It’s been another frightful week of repression and intimidation in the nascent theocracy of Abbottistan. The grip of the fanatical single-party caliphate further tightened its grip around the necks of the populace as its leaders announced the escalation of its longstanding fatwa against poor and minority women in the region. The government in that country has demonstrated a flagrant disregard for human rights and dignity since the rise to power of the single-party caliphate in the late 1990s. Many western observers fear the caliphate’s new focus on the fatwa could lead to further destabilization and violence in the region that could have an adverse economic impact on the United States and other western democracies, and further destabilize neighboring states Jindali, Asaland, and Fallinia that are heavily influenced by the caliphate. Many observers believe that the health and safety of all women in the region, not just poor and minorities, are at high risk and that an international emergency should be declared.

You can say the above paragraph is fiction, a flight of fancy, perhaps. Or is it? Replace Abbottistan with Texas, single-party caliphate with Republicans, and fatwa with legislation and other governmental actions, and you get an idea of what is happening right in the middle of a supposedly enlightened first world country.

On Monday, Texas Inspector General Stuart Bowen sent a letter to the state’s four Planned Parenthood affiliates, informing them of the state’s intention to end their Medicaid funding. The affiliates have received approximately $310,000 in state money and $2,800,000 in federal money from Medicaid in 2015. The letter cites heavily edited undercover videos produced and distributed by Operation Rescue offshoot Center for Medical Progress as evidence of “violations of standard medical practices”. The cited video purportedly shows a Planned Parenthood official in Houston discussing the sale of fetal tissue and organs with CMP agents posing as researchers. The letter also cites accusations of billing fraud by former Planned Parenthood Employees who have filed whistleblower suits against the organization in federal courts as justification for the Medicaid defunding.

Both the video and the billing fraud allegations involve only one of the Texas affiliates, Planned Parenthood Gulf Coast, headquartered in Houston with clinics in Bryan, Lufkin, other East Texas cities, and two locations in Louisiana. The video cited was purportedly taken at the Houston headquarters. The billing fraud allegations were made at clinics in Huntsville and Lufkin. A third fraud suit not mentioned in the letter was brought by ”pro-choice to pro-life convert” Abby Johnson, alleging some 87,000 instances of over-billing totaling $5,701,055 by the Bryan clinic. That suit was dismissed by the Southern District of Texas in 2013. The dismissal was upheld by the 5th Circuit the following year.

Of the two suits cited in the letter, Reynolds v. Planned Parenthood Gulf Coast and Carroll v. Planned Parenthood, only Carroll is still active and pending trial in the Southern District of Texas, Houston Division. The Lufkin Court in the Eastern Division of Texas dismissed the state claims in Reynolds in 2012. The remaining federal claims were subsequently settled by Planned Parenthood for $4,300,000, with the organization claiming it would be less costly to settle the case than pay legal fees to contest the allegations all the way through trial. The state claims in Carroll were also dismissed, and only federal claims remain subject to the trial. The suit does not involve fraud by over-billing, but mis-categorization. It alleges Planned Parenthood in Huntsville took blood samples for HIV tests at a juvenile detention facility rather than at the clinic as reported on its Medicaid forms. The suit claims the detention facility was not an approved medical facility and thus Planned Parenthood was disqualified from Medicaid reimbursement for the procedures.

The Houston Chronicle and Austin American-Statesman were quick to publish editorials condemning the state’s Medicaid defunding plan as so much political grandstanding by conservatives. The publications point out that if decreasing the number of abortions in the state is the goal of the move, the state is going about it backwards. Medicaid funding for abortion in Texas and the nation is currently $0, and has been since 1976 with the passage of the Hyde Amendment which makes exceptions for “rare cases of rape, incest and the health of the mother.” The Medicaid money currently going to Planned Parenthood in Texas and elsewhere is for family planning, education, and birth control that would reduce the number of unwanted pregnancies. It mostly helps poor young women without insurance or any other health care options.

According to the Houston Chronicle Editorial:

What Medicaid does fund is family planning services that help make abortions unnecessary.

But in the war against abortion, fighting Planned Parenthood is easier than actually reducing the number of unwanted pregnancies. So instead of better sex education or broader access to birth control, Texas will get another lawsuit. That won’t do much to help everyday Texans, but politicians will be able to count it as a win. If only they could share the spoils of victory with a young woman who can’t afford basic health care.

The Austin American-Statesman declared:

Once again policy makers have institutionalized the poverty penalty, which requires people with the least amount of time and resources to cobble together medical care. For those women, cost is a complicated equation that includes more than just the price of services. Transportation, wait times, comfort and choice all come into play. The net result is that if the penalty is too steep poor women choose to postpone care, often resulting in more costly and harmful outcomes.

Indeed, the taxpayers of Texas will get to pay for yet another expensive lawsuit. Mind you, this is a state that recently got a legal bill for over $700,000 after it lost its fight against same-sex marriage. Louisiana, Arkansas, Utah, and Alabama have already tried the stunt Texas just pulled, and they all got hit with federal lawsuits that will cost their taxpayers hundreds of thousands, if not millions of dollars, over the next few years. Texas and its taxpayers will soon follow those states to the courthouse.

Another issue the Inspector General’s letter indirectly addresses is the allegations construed from the Center for Medical Progress videos made in Houston and around the country that Planned Parenthood is profiting from selling fetal tissue and organs, an illegal activity under federal law. What is allowed under federal law is tissue donation with reimbursement for costs paid by the research facilities receiving it. CMP and others, including Abby Johnson, claim that PP marks up its costs associated with the donations and makes adjustments to its accounting in order to make a profit from fetal tissue donations. What both CMP and Johnson fail to disclose is that no PP affiliates in Texas have collected fetal tissue since 2010 when PPGC did so on behalf of the University of Texas Medical Branch. As the Chronicle points out, no one is crying out for the University of Texas to be defunded. Investigations of similar allegations in Georgia, Indiana, Massachusetts, and Indiana found no evidence of the illegal activity. The investigation launched in Texas this summer has yet to find any evidence of wrongdoing by Planned Parenthood.

Abby Johnson went before a Texas Senate subcommittee in July, and claimed she witnessed such illegal markups while she was director of the Bryan Planned Parenthood. Johnson left Planned Parenthood and joined a pro-life group in 2009. In 2013, she filed her whistleblower suit against PP. There is no mention of the fetal tissue reimbursement markups in the lawsuit. Like the rest of her “conversion” story, this claim seems a bit, to put it mildly, suspicious.

Planned Parenthood has 30 days to respond to the Inspector General’s notice. It is likely that it will file a federal lawsuit prior to that time and the defunding will be stayed by the Court.

US District Judge John W. deGravelles has already issued a restraining order against the state of Louisiana in its suit against Planned Parenthood Gulf Coast, writing:

The uncontradicted evidence in the record at this time is that PPGC … is not involved in the sale of fetal tissue and none of the conduct in question occurred at the PPGC’s two Louisiana facilities. Based on the record before it, it appears likely that Plaintiff will be able to prove that the attempted termination against it are motived and driven, at least in large part, by reasons unrelated to its competence and unique to it.

[The Court] turns to the uncontested and unquestioned facts—PPGC serves 5,200 poor and needy women, and PPGC has repeatedly been deemed a ‘competent’ provider by DHH—and honors the public interest in affording these women access to their provider of choice…For decades, PPGC has served numerous at-risk individuals and helped DHH combat a host of diseases, and, in the process, become the regular provider of over 5,000 women.

It’s good that someone is seeing through this conservative charade. A federal judge in Texas should be writing something similar in the next few months. In the meantime, the war against women and reproductive rights rages on all around the country.