Since 2010, nine states have tried to strip funding from their local Planned Parenthood chapters. Not three years later, almost all of their schemes have been laughed out of court. In the cases of Arizona, Indiana, and Texas, where legislatures and governors had tried to bar the federally approved provider from participating in state Medicaid, judges ruled that states simply can't do that and expect to receive federal dollars. The governor of one of those states, however, decided that if federal rules won’t allow him to defund Planned Parenthood, so be it. He would achieve his goal by forfeiting hundreds of millions of federal dollars in Medicaid tagged for women's health care.

That governor, of course, is Rick Perry of Texas. Since fading from our national memory as the presidential candidate who couldn’t remember the Department of Energy, Perry has gone home to oversee the dissolution of what was once a decent health-care partnership with the federal government, the Women's Health Program. Its replacement, an entirely state-run and -funded program of the same name, launched January 1 with rules that exclude Planned Parenthood. As a result, Texas is no longer eligible to receive the $200 million–plus a year that Medicaid provided to Texas to care for low-income women, a fact that doesn't bother Perry one whit.

Perry hasn't won outright; Planned Parenthood has filed lawsuits in state and federal court, and a state court will decide Friday whether to grant an injunction that would temporarily protect Planned Parenthood’s local funding. But Perry's success thus far is instructive to other conservatives looking to give Planned Parenthood the boot. (It's not clear who might be the first to reprise the fight, although a Planned Parenthood official said the organization is keeping a fretful eye on onetime antagonist Wisconsin Gov. Scott Walker.) With that in mind, and with the far-right dream of defunding Planned Parenthood alive and well, it’s worth examining just what Texas has sacrificed with all those federal dollars—and what kind of a public health mess it has on its hands as a result.

The costs are stark. One-quarter of Texas women are uninsured, and the Women’s Health Program was a reliable way to cover at least some of their needs. But by freezing Planned Parenthood out of the program last week, Texas has forced more than 50,000 of them to search for a new primary care doctor within the Women’s Health Program—and it is not at all clear that the system has the capacity to reabsorb them. Planned Parenthood accounted for about half of Women’s Health Program services last year—mostly in the form of cancer, diabetes, and STI treatment, plus high blood pressure screenings, contraception dispersement, and annual checkups. In many parts of Texas, Planned Parenthood served half of all low-income women enrolled in the Women’s Health Program; in certain areas, that number was as high as 80 percent. And having rejected Medicaid, which provided about $9 to the Women’s Health Program for every $1 the state spent, Texas is now challenged to come up with about $200 million for the program over the next five years. (One proposal is to make up the gap through Medicaid fraud penalties, but the state's method for collecting these is dubious and under heavy fire). All this has taken place at a time when Republican legislators have already slashed the family-planning budget by two-thirds. “This is Rick Perry versus Texas women, literally,” a Planned Parenthood official told me.

For its part, the Texas Health and Human Services Commission (HHSC), which administers the Women’s Health Program and wrote rules to exclude Planned Parenthood at Perry’s behest, disputes that shedding Planned Parenthood has created a problem. In a media blitz begun this week, its officials are touting a survey of state-approved providers who say they have more than enough capacity to serve Planned Parenthood’s former patients. But Texas reporters have called alternative providers listed by the HHSC and found that many are not actually participating in the Women’s Health Program or are not accepting new clients. State Rep. Donna Howard, a Democrat from Austin, and her staff have placed a few such calls, too. “We’ve been told that providers are no longer there, that they don’t take Medicaid, a wide variety of answers,” she said. The website, she added, lists an assortment of providers who perform important auxiliary services—like radiologists, anesthesiologists, and endoscopic physicians—but don’t provide the primary care that would replace a visit to Planned Parenthood. “It’s very confusing.”