History of LWV-TX Action on Women's Health

 1983-89 This national position was adopted in 1983. During each succeeding legislative session, bills attempting to place various restrictions on abortions have been introduced. The LWVTX has worked with other prochoice groups to defeat these measures, initially with great success. But laws enacted in recent sessions severely restrict Texas women’s access to meaningful reproductive choices. Also in recent years, prochoice groups, including the LWVTX, have broadened their focus in this area to include advocacy for women’s access to comprehensive reproductive health services and for medically accurate sexuality education. In supporting these initiatives, the LWVTX has relied on the LWVUS positions on Health Care and Meeting Basic Human Needs. The LWVTX position on Health Care for Those of Lesser Means also supports advocacy for access to comprehensive reproductive health services. Following the 1989 U.S. Supreme Court decision in Webster v. Reproductive Health Services that gave states increased power to regulate abortion and threatened to overturn Roe v. Wade, prochoice groups in Texas, including both state and local Leagues, began organizing concerted responses to the escalating calls for restrictive legislation.

1991 In 1991 bills attempting to mandate parental notification for teenage abortions and to ban so-called sex-selection abortions were introduced. These measures received a hearing in a House committee, but were never reported out and were not heard in the Senate.

1993 Once again in 1993, several bills were introduced which would have placed various restrictions on reproductive choice (e.g., parental involvement, requirements for minors, waiting periods, informed consent requirements). These measures all died in committee, with the LWVTX and other prochoice groups working successfully behind the scenes to avoid the circus-atmosphere hearings. On a more discouraging note, bills filed in both houses that would have stiffened the penalties for criminal trespass on the premises of health care facilities also died in committee. An antichoice fanatic introduced these measures following the murder in Florida of Dr. David Gunn, an abortion provider. The LWVTX filed testimony in support of the proposals at a House committee hearing.

1995  Prochoice groups, including the League, faced and surmounted several close calls in the 74th Legislature. As in previous sessions, a number of bills were filed that would have imposed restrictions on reproductive freedom. For the first time, two of these measures were voted out of Senate committees. One would have mandated parental or judicial involvement in a minor’s decision to seek an abortion. The other would have classified abortion providers as ambulatory centers, thereby driving the cost of the procedure beyond the means of most women. At committee hearings, The LWVTX presented testimony in opposition to both bills. Fortunately, neither measure garnered the 21 votes necessary to be voted for consideration on the Senate floor. Local Leagues with senators who were uncommitted or considered to be swing votes in the move to block consideration responded swiftly and effectively to the LWVTX requests to contact these officials and inform them of League opposition to these measures.

1997 The session’s major antichoice legislation (requiring parental involvement in minors’ abortions) seemed securely on its way to passage when, on the last weekend, the bill was killed on a Point of Order and reproductive choice was still intact in Texas. Indicating increased legislative opposition to choice, a health insurance bill was passed which contains a clause exempting religiously affiliated health maintenance organizations from providing services which conflict with their beliefs and from referring or paying for a member to receive such services from another provider.

1999 After many failed attempts in previous sessions, antichoice proponents were able to enact a parental notification bill, vigorously opposed by the League. Under its provisions, a physician performing an abortion on a minor must provide 48-hour notice to a parent. A judicial by-pass was provided as the only alternative to parental notification.

2001 The LWVTX opposed Injury to a Pregnant Woman legislation that was introduced. Because the League believes in the right of every woman to safely carry a pregnancy to term, the LWVTX supports legislation enabling women who have suffered the loss of a pregnancy due to deliberate 3rd party misconduct to seek civil remedies and be assured of appropriate criminal prosecution. But the introduced legislation went beyond addressing this important issue and established risky precedents for pregnant women. It is important to note that a nationwide effort was underway by antichoice

2003 Several laws were enacted that further compromise a woman’s right to choose:

  • An omnibus law implements a 24-hour waiting period before a woman can obtain an abortion, requires physicians to provide women seeking abortions with informational materials including misinformation linking abortion to breast cancer, and requires abortions after 16 weeks be performed in ambulatory surgical centers, making their availability and cost prohibitive for most women.
  • Another law allows criminal or civil charges to be brought against anyone who causes the death or injury of a fetus, and defines an individual as "an unborn child at every stage of gestation from fertilization until birth." By thus giving a fetus status as an individual, this law opens the door to future measures and lawsuits that would undermine women’s reproductive choices. The law also has the potential to interfere with a doctor’s care of a pregnant woman, as a doctor might not be willing to perform certain procedures (such as amniocentesis) for fear of being charged with a crime if the woman lost the fetus as a result.

