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“Fetal remains” law blocked in court

It’s deja vu all over again.

Texas’ second attempt to require health providers to bury or cremate fetal remains has been temporarily thwarted by a federal judge and another court battle is imminent.

In his Monday afternoon ruling, U.S. District Judge David Alan Ezra said the Texas Department of State Health Services’ arguments “lack merit.”

“For those eager for a result in this case, it is tempting to read the Court’s decision as a signal on who will win at trial or as a determination of the validity of Plaintiffs’ claims,” Ezra said. “Such guesswork would be premature. The Court only concludes Plaintiffs establish injunctive relief is warranted to preserve the status quo.”

The current fight is over Senate Bill 8, a law passed during the 2017 legislative session that has a provision forcing health care facilities to bury or cremate any fetal remains from abortions, miscarriage or treatment for ectopic pregnancy, regardless of their patients’ personal wishes or beliefs. That provision was supposed to go into effect Feb. 1.

In his temporary ruling, Ezra said attorneys for the Center for Reproductive Rights, who are representing the plaintiffs, showed evidence that the new rule would infringe on women’s right to an abortion and that medical providers would have a difficult time following through with the rule, causing them to be fined.

Ezra’s ruling echoes a case from 2016 where reproductive rights groups sued to stop the Health and Human Services Commission from implementing a similar fetal burial rule. During the multi-day court hearing at the time, state attorneys said the rule was designed to provide aborted or miscarried fetuses a better resting place than a landfill. They also argued that there would be no cost for patients to worry about and only miniscule costs for providers. The state also said that there were multiple groups willing to help with costs.

U.S. District Judge Sam Sparks struck that rule down in 2017, saying it was vague, caused undue burden on women and had high potential for irreparable harm.

See here for some background on the legislation. This is just an injunction hearing, to decide whether to allow the law to take effect while the litigation is ongoing. The hearings and rulings on the merits come afterward. As noted, the rule that preceded this law was struck down almost exactly a year ago; the state is of course appealing that ruling. From the zealots’ perspective, it almost doesn’t matter if they win or lose. It’s time consuming and expensive for the clinics to fight – and let’s not forget, even as the omnibus HB2 was struck down awhile back, many clinics closed for good in the meantime – and it keeps the rubes whipped up. What’s not to like for them? A statement from the Center for Reproductive Rights is here, and the Current has more.

Just a reminder, CHIP is still running out

In case you were wondering.

Nearly 400,000 Texas children could lose healthcare coverage in late January unless Congress renews funding for the Children’s Health Insurance Program, a decades-old federal program that provides health care to millions of children across the country.

Texas officials have asked the federal government for $90 million to keep CHIP alive through February, but without that funding, letters could go out later this month from state officials alerting parents that their children’s benefits could be at risk.

Congress allowed the program to expire on Sept. 30, leaving Texas and other states with dwindling coffers. CHIP typically receives bipartisan support, but lawmakers have failed to agree in recent months on how to fund it.

“We’re closely monitoring congressional efforts to reauthorize the program and are hopeful that it will be extended prior to the exhaustion of our current allotment,” said Carrie Williams, a spokeswoman with the Texas of State Health Services. “Based on our conversations with [Centers for Medicare and Medicaid Services] … we are confident that a redistribution of funds will happen.”

[…]

If the state doesn’t get additional funding soon, it will have to begin shutting down the program, officials said. State law requires termination notices go out to parents a month before they lose coverage; those letters would likely go out days before Christmas.

Catherine Troisi, an infectious disease epidemiologist at the University of Texas School of Public Health in Houston, said many children on CHIP have chronic diseases and rely on regular, monthly appointments.

“That’ll put a lot of stress on families who don’t know if they are going to be able to continue to get that kind of care,” she said.

Unlike other states, Texas doesn’t currently have any plans to fund the program. If the state runs out of money, it will send all CHIP recipients to the federal government’s health care marketplace.

See here and here for the background. This is 100% the fault of Congressional Republicans, who let this lapse during their months-long obsession with Obamacare repeal. They’re not paying attention to it now because of the need to cut taxes for millionaires. Better grow up to be rich, kids. It’s your only hope.

By the way, CHIP is still running out

Just in case you were wondering.

