"We don't have a magic revenue stream," said Hagstrom Miller, a self-described "social entrepreneur" who has been in the abortion field for 24 years and started her company 10 years ago.
She charges $400 for an abortion under 12 weeks of gestation. The charge rises to $2,000 at 24 weeks.
She said most insurance companies cover abortions except in instances when employers object. In Texas, Medicaid isn't an option for abortions, so many clients are cash customers.
A visit to Hagstrom Miller's North Austin abortion clinic underscores the difference between the two types of facilities.
It resembles a small doctor's office with three procedure rooms, each the size of a typical examination room. There are also spaces for an ultrasound room, a nurses station and a recovery area with several recliners.
There are about eight or so staffers on hand, including one or two nurses. Hagstrom Miller said her doctors, who are under contract, work part-time since they either have their own practice, are employed by a hospital or are semiretired.
By comparison, an ambulatory surgical center resembles a small hospital capable of keeping patients for up to 23 hours. It has wide halls for gurneys, special air filtering systems to control infections, a back-up generator, a pharmacy, fire walls and procedure rooms that are four times the size of those at Hagstrom Miller's abortion clinic.
A surgery center requires much more staff, including three or more nurses, depending on its size.
Hagstrom Miller said a surgery center is unnecessary for most abortions.
"Abortion is complex morally and ethically, but it's one of the simplest, safest medical procedures," she said.
She said about half of her clinic's patients take a pill at the clinic and more medicine at home. The abortion occurs at home. The other half select a medical procedure either with a local anesthetic or conscious sedation with an IV. There is no anesthesiologist involved.
Texas has more than 400 day surgery centers, but only six perform abortions. The others typically focus on procedures such as eye surgery, colonoscopies and such.
Hagstrom Miller runs one of the six surgery centers that perform abortions. She said she leased the San Antonio facility the past two years because she couldn't afford to build one at the going rate of $300 to $350 per square foot.
Planned Parenthood just completed a 19,000-square-foot facility in Fort Worth for $6.5 million.
Hagstrom Miller said a surgery center is also expensive to operate. She has testified that hers costs $40,000 more per month to operate than an abortion clinic.
"It has never made money," she said. Her clinics, she said, subsidized the surgery center.
Planned Parenthood is affiliated with 10 of the state's 36 abortion clinics, with Planned Parenthood of Greater Texas operating in Austin, Waco and the Dallas-Fort Worth area.
Danielle Wells, a spokeswoman, said 95 percent of Planned Parenthood's services are preventive health care, including cancer screenings, birth control and testing for sexually transmitted diseases.
"We provide abortions at only a handful of our health centers," Wells said. She said the Greater Texas chapter provides abortions at four of its 27 health centers.
"We'd have to make some very careful considerations about staying open," she said. "We'll certainly be considering all options."
Many abortion opponents point to the the wealth of the Planned Parenthood Federation of America -- its national office in 2011 reported $1.2 billion in net assets, more than $500,000 in salary for its chief executive and $87 million in excess revenue over expenses.
"When an industry is making an $87 million net profit, there is more than adequate resources to spend on (upgrading) those clinics," argued state Rep. Charles Perry, R-Lubbock, on Tuesday.
Officials with the national Planned Parenthood office didn't respond.
At times, proponents of the tougher abortion standards have sent mixed messages about their intentions.
While Gov. Rick Perry and Lt. Gov. David Dewhurst have talked of ending abortion in Texas, two doctors who are in the Senate are saying they believe the abortion industry will adjust to the new law.
State Sens. Robert Deuell, R-Greenville, and Donna Campbell, R-San Antonio, said abortion providers, including the nonprofit Planned Parenthood, just don't want to spend the money demanded by the higher standards.
"When you look at the millions of dollars that go through this industry, my opinion is that I can't help but think it's about protecting a cash cow," Campbell said.
Campbell said there is a price tag for higher standards: "Any ambulatory surgery center who wants to open has to invest a lot of money to meet all the standards."
Deuell said he believes the abortion clinics have the money to upgrade.
"I just don't think they'll close," he said.
He said he doesn't find it unusual that abortion clinic owners say they have thin profit margins.
Deuell, who owns clinics that don't provide abortion services, said clinics typically reinvest profits back into their business to avoid taxes. He said the money is spent as employee benefits or higher salaries for the owners or doctors.
"They are just folding it back into their salaries," Deuell said.
He said he based his opinion on conversations with former abortion providers.
He said current providers could put an end to the profit debate.
"If I thought the Legislature was going to put me out of business," Deuell said, "I'd open up my books."
Laylan Copelin writes for the Austin American-Statesman. E-mail: firstname.lastname@example.org.
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