 

The legislature failed to enact emergency contraception measures supported by the LWV-TX. Emergency contraception has the potential to reduce the number of unintended pregnancies and abortions in the United States by 50%. Access to emergency contraception is especially important to survivors of sexual assault. One bill that died would have enabled Texas women to access emergency contraception directly through their pharmacists; another would have required hospitals to inform sexual assault survivors about emergency contraception and provide it if requested. Subsequently promulgated federal rules allow over-the-counter sale of emergency contraception to women over the age of 18.

Antichoice bills opposed by the LWVTX that died included: mandatory viewing of materials about fetal pain prior to obtaining an abortion, "Choose Life" license plates for which fees would have been allocated to so-called crisis pregnancy centers, requirement that judges from whom minors seek judicial bypass as an alternative to parental notification do not have to keep detailed records and make them available to the public.

Enacted setbacks to choice were in the form of amendments attached to the measure reauthorizing the Texas Medical Board. These amendments mandate parental consent for a minor’s abortion (cf. the notification requirement enacted in 1999), and further restrict the already extremely narrow circumstances under which a woman can obtain a legal abortion in the third trimester of pregnancy to cases where the fetus has a severe and irreversible brain impairment or the women risks death or severe and irreversible brain damage or paralysis.

Other setbacks for women’s health included two riders attached to the state budget: One diverted $5 million to crisis pregnancy centers whose chief mission is giving misinformation to pregnant women in order to discourage them from having abortions, rather than providing actual health care services. The other rider diverted $20 million from existing providers (including Planned Parenthood affiliates, medical schools, hospital districts, and health departments), displacing over 70,000 low-income women currently receiving family planning and other health care services from these entities.

Egregious measures opposed by the League and other prochoice groups and individuals that met well-deserved oblivion include the so-called "right of refusal bill" that would have enabled pharmacists to refuse to fill or provide referrals for birth control prescriptions and several measures that would have made it more difficult for a minor to obtain a judicial bypass permitting her to choose an abortion without parental involvement (involvement that will henceforth equal consent under the new law discussed above). The proposed measures targeting the judicial bypass process included restrictions on the venue of such cases, requirement that rulings be collected and published, and raising the standard of proof/level of parental abuse that must be shown.

On the good news front, the legislature passed the Medicaid Waiver bill, which instructs Texas Health and Human Services to apply for a federal waiver that will expand access to preventive health care and family planning services for low-income women, including screening for diabetes, cervical and breast cancer, hypertension and tuberculosis, as well as counseling and education on contraception. Unfortunately, a bad amendment attached to the waiver prohibits waiver funds from going to agencies that perform or promote abortions and limits coverage of information about and prescriptions for emergency contraception. Another victory was passage of a bill mandating hospitals to implement plans for adequate and comprehensive services to victims of sexual assault, though it regrettably does not mention emergency contraception.

Unfortunately, several bills that would have promoted choice and/or women’s health died, including provisions for increased access to educational information about emergency contraception and other forms of contraception, and removal from the so-called informed consent to abortion law enacted in 2003 the required misinformation that having an abortion increases one’s risk of getting breast cancer.

2007  For better and worse, status quo is an appropriate summation of the 81st Legislative Session in this program area. On the better side, no antichoice bills were passed, thanks in part to unrelated procedural maneuvers. Measures opposed by the LWVTX that came close to passage included those that would have (a) required an ultrasound prior to abortion, (b) authorized Choose Life license plates whose purchase would fund unregulated, unlicensed pregnancy centers, and (c) placed burdensome new reporting requirements on women seeking and physicians performing abortions, under the guise of protecting women from coerced abortions.

On the worse side, efforts to improve sex education in public schools and to expand low-income women’s access to preventive family planning and other health care services were ultimately unsuccessful. Some of these efforts were encompassed in the Education Worksbills and the Prevention Worksbills strongly supported by the LWVTX. Kudos to Representatives Castro, Villarreal, and Strama who tried but failed, during the frantic waning days of the session, to attach amendments to an education-related bill that would have required information taught in sex education courses to be medically accurate.

Also for the worse, provisions included in the state budget opposed by the LWVTX impede women’s access to preventive health care:

  • Rider 56 diverts $20 million from expert family planning health care providers, such as Planned Parenthood, and gives it to Federally Qualified Health Centers that don’t have the capacity to see large numbers of family planning patients. Since the rider was enacted in 2005, 70,700 fewer such patients have been served. A bright spot: New language was added requiring funds not spent by Federally Qualified Health Centers to go back to family planning providers who can use them.
  • The Alternatives to Abortion program was also renewed, with increased funding that is directed to crisis pregnancy centers–organizations that provide no medical services and do nothing to help women prevent unintended pregnancies.

