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July 8th, 2013:

Interview with BGTX Summer Fellow Elizabeth Garcia

I trust by now you are familiar with the mission on Battleground Texas. With the Wendy Davis filibuster and all that’s been going on in the Legislature lately, it feels like they arrived at just the right time. But Battleground Texas isn’t about any one event, it’s about building infrastructure and investing in the future. One way in which they are doing that is with their Summer Fellows program, in which some 200 students have come to Texas for six weeks of their summer to register voters, engage with supporters, and build neighborhood teams to continue doing this work after the summer ends. There are three BGTX Summer Fellows in the Fort Bend area – Juanita hosted a reception for them at her house the other day – with numerous others working in the greater Houston area. I had the opportunity to meet one of the FB Fellows, Elizabeth Garcia, about two weeks ago, and I was very interested in hearing more about what she and her fellow Fellows are doing for those six weeks. She graciously agreed to do an interview with me. Here’s what we talked about:

Elizabeth Garcia interview

That’s the sound of the future. I’m looking forward to it.

With Rick Perry, you always have to ask “Who benefits?”

Texas Politics had an item on Friday that perhaps should have received a higher profile.

One of the controversial tenets of the abortion restriction bill would require all abortions to be performed in ambulatory surgical centers, which are a distinct type of healthcare facility set up for outpatient surgeries. Abortion rights advocates say the new requirement would force many clinics to close because they wouldn’t be able to afford to upgrade their facilities. They also say the upgrades are unnecessary and that no data shows current clinics aren’t properly equipped to provide good care.

If the bill passes, only five Texas abortion clinics would remain open — those that are already equipped as ambulatory surgical centers, advocates say. But a question remains: would the 420 other ambulatory surgical centers that exist in Texas begin performing the operation? Abortion rights advocates predict that the demand for the procedure won’t disappear with passage of the law.

One company that will be faced with that decision is United Surgical Partners International, based in Addison, TX. Their vice-president of government affairs is Milla Perry Jones, Gov. Rick Perry’s sister. She is also on the board of the Texas Ambulatory Surgical Center Society. It should be noted that the legislation now under consideration by the Texas Legislature is patterned after proposals that have been adopted in other states, so it did not originate with Gov. Perry’s office. Rich Parsons, a Perry spokesman said he could not say whether Perry has discussed the legislation with his sister, but said, “he strongly supports protecting women’s health by raising the standard of care they receive at abortion clinics.”

Uh-huh. As both Texpatriate and Nonsequiteuse noted, there’s more to the story than that. Here’s a Texas Observer story from last year that delved into the Perry connection to ambulatory surgical centers.

Corndogs make bad news go down easier

Beware the power of the corndog lobby

Both Governor Perry and his sister have championed doctor-owned facilities in Texas and Washington.

The trade publication “Who’s Who in the Ambulatory Surgery Industry” describes Milla Perry Jones as “a true advocate for the physician-owned healthcare model.” Industry publications say she manages United Surgical’s “state and federal advocacy efforts” and coaches entrepreneurial doctors on how to lobby public officials. The governor’s sister has held leadership positions with the Texas Physician Hospitals Advocacy Center and the Texas Ambulatory Surgery Center Society, both headed by Austin lobbyist Bobby Hillert. Hillert’s ambulatory group “supports physician ownership in all forms” and opposes “any attempts to ban or restrict physician ownership in Texas, in any manner.” Hillert says Milla Perry Jones sat on the PAC committee of his ambulatory group, which endorsed Rick Perry’s 2010 reelection. Milla Perry Jones declined to discuss her work with the Observer, referring all questions to Hillert. “I’m trying to be as helpful as I can,” she said before terminating the call. “I should’ve hung up two minutes ago.”

President Obama and other critics argue that doctors who own stakes in medical facilities drive up health costs because they have a financial interest in ordering excessive procedures. In one of many such studies, a 2006 federal report found that Medicare costs are 20 percent higher at doctor-owned orthopedic surgical hospitals than at competing community hospitals. These studies typically do not determine if the extra procedures are beneficial. The doctor-owned industry says it delivers superior care and points to contradictory research that does not associate doctor ownership with higher costs.