Advocates say Texas will run out of funding for the Children’s Health Insurance Program sooner than they thought. The program, which Congress failed to reauthorize last month, covers nearly 400,000 children from working-class families in the state.

“It’s expected that Texas will run out of CHIP funding in January,” said Adriana Koehler, a policy associate with the advocacy group Texans Care for Children. “With the holidays coming up in the next few months, we really need Congress to get the job done now.”

Just a few months ago, advocates said it was unclear when the state would run out of CHIP funds. Some advocates expected the state had until next September; others said funds would run out in February.

Carrie Williams, a spokesperson with the Texas Health and Human Services Commission, said the funding could run out as early as January.

Williams said the agency pushed up the timeline because of reduced income from co-pays. After Hurricane Harvey hit, the federal government waived co-pays and enrollment fees for CHIP recipients. That meant less money was coming into the program than expected.

“So funds may be exhausted a bit sooner than February,” she said.

See here for the background. One might think that such a fanatically and performatively “pro-life” state like Texas would be full of leaders who would care deeply about 400,000 children losing access to health care, but one would have to be deeply naive to believe it. At this time, it looks like the best bet for action will be CHIP reauthorization as a part of a successful government shutdown hostage negotiation. There’s a sentence I hope I never have to type again. Remember when we had a government that was interested in actually, you know, governing? Those were the days, I tell you.

Now is not a good time for HHSC to be dysfunctional

And yet here we are.

Under Charles Smith, the longtime ally of Gov. Greg Abbott picked to lead the state’s Health and Human Services Commission, Texas’ government health care infrastructure is hemorrhaging veteran employees and facing criticism for its response to the humanitarian crisis caused by Hurricane Harvey.

Dozens of experienced senior staff members have left the agency since Smith took over last year. Current and former employees attribute the exodus to widespread dissatisfaction with the executive commissioner, who they say lacks technical knowledge of the agency and pushes a political agenda backed by the governor.

Interviews with 11 current and former long-serving health commission staff, ranging from senior executives to mid-level managers, paint a picture of a state agency in disarray, with veteran staff clashing regularly with Smith and his supporters in the governor’s office. The internal conflict has spurred a wave of resignations, leaving the agency with a void of talent that critics say is hampering the state’s ability to aid victims of Hurricane Harvey.

“It’s hard to watch,” said one former high-ranking health commission official, who spoke on the condition of anonymity because of an ongoing professional relationship with the health commission. “Anybody with any knowledge or experience is not going to stay.”

[…]

Critics point to the agency’s actions in the month after Hurricane Harvey as evidence of its dysfunction.

Specifically, sources inside and outside of the commission told the Tribune that the agency was slow to act in providing guidance and assistance to Texans affected by Harvey who qualify for public programs such as food stamps and Medicaid.

Doctors have complained that basic information, such as whether displaced Medicaid patients could seek care outside of their insurance network or get prescription medications refilled, was slow to emerge from the agency, and advocates for low-income Texans were frustrated to see a flurry of revisions to information posted on the agency’s website as victims sought government assistance.

Others pointed to the delay in rolling out disaster food stamps benefits. Hurricane Harvey made landfall in Texas on Aug. 25, and the health commission began rolling out disaster food stamps on Sept. 13, nearly three weeks later, but only in some counties. Houston, Corpus Christi and other areas that suffered some of the most extensive damage from the storm were not included in the initial rollout.

By comparison, when Hurricane Ike struck Galveston in 2008, then-Executive Commissioner Albert Hawkins announced the agency would provide emergency food stamps five days after the storm made landfall.

“When I see the response to Harvey, I am quite concerned about the level of expertise in the agency,” said one former commission official who has closely followed the hurricane response. “This stuff is not rocket science. We’ve had disasters before. There are templates for this.”

The Texas State Employees Union said this week that falling employee morale and a shortage of workers has hampered the state’s ability to provide recovery after Hurricane Harvey. Union officials say the health commission has lost nearly 11 percent of its eligibility operations staff — the workers who help connect Texans with public benefits.

In a statement for the union, Rashel Richardson, a caseworker in Houston, asked, “How are we supposed to work this much forced overtime week after week while our homes have been destroyed? How are we supposed to concentrate and get people services when we need services ourselves? It’s as if the state has no sympathy for workers who lost everything.”

