Just hours after a federal judge ruled against Texas’ controversial decision to bar Planned Parenthood clinics from the vital Medicaid-based Women’s Health Program (WHP), Texas officials were quick to call for an appeal of the temporary injunction, adding another hurdle in the ongoing tug of war over basic reproductive health care.

Planned Parenthood affiliates filed suit in early April to contest the state’s enforcement of a rule prohibiting the clinics from taking part in the WHP because they provide abortions, despite the fact abortion services are not paid for by WHP and can’t legally be subsidized by federal or state funds. The suit challenges the state’s decision as “unconstitutional” under the First and Fourteenth Amendments and argues that women should be allowed to choose their health care provider without state interference. It also claims that the Health and Human Services Commission’s (HHSC) regulation violates Texas law, as it conflicts with the intention of the statutes that created the program.

In his Monday ruling, U.S. District Judge Lee Yeakel – appointed to the bench by George W. Bush in 2003– found that Texas is not allowed to exclude the centers from the federal program, as they collectively provide a “critical component” of the WHP. Doing so would likely be unconstitutional, Yeakel argued, since Texas is basing Planned Parenthood’s participation in the program on their abortion affiliation, services which are maintained as financially and legally separate and are constitutionally protected operations.

Shutting nearly 50 Planned Parenthood centers out of the WHP– a program that provides basic reproductive health care like birth control, cervical cancer and STD screenings to uninsured low-income women– would cause “substantial and irreparable harm” as clinics would be forced to close, lay off staff and reduce operating budgets, wrote Yeakel. And the damage isn’t limited to WHP patients, he wrote– if clinics are forced to close their doors or reduce hours, tens of thousands of other clients would be turned away, as well.

The exclusion would result in a “significant reduction in funding family-planning services” and deprive hundreds of thousands of women basic access to health care, especially in rural areas, the court noted, pointing to already beleaguered clinics in North and West Texas, Lubbock and Hidalgo County. The assurance by state health officials that they will find replacement providers for displaced rural women who rely on Planned Parenthood–an issue previously reported on by the Texas Independent–came under scrutiny by the judge.

“The court is unconvinced that Texas will be able to find substitute providers for these women in the immediate future, despite its stated intention to do so,” wrote Yeakel.

It is in the public interest to allow Planned Parenthood providers to continue their services within the WHP, he found.  The judge also expressed little faith in Texas’ ability to recoup the $35-40 million in federal funds lost due to its decision to cut Planned Parenthood out of the mix of providers.

“Although the Governor has instructed that the program is to continue fully funded by Texas, the current record gives the court no comfort that funds are or will be available to continue the program after the phase out of federal funds,” Yeakel wrote in his conclusion.

Patricio Gonzales, who heads Planned Parenthood Association of Hidalgo County– a poverty-stricken border area hit hard by budget cuts and bracing for additional slashes– called on Governor Rick Perry and the state to prioritize women and “set aside any vendetta they may have against Planned Parenthood.”

“No woman should ever have to fear being cut off from her doctor’s care because of shortsighted political games,” said Gonzales in a statement. “Legal action is always a last resort, but the state and Governor Perry’s actions gave us no other option. The health and well-being of our patients is our number-one priority. We hope that this decision will allow us to continue our lifesaving work of providing high-quality health care and cancer screenings to some of Texas’ most vulnerable women.”

In his concluding remarks, Yeakel stressed the ruling was not definite. A “thorough airing of the issue by trial” remains necessary. If the federal funds are phased out and Texas fails to salvage the program, the judge admitted the ruling “may be of no consequence.” A conference date to determine when the full trial will begin is scheduled for May 18.

Not wasting any time, Texas Attorney General Greg Abbott on behalf of HHSC Commissioner Tom Suehs responded by issuing an appeal in the hours following the ruling.

How Gov. Perry and state health officials will create a wholly Texas-run WHP program and come up with the millions in federal funds forgone because of their decision, and whether the program will continue at all are equally questionable at this point. Some fear the state will dismantle the program, as officials have publicly vowed to do if Planned Parenthood won the suit, according to the San Antonio Express-News earlier this month. HHSC says it will follow the ruling for now, but seems determined to stick by what officials view as a state’s rights issue.

“We received the judge’s order and will comply with the ruling, but we remain confident that federal law gives states the right to establish criteria for Medicaid providers,” said HHSC spokesperson Stephanie Goodman in an e-mail response.

When asked if cutting the life-saving Medicaid program altogether was still an option on the table now that the temporary injunction has been granted, Goodman said the department is in talks with the AG’s office to determine their next steps.

“We’ll need to carefully review the ruling and consult with the Attorney General’s Office before we make any decisions on the program’s future. One of things we’ll be looking at is whether the judge’s ruling allows for the creation of a state-funded program that excludes abortion providers and affiliates,” she said. “We remain committed to ensuring that the program ultimately complies with state law.”

In a statement released after the ruling, Perry spokesperson Catherine Frazier responded similarly.

“Texas has a long history of protecting life, and we are confident in Attorney General Abbott’s appeal to defend the will of Texans and our state law, which prohibits taxpayer funds from supporting abortion providers and affiliates in the Women’s Health Program,” she said. “We will continue to work with the Attorney General to pursue all available legal options.”

Perry and state officials argue their ability to block Planned Parenthood from the program is constitutionally sound under state law and have attacked the Obama administration’s “pro-abortion agenda” for disallowing their rule, despite a comparable block by the health administration under former President Bush, the Texas Independent reported. The ban is said to run counter to federal Social Security law and is therefore prohibited.

Planned Parenthood says it is keeping an eye on the state’s next move. For them, Texas’ speedy appeal is a sign that the fight is far from over.

“The state has given us every indication that they would end the program entirely,” said Planned Parenthood representative Erica Prosser. “We are waiting and watching to see what they do next.”

A copy of the preliminary injunction ruling can be read here. A copy of the state’s appeal can be read here.

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