No state has more doctor-owned hospitals than Texas, which claims more than 90 of about 300 such hospitals nationwide. Only California has more doctor-owned ambulatory outpatient facilities, most of which are part owned by physicians. Milla Perry Jones’ company owns interests in 13 U.S. surgical hospitals and 171 surgical centers. United Surgical co-owns its typical facility with both doctors and local non-profit hospitals. The company’s 2010 annual report says that the hospitals provide access to health insurers and doctors. “Our sales and marketing efforts are directed primarily at physicians, who are principally responsible for referring our patients to our facilities,” the report says. Before joining United Surgical in 2004, Milla Perry Jones worked for a foundation supporting Dallas-based Baylor Health Care System, which invests in more United Surgical facilities than any other hospital.

[…]

In 2010, a doctor-owned hospital in Tyler, Texas and a national trade group that Perry’s sister works with filed a lawsuit alleging that Obamacare restrictions on doctor-owned hospitals are an unconstitutional taking of private property. Rejecting this claim, a federal judge appointed by George W. Bush ruled in 2011 that “it is not the function of the Court to determine the wisdom of congressional action.” Three judges on the New Orleans-based U.S. Firth Circuit then threw out the lawsuit on appeal. They ruled in August that the plaintiffs must exhaust their administrative appeals to U.S. Health Secretary Kathleen Sebelius before they go to court.

Unlike Obama, Governor Perry avidly promotes the doctor-owned industry. In 2009 Congress considered restricting doctor-owned hospitals to pay for children’s health insurance. This prompted the governor of the state that leads the nation in doctor-owned hospitals and uninsured people to write Texas’ congressional delegation. Doctor-owned facilities “play a vital role in health care delivery in the state,” Perry wrote, “a role that is rightfully determined by the needs of Texas communities.” Perry spokesman Josh Havens wrote in response to Observer inquiries that the governor “believes that a patient should have options when addressing their health care needs and, respecting free-enterprise, he supports physician-owned hospitals as one of those options.”

Of course he does. Nonsequiteuse correctly compared this to the HPV vaccine executive order of 2007, which also stood to greatly benefit a Friend of Perry, in that case his former chief of staff Mike Toomey. Principles, such as he has them, will always take a back seat to helping a crony. The only surprise here is that it’s taken this long for someone to make the connection.

First lawsuit filed against Texas Double Secret Illegal Anti-Gay Marriage amendment

Probably not a game-changer, however.

RedEquality

A Galveston man filed a federal lawsuit Tuesday challenging a provision of the Texas Constitution defining marriage as a union of a man and a woman.

Domenico Nuckols, 60, said he believes he will prevail because of last week’s U.S. Supreme Court ruling striking down the federal Defense of Marriage Act, which included the same definition of marriage.

“It’s going to be an uphill battle, but I fired the first shot,” Nuckols said.

The gay rights group Equality Texas was unaware of any similar lawsuits since the Supreme Court Decision, said Chuck Smith, executive director. A section of the state constitution’s Bill of Rights reads, “Marriage in this state shall consist only of the union of one man and woman.” A ballot measure adding the clause passed in 2005 with 75 percent of the vote.

[…]

Nuckols, a retired nuclear engineer, is representing himself and has asked the court to waive his filing fees.

Although supportive of Nuckols’ goal, Smith worried that Nuckols’ lack of an attorney may indicate that he doesn’t have a well-planned legal strategy.

“I would not encourage someone to do something like this without having legal counsel to asses the strategic values of the case,” Smith said. “If you don’t do it the right way you can do more harm than good by losing a case and setting a negative precedent.”

