As of this week, nearly three thousand low-income women in Texas will need to find a new place to get their breast and cervical cancer screenings, thanks to a decision by lawmakers to oust Planned Parenthood from the program that subsidized care for uninsured women. The new rule is just the latest reminder that reproductive health services that were once off-limits are now fair game in the GOP’s long and tireless battle against abortion.

Wendy Davis launched Texas into the national spotlight in the summer of 2013 when she filibustered HB2, a law that placed sweeping restrictions on abortion providers and quickly closed 17 of the state’s 41 clinics that offered the procedure. In November the Supreme Court will decide if it will hear the case, and if it rules the law constitutional, seven more will close.

Many of the restrictions included in HB2 have also been implemented in other states, reducing access to birth control, pap smears, breast exams, pregnancy tests, and abortion.

But long before HB2 turned national attention to Texas, lawmakers had been busy dismantling the state’s reproductive health infrastructure. Between 2011 and 2013, they cut the state’s family planning budget by nearly two-thirds and established a tiered system that prioritized primary care centers, health department providers, and “crisis pregnancy centers,” leaving little to no funding for family planning clinics – the very entities for which the funding is intended. The state violated federal regulations by banning Planned Parenthood from its Medicaid Women’s Health Program (WHP) and forfeited the federal government’s 9:1 funding match. Governor Perry insisted the state could operate the program without federal support, but the results have proven otherwise: in 2013 the new WHP served almost 30,000 fewer women – and received more than 100,000 fewer claims for birth control – than it did in 2011 (before it lost Medicaid funding). In the wake of these vast changes, 82 family planning clinics closed, 49 more reduced hours, and 54 percent fewer clients were served. In response to public outcry, lawmakers increased funding in 2013, but many women remain left out.

In a recent survey of providers in Texas, respondents reported that “they did not know what had happened to their former clients but suspected that they simply were not seeking reproductive health care.”

Despite the mounting challenges to accessing care, Texas lawmakers added yet another barrier. For 20 years Planned Parenthood participated in the state’s Breast and Cervical Cancer Screening (BCCS) Program, and last year served 10 percent of the state’s patients who receive the subsidized services. Lawmakers intent on routing abortion – and Planned Parenthood – out of their state argued that clinics receiving BCCS funding “should not be facilities for performing abortions.” Texas lawmakers insist women can simply receive their care elsewhere, but that’s simply not the case, and it’s particularly troublesome given that the incidence of cervical cancer among Texas women is 17 percent higher than the national average. According to a new report from the National Latina Institute for Reproductive Health, Texas Latinas experience a higher incidence rate of cervical cancer than their white or Black peers, and those living in counties near the Texas-Mexico border – among the worst impacted by the regulations of the last four years – are 31 percent more likely to die of cervical cancer compared to women living in non-border counties.

Aimee Arrambide, Director of Policy and Advocacy for the Texas Women’s Healthcare Coalition, said it’s hard to predict where the women who relied on Planned Parenthood for their cancer screenings will now go. “Even after the 2013 Texas Legislature restored funding to the Texas women’s healthcare programs, the safety net of providers was already so devastated by the 2011 cuts and the exclusion of the most active providers, like Planned Parenthood, that it did not recover.” Rebuilding clinics and getting patients back into the fold is a long and complicated process, especially when new restrictions keep cropping up.

Lawmakers in other states have followed the lead of their Texas colleagues in extending the battle against abortion access to a broad range of reproductive health services. Today Ohio and Michigan have developed tiered systems similar to that of Texas. Oklahoma and Kansas prohibit private family planning providers from receiving state and federal funding and seven other states prevent organizations that also provide abortion services from receiving funding.

Republicans at the federal level have followed suit. In 2011 the GOP proposed eliminating Title X, the national family planning program started in 1970 by President Nixon and then-Congressman George H.W. Bush (marking the first of such efforts in the program’s 40-year history). Today funding for Title X is 70 percent lower 1980 levels (accounting for inflation), and House Republicans again proposed eliminating Title X in June of this year, while Senate Republicans proposed further funding cuts. The GOP has voted 55 times to overturn the Affordable Care Act – which has dramatically improved reproductive health coverage – and it shut down the government in opposition to the law’s requirement that employers and insurers cover all FDA-approved methods of contraception. In recent weeks Republicans have lined up to decry the heavily doctored Planned Parenthood videos and demand the organization be stripped of its federal funding. Last week Jeb Bush, a GOP presidential hopeful, argued that Planned Parenthood is not “actually doing women’s health issues.”

Texas lawmakers might have blazed the trail in steamrolling reproductive health access, ignoring the cost to the health and lives of their constituents, but it’s clear that others are eager to follow the same path, methodically whittling away at the reproductive health infrastructures on which so many individuals have long relied – particularly poor women, women of color, young men and women, and members of the LGBT community.

Texas governor Greg Abbott said in his inaugural speech. “As goes Texas, so goes America.” Unfortunately for women and families, that certainly seems to ring true.