There’s more, so read the whole thing. Not that there’s ever a good time for such a large agency that affects so many people to be dysfunctional, but in the aftermath of a huge natural disaster that has done so much damage? That’s a really bad time. Of course, HHSC has been a problem child for a long time, so none of this should be a big surprise. On the other hand, the HHSC under Greg Abbott has been particularly hostile to women’s health, so it’s all good as far as he’s concerned.

State seeks Medicaid money it gave up over Planned Parenthood ban

Ugh.

Right there with them

Four years after Texas gave up millions of dollars in federal Medicaid funds so it could ban Planned Parenthood from participating in a family planning program for low-income women, the state is asking the Trump administration for the money back.

The request presents an important early test for the administration of President Trump, who recently appointed an anti-abortion official to oversee federal family planning programs. Under President Obama, federal health officials would not allow Medicaid funds to flow to the Texas program after it excluded Planned Parenthood, because federal law requires states to give Medicaid beneficiaries their choice of “any willing provider.”

If the administration agrees to restore the funding for Texas, it could effectively give states the greenlight to ban Planned Parenthood from Medicaid family planning programs with no financial consequences.

“They’re asking the federal government to do a 180 on its Medicaid program rules,” said Elizabeth Nash, a policy analyst at the Guttmacher Institute, a research center that supports abortion rights. “And depending how this shakes out, you could see a number of other states follow suit.”

[…]

In its draft waiver application, the state said it hoped that by turning Healthy Texas Women back into a Medicaid waiver program, it would improve access and participation. The application noted that Texas had the nation’s highest birthrate, with more than 400,000 births in 2015, more than half of which were paid for by Medicaid. It also noted than more than one-third of pregnancies in the state were reported as unintended, and that Texas had one of the highest teen birthrates in the country.

On Monday, at a public hearing on the plan in Austin, several women and representatives of health advocacy groups expressed concern about the request.

“A strong Healthy Texas Women program should include Planned Parenthood,” said Blanca Murillo, 25, who said she relied on Planned Parenthood for contraception that helped treat her polycystic ovary syndrome when she was a student at the University of Texas. “I’m asking the state to choose the health of Texas women — which it has a duty to protect — over scoring political points.”

Stacey Pogue, senior policy analyst at the Center for Public Policy Priorities, a liberal research group, pointed to the so-called freedom of choice provision in Medicaid and said she was concerned that “submitting the waiver as is would invite litigation.”

A spokeswoman for the Centers for Medicare and Medicaid Services, or C.M.S., which oversees Medicaid waiver programs, declined to comment.

Carrie Williams, a spokeswoman for the Texas Health and Human Services Commission, said, “We’re been encouraged to present new and innovative ideas to C.M.S. for discussion for possible funding. This is a new administration, and we’re looking at what funding opportunities may exist for us.”

Texas is also seeking to cut off all Medicaid funding to Planned Parenthood; a federal judge blocked the effort earlier this year, but the state is appealing the decision.

It’s for stuff like this that Republicans have remained loyal to Trump regardless of the disaster he creates everywhere. They want their shiny ideological objects, and it doesn’t get much shinier than shivving Planned Parenthood. Who cares if some of the money winds up going to frauds? It’s not like they actually cared about women’s health in the first place. So yes, I expect this request to be granted in short order, and then replicated in other states. The only way to undo that is going to be to undo who is in charge of the government. The Associated Press, the Trib, and the Current have more.

This is why you leave women’s health to the professionals

Because amateurs and zealots do a lousy job.

Right there with them

In pushing a replacement for the Affordable Care Act that cuts off funds for Planned Parenthood, Republicans are out to reassure women who rely on the major health care organization that other clinics will step up to provide their low-cost breast exams, contraception and cancer screenings.

Texas is already trying to prove it. But one big bet is quietly sputtering, and in danger of teaching the opposite lesson conservatives are after.

Last summer, Texas gave $1.6 million to an anti-abortion organization called the Heidi Group to help strengthen small clinics that specialize in women’s health like Planned Parenthood but don’t offer abortions. The goal was to help the clinics boost their patient rolls and show there would be no gap in services if the nation’s largest abortion provider had to scale back.

The effort offered a model other conservative states could follow if Republicans make their long-sought dream of defunding Planned Parenthood a reality under President Donald Trump. Several states are already moving to curtail the organization’s funds.