2011-2012  vigorous advocacy by the LWVTX and other prochoice groups and individuals, women's health and reproductive choice were big losers in the 2011 Legislature and its aftermath.

Family planning funds and the Texas Women's Health Program. A budget cut of approximately $62 million from the state family planning program will leave an estimated 200,000 women without access to basic health services. Adding insult to injury, the budget actually includes an increased amount for the Alternatives to Abortion program that encourages women in crisis pregnancies to carry to term, often with Medicaid support. The Alternatives to Abortion program, which has an $8.3 million budget in the current biennium, provides no medical services, although it does make referrals to other government programs.

Although the Texas Women's Health Program was reauthorized, this was something of a pyrrhic victory, first because the loss of family planning funding means that providers will not be able to give preventive care to many of the neediest women during this budget cycle. And second, the renewal application that the state submitted to the federal government effectively excluded Planned Parenthood centers from providing Texas Women's Health Program services. The specious line of reasoning used to justify the exclusion is that the 2005 enabling legislation for the Texas Women's Health Program indicated that the Texas Health and Human Services Commission is prohibited from contracting with agencies affiliated with organizations that provide abortions and that the commission has the authority to define affiliated.

The federal government responded that excluding qualified providers is a violation of federal law and that funding for the Texas Women's Health Program would be withheld if Planned Parenthood were excluded. The state refused to back down. Planned Parenthood then filed a lawsuit against the state Health and Human Services Commission, alleging that it is unconstitutional to block Planned Parenthood from participating in the Medicaid Women's Health Program and depriving women of the right to choose their health care provider. The judge has issued a temporary injunction that allows renewal of the program and Planned Parenthood participation pending a full hearing and arguments from both sides.

Antichoice legislation/regulations.

Sonogram requirement. As passed and signed into law, Texas now has perhaps the most extreme preabortion sonogram requirement law in the country: It mandates that the woman receive a verbal description of the fetal image even if she opts out of viewing it. (Only Oklahoma has a similar provision.) Another especially harmful provision in the law is increased penalties, including possible loss of license that may be imposed on doctors who violate any part of the informed consent process of which the mandatory sonogram is a part. Further, although a woman may certify that she doesn't wish to view the fetal image, the law actually says that her consent to the medical procedure of an abortion is not informed if she doesn't view the image. This provision could have a further chilling effect on doctors' willingness to perform abortions.

The Center for Reproductive Rights, a national organization, filed a lawsuit in the U.S. District Court in Austin challenging the constitutionality of the sonogram law and alleging that it violates the First Amendment rights of doctors and patients. The Center for Reproductive Rights described the law as an intrusive and patronizing hijacking of the doctor/patient relationship to promote an antichoice agenda. The suit was filed on behalf of a plaintiff class of physicians and medical facilities that provide abortions. Unfortunately, the 5th Circuit Court of Appeals overturned an injunction against enforcement of the law issued by the district judge in the case, prompting the district judge to declare that the appellate court's decision "effectively eviscerated the protections of the First Amendment and allows the government to make puppets out of doctors."

Choose Life license plates. This new law authorizes the issuance and purchase of Choose Life license plates. Proceeds from the purchases will go to eligible organizations that give assistance to pregnant women who are considering placing their children for adoption. But organizations that provide abortions or abortion-related services or make referrals to abortion providers or are affiliated with such referrers or providers are not eligible to receive these funds.

Funding restrictions. Another amendment to SB 7, the special session's omnibus health care bill, effectively bans hospital districts from using local tax revenue to fund abortions or risk losing state funding. The amendment allows exceptions if the woman's life is in danger or if the fetus has a severe fetal abnormality, meaning "a life-threatening physical condition…incompatible with life outside the womb." The measure is clearly aimed at Travis County, as its hospital district is the only one in the state that currently uses tax dollars to pay for elective abortions. But it has been reported that most of those funds come from local taxes and other nonstate funds, so the law might not have much bite.

Reporting requirements. Most recently, the State Health Services Council has proposed a rule that would require a woman seeking an abortion to first file a report indicating how many children and how many abortions she has had, her level of education, whether she viewed the required sonogram and, if a minor, whether she obtained a judicial bypass in lieu of parental consent. And physicians performing the procedure would be required to report on complications, although what constitutes a complication is unspecified. This proposed regulation, if it goes into effect, would impose requirements that even the most antichoice legislatures have rejected legislatively.

