AUSTIN — When Texas lawmakers set up the Women's Health Program in 2005, the goal was to help poor women get access to birth control, check-ups and preventive health care. The program has saved Texans tens of millions in unwanted pregnancies and early detection of disease.
When the program came up for renewal last year, many conservatives wanted to exclude clinics that affiliated with groups that support abortion rights. The ensuing battle has brought Texas national attention with two federal lawsuits and accusations from both sides that the other is disregarding the health care needs of 292,000 women enrolled in the program.
Two things have become clear: The Women's Health Program is not ending, nor is the fight about who will fund it or participate in it.
The fundamental questions that two federal judges — one in Washington and one in Austin — must answer is whether Texas can impose a political test on whether an organization receives taxpayer dollars.
In pushing for the provision, Texas lawmakers acknowledged that no state or federal tax money is spent on abortions, or clinics that provide them. But for many conservatives that was not enough. They wanted to make sure that no clinic that shared the same name, ownership or board of directors with an abortion clinic could enroll in a taxpayer-funded health program.
Cindy Mann, director of the federal Centers for Medicare and Medicaid Services, decided the state law violated the federal Social Security Act and therefore disqualified Texas from federal funding. The federal government provides Texas with $9 for every $1 it spends on the $35 million program, and it's beginning to phase-out support for the program.
Gov. Rick Perry has promised the state will pick up the tab. Texas officials say the number of births paid for by Medicaid, the health program for the poor, would spike without the program and would end up costing Texas taxpayers more in the long run.
The federal decision to cut funding, though, prompted Texas Attorney General Greg Abbott to sue Washington, claiming that Texas has the right to determine who is qualified to participate in Medicaid. His court filing said Mann's decision "violates the Constitution of the United States by seeking to commandeer and coerce the States' lawmaking processes into awarding taxpayer subsidies to elective abortion providers."
Abbott said the law was needed to gain support from lawmakers who did not want to fund a program that provided taxpayer money to Planned Parenthood or any groups that provide elective abortions.
"Without this statutory restriction on abortion subsidies, the Women's Health Program would not exist because the Texas Legislature would not have authorized its creation," Abbott writes.
Catherine Frazier, a spokeswoman for Gov. Rick Perry, said Texas law is clear.
"The state of Texas is under no obligation to provide taxpayer dollars to Planned Parenthood," Frazier said.
No one appears to challenge whether the affected clinics meet the medical requirements to provide health services. The only concern is that they have "Planned Parenthood" in their name or otherwise work with a similarly politically oriented organization.
Texas House Democratic leader Rep. Jessica Farrar said poor women should be allowed to choose their doctors and accused Texas Republicans of waging a war on women's rights.
"Texas women are strong and proud, and we will not sit idly by while a group of extremists attack our health and well-being," she said.
In a lawsuit filed Wednesday in Austin, eight Planned Parenthood clinics and one other provider that will lose funding at the end of the month filed a federal lawsuit saying that Texas is violating their rights to free speech and association.
The rule violates their rights because it disqualifies them "from eligibility based upon their advocacy to protect access to safe and legal abortion services," the group said in court papers.
So it appears that both sides agree that the issue is whether the state can impose political conditions on a private health care provider that fulfills government contracts.
Attorneys for Planned Parenthood have asked Judge Lee Yeakel to issue an order before April 30 blocking Texas from enforcing the rule. To do that, Yeakel must determine that Planned Parenthood is likely to win. That will be the first sign of how this legal battle will play out.