A new university study has found Texas wanting when it comes to reproductive health care in the state. Researchers at George Washington University have found that if Texas manages to exclude Planned Parenthood from participating in the Texas Women’s Health Program (WHP), “tens of thousands of low-income Texas women could lose access to affordable family planning services and to other women’s health services.”

GWU has had its eye on the state since May, when it released a report questioning claims by Texas’s Department of Health And Human Services that non-Planned Parenthood providers could easily see the 50,000 or so Texans who currently rely on Planned Parenthood for breast and cervical cancer screenings, contraceptive supplies, and other basic preventive care. Lawmakers in Texas want to exclude Planned Parenthood from the program because they consider it an abortion “affiliate,” even though no Planned Parenthood clinic enrolled in the WHP provides abortions and the WHP itself cannot ever be used to serve a pregnant person—it’s intended solely for the use of Texans who do not want to be, and who are not, pregnant.

The study released this week casts even more doubt on the state’s ability to find new providers to pick up the slack, focusing especially on poorer rural areas where alternatives to Planned Parenthood are few.

Where alternatives do exist, researchers concluded, “they are generally at, or close to, the limits of their capacity and will not be able to expand much, if at all, due to other resource or staffing constraints. There is no evidence that they are prepared to sustain the very large caseload increases that would be required to fill the gaps left after Planned Parenthood affiliates are excluded.”

In a statement released today by HHSC Executive Commissioner Kyle Janek in response to the study, the department says it intends to add new providers to the program on top of the 500 added since the spring. “We’re confident that we’ll be able to provide women with access to family planning services and fully comply with state law that bans abortion providers and affiliates from the program.”

In his statement, Janek said that HHSC has “five family planning clinics and more than 70 individual physicians waiting to take the place of every clinic that won’t qualify under the new rule.”

Indeed, if the WHP provider base is not increased in Texas, existing providers will be asked to take on huge numbers of former Planned Parenthood clients. From the GWU study, which looked at five Texas markets, including rural Lubbock, Hidalgo and Midland counties as well as urban Bexar County, which contains San Antonio, and Dallas County:

“If Planned Parenthood affiliates were excluded from WHP, the remaining non-PPFA clinics would have to absorb a massive increase in WHP patients in order to maintain the overall 2011 caseload level. Non-PPFA clinics in Bexar and Dallas Counties would have to double their capacity. Lubbock County providers would need to expand by 250% if the Planned Parenthood affiliate was excluded. In Hidalgo and Midland Counties, the average non-PPFA clinics would have to serve more than five times their current caseloads. In these five markets, the WHP caseloads would need to expand by two to five times their current capacity in order to absorb the patients already served by Planned Parenthood.”

This is a situation entirely of Texas lawmakers’ and bureacrats’ making, achieved through drastic family planning budget cuts in 2011 and this year’s attempt at excluding Planned Parenthood from the WHP, though pending litigation has held up the ultimate ruling on Planned Parenthood’s fate.

The State of Texas is in an interesting position. By taking steps to address the demonstrable gaps left by the exclusion of Planned Parenthood, Texas and its governor, Rick Perry, have to admit that what they’ve been claiming along—that Planned Parenthood’s participation in the program is insignificant and easily replaceable—is completely false.

Texas already has a shortage of primary care physicians, and while bringing in five clinics and 70 doctors is a step in the right direction, it’s not clear whether those clinics and doctors can see the number of patients served by Planned Parenthood. In 2011, for example, Planned Parenthood saw nearly half of Texas’ 115,226 WHP clients. Five clinics seeing 200 patients, and 70 doctors seeing 15 patients, adds up to just 2,050 patients served. That’s a far cry from addressing the needs of the fifty thousand Texans who will have to find non-Planned Parenthood providers.

If the State of Texas cannot find the hundreds of new providers and clinics it will take to fill the gap left by Planned Parenthood, the negative consequences won’t just be borne by the low-income enrollees in the WHP, but in higher bills for the state. Taxpayers will end up paying for more Medicaid births in the state. GWU estimated that, if Planned Parenthood had been excluded from the WHP in 2011, the state would lose $5.5 million to $6.6 million as a result of paying for the entirety of the program itself—instead of benefiting from the 90 percent federal match in funds it saw in years past—in addition to paying the costs for a larger number of Medicaid births to women who wanted to avoid a pregnancy and who before the program shift would have had access to free or affordable contraception and, by extension, more freedom to plan their families.