2013 As the regular session adjourned, the LWVTX and other advocates for reproductive choice and for comprehensive, affordable women’s health care briefly rejoiced that:

  • None of the bills on these issues that the LWVTX opposed passed. In fact, none of them even received a vote from either chamber.
  • Preventive health care for women was a winner in the state budget that:
    • Allocated $71.3 million in state funding for the Texas Women’s Health Program. Approximately 90% of this was to replace lost federal funding because of the Affiliate Ban Rule enacted in 2011. This funding maintains the Texas Women’s Health Program but shifts the funding source from federal to state dollars.
    • Expanded the state’s Community Primary Care program by $100 million to support women’s preventive care, including contraceptive care for approximately 100,000 low-income women.
    • Added $32.1 million to the Texas Family Planning Program to replace federal Title X grant funds that were awarded to the Women’s Health and Family Planning Association of Texas instead of to the state.

As noted by the Texas Women’s Healthcare Coalition (of which LWVTX is a member), the budget was "a critically important step in repairing the tattered women’s healthcare safety net [and]…represents important progress toward the goal of access to preventive care for all Texas women." But although this budget included funds for approximately the same number of clients in 2014-15 as before the big cuts in 2011, "the women’s health safety net will take time to rebuild," and many specialized family planning providers (e.g., Planned Parenthood) with expertise and geographic reach were excluded.

Unfortunately, along with the death of the antichoice bills opposed by the LWVTX during the regular session, all of the prochoice and prowomen’s health measures supported by the LWVTX also died without receiving votes.

In the 1st special sessionthat immediately followed the regular one, the governor added "legislation relating to abortion procedures, providers and facilities" to the agenda. The Senate rule that requires a two-thirds vote to consider bills was declared to be inoperative in special sessions, enabling a simple majority to pass bills in the Senate. A number of abortion bills were filed but the ones that moved were companions SB 5 (Hegar) and HB 60 (Laubenberg)–omnibus measures banning abortion after 20 weeks, requiring all procedures to be performed in a mini hospital forcing women to make four trips to a clinic for a drug-induced abortion, and requiring all abortion doctors to have admitting privileges at a nearby hospital. In spite of impassioned and cogent arguments against SB 5 by the LWVTX and many other others at the Senate Health and Human Services Committee hearing, the bill passed out of the Committee by a 5-2 vote. The committee substitute for SB 5 added an exception to the 20-week ban for situations involving a severe fetal abnormality.

The Senate passed SB 5 (20-10 vote) after an amendment by Senator Hegar to remove the 20-week ban on abortions was accepted by the majority. All amendments offered by other senators that would alleviate the harmful impact of the bill were rejected. The battleground then moved to the House where the State Affairs Committee scheduled HB 60 and HB 16 (Laubenberg), a stand- alone fetal pain measure banning virtually all abortions after 20 weeks, for hearing. Responding to calls to action by prochoice and women’s health advocates, hundreds of women (estimates as high as 700) registered to be heard. The LWVTX Capitol Corps member Judy Parken registered with prepared testimony. After more than 10 hours of testimony, with hundreds (including the LWVTX) still waiting to be heard, the committee closed the hearing.

The State Affairs Committee reconvened the next day and quietly approved both HB 60 and its companion bill SB 5, as well as HB 16. But prochoice advocates were heartened that, with the special session set to end by midnight on June 25, their testimonies had held up the bills for precious hours that might enable senators to filibuster the legislation on its return to the senate for final approval. Texas women’s impassioned and eloquent stand against these antichoice bills began to receive national attention. The marathon testimony in the State Affairs Committee was widely reported and dubbed "the people’s filibuster." With the full House set to hear SB 5 and HB 60 on Sunday June 23, hundreds of motivated and mobilized reproductive rights advocates headed for the Capitol, most wearing orange as urged by organizers and many wearing orange tee shirts saying "Stand with Texas Women."

On the House floor, prochoice representatives, knowing they were outnumbered, adopted the strategy of delaying votes on the bills as long as possible, hoping to forestall their arrival in the Senate where, with the June 25 midnight deadline looming, a filibuster might prevent passage. Filibusters are not an option in the Texas House. Instead, prochoice House members utilized chubbing as a delaying tactic, extending their conversations on the bills for several hours on Sunday afternoon and into the night. Meanwhile, it became clear that antichoice representatives would focus on passing SB 5. That bill had already passed the Senate, but Senate concurrence was needed on the House change to the bill−add the fetal pain provision. After hours of debate that went on into Monday morning, the House passed SB 5 on a vote of 95-34 with 20 members absent.

As the bill moved back to the Senate for its final approval on Tuesday June 25, activists began arriving early in the Senate gallery. Although the weekday turnout was lower than on Sunday, hundreds of prochoice activists showed up as the day wore on, bolstered by the presence of Cecile Richards, president of Planned Parenthood of America. Senator Davis began to filibuster against SB 5 at approximately 11 a.m., needing to continue until midnight in order to kill the bill. Filibuster rules prohibit the speaker from eating, drinking, taking bathroom breaks or straying off the subject of the bill. According to Davis’ communications director, Davis was acting as the "voice of those people that were basically cut off from presenting their stories and testimony" at the previous hearing.

