Best American Magazine Writing 2013

by The American Society of Magazine Editors

  In Texas the past decade has seen a sharp turn in the rhetoric of the issue. Some of it is the result of the ferocious GOP primary wars that are now a fixture in what has essentially become a one-party state. Since there is only one election that matters anymore, it has tended to become a contest over who can move furthest to the right. Being labeled a RINO—a “Republican in Name Only”—is a fate worse than death, and what better way to establish one’s conservative bona fides than by passing laws limiting abortion?

  A parental notification law for minors seeking abortions passed in 1999 (later, legislators passed a law requiring that minors get permission from their parents before getting the procedure). The 2003 Woman’s Right to Know Act, sponsored by Representative Frank Corte, of San Antonio, required doctors to give pregnant women a booklet—tinted pink with a daisy on the cover—that includes information about the growth and development of “the unborn child” and color photos of the fetus from 4 to 38 weeks of gestation. (This booklet is also infamous for erroneously linking abortion with difficulties during future pregnancies and higher rates of breast cancer.)

  By far the most important change came as a result of a 2005 lawsuit called Planned Parenthood of Houston and Southeast Texas v. Sanchez, which required the separation of all family-planning facilities into two entities: one would distribute birth control and perform women’s wellness checkups and cancer screenings while the other would provide abortions exclusively. Government audits were mandated annually to make sure that no state money—no tax dollars—could ever be used to fund abortions.

  “I think we all thought this was harassment—it wasn’t going to improve public health. But we said okay, we’ll get through this too,” said Peter Durkin, who was the president and CEO of Planned Parenthood Gulf Coast for twenty-seven years. Still, despite all the conflict over abortion, there remained some restraint in the Legislature over family planning. It was a given that reasonable people could differ over abortion, but most lawmakers believed that funding birth-control programs was just good policy; not only did it reduce the number of abortions, but it reduced the burden on the state to care for more children.

  That changed dramatically after 2010, when Republicans won twenty-five seats in the House, giving them a supermajority of 101 to 49 and total control over the law-making process. (The male-female split is 118 men to 32 women.) As the Eighty-second Legislature began, a freshman class of right-wing legislators arrived in Austin, determined to cut government spending—a.k.a. “waste”—and push a deeply conservative social agenda. At the same time, Governor Perry was preparing to launch his presidential bid, burnishing his résumé for a national conservative audience. It wasn’t a good time to be a Democrat, but it wasn’t a great time to be a moderate Republican either. Conservative organizations turned out to be as skilled at social media as your average sixteen-year-old, using Twitter and Facebook to chronicle and broadcast every move of the supposed RINOs. A climate of fear descended on the Capitol. “Most people in the House think we should allow poor women to have Pap smears and prenatal care and contraception,” an aide to a top House Republican told me. “But they are worried about primary opponents.”

  The result, in Texas and beyond, was a full-scale assault on the existing system of women’s health care, with a bull’s-eye on the back of Planned Parenthood, the major provider of both abortions and family planning in Texas and the country. As Representative Wayne Christian told the Texas Tribune, in May 2011, “Of course it’s a war on birth control, abortion, everything. That’s what family planning is supposed to be about.”

  For those with institutional memory, the most striking thing about Cecile Richards is how unlike her mother she is. The president of the Planned Parenthood Action Fund possesses none of the folksiness and none of the bite that helped make Ann Richards an icon, maybe because neither quality is really necessary or useful anymore (and could actually be considered a hindrance for the head of a national women’s organization in 2012). In fact, on the rainy day I met with Richards at Planned Parenthood’s headquarters in Manhattan, she looked like someone who had come into her own. Long gone was the awkward perm she once sported. Tall and willowy, she wore a deep-purple sheath with matching peep-toe heels, a combination of chic understatement with just a hint of flash.

  Clearly, she had learned her political skills not just from her mother but also from her father, labor lawyer David Richards. Before coming to Planned Parenthood, in 2006, Cecile was a labor organizer and the founder of two progressive groups: America Votes, a nonprofit designed to promote liberal causes, and the Texas Freedom Network, an organization designed to combat the Christian Right. In other words, to Planned Parenthood’s opposition, she’s the Antichrist.

  Richards long ago learned to modulate her anger for public consumption. But when she gets to talking, she can be extremely frank. “The equity that women have now in education and wages is because of family planning,” she told me, leaning forward, her voice hardening just a little. “For women, it’s not a social issue. It’s not political. It’s fundamental—fundamental to their economic well-being.” She went on, seemingly unable to believe that she was being forced to restate the obvious: birth control enables women to stay in school instead of dropping out, and to get a degree that boosts their economic status for life. It allows them to control the size of their families so that they can afford the kinds of futures they envision for themselves and for their children. A woman who once had five kids might now only have two—and send them both to college. And so on.

  But why, I asked, should taxpayers be on the hook to pay for it?

  “Why should we pay for Viagra?” she responded. “Why should men be treated differently? We pay for all other medications. Birth control is the most normative prescription in America. Ninety-nine percent of women use birth control. It’s 2012, for God’s sake!”

