Despite the furor over Planned Parenthood on Capitol Hill—one that helped to oust a House Speaker, no less—House Republicans have made no progress in their efforts to defund the organization. Outside Washington, however, GOP-controlled states continue to invent new ways to undermine the women's health provider—and they are making headway.  

Ohio lawmakers, notably, are breaking new ground by going beyond the traditional fights over family-planning services. The state's Republican-controlled legislature is fast-tracking a new bill that aims to cut off federal funds Planned Parenthood receives—and which are distributed as grants by the state—for a range of health services including HIV testing, infant mortality reduction, rape-prevention classes, and breast and cervical cancer screening. Such programs are less frequently associated with Planned Parenthood, but have now become ripe targets for anti-abortion activists. “For a long time, when somebody said defunding Planned Parenthood, it meant cutting family planning—Title X money," says Kellie Copeland, executive director of NARAL Pro-Choice of Ohio. "Now it means any dollars going to Planned Parenthood, be it for sexually transmitted infections, sex education. It’s much broader."

The dollar amounts are relatively small: Planned Parenthood of Greater Ohio estimates that its clinics stand to lose between $1 million and $7 million, depending on the final language and implementation of the bill. But the measure would open up a new frontier in Ohio conservatives' ongoing battle against abortion providers, cutting off yet another stream of funding and clientele at a time when new restrictions are already forcing clinics in the state to close their doors. “Ohio would be one of the first to move forward on that train,” says Katherine Franklin, director of communications for Ohio Right to Life.

Anti-abortion advocates in Ohio have already banned Planned Parenthood from receiving state funds for family planning; the latest bill is a way to get at federal funds administered by the state government. The ultimate goal is to shut down Planned Parenthood entirely by cutting off public money, following Texas’s lead in gutting access to reproductive health care. In Ohio, Franklin says, “We’re trying to pursue a different kind of incremental approach."

Anti-abortion groups had been making the case for the bill since the beginning of the year, but the legislative push began in earnest in July, after anti-abortion activists first released undercover videos accusing Planned Parenthood of illegally profiting from the sale of fetal tissue. The measure is now going through hearings in both the state Senate and House of Representatives. Supporters and opponents alike expect it to be voted out of committee, pass the General Assembly, and hit Governor John Kasich's desk by Thanksgiving. A Kasich spokesman said the governor would not comment on pending legislation, but he’s widely expected to sign the bill if it passes. Despite pitching himself as a moderate in his presidential campaign, and slamming House Republicans for threatnening the shut down the government over Planned Parenthood, Kasich has green-lit every significant restriction on abortion and family planning since he took office in 2011. 

Even Democratic opponents admit that the bill has been cannily packaged and presented. “The Republican Party did a good job with this," says state Representative Greta Johnson. "They came out strong with these horribly edited videos and scared even moderate Democrats into thinking, ‘I can’t be affiliated with them.' " Anti-abortion advocates have touted the bill as bipartisan, having scored the support of Democratic state Representative Bill Patmon, who is co-sponsoring the measure in the House. But the vast majority of Democrats are vocally opposing it.  

The Ohio strategy is more piecemeal than what we're seeing in states like Arkansas and Louisiana, whose governors have tried to go big by cutting the organization’s contracts with Medicaid, which provides roughly 75 percent of its funding. Texas Governor Greg Abbott this week announced that his state was dropping Planned Parenthood from Medicaid (court challenges will follow), and Ohio anti-abortion groups have clamored for Kasich to do the same. But Ohio’s current legislative strategy could ultimately prove more lasting, as federal courts have temporarily halted Arkansas and Louisiana's attempts to cut Planned Parenthood out of Medicaid funding. “In Ohio we’ve been careful to enshrine as much as we can in law," says Franklin. "It would stand longer and it would hold regardless of who is our state’s executive. That’s important to us for making long-term change." 

Other states are taking a similarly incremental approach. North Carolina’s GOP-controlled state legislature passed a budget last month that bans Planned Parenthood from receiving state money for family planning and pregnancy prevention. Also last month, Wisconsin’s state Assembly passed a measure that aims to prevent Planned Parenthood from receiving federal Title X funds by having the state's health department apply for the federal grant instead. 

Supporters of the Ohio bill say that the funds will simply be redirected to other clinics, community health centers, and local health departments, without interrupting health services. But the state's community health centers are already under strain, and might not have the capacity to take on the additional clients. “You’re going to take a proven, effective program that’s making a difference—you’re going to disrupt that and try to find someone else to replicate it,” says Copeland, who points out that Planned Parenthood clinics were awarded the federal grants through a competitive process. 

There is growing evidence that undermining abortion providers like Planned Parenthood has harmed low-income women’s access to reproductive health services. Texas has massively reduced participation in its family-planning program, with a 38 percent drop in claims for birth control and a 23 percent drop in wellness exams. Opponents of the Ohio bill are particularly concerned about the funds for Planned Parenthood’s infant mortality prevention programs; the state has one of the highest infant mortality rates in the country. “I know it seems like a smaller dollar amount, but we’re talking about really the most vulnerable population,” says Johnson.

Ohio’s new legislative push comes on the heels of a string of victories for anti-abortion activists during Kasich's tenure. The state’s 2013 budget included newly tightened regulations that made it difficult for clinics to remain open. Five abortion clinics have been shuttered in Ohio since that budget passed, reducing the total number of abortion providers in the state from 14 to nine. That’s why Ohio Right to Life has called Kasich “the most successful pro-life governor we’ve ever had." Says Donna Crane, NARAL’s vice-president of public policy: “It’s one of the places we watch on a daily basis to see if clinics are open." Anti-abortion opponents in Ohio are also currently pushing two other restrictions: Lawmakers are also expected to pass a new bill banning abortion if Down syndrome is the reason for termination. A 20-week abortion ban is also in the docket, having already passed the Ohio Senate this summer. 

As it has in other states, Ohio Planned Parenthood has found ways to thwart some of the defunding efforts with help from the Obama administration. In 2013, when Ohio tried to block Planned Parenthood from receiving federal Title X funds distributed by the state, the group went directly to the feds for the money instead. But the federal government may not be so quick to make such accommodations this time around. Stephanie Kight, president and CEO of Planned Parenthood of Greater Ohio, says she has talked to the federal government to see if a workaround might be possible if the bill passes, but she isn’t confident that the administration will bother this time around. “It’s less likely in this case because they are smaller grants,” she says. 

Even if Planned Parenthood does find a workaround, Stephanie Krider, executive director of Ohio Right to Life, says the measure will be a significant victory—and a sign of what may be to come on a national scale. “Winning at the state government level is still winning," she says. "It certainly bolsters our case that with a pro-life president, we could have a real impact on public funding of abortion.”

NARAL's Crane can't argue with that. “The way we see Ohio is that it's one of the ground zeroes—it’s one of the prime examples of how elections have consequences,” she says. "You have John Kasich come in and get elected in the [2010] sweep. All of a sudden everything changes.”