First you make it so abortion clinics are unable to operate unless they work with a hospital. Then you harass the hospitals that work with them.

A federal judge has declared part of Texas' abortion law to be unconstitutional, blocking a provision that requires abortion providers to secure admitting privileges at hospitals within 30 miles of where they perform abortion procedures.

Hospital corridor via Shutterstock

It’s a lot easier to harass and picket a hospital than a reproductive health clinic these days. While a clinic and its staff may be resigned to putting up with endless harassment, a hospital is far more susceptible to pressure. Hospitals have board members, doctors, patients, and donors. Some hospitals are religious entities that won’t allow anything involving abortion to take place in their facility, even when pregnant individuals need such medical care, while others are publicly supported institutions that are subject to local or regional government pressures for grants or reimbursements.

All those factors play into the anti-choice movement’s obsession with targeted regulation of abortion provider (TRAP) laws that require medical practitioners at abortion clinics to have admitting privileges at a local hospital. By making hospitals the gatekeeper for whether or not abortions can be provided at an unrelated clinic, anti-choice activists can move their attention to a much more vulnerable target.

A recent example of how easy it is for abortion opponents to cut off abortion providers by targeting a hospital can be seen in Ohio, where Ohio Right to Life is trying to get the University of Toledo Medical Center to revoke its transfer agreement with Capital Care, a Toledo abortion provider. There are only two clinics in Toledo, which, because of their location, also serve a large portion of southern Michigan and northeast Indiana.

John Coats, executive director of Ohio Right to Life, is upset with the terms of the agreement. In his mind, because the hospital is associated with a university, any sign of working with an abortion provider is tantamount to taxpayer funding of abortion. “Our problem was, and is, that the transfer agreement was signed by the University of Toledo, a publicly funded university, and is totally tax payer funded,” Coats told the Independent Collegian. “We know if the transfer agreement did not exist then this abortion mill would not be able to legally operate …. Ohio law prohibits state tax dollars from paying for abortion and it is against the law for publicly funded state hospitals to perform non-therapeutic abortions.”

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However, the hospital does not provide abortions. It merely allows a transfer to its facility in the rare case of a complication. In such cases, the resulting procedure wouldn’t be a “non-therapeutic abortion” or likely any sort of abortion, but rather follow-up treatment for a person who had an abortion.

Ohio Right to Life’s leaders claim they are working with a state representative to introduce a bill that would ban transfer agreements between a “tax-funded public hospital” and an abortion clinic. Should that sort of law become copy-cat legislation—and in today’s political climate, there is little doubt it would—it would essentially shut off all options for transfer agreements or admitting privileges for any abortion providers. Once you eliminate public hospitals and religious hospitals, you are left only with a small handful of private, for-profit hospitals that would qualify, none of which would be likely to take on a medical agreement that not only would offer little profit, but that could come with harassment, potentially driving profitable patients away.

The legislation may still be on the horizon, but the pressure from the state’s anti-choice activists has already gotten to the University of Toledo Medical Center, which has announced that it not only will not be renewing its agreement with Capital Care, but will cease negotiations with the only other local clinic to allow it to transfer patients. As a result, without another hospital willing to step in, both clinics could close.

“Ohio Right to Life, led Mike Gonidakis, Kasich appointee to the State Medical Board, bullied the University of Toledo Medical Center into cancelling these transfer agreements. If other transfer agreements cannot be secured, these clinics may be forced to close,” Kellie Copeland, executive director of NARAL Pro-Choice Ohio, told Rewire. “Closing legal abortion clinics is not going to stop women from having abortions, it will just make them extremely dangerous. Why is an organization run by a member of the State Medical board putting the lives of women at risk by attacking hospitals and legally operating medical facilities in our state?”

No hospitals means no clinics, and no clinics means no safe abortion access. And anti-choice activists can achieve all that without setting foot near an abortion provider. No wonder admitting privileges bills are the new anti-choice darlings.