Local citizens and employees of the Planned Parenthood clinic in San Angelo, Texas gather in front of the clinic last month to participate in the "Don't Mess with Texas Women" rally. (Patrick Dove/AP)

This year hasn’t been any easier. In January, a change to the Susan G. Komen Foundation’s funding policies threw private dollars into jeopardy. Just two months later, more bad news: Texas would shutter a Medicaid program for low-income women in a dispute. On April 30, another $40 million will disappear.

“We may have to consider more clinic closures, that’s the point we’re at right now,” said Ken Lambrecht, chief executive officer of Planned Parenthood North Texas. His affiliate covers Texas’ largest metropolitan area, alongside a handful of more rural locations like Plano and Sherman, near the Texas/Oklahoma border.

Over the past two years, Planned Parenthood has seen both its private and public funding come under siege like never before. Nine states have, so far, passed laws that would defund the abortion provider from participating in reproductive health programs, providing services like breast exams and pap smears.

Nowhere in the country has this been more true than in Texas. Of the nine states that have defunded Planned Parenthood, eight are held up in legal challenges. Texas’ is the only to come into effect. Lambrecht and I spoke last week about what, exactly, it’s like to be a Planned Parenthood in Texas right now.

The reduced funding couldn’t come at a worse time, he said. Texas has the highest rate of uninsured; a quarter of its residents lack coverage. That number has grown during the economic downturn, as have the women Planned Parenthood sees.

“We’re very much figuring this out as we go,” Lambrecht said. “It’s problematic because these are women who live paycheck to paycheck. They’re earning about $150 a week and their gas tank is empty with $4 gas.”

Lambrecht has learned a lot about the best way to close a women’s health clinic. When five buildings closed in 2011, which had previously served 12,000 women, Planned Parenthood still managed to serve 8,000 of them elsewhere. They’re testing out travel voucher programs, for those who have lost a nearby location, and giving more birth control prescriptions over the phone.

“The people who are really hurt are rural Texans,” he said, “Who have few alternatives. So we’re looking at building clinics that are bigger, and have less overhead, to try and reduce costs.”

He may have to face more clinic closures soon: Last year, Texas passed a law that bars abortion providers from participating in its Medicaid program for women’s health.

The federal government concluded that violated the terms of participating in Medicaid - states cannot discriminate against health care centers for providing a legal service - and pulled the $40 million it has traditionally provided.

“We very much regret the state’s decision to implement this rule, which will prevent women enrolled in the program from receiving services from the trusted health care providers they have chosen and relied on for their care,” Medicaid director Cindy Mann wrote last month to Texas officials.

The past two years have been hard, but there have been some bright spots. There was the time that the Komen foundation reversed course on an initial decision to defund Planned Parenthood. North Texas has traditionally been funded by the breast cancer organization and, with the grant criteria revised, will continue to receive a $91,000 grant. Planned Parenthood North Texas is among more than a dozen Planned Parenthood affiliates that have received Komen funding, after this year’s controversy.

“The fact remains, there’s still a desperate need for these services, especially when you look at the economy we’re in,” said Jennifer Legere, chief executive officer of Komen Dallas. “There’s a definite need for charities to fill some gaps. I sometimes joke and say, we’re where the government isn’t. It’s really our role to raise these funds.”

With two weeks left until the Texas Women’s Health Program closes, Lambrecht has been reaching out to local philanthropists. He’s so far raised $315,000 to replace the Medicaid funds. But he expects to lose $3 million. So while it’s a significant amount, it may not prevent more clinics from closing.

“We are very actively working to raise funds,”Lambrecht said. “We should know within the next 90 days or so whether we’ll be closing locations.”

Until then, Lambrecht will keep up the outreach. He’s also joined the other Texas Planned Parenthood affiliates in a lawsuit, challenging the Texas law that bars abortion providers from participating in the women’s health program. He has one big donor he’s working on right now, who he’s hopeful will come through with a $500,000 grant. That would bring the fundraising total to nearly $1 million.

“We have several contingency plans,” he said.

Now, for Lambrecht - and the women who use Planned Parenthood in North Texas - it’s about finding one that will work.