  As for the changes in Texas, she was deeply disappointed. She had worked on the border with women who have since lost access to cancer screenings. She didn’t think Governor Perry was taking the majority of Texans where they wanted to go. “It’s hard to go back home,” she told me. “That heartlessness does not track with the Texas I grew up in.”

  Indeed, in the Texas of Richards’s youth (she was born in 1958), lieutenant governors like Bill Hobby and Bob Bullock worked with Planned Parenthood to set up a network of clinics all over Texas, in both small towns and big cities. Texas Health and Human Services offered funding through a federal grant for communities willing to open new clinics for the underserved, and Planned Parenthood provided everything from breast and cervical cancer screenings to abortions. “We were encouraged to open new locations,” Durkin recalled, “and the state sat right next to us when the extremist furor erupted—and it always died down.”

  One reason for the tolerance, Durkin said, was that twenty-five years ago there was a greater tendency to “keep out of a lady’s business.” “In the good old days,” he explained, “the Texas Department of Health was managed by retired military doctors who focused more on afternoon golf than reproductive health care issues. And the governor’s office didn’t interfere either.”

  The expansion of family planning was crucial to the general health and future of the state itself. Texas has the second-highest birthrate in the nation, behind California. Historically, it has also had one of the highest rates of uninsured women in the country. Today, more than half the babies born each year are to mothers on Medicaid. Since the cost differential between a Medicaid birth plus postnatal care and a year of birth control pills is huge (around $16,000 for the former versus $350 for the latter), the notion that publicly funded birth control was good public policy had never been a subject of debate in the past. Prior to the last legislative session, the state’s family-planning program was serving close to 130,000 clients who had no form of health insurance, the poorest of the poor. And according to the nonpartisan Legislative Budget Board, the state’s investment in family planning saved $21 million a year by avertin
g more pregnancies. Ironically, before the last session began the LBB advocated for more money to be spent on family planning in order to save on the cost of pregnancies and births, which last year totaled $2.7 billion.

  But that’s not exactly what happened.

  “We’re going to be making bad decisions all day.” It was the morning of April Fool’s 2011, a day of important debate in the House over HB 1, the budget bill, and Wayne Christian was just getting started. Christian, from Center, is one of the more ebullient House members, and despite his grim prediction, his mood seemed upbeat. He knew that, thanks to his party’s supermajority, power would continue to rest in the heart of the Republican caucus, a place he felt very much at home. A past president of the Texas Conservative Coalition and a successful gospel singer, Christian qualified as a true believer, and on this day he was calm. He was, after all, a man with a plan.

  The plan had emerged from several years of strategizing by Texas pro-life groups, and it had as its central goal the demise of Planned Parenthood. To those who oppose abortion, the separation of health-care clinics and abortion clinics that the Legislature mandated in 2005 had not gone far enough. Even though organizations like Planned Parenthood are audited annually by the state to ensure that no taxpayer dollars go to pay for abortions, this arrangement remains suspect to pro-lifers.

  “The separation agreement is not really enforceable,” said Elizabeth Graham, an attractive, sharp-tongued brunette who is the director of Texas Right to Life. “The Legislature has never been comfortable with giving money to 1200 Main Street and 1201 Main Street isn’t getting that money. The funds are fungible.” So Graham’s organization had been working with legislators like Christian, diligently preparing, waiting for the right opportunity. It had finally come. The tactic was to eviscerate Planned Parenthood through the family-planning budget. Lawmakers, Graham later told me, “were prepared and understood where funds could go. They had assistance from agencies and information that helped them to redirect funds.”

  House Republicans also had a clever procedural maneuver up their sleeves. Ordinarily, budget amendments are vetted by the Appropriations Committee, which may hold public hearings on controversial issues. This time, however, the GOP legislators kept mum, intending to present these amendments from the floor, circumventing the traditional vetting process. (Unlike his iron-fisted predecessor, Tom Craddick, current House speaker Joe Straus has proved less inclined to prevent such tactics.) This meant the amendments would come with no advice from Appropriations, so members were left without guidelines on how to vote.

  Indeed, on April 1, when the family-planning section of the budget came up for review, conservative legislators began attaching a blizzard of new amendments, each one designed to shrink the size of the $111.5 million budget from which Planned Parenthood drew support. First up was Representative Randy Weber, who wanted to move $7.3 million out of family planning and allocate it to an organization that seeks alternatives to abortion.

  In support of his amendment, Weber, a conservative Republican from Pearland, cited a journal article from 2002 that asserted that in addition to contraception not eliminating pregnancies, it also correlated to a higher rate of pregnancy among women who use it. (In fact, the article stated the opposite.) Representative Mike Villarreal, a Democrat from San Antonio, asked Weber if he thought that birth control simply didn’t work.

  “Not for those that get pregnant,” Weber quipped.

  “Have you ever used contraceptives yourself?” Villarreal shot back.

  “Well, you know, I don’t think I know you well enough to go down this road,” Weber cracked.