As afternoon turned into evening, several senators challenged Davis with specious points of order, alleging that it was out of order for Davis to accept a back brace from Senator Ellis as she stood on the floor and that twice, her remarks had strayed from the subject and were not germane. Unfortunately, the points of order were sustained and as senate rules provide, the filibuster ended on the third ruling, shortly after 10 p.m.

Other prochoice senators then stalled a vote on the bill with procedural questions until 11:45 p.m. As Senator Duncan, presiding in place of Lt. Governor Dewhurst, was about to start the roll call on a procedural vote before the final vote on the bill, Senator Van de Putte interrupted with a parliamentary inquiry, asking at what point must a female senator raise her voice to be heard by her male colleagues. At that point, the gallery filled with prochoice supporters erupted in cheers that were taken up and echoed by others standing outside the gallery and all around the Capitol building. Midnight came and went and the bill died amid the cheering and chaos.

Although faced with another special session and another round of antiabortion proposals and tactics, the experience of the 1st special session was an inspiration and motivation for all champions of reproductive health and rights to stay strong and hang tough. Governor Perry wasted no time in calling a 2nd special session for July 1, with abortion front and center on the agenda. With unabated passion, approximately 5,000 prochoice supporters, including many LWVTX members, assembled on the Capitol steps on July 1 to bring their message to legislators.

In the 2nd special session, although many abortion bills were filed, the Legislature focused on SB 1 (Hegar) and HB 2 (Laubenberg), companion, omnibus measures that mandated (a) prohibition on abortion after 20 weeks, (b) requirements that facilities where abortions are performed meet the standards of ambulatory surgical centers and that doctors performing them have admitting privileges at a nearby hospital, and (c) a requirement that physicians administer in person the two medicines used for drug-induced abortions and see the patient again within 14 days.

Capitol Corps member Grace Chimene brought the LWVTX testimony against HB 2 to a hearing by the House State Affairs Committee on July 2 but was not called to testify before the committee chair closed the hearing at midnight−3,543 persons had signed up to speak but only 100 were heard. The committee voted (8-3) to send the bill to the full House, which passed it in short order. On July 8 the action shifted to the Senate Health and Human Services Committee for a hearing on SB 1. Grace Chimene, representing the LWVTX, presented testimony. She was one among thousands who had registered to testify.

Unfortunately, HB 2 passed both House and Senate and was signed into law by Governor Perry on July 18.During floor debate in the Senate, prochoice senators offered 20 amendments, ranging from proposals to add exceptions to the 20-week abortion ban for victims of rape and incest to requiring annual inspections of abortion facilities. All were rejected. Senator Davis did not try to reprise her heroic filibuster but spoke eloquently against the bill, noting the numbers and passions of citizen opponents who showed up again and again at the Capitol during the special sessions, "The fight for the future of Texas is just beginning." The Texas Tribune reported about the chants and cheers from the massive crowd of prochoice advocates gathered outside of the chamber and that the audience observing from the gallery remained mostly quiet and orderly throughout the proceedings, in contrast to the closing hours of the 1st special session.

The bad news is that Texas now has one of the strictest abortion laws in the U.S., designed to drastically reduce women’s access to safe, legal abortions. The silver lining is that the sleeping giant−the pro-choice majority−has been awakened and activated. On another hopeful note, Planned Parenthood and other abortion providers have filed suit in federal court seeking to block the state from implementing the new law because its provisions conflict with the U.S. Supreme Court rulings in Roe v. Wade and Planned Parenthood v. Casey that states cannot enact substantial obstacles to women seeking abortion.

2015  Following their victories in the 2013 Legislative Session, those who oppose women’s access to safe, legal abortions and to comprehensive, affordable and accessible reproductive health care were not content to rest on their laurels in 2015. Regretfully, these people worked to restrict access to safe, legal abortions even further, coming up with new, draconian proposals affecting women’s health. Given the large number of such bills that were filed and the makeup of the legislature, we can be grateful that most died, along with some good bills supported by the LWVTX. Details below.

Access to safe, legal abortions.