As you know, I Am Not A Lawyer, but I am not too worried about this suit creating a bad precedent because I doubt it will survive a motion to dismiss. Correct me if I’m wrong here, but I don’t think one can advance a lawsuit like this without demonstrating that one has been harmed by the conflict between federal and state law. Since DOMA has just been struck down, and people are still analyzing the opinion and figuring out what its implications are, it has to be too soon for anyone to demonstrate such harm. Mr. Nuckols is talking about being harmed by the deportation of his partner in 1986. I don’t doubt that he was harmed by that, but I don’t think the striking down of DOMA – which didn’t even exist in 1986 – can be used to address that.

I am sure, just as Chuck Smith is, that someone will come forward soon enough that will have good cause for a lawsuit. I have always believed that this is the shortest path to remedy the damage that the 2005 Double Secret Anti-Gay Marriage constitutional amendment cased. Public opinion is changing – support for marriage equality is now the pluarlity position in Texas – but as we know it’ll take a lot more than that to repeal a constitutional amendment. I’m also quite sure that when the right case comes along, the plaintiffs will not be representing themselves. I wish Mr. Nuckols all the best, but I don’t expect his name to be the one associated with the eventual case that brings equality to Texas.

A cautionary tale about expanded gambling

Wonkblog:

Earlier this week, Delaware’s casinos got a surprise windfall. Just days after saying no to tax breaks, Gov. Jack Markell (D) proposed that $8 million of the state’s budget surplus be distributed amongst its three struggling establishments, to forestall the layoffs that at least one of them had threatened.

That would seem to defeat the purpose of casinos: Generating revenue for states. The problem is, for the past decade, almost every state in the nation has tried to cash in–and gamblers aren’t keeping up. Twenty-three states have now legalized commercial casinos, and revenues are back to 2007 levels after taking a dip during the recession. Twenty-eight states have Native American-owned casinos, where revenues have been essentially flat since 2007. Almost all new gambling facilities take revenue away from somebody else, and one state’s explosive growth is another’s stagnation.

Delaware is a prime example. Neighboring Pennsylvania went from none in 2006 to 11 casinos making more than $3 billion in 2012, while Maryland opened two casinos over the past two years and more than doubled its revenues. And it’s not the only nearby state in trouble. Even before Hurricane Sandy barreled into Atlantic City, its gambling industry was in a long decline, and even a state-of-the-art new facility looks headed toward bankruptcy.

“Pennsylvania and Maryland had provided a substantial amount of the business for the casinos around there, and when they get their own casinos, all things being equal, people will gamble closer to home,” says Joseph Weinert, an analyst with Spectrum Gaming. “The whole purpose of those states legalizing casinos to begin with is to keep their residents’ tax dollars in state. Delaware’s in a pickle, there’s no two ways about it.”

It’s the same sad song in the Midwest, where casinos have raced to open in Ohio; Connecticut, where customers have been vacuumed up by new facilities in New York, and Missouri, hit by Kansas’ three new casinos since legalizing gambling in 2007.

[…]

At the end of the day, geography is destiny: The winners in this new world of ubiquitous gambling will be those with casinos close to large population centers (hence the hot competition to build a new facility in National Harbor, across the river from Washington D.C.). Gaming industry advocates like to point to Las Vegas, saying it’s possible to create a destination that people will travel to with rock-bottom tax rates and massive development. But Delaware isn’t going to create an east coast Vegas. And it’s probably a better idea, as the News Journal advised, to pick up and move on.

One can certainly argue that Delaware’s situation is not at all like Texas’ would be. It’s a short drive from Maryland and Pennsylvania to Delaware, so when those states allowed gambling and casinos sprung up, it was likely just too much competition in a limited geographic area for them. That won’t be a problem in Texas, since even though we’re surrounded by gambling states, it’s too far for many people to drive. Still, I’d be concerned that the market for gambling – casinos, slot machines at racetracks, whatever – is inherently limited, perhaps more so than we think. In addition, the existing casinos aren’t going to give up their Texas customers without a fight. I remain largely ambivalent on the question of whether or not to expand gambling in Texas, but I also remain skeptical of the claims that they will bring a bonanza to us. As with the Lottery, we should be very wary about getting dependent on any revenue from this kind of source.