Abortion wait times in Texas: The shrinking capacity of facilities and the potential impact of closing non-ASC clinics

Over the past four years, the Texas Policy Evaluation Project has closely monitored which facilities providing abortion care in the state are open. Since April 2013, when debate began around the bill that became House Bill 2 (HB2), the number of facilities providing abortion care has dropped from 41 to 18. According to our interviews with facility staff, many of these closures have been related to difficulty obtaining hospital admitting privileges for physicians at the facilities, while others have been related to difficulty complying with the requirement that facilities meet the standards of ambulatory surgical centers (ASCs). This ASC requirement is currently enjoined by the US Supreme Court while it determines if it will consider hearing a legal challenge to HB2 in its next term.

To determine how well the existing facilities are meeting the demand for services and if the clinics’ capacity to meet the demand differs across the state, we have performed monthly mystery calls to open facilities providing abortion care since November 2013, when the admitting privileges requirement went into effect. 

These calls sought to document wait time, defined as the number of days between when the mystery caller telephoned the facility and when the next consultation appointment was available. With a time-sensitive procedure such as abortion, wait times serve as a measure of facility capacity to meet the demand for services.

In this Research Brief, we present the results of our monitoring of abortion wait times since November 2014. Services were disrupted across the state in October 2014 when the ASC requirement was briefly enforced; this Brief focuses on the period after the non-ASC clinics reopened. We particularly focus on wait times at facilities in Dallas and Ft. Worth after a large-volume provider in Dallas closed in June 2015.

We also explore the wait times at the existing nine ASCs in Texas. In early 2014, we found that only 22% of all abortions were being provided by the ASCs. We suggested that it would be difficult for those facilities to increase their capacity sufficiently to meet the demand for all abortions in the state, while proponents of HB2 said that there was no reason to believe that they could not meet this demand.

Finally, we explore what the impact of the closure of all the non-ASC clinics in the state might be in terms of increasing wait times and the resultant increase in second-trimester abortion in Texas.