The worst bill that passed. HB 3994imposes significant and unreasonable restrictions on the judicial bypass option for young women seeking safe, legal abortions. Prochoice proponents managed to kill a provision in the bill that would have required all doctors to presume that any pregnant woman seeking an abortion is a minor unless she presents a valid government record of identification to prove she is 18 or older. Prochoice proponents also killed the presumption of denial of bypass when a judge’s fails to rule on a bypass petition within the required time. The harmful provisions of the bill as passed include: (a) requirement that bypass petition be filed in the teen’s home county (unless the county has a population under 10,000), (b) elimination of physical, sexual or emotional abuse as grounds for a bypass, (c) extension of the time (from 2 to 5 business days) in which judges must rule on bypass petitions, and (d) requirement that the minor’s attorney and guardian ad litem be the same person. This omnibus judicial bypass measure will have an especially adverse impact on vulnerable minors who have been neglected, abused or abandoned.

Another bad bill that passed. HB 416requires abortion facility personnel to take education and training on human trafficking. The author initially stated that she would accept an amendment that would expand the bill to include other medical settings, such as emergency rooms, where health care staff is also likely to encounter trafficking victims. But the bill as passed does not contain such an amendment. The measure as passed is thus a targeted regulation of abortion providers that should apply to all frontline medical personnel. Note that Planned Parenthood clinics in Texas have for many years been proactive in training staff to recognize and appropriately deal with trafficking victims.

Biggest victory for prochoice advocates. Death of SB 575that would have prohibited health benefit exchanges that might be established under the Affordable Care Act from providing abortion coverage except when a life-threatening physical condition exists. Unfortunately, a number of good bills also died, including measures that would have ameliorated some of the laws restricting access to safe, legal abortions enacted in previous session.

Women’s health care safety net.

Budget–the good news. The General Appropriations bill for 2016-2017 includes $50 million in new funding for women’s preventive health care, including contraception. As expressed by the Texas Women’s Healthcare Coalition of which the LWVTX is a member, "Combined with the funding restoration in the 2013 Legislative Session, this funding has the potential to reverse much of the devastating effect of the 2011 budget cuts and subsequent upheavals to women’s health programs." The Coalition has called for thoughtful implementation that will 'increase the number of women served and help provide access for the more than 1.3 million Texas women in need of contraception and other preventive services. If the budget rider that requires increasing access to long acting reversible contraceptives (e.g., implants, intrauterine devices) is properly implemented with education and training, it has the potential to dramatically lower rates of unplanned pregnancy and abortion.

Budget–the bad news. Unfortunately, the budget as passed effectively removes Planned Parenthood’s participation in the Breast and Cervical Cancer Screening program by stipulating that providers of these screenings must be eligible for the Texas Women’s Health Program. (Planned Parenthood was excluded from that Program in 2011.) Planned Parenthood has been serving about 10% of BCCS program clients. The budget also stipulates that family planning funds cannot be used for sexuality education or family planning instruction if the instruction is provided by affiliates of abortion providers (e.g., Planned Parenthood).

Good bills that passed. HB 786 requires public employers (e.g., state agencies, local governments, public schools) to provide accommodations for mothers who need to pump breast milk while at work. According to the Texas Breastfeeding Coalition, 40% of mothers who return to work choose not to breastfeed because they anticipate lack of accommodations at work. An amendment to SB 200 requires appointment of an advisory committee to provide recommendations to the Health and Human Services Commission on the consolidation of women’s health programs.

Good bills that did not pass included proposals to (a) extend eligibility for benefits under the Texas Women’s Health Program, including access to family planning services, to females 15 or older and (b) provide coverage for contraceptive drugs or devices for children enrolled in the child health program with written consent from child’s parent.

Comprehensive, medically accurate sexuality education. Although both good and bad bills relating to sexuality education were filed, none passed. However, as noted above, the budget that passed unfortunately contains a stipulation that family planning funds cannot be used for sexuality education or family planning instruction if the instruction is provided by affiliates of abortion providers, such as Planned Parenthood.

Note. On July 1, 2016, the Texas Women's Health Program and the Expanded Primary Health Care for Women program were consolidated into the Healthy Texas Women program. The program provides pregnancy testing and counseling, family planning, breast and cervical cancer screenings, immunizations, and screenings and treatment for diabetes, high blood pressure and high cholesterol to low-income women. It covers minors as young as age 15 years with parental consent, including access to free birth control.

2017  The 2017 Legislative Session was very challenging for reproductive choice proponents. Despite or perhaps because of the 2016 U.S. Supreme Court decision that struck down the 2013 Texas law that severely impeded abortion access, opponents of reproductive justice were determined to impose new restrictions and requirements. In the end, as detailed below, only one of the many antiabortion measures filed in the session was enacted and became law. But, unfortunately, that one is particularly heinous. As also detailed below, several measures that strengthen the women's health care safety net passed into law although many others failed. Legislative attempts to ensure comprehensive, medically accurate sexuality education go nowhere. 

