As the Legislature prepares to increase dramatically the standards for abortion clinics, the two sides disagree on whether clinics would shutter their doors and the number of abortions in Texas would plummet.
The debate over the economics of abortion is largely anecdotal, but this isn't the first time that Texas has changed its abortion standards. In 2003, as part of the Woman's Right to Know law, the Legislature mandated that pregnancies at or beyond 16 weeks of gestation must be ended at ambulatory surgical centers rather than at abortion clinics.
Theodore Joyce, a Baruch College professor in New York who studied the impact of the 2003 law, expects a short-term reduction -- 10 to 12 percent -- in abortions if the current bill becomes law.
"As women adjust and as the clinics adjust, the long-term impact won't be as great as the right-to-life folks think," he predicted. "The cost of dealing with a child is enormous."
He bases his opinion on what happened a decade ago.
In 2004, when the Woman's Right to Know law went into effect, Joyce said none of the abortion providers qualified as ambulatory surgical centers. He said the number of abortions performed in Texas at or after 16 weeks of gestation dropped by 88 percent over one year. Meanwhile, the number of Texans who left the state for a late abortion quadrupled.
Writing in the New England Journal of Medicine, Joyce said that by 2006 Austin, Dallas, Houston and San Antonio had ambulatory surgical centers to perform abortions. He noted that late abortion rates recovered, but remained below 2003 levels at the time of his study.
With this year's more sweeping legislation, Joyce said the impact on abortion rates depends on the ability of the six existing surgical centers to ramp up to either perform more abortions or refer patients to out-of-state facilities.
In 2011, the latest year for which statistics are available, there were 72,332 abortions performed in Texas -- about 10,000 below the peak in 2006. Seventy-seven percent of the 2011 abortions were performed in the state's 36 abortion clinics and 22 percent in ambulatory surgical centers.
Unlike the 2003 law, the pending legislation affects all abortions one way or another. It would prohibit most abortions after 20 weeks of gestation, require doctors performing abortions to have hospital privileges and mandate that abortion clinics be certified as ambulatory surgical centers.
It is that last requirement that some abortion clinic owners say threatens their survival, while proponents of the law insist that the industry will continue in Texas.
Amy Hagstrom Miller, who owns five abortion clinics in Texas, including one in Austin, said she expects to close her doors if the Legislature requires the clinics to become the equivalent of day surgery centers.
Planned Parenthood may be the largest abortion provider, but about three-fourths of the abortions in Texas are performed by independently owned operations such as Hagstrom Miller's Whole Woman's Health, according to interviews with abortion clinic owners.
While proponents of the tougher standards argue that the abortion industry can afford the new regulations because abortions are a "cash cow," Hagstrom Miller begs to differ. She said her five clinics had a profit margin of 3.3 percent last year and lost 6.3 percent in 2011.
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