It is no small feat for an Austinite to reach their nearest abortion clinic. Four years ago, at least 19 clinics operated in the state of Texas. In North Austin, you could find Whole Woman’s Health in an office park beside kidney specialists and a birthing center.
Now, an Austin patient must book a flight or drive 11 hours through oil fields and desert to Albuquerque, New Mexico. Out of a tan little building there – an unremarkable office that housed a foot doctor until 2023 – thousands of Texans receive abortions each year.
Roughly nine in 10 patients at the Whole Woman’s Health clinic in New Mexico come from Texas, according to stats provided by the nonprofit.
Still, Whole Woman’s Health is treating a small fraction of the Texans it treated prior to the state’s near-total abortion ban taking effect in 2022, says founder and CEO Amy Hagstrom Miller.
“That keeps me up at night,” Hagstrom Miller told the Chronicle. “It’s knowing how many people are being left behind.”
Despite state and federal efforts to make abortion harder to access for Texans, ultimately, it appears that not much will change for Austinites seeking an abortion in 2025.
One Big Beautiful Bill does include a measure to defund Planned Parenthood – one Republican congressman called it “the most pro-life and pro-family piece of legislation signed into law in decades” – but Planned Parenthood was already unable to provide abortions in Texas.
“Pre-compliance is the first sign of authoritarianism, right?”
Whole Woman’s Health Founder and CEO Amy Hagstrom Miller
A measure in earlier versions of OBBB aimed to make abortion an out-of-pocket expense, but that provision disappeared from the final version. The old wording would have blocked insurance companies from receiving federal funding for Affordable Care Act plans if they provided abortion coverage. The National Women’s Law Center warned that this disincentive could have resulted in “all insurers [dropping] abortion coverage for all Americans.”
But Hagstrom Miller points out that, in today’s political climate, a proposed law might be nearly as discouraging to abortion-seekers as one that actually takes effect.
“The messaging is already having a huge effect on our patients who think they can’t use their Medicaid anymore because of how it’s being covered,” Hagstrom Miller says.
Already, she says many patients seem to think abortion is more tightly restricted than it actually is. For example, she says, many Texans seem to think it’s illegal to leave the state for an abortion. Data backs this up: Nearly one in four Texans wrongly believe that a law was enacted to block out-of-state travel for abortion, according to a 2024 survey from Resound Research for Reproductive Health.
“Pre-compliance is the first sign of authoritarianism, right?” Hagstrom Miller says. “It just stops me dead in my tracks when I think about it, because, you know, even with SB 8 [a 2021 bill which allowed lawsuits against abortion providers] everybody pre-complied. During that time period, our clinics were the only clinics open, still seeing patients, because we figured out loopholes, but the chilling effect was so powerful.”
Likewise, Hagstrom Miller wonders how many pregnant Texans choose not to abort because they fear prison time – even though, in truth, prison time is only a possibility for doctors who provide abortions, and not for patients, under current Texas law. And even then, Texas doctors have yet to actually face imprisonment.
Now, One Big Beautiful Bill does nothing to disincentivize insurers from covering abortion, but Hagstrom Miller fears that simply seeing the words “Medicaid” and “abortion” paired in headlines could be enough to scare some pregnant people on Medicaid from seeking abortions. The impact could be significant. At the clinic in New Mexico, 15% of patients use Medicaid to pay for their abortion care, according to the nonprofit’s stats.
“The power of what could happen, what might happen, what they’re threatening to happen, is so huge,” Hagstrom Miller says.
It’s not just a chilling effect for patients, she says, but for doctors, some of whom referred patients to Whole Woman’s Health for more than a decade, and now fear to make such a referral.
“They can still refer to us, right? But the amount of education that we need to do in order to reach all those people, it’s almost insurmountable,” Hagstrom Miller says. “Because people are afraid to go visit a doctor’s office, or a doctor is afraid to hand out a brochure about a clinic in a different state. They’ve just come to believe that all of those things could be defined as ‘aiding and abetting’ or illegal. That is incredibly powerful.”
Of course, pre-compliance is not the only issue blocking abortion access. Whole Woman’s Health has clinics in blue states across the country. Planning ahead is hard in today’s political climate, because the team struggles to predict where abortion restrictions could disrupt or dismantle their operations. It’s precisely because of this uncertainty that the nonprofit has supplies for two complete clinics – art, furniture, medical equipment, everything – sitting in storage units.
“I know how many people in these southern states used to have access to care and don’t anymore. If I open a clinic in North Carolina, it seems like a smart idea,” Hagstrom Miller says. “But I have no idea if those people are going to actually be able to make it to us, right? And I also don’t know if North Carolina is going to pass a law restricting the care next week.”
This article appears in October 3 • 2025.