At 19, Natalie Vallot was diagnosed with a lump in her breast during an annual wellness exam. Then a waitress in Houston, Vallot didn鈥檛 have health insurance, so she relied on low-cost services at Planned Parenthood, her sole provider at the time. The nurse there referred her to a surgeon who accepted uninsured patients, and Vallot had the walnut-sized tumor removed. The surgeon told her that while the tumor was benign, it was growing rapidly and could have become malignant had it not been detected early.
鈥淚 really feel like Planned Parenthood saved my life,鈥� said Vallot, now 48.
Vallot continued to visit Planned Parenthood for follow-up mammograms after her breast cancer scare to ensure the growth did not return. During the 15 years she was a patient, she was provided health exams, STD tests and treatment, and birth control, all for affordable, sliding-scale fees. But the services she relied on during her most vulnerable years may vanish for thousands of other low-income Texans if the state gets its way.
As part of a decade-long strategy to topple the abortion provider, Texas officials in 2022 鈥檚 national organization as well as its state affiliates in federal court for more than $1.8 billion, claiming it committed Medicaid fraud when it filed reimbursements at a time when the state was seeking to expel the organization from the federal program. Should it lose the case 鈥� believed to be the first of its kind in the United States 鈥� Planned Parenthood could go bankrupt.
Planned Parenthood calls the lawsuit and 鈥減olitically motivated,鈥� that there was a court order in place that allowed it to continue to bill Medicaid. Texas knew the clinics were providing the services, reimbursed them for those services, and never asked them to repay the state before filing the lawsuit, the provider says.
鈥淸T]his is a baseless case that should go no further,鈥� Susan Manning, an attorney with Planned Parenthood Federation of America, said in a recent interview. 鈥淧lanned Parenthood organizations are nonprofits that follow the law and provide essential, life-saving health care to their patients. The plaintiffs鈥� only goal in this case is to achieve their decades-long goal of shutting down Planned Parenthood to advance a political agenda.鈥�
More than a decade of attacks
Texas officials have been steadily chipping away at Planned Parenthood 鈥� a punching bag for anti-abortion politicians 鈥� despite the fact that state and federal funds are barred from covering abortion care. In their quest to dismantle the provider, Republican state lawmakers have decimated the family-planning safety net and stymied access to basic care for the state鈥檚 poorest residents. Even with multiple laws banning abortion care in Texas, conservative state leaders continue the fight.
In 2011, Texas lawmakers the state鈥檚 family-planning budget by $72 million and ensured Planned Parenthood would be last in line for funding. The cuts resulted in the , a third of which were operated by Planned Parenthood. None provided abortion care; instead, they offered preventive care, like health exams and birth control. One year later the state sought to from the Medicaid-based Women鈥檚 Health Program, leaving roughly 50,000 low-income patients without care.
Dr. Kari White, lead investigator for TxPEP.
While the Centers for Medicare and Medicaid Services Texas by threatening to withhold $30 million in federal funding, the state simply walked away from the cash, choosing instead to fund the program itself so it could keep Planned Parenthood out. The crusade continued in 2015, when lawmakers booted Planned Parenthood鈥檚 patients from a life-saving and halted funding to an HIV-prevention program.
Research from the (TxPEP) 鈥� which tracks the real-world effects of state reproductive health care policies 鈥� shows that after these exclusions, patients faced barriers to finding new providers and experienced to the most effective forms of contraception. Among those who weren鈥檛 able to access their preferred birth-control methods, TxPEP researchers found, there was an increase in taxpayer-funded births 鈥� the very outcome lawmakers intended to curb when starting the original Women鈥檚 Health Program.
鈥淭exas reproductive health policy since the 2010s 鈥� and even before 鈥� has often focused on preventing Planned Parenthood and other specialized family planning providers from receiving state funds for contraception and other reproductive healthcare services,鈥� said Dr. Kari White, lead investigator for TxPEP. 鈥淭his legislation has damaged the safety-net provider network and reduced access to high-quality, continuous reproductive health care for the most vulnerable Texans.鈥�
By 2016, the state set its sights on Planned Parenthood from Medicaid, basing its claims on misleading 鈥渟ting videos鈥� surreptitiously recorded by the Center for Medical Progress, an anti-abortion activist group. The heavily edited videos purported to show a discussion about the illegal sale of fetal remains. , including Texas and a congressional found no evidence of wrongdoing by Planned Parenthood. In fact, a grand jury in Houston the anti-abortion activists for deception and fraud. Nevertheless, after a five-year court battle, the state 鈥� aided by the conservative 鈥� used the fallacious claims to drive the provider from Medicaid in March of 2021, leaving 8,000 patients scrambling for family- planning care.
Now, an anonymous activist associated with the same anti-abortion organization, along with suspended Texas Attorney General Ken Paxton 鈥� the subject of an for bribery and abuse of office 鈥� argue that Planned Parenthood must pay back Medicaid reimbursements from 2017 to 2021, despite a 2017 strongly worded in place that allowed them to continue billing the state.
Last year, it was 鈥渦nthinkable that Planned Parenthood would continue to take advantage of funding knowing they were not entitled to keep it.鈥� Under the federal False Claims Act, which allows fines for every alleged improper payment, the plaintiffs maintain that Planned Parenthood should pay $10 million, in addition to penalty fees for each of the thousands of claims filed for services, totaling around $1.8 billion, a figure that would likely bankrupt the national organization and wipe out Texas clinics.
