Anti-abortion forces in Texas achieved a major triumph in 2011, the last time the state legislature convened. They passed laws requiring a 24-hour waiting period and requiring all women seeking an abortion to undergo a fetal ultrasound. The idea was to force down abortion rates by changing women’s minds. A follow-up study indicated that abortions did decline by 10-15 percent, but probably because the waiting period created logistical and financial hurdles for many women, not because women’s minds were changed.

This year, a flood of new proposals have left pro-abortion rights advocates scrambling once again. The bills now favor policies that would impose more regulations on abortion clinics, rather than policies (like ultrasound) that are meant to change women’s minds. The National Abortion Federation calls such policies “TRAP laws” (Targeted Regulation of Abortion Providers) and more than half of states have passed them.

There are five key bills that many are watching. Here is what they would do:

• Ban all abortions after 20 weeks (the “Preborn Pain Act”).
• Force abortion clinics to be licensed as “ambulatory surgery centers.”
• Require a  doctor (not a nurse) to dispense the medical abortion pill RU-486.
• Require that doctors performing abortions have admitting privileges at a nearby hospital.
• Ban any health insurance plan, including those offered in the upcoming “exchanges” under the federal health law, from offering abortion coverage, unless purchased as separate coverage and paid for with a separate premium.

At first glance, the “Preborn Pain Act” seems the most straightforward attack on abortion.

“This bill would basically say at 20 weeks you can’t get an abortion unless your life is in danger,” said Heather Busby, executive director of NARAL Pro-Choice Texas. “It doesn’t make any exceptions for fetal anomalies or rape or incest.”

Busby points out that most abortions happen much earlier, so this bill would affect only a small percentage of all abortions. But late-term abortions usually involve dire circumstances, she added, such as a major medical complication in the pregnancy or a young abuse victim realizing too late that she was pregnant.

“There’s no way that a politician can predict every life circumstance that someone would find themselves in and be able to write a bill that would account for that,” Busby explained.

Busby and her allies seem most concerned about Senate Bill 537, which would require every abortion facility in the state to be licensed for ambulatory surgery.

The bill’s backers say it’s about patient safety.

“There are many physical complications of an abortion and we think requiring abortion clinics to be held to a much higher standard might avert some of those complications,” says Elizabeth Graham, director of Texas Right to Life.

“While abortion is legal – and until we can help every woman continue her pregnancy – we don’t think they should be going to sub-standard abortion mills.”

But pro-abortion rights activists say there’s no evidence that abortion has become unsafe or that the clinics suddenly need a new set of regulations – in fact they point out that abortion is less invasive and less risky than childbirth and many other types of surgery.

Of the 42 abortion clinics in Texas, only five are currently licensed for ambulatory surgery.

“That means you’re going to in one fell swoop wipe out 90 percent of the providers that women rely on when and if they need to end a pregnancy,” said Rochelle Tafolla, a spokeswoman for Planned Parenthood Gulf Coast. “Plain and simple, it’s about banning abortion statewide.”

Ambulatory surgery centers (ASCs) do a wide range of outpatient surgeries, from orthopedic surgery to cataract removal. Tafolla says state regulations for an ASC include requirements for floor space and equipment that are simply unnecessary for most abortion clinics, unless they are also performing other procedures. Abortion facilities in Texas currently have their own set of licensing requirements.

Kathy Kleinfeld is a national consultant for abortion clinics. She says most of her clients would have to gut their facilities and perform expensive renovations, such as installing hands-free sinks and janitor’s closets in every procedure room.

“In Houston we have clinics that are in doctor’s offices,” Kleinfeld said. “Some of which are in medical buildings and some of which are in office buildings. They don’t own those buildings, so how are they going to do those kind of renovations?”

Gov. Rick Perry had no sympathy for that concern. He spoke about the bill at a rally on March 26.

“There are those who say asking abortion clinics to live up to the standards of other surgical facilities will be too expensive for them, and they’ll have to close their doors. Well, that’s up to them and their accountants.”

SB 537 has passed a Senate committee and is currently awaiting a full vote in the Texas Senate.

Pro-abortion rights advocates say the other bills also whittle away at abortion access through unnecessary regulation. The bill requiring a doctor, not a nurse, to dispense RU-486, the abortion pill, when combined with the 24-hour waiting period law, would mean that a patient would have to make four separate visits to the clinic. These advocates point out that four trips to a clinic would unfairly burden low-income women or patients who live far away.

Pro-abortion rights legislators have introduced their own bills. One would remove the 24-hour waiting period required between an initial consultation (and ultrasound) and the abortion. Another would remove the requirement that doctors inform patients that abortion increases the risk of breast cancer. But even if such bills were approved by the Republican majorities in both chambers, it’s unlikely that Perry would sign them into law.

This story is part of a collaboration that includes KUHF, NPR and Kaiser Health News.