  Villarreal shifted tactics, insisting that Weber’s plan would do nothing to reduce abortions. Further, if they did what Weber asked, members would be moving money from programs that would save the state around $60 million into one that would not save it a cent.

  Weber’s amendment passed 100–44. Next up was Christian, who proposed an amendment that would move $6.6 million from family planning into a program to help autistic children. After consideration of additional proposals, Christian’s amendment passed 106–34. Two more Republican representatives came forward and laid out amendments to move $20 million into early-childhood intervention programs and the Texas Department of Aging and Disability Services. Those passed too. Representative Bill Zedler asked to move funding from “the abortion industry” to services for the deaf and blind and those with mobile disabilities. Representative Jim Murphy wanted to move money to EMS and trauma care, which was operating with a $450 million surplus at the time. Representative Warren Chisum followed with an amendment to move family-planning money to more-generalized medical clinics.

  As the night wore on, tempers flared; sometimes it was hard to hear over the members’ shouting at one another. Even a staunch Republican like Beverly Woolley found herself moving to the microphone in solidarity with the Democrats. But on and on it went. By one in the morning, the House had slashed the family planning budget from $111.5 million to $37.9 million. The final vote passed with 104 ayes. On May 3, the Senate passed its budget, with the same cuts in place—partly because House Republicans had threatened to hold up the entire budget process if they did not.

  By this point, the tenor of the session was clear. As the chair of the Senate Democratic Caucus Leticia Van de Putte said, “Texas is going to shrink government until it fits in a woman’s uterus.” A little over a month later the sonogram bill went to the governor’s desk. “This will be one of the strongest sonogram bills in the nation,” declared an exultant Sid Miller. “This is a great day for women’s health. This is a great day for Texas,” said Dan Patrick, who had tried twice before to get such a bill passed.

  Needless to say, not everyone agreed. “I went to an event with Senator [Kevin] Eltife,” Patrick told me some months later, “and I parked and a car pulled up behind me and a woman started screaming at me. I’ve never had that happen. I’ve had some interesting e-mails too. Just amazing. But I’m a big guy. I can take criticism, because this is the right thing to do to save a life.”

  By his account, over time the sonogram bill will save up to 15,000 lives. “There will be people alive in ten to twenty years who wouldn’t be alive without this bill,” he told me. To Patrick, the legally mandated ultrasound isn’t an invasive procedure. Critics of the bill further contend that its ultimate purpose is to limit access to abortion, especially for low-income women who may not be able to take off more than one day of work to accommodate the twenty-four-hour waiting period. Patrick rejects this argument too. As he puts it, “The purpose in sponsoring this bill was to improve women’s health care.” His political opponents, he says, “don’t know the facts. They are dealing from emotion.” He thinks the claim that most women have made up their minds long before they reach the door of an abortion clinic is “nonsense.”

  “Most of these women don’t know,” he said. “No one is trying to embarrass them, but we are trying to save a life. You want the woman to have a choice to have a baby or not, but you don’t want them to have a choice to look at a sonogram? That makes no sense to me.” (In fact, prior to the sonogram bill, women seeking an abortion at Planned Parenthood could elect to look at a sonogram.)

  As the session reached its halfway point, many female legislators grappled with the magnitude of what had happened. Democratic women could at least enjoy the full-throated support of their male colleagues, but moderate Republican women frequently found themselves all alone, treated to a front-row seat from which to view their own powerlessness. To speak up was to be targeted for defeat in the next primary, after all. They dragged through the Capitol with heads down, making apologies to staffers and colleagues for their votes. Ultimately, both Beverly Woolley and Florence Shapiro announced their retirements. The latter told a lobbyist, “These are no longer the people who elected me.”

  Shapiro and Woolley weren’t the only veteran Republicans to find themselves in an awkward position. Take the case of Robert Deuell and the Women’s
Health Program. Senator Deuell, a physician from Greenville who has held office since 2003, was known to be both pragmatic and conservative when it came to public health. He supported programs like needle exchange for addicts, but he was strongly opposed to abortion. In fact, he had worked tirelessly since 2007 to toss Planned Parenthood from the network of providers included in the Women’s Health Program, a Medicaid fund for poor women started in Texas in 2006. Yet unlike many of his new comrades-in-arms, Deuell favored taxpayer-supported birth control.

  If the state doesn’t make birth control available, he told me, “we are going to be providing prenatal care. It’s the lesser of two undesirables, and that’s the point I’ve tried to make. Do I wish women waited? Yes, but they don’t.”

  Deuell has always favored shifting the services provided through the WHP from Planned Parenthood to community-based health organizations and clinics known as Federally Qualified Health Centers. There were some obstacles to this, among them the question of whether the FQHCs could deliver the same quality of care. Many FQHCs were already overrun with very sick people. Jose Camacho, the head of the Texas Association of Community Health Centers, which oversees FQHCs in Texas, had insisted that, despite what Deuell wished, the FQHCs could not absorb the overflow, given Texas’s soaring birth and poverty rates along with the vast number of uninsured. “We served one million patients this year, at least,” he told me. “To think that any health system can ramp up to take, in effect, 20 percent more patients is not realistic.”