Access to safe, legal abortions.

Very bad news. SB 8 (Schwertner), opposed by the LWVTX, is now law. As passed by the Senate, SB 8 requires burial or cremation of fetal remains after an abortion and also bans the donation of aborted fetal tissue for medical research. It also bans partial birth abortions, which are already prohibited by federal law.

In the House, after heated debate and the offering of many amendments (both good and bad) that failed, an amendment was added to SB 8 (and approved when sent back to the Senate) that prohibits abortion providers from performing dilation and extraction abortions. Called "dismemberment abortions" by opponents of the procedure, it is the most commonly used and safest method of performing abortions during the 2nd trimester. In opposing a ban on this procedure, the Texas branch of the American College of Obstetricians and Gynecologists stated that such a ban would create "a dangerous environment for patients that would prevent doctors from having every option available when providing a patient with the best possible care in any given situation."

Regarding the requirement to bury or cremate fetal remains, the Texas Department of State Health Services promulgated a similar rule in 2016 that is the subject of a federal lawsuit brought by the Center for Reproductive Rights. In January the trial court judge issued a temporary restraining order against implementation of the rule on the grounds of vagueness and undue burden. The court restraining order remains in effect and is also applicable to the fetal remains provisions of SB 8. So the requirement has not been implemented pending the outcome of the litigation.

A separate federal lawsuit has been filed by Whole Women's Health challenging the prohibition of the dilation and extraction procedure in the 2nd trimester, arguing that the prohibition is unconstitutional under the undue burden standard set forth in 2016 by the U.S. Supreme Court in a Texas case also initiated by Whole Women's Health. A trial judge has blocked implementation of this prohibition pending the outcome of the litigation. There is hope for good outcomes to both of these lawsuits.

Better news. Several bills, opposed by the LWVTX, appeared headed for passage that would have made abortion access even more difficult died in the last-minute crunch of deadlines. These included:

  • SB 20 (L. Taylor): Prohibiting all insurance plans from covering abortions.
  • SB 25 (Creighton)/HB 434 (Simmons): Eliminating wrongful birth cause of action and thus allowing health professionals to withhold information from parents about the condition of the fetus.
  • HB 2962 (Capriglione): Requiring additional, extensive, burdensome reporting related to abortion complications by licensed abortion facilities.

Many other antiabortion bills died earlier at various states in the legislative process. Unfortunately, some good bills intended to ameliorate previously enacted harmful laws met the same fate. These included elimination of waiting period before abortion and removal of unproved information from informed consent to abortion materials.

Women's health care safety net. Although many good bills that would have strengthened the safety net failed to pass, several supported by the LWVTX are now law. These include:

  • Measures that address the recent disturbing spike in maternal mortality and morbidity in Texas:
    • SB 1599 (Miles): Adds to the required information that must be made available online regarding pregnancy-related deaths.
    • HB 2466 (S. Davis): Provides insurance coverage for maternal medical depression screenings during a Medicaid or Children's Health Insurance Program visit up to 1 year after a child's birth.
    • HB 1036 (S. Thompson): Mandates insurance coverage of digital diagnostic mammography.
    • HB 1729 (Neave): Establishes a donation-based program to fund forensic testing in sexual assault case.

Particularly disheartening was the near passage but ultimate failure of two measures strongly supported by the LWVTX:

  • HB 2373 (S. Davis): Enabling teen mothers 15 years or older to consent to examination and treatment relating to contraception. Died in committee.
  • HB 2403 (Thierry): Mandating the state Maternal and Mortality and Morbidity Task Force to evaluate conditions that disproportionately affect mortality and morbidity in the African American population. Died in chamber.

Note. The comprehensive bill addressing the maternal mortality crisis that passed in the special session (see below) mandating study and review of health conditions and factors that disproportionately affect the most at-risk populations seems to include this type of evaluation.

  • SB 790 (Miles): Continuing the Women's Health Advisory Committee for an additional 2 years. Vetoed by the governor. According to Governor Abbott, the bill "does nothing more than extend the expiration date of a governmental committee that has already successfully completed its mission." Reacting to the veto, Janet Realini, cochair of the committee and leader of the Texas Women's Health Coalition (of which LWVTX is a member) stated, "There's 1.8 million women who need publicly subsidized services, family planning in particular, and right now we're serving less than a quarter of those, so I thin we have a long way to go."

