the program a patient wanted to use, in 2021.

And finally this year, the Trump administration pinched off what government funding is left for Texas Planned Parenthoods, rescinding more than $2 million they had won from Title X federal grants for family planning and preventive health services.

Since the state first restricted its funding, Planned Parenthood’s eight branches and at least 66 clinics have shrunk to two affiliates and 29 clinics, concentrated in urban hubs.

Vast areas have no reproductive care providers, and some counties have fewer than ten after funding cuts shuttered Planned Parenthood and other women’s health centers. Planned Parenthood clinics are part of the “safety net” for reproductive care, particularly for uninsured Texans, Wheat said.

Wheat’s Greater Texas formed in a 2012 merger of three arms and now primarily serves Austin, Dallas-Fort Worth and Houston. Affiliates that have closed and merged with others include Lubbock, West Texas, Hidalgo County and — as of this month — Gulf Coast.

To make up for the loss of Planned Parenthood clinics in those areas, Texas’ two affiliates launched telemedicine in 2018 and 2020 to offer services including birth control, clinician consultations and gender affirming hormones. In 2023, Greater Texas conducted 14% of its appointments online.

“In a smaller community, you're going to be seeing fewer patients, just by nature,” Wheat said. “We cannot financially operate every health center that we would like to, and so then it really requires taking a hard look at, well, where can we serve the most patients?”

Access to care after Planned Parenthood defunding 

When Texas removed Planned Parenthood from its women’s health programs, many of the nonprofit’s low-income patients had to find a new provider.

Anti-abortion advocates say Texans have not been harmed by the loss of Planned Parenthood because of the state’s heavy investment in its three subsidized health programs.

Since 2021, those programs have served around 315,000 clients each year — about the same number as Texas’ state and federally funded reproductive care programs saw in 2010, before gutting its family planning budget and asking to remove Planned Parenthood from the federal funding program. Texas allocated more than $460 million to its women’s health programs for 2026-27.

“We don't need Planned Parenthood in Texas to offer true health care for women; we've got that covered through what's been appropriated in our state through the Healthy Texas Women program,” said O’Donnell of Texas Alliance for Life. “That’s not to say that we can’t do more.”

Healthy Texas Women and the state-funded Family Planning Program offer reimbursement for the same services Planned Parenthood provides. While patients can access that care at the 3,000 providers in these programs, the sizable chunk who used to seek reproductive care at Planned Parenthood have had to go elsewhere, said White of Resound Research. Combined with the closure of many Planned Parenthood clinics, the result has been less access to reproductive care.

More than a decade after Texas’ first jab at Planned Parenthood’s funding, the proportion of those enrolled in Healthy Texas Women who got care through it dropped to 59% from 90%, according to a report from Every Texan , a nonprofit research organization. Contraceptive use was especially hard hit, with a decrease in use of more than half.

“The funding that is available for women's health services in Texas and family planning services has just not been enough to meet the demand,” said Kari White, executive and scientific director of Resound Research.

More than a decade after Texas’ first jab at Planned Parenthood’s funding, the proportion of those enrolled in Healthy Texas Women who got care through it dropped to 59% from 90%, according to a report from Every Texan , a nonprofit research organization. Contraceptive use was especially hard hit, with a decrease in use by enrollees of more than half.

“The funding that is available for women's health services in Texas and family planning services has just not been enough to meet the demand,” White said.

In 2020, the Trump administration reinstated Medicaid funding for Texas’ primary health program for low-income women, now called Healthy Texas Women, despite it still excluding Planned Parenthood.

The move expanded the application from two pages to 13 and caused the program’s rates of approval to plummet, according to a study that surveyed 600 patients who were eligible for Healthy Texas Women. The Medicaid program denied almost half of its applicants that year, leaving some waiting up to 90 days for a decision, according to reporting from The Nation .

Such “repeated and dramatic” upheavals to Texas’ reproductive health programs have reduced access to care, especially among underserved populations, White said. Her research has shown that other providers cannot fill the gap left by Planned Parenthood, White said.

This year, the state aimed to patch up the holes in reproductive care access by increasing the women’s health budget by $13 million and adding a new provision to shorten the application for Healthy Texas Women. White said the increased funding and shorter application may help more Texans access care.

“I think that there are a lot of lessons to be learned from the Texas experience,” White said. “Despite all of these efforts by the state to exclude Planned Parenthood from a diverse set of funding sources, there are still Planned Parenthood health centers that are here providing care to people in Texas.”

How Planned Parenthood in Texas is surviving

Texas’ Planned Parenthood affiliates have altered their services, administrative structures and funding sources, but they have no plans to change their name.

Some of the nonprofit’s affiliates rebranded in 2012 after the national federation mandated that they provide abortion if they are in a state where it’s permitted. But Wheat and Laura Terrill of Planned Parenthood South Texas aim to keep the Planned Parenthood brand. The organization’s national federation offers affiliates name recognition, grant opportunities, guidelines, technical support and advocacy, they said.

In Texas, and now federally, legislation barring Planned Parenthood operations from Medicaid reimbursement has cited their affiliation with abortion providers. Texas’ Planned Parenthoods stopped providing abortions before the Dobbs v. Jackson Women’s Health decision allowed the state’s abortion ban to take effect.

The state’s Planned Parenthood clinics now refer patients for abortions outside the state.

“The concept of controversy, I mean, it's been part of Planned Parenthood since day one,” Wheat said. “That is not new to have politicians dictating what choices and what resources and what health care women receive … today, it just looks different.”

Last year, the Planned Parenthood Federation of America gave $2.36 million and $1.66 million in grants to its Greater Texas and South Texas affiliates, respectively, according to the federation’s tax filings . Texas’ Planned Parenthoods have boosted marketing to insured patients, and they’ve drawn on private funds to continue offering subsidized and free care.

Last year, the South Texas branch provided more than $2 million in financial assistance , and it launched a voucher program for free services, like birth control and STI testing and treatment.

It’s the affiliate’s most recent maneuver to keep providing Texans subsidized care, even without state or federal support.

“We're fond of saying that we're here for good, and we mean that as a double entendre,” Terrill said. “We're here for good to provide good services and the wellness that people need, and the permanency of that is also very much intended.”

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