Planned Parenthood has managed to stay open in Texas despite the state’s best efforts to shut it down. But a lawsuit in front of a conservative judge poses an existential threat.

AUSTIN, TX – AUGUST 8: Dr. Amna Dermish, chief operating and medical services officer at Planned Parenthood of Greater Texas poses for a portrait in an exam room in the Planned Parenthood offices in Austin, Texas on August 8, 2023.

Dr. Amna Dermish, chief operating and medical services officer for Planned Parenthood of Greater Texas, poses for a portrait in an exam room of a Planned Parenthood facility in Austin on Aug. 8, 2023. Credit: Montinique Monroe for The Texas Tribune.

For more than a decade, the state has been trying and failing to chase Planned Parenthood out of Texas.

Texas restricted and then banned abortion. The state removed Planned Parenthood affiliates from state-funded health programs and turned down federal dollars rather than allow Planned Parenthood to receive them. Planned Parenthood has been cut out of funding for cancer screenings, contraception, HIV prevention and sex education.

Despite this concerted effort from the highest levels of state government, Planned Parenthood’s clinic doors have remained open in Texas.

“My mantra is, every day that I show up to the clinic, I’m winning,” said Dr. Amna Dermish, the chief operating and medical services officer at Planned Parenthood of Greater Texas.

But now, the organization is facing a potentially existential threat from its longtime tormentor.

Last year, the state filed a federal lawsuit claiming Planned Parenthood improperly billed Medicaid for $10 million in payments during the period when the state was trying to remove the organization from the program.

Texas is seeking more than $1.8 billion in reimbursement, penalties and fees.

Planned Parenthood has called the lawsuit meritless, pointing out that there was an injunction in place that allowed it to continue to bill Medicaid during that time.

U.S. District Judge Matthew Kacsmaryk, a conservative who previously worked on anti-abortion cases as a religious liberty lawyer, will hear arguments from both sides today in Amarillo.

“We have weathered a lot of storms, but we’ve always been able to come through and be there for our patients,” Dermish said. “That ultimately is why I come to work every single day, and it’s just my biggest fear if one day we’re not able to do that.”