Among its counterclaims, Planned Parenthood points out that federal and state Medicaid regulations expressly require that states notify a provider of any overpayment. Texas failed to issue such notice at any point before filing a lawsuit, evidence that the legal challenge is a 鈥渢ransparent鈥� attempt to achieve their ultimate goal of once and for all shutting down the health care clinics, Planned Parenthood said in a filed in January.
鈥淭here is no authoritative guidance 鈥� indeed, no guidance whatsoever 鈥� from either of the states or the federal government that suggests, let alone clearly states, that payments, lawful when received, could retroactively become 鈥榦verpayments鈥�,鈥� the motion says.
鈥楢ll you鈥檙e doing is punishing patients鈥�
A ruling in Texas鈥� favor would hit vulnerable communities the hardest. For instance, Planned Parenthood of Greater Texas 鈥� which oversees 19 clinics, including in Austin, Dallas and El Paso 鈥� typically see younger patients, two-thirds of whom are uninsured. Serving annually, the clinics are relied upon for contraception care and STI prevention. They also offer gender-affirming hormone therapy, cervical and breast cancer screenings, HPV vaccines, post-menopausal hormone therapy, PrEP prescriptions and rapid HIV tests.
The centers fill a specific 鈥� and growing 鈥� need amid Federally Qualified Health Centers and the dwindling number of reproductive health clinics in the wake of the U.S. Supreme Court鈥檚 ruling in Dobbs v Jackson Women鈥檚 Health, which overturned abortion rights. The 19 Texas clinics have seen client volume increase by 20% from last year 鈥� in just August alone they saw 8,000 patients 鈥� underscoring the need for services.
鈥淭he demand is huge,鈥� said Dr. Amna Dermish, chief medical officer of Planned Parenthood of Greater Texas. 鈥淚f we鈥檙e gone, who steps into that space? The capacity is not there. We have a syphilis epidemic. We have little access to prenatal care and a high maternal mortality rate. We have the highest rate of uninsured in the country. There hasn鈥檛 been an effort by the state to expand care since [Dobbs] so there鈥檚 going to be a big void that will have a devastating effect.鈥�
In a study documenting the impact of the state鈥檚 decision to remove the provider from Medicaid in 2021, researchers with the found non-Planned Parenthood clinics have to provide timely access to contraception. Researchers also found that Medicaid patients booted from Planned Parenthood said other providers were unable to meet their needs; as a result, the patients could not access 鈥渢ime-sensitive, affordable鈥� reproductive health care. With few realistic alternatives to Planned Parenthood, some patients reported that the process of re-establishing care elsewhere was so burdensome that they still had not found a new provider and worried that they never would.
鈥淚 know the state wants to punish Planned Parenthood for being an abortion provider 鈥� but all you鈥檙e doing is punishing patients,鈥� Dermish said.
The case is pending before U.S. District Judge Matthew Kacsmaryk of Amarillo, who is expected to rule in the coming weeks. The Trump-appointed judge is a polarizing figure with and , including opposition to birth control and sex outside of marriage. A former attorney with the conservative Christian legal group First Liberty Institute, Kacsmaryk鈥檚 rulings on the bench appear to reflect his principles; he has struck down the ; ruled against seeking contraception under Title X; and most notably 鈥� in a decision rooted in 鈥� found in favor of an anti-abortion group鈥檚 of abortion drug mifepristone. In what many describe as conservatives eyeing favorable rulings with national implications seek out Kacsmaryk鈥檚 courtroom, in a federal district with a single, uber-conservative judge. Geographic relevance need not be an issue: In this case, no Planned Parenthood health center is located in or anywhere close to Amarillo.
Dermish, who worked as an abortion provider at Planned Parenthood from 2013 until the Dobbs ruling came down last year, said that her inability to perform abortions under the state鈥檚 harsh laws 鈥� starting in 2021 with Senate Bill 8, which imposed a near-total ban 鈥� has been nothing short of 鈥渢raumatizing.鈥� She struggles to talk about the experience without crying. Still, Dermish chose to remain in Texas and weather another state-led attack so she can offer preventive care. 鈥淲e cannot provide abortion but we still have an important role in our communities,鈥� she said.
Dermish noted what she called the hypocrisy of stripping away basic health-care services amid laws that will likely cause a jump in pregnancies and births, increasing the need for services.
鈥淲e live in a state that bans abortion because of ostensibly pro-life values, but the same people are trying to block treatments that could help pregnant women be safer and healthier?鈥� she said. 鈥淭he disconnect has been hard to reconcile.鈥�
Natalie Vallot鈥檚 appreciation for Planned Parenthood has only grown since her cancer scare nearly three decades ago. Working in Texas hospitals as an internal medicine provider, she sees emergency rooms teeming with patients who let ailments fester because they could not afford either preventive care or required treatments. Without low-cost providers like Planned Parenthood, already overburdened hospitals and clinics will feel added strain.
鈥淓very doctor and nurse I talk to knows how devastating this could be 鈥� honestly, they are scared,鈥� Vallot said. 鈥淭he infrastructure Planned Parenthood has built in the community is being completely taken for granted by Texas. The repercussions of this will be felt throughout the whole health care system.鈥�
Mary Tuma is a freelance writer in Austin who covers reproductive rights. She wrote this article for , a nonprofit investigative news organization.
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