Women's health budget. Positive news on this front includes level funding for the states women's health programs, including family planning, despite cuts to other health and human services programs. The state budget also assumes that the Centers for Medicare & Medicaid will approve a new waiver under Section 1115 of the Social Security Act for the Healthy Texas Women Section 1115 Demonstration Waiver for fiscal year 2019. This would allow the state to draw down $90 million in federal matching funds for the Healthy Texas Women program. Legislators have said they intend to maintain both the Healthy Texas Women program and the Texas Family Planning Program whether or not the waiver is received. The Texas Women's Healthcare Coalition, of which the LWVTX is a member, will closely monitor the process to ensure the continuity of care for Texas women.

Another positive: A budget rider requires a 5-year strategic plan to reduce barriers to long acting reversible contraceptives. A negative: Another rider bans Planned Parenthood from receiving any state funds although thousands of women throughout Texas rely on Planned Parenthood clinics as their primary source of essential health care and prevention and screening services.

2017 special session. While we rejoice that vouchers for private schools and the "bathroom bill" did not pass in the special session, abortion access took several big hits. Apparently abortion access is an easier target for extremist legislators, including the governor and lt. governor. On the other hand, the crisis in maternal deaths in Texas received long overdue attention that resulted in a comprehensive bill addressing the situation.

 Access to safe, legal abortions.

  • HB 13 (Capriglione): Imposes burdensome and unnecessary reporting requirements concerning abortion complications on attending physicians. The bill passed and was signed by the governor despite strong opposition form the LWVTX and other reproductive rights advocates and from prochoice legislators who argued that the measure violates privacy rights of doctors and patients and is a thinly veiled attempt to intimidate abortion providers who face stiff fines for noncompliance.
  • HB 215 (Murphy): Targets minors' abortions, forcing physicians to report unnecessary details about minors who obtain abortions and requires clinics to report if their personnel tell minors seeking abortions about the judicial bypass option. The bill passed and was signed by the governor despite valiant opposition efforts from reproductive rights advocates and prochoice legislators.

Insurance coverage.

  • HB 214 (Smithee): Prohibits private insurance companies from providing coverage for elective abortions unless a woman purchases a supplemental policy. The LWVTX and other reproductive rights advocates fought hard against this cruel measure that makes abortion unaffordable for many women, especially women of color, rural residents, and immigrants. Women's health champions presented strong arguments against HB 214 during floor debates in both house, calling it the "rape insurance bill" and pointing out that no woman plans to have an abortion and no one can plan to be raped or to be sexually assaulted by a family member. But bill proponents rejected several amendments that would have ameliorated its harmful impact (i.e., exceptions for fetal abnormalities, rape, and incest). Signed by the governor.
  • HB 14 (Springer): Would have prohibited local governments from entering into transactions that benefit abortion providers and their affiliates and could have resulted in more clinic closures and consequent denial of reproductive health care (not just abortions) to many women, particularly low-income women and women of color. It represented a threat to the power of local governments to enter contracts with or allocate funds to local organizations that benefit their communities. Died in chamber.

 Women's health care safety net−addressing the maternal mortality crisis. Passage of SB17 with bipartisan support was a big win for women's health advocates, including the LWVTX. Special thanks to the Women's Health Coalition for keeping us informed and active on efforts to address the maternal mortality and morbidity crisis during the special session. As the bill wound its way through committee hearings and floor debates in both houses, it was strengthened and improved. Highlights of SB 17 as passed include:

  • Continuation of the Maternal Mortality and Morbidity Task Force until 2023, giving more time for the state to directly address the causes of pregnancy-related deaths in Texas and demonstrating the state's commitment to reducing the high rate of maternal mortality and morbidity.
  • Expansion of the duties of the Maternal Mortality and Morbidity Task Force to include study and review of health conditions and factors that disproportionately affect the most at-risk populations and best practices and programs in other states that have reduced the incidence of pregnancy-related deaths and severe maternal morbidity.
  • Requirement that the Maternal Mortality and Morbidity Task Force compare the rates of pregnancy-related deaths based on the mother's socioeconomic status and consult with the Perinatal Advisory Council when making recommendations to reduce the incidence of pregnancy-related deaths and severe maternal morbidity.
  • Requirement that the Texas Department of State Health Services conduct a statistical analysis of the aggregate data for pregnancy-related deaths and sever maternal morbidity to identify trends, rates, and disparities; and empowering the Texas Department of State Health Services to convene a panel of experts to advise the department and the Maternal Mortality and Morbidity Task Force in developing recommendations for improving collection of accurate data.
  • Requirement that the Texas Health and Human Services Commission evaluate options for treating postpartum depression in economically disadvantaged women, which could lead to improved access to mental and behavioral health screenings before and after childbirth.
  • Requirement that the Mortality and Morbidity Task Force coordinate with the Texas Department of State Health Services to develop and make available to health care providers materials on substance use and best practices in substance abuse screening of pregnant women and a list of substance use treatment resources statewide.