But eight months later, the Heidi Group has little to show for its work. An Associated Press review found the nonprofit has done little of the outreach it promised, such as helping clinics promote their services on Facebook, or airing public service announcements. It hasn’t made good on plans to establish a 1-800 number to help women find providers or ensure that all clinics have updated websites.

Neither the group nor state officials would say how many patients have been served so far by the private clinics.

The Heidi Group is led by Carol Everett, a prominent anti-abortion activist and influential conservative force in the Texas Legislature.

In a brief interview, Everett said some of the community clinics aren’t cooperating despite her best efforts to attract more clients.

“We worked on one Facebook site for three months and they didn’t want to do it. And we worked on websites and they didn’t want to do it,” Everett said of the clinics. “We can’t force them. We’re not forcing them.”

Everett said that advertising she planned was stalled by delays in a separate $5.1 million family planning contract.

Everett proposed helping two dozen selected clinics serve 50,000 women overall in a year, more than such small facilities would normally handle. Clinic officials contacted by the AP either did not return phone calls or would not speak on the record.

The Texas Health and Human Services Commission, which awarded the funding to the Heidi Group, acknowledged the problems. Spokeswoman Carrie Williams said in an email that the agency had to provide “quite a bit” of technical support for the effort and make many site visits. She disputed that the contract funding has been as slow as Everett alleged.

“The bottom line is that we are holding our contractors accountable, and will do everything we can to help them make themselves successful,” she said.

See here and here for some background on the Heidi Group. I’m thinking that maybe the reason these clinics didn’t want Carol Everett’s help is because she’s incompetent. Nothing in her history suggests she has any of the relevant skills, and clearly promoting women’s health isn’t her main focus. Anti-abortion activists tend to be pretty hostile to things like contraception, and often are quite ignorant of basic biology, so who can blame the clinics for keeping her at arm’s length. But let’s let Carol Everett herself sum this up:

Asked whether the Heidi Group would meet the patient targets in her contract, Everett said her own goal was to serve 70,000 women.

However, “it’s not as easy as it looks because we are not Planned Parenthood. We are working with private physicians and providers,” Everett said after leaving a committee hearing this week at the Texas Capitol. She said the clinics she is working with are busy seeing 40 to 50 women a day. “They don’t have time to go out and do some of the things that we would really like to help them do. But we’re there if they want to. And we’re there when the need it. And we’re in their offices and we’re helping them.”

Emphasis mine. No, you’re not. And you never will be. Link via the Current.

Texas cannot bar Planned Parenthood from Medicaid

Good.

Right there with them

U.S. District Judge Sam Sparks ruled Tuesday afternoon that Texas clinics affiliated with Planned Parenthood can continue to care for patients under the state’s Medicaid program, a phew-worthy victory for reproductive rights advocates and a loss for the state’s GOP leaders.

In a 42-page ruling, Sparks wrote that the state’s arguments in the case were “the building blocks of a best-selling novel rather than a case concerning the interplay of federal and state authority through the Medicaid program.”

“After reviewing the evidence currently in the record, the Court finds the Inspector General, and thus [the Texas Health and Human Services Commission], likely acted to disenroll qualified health care providers from Medicaid without cause,” the ruling read. “Such action would deprive Medicaid patients of their statutory right to obtain health care from their chosen qualified provider.”

[…]

In court, Planned Parenthood attorneys argued that not allowing the reproductive health provider to stay in the Medicaid program, which is largely funded by the federal government, would severely curb access to care for poor Texas men and women seeking preventive and sexual health services. The attorneys also argued that the state did not have the capacity to deliver these services in the same way Planned Parenthood does and reiterated that state and federal law already prohibit taxpayer dollars from being spent on abortion services.

State attorneys, meanwhile, leaned heavily on the web video throughout court proceedings, pointing out various clips as part of their evidence. While the video appeared to back up their claims, Planned Parenthood attorneys forced several of the state’s witnesses to concede that no employees were seen committing illegal acts in the undercover video.

Throughout the ruling, the phrase “no evidence” appears multiple times. Sparks said Texas Health and Human Services Commission Inspector General Stuart W. Bowen Jr. “did not have prima facie of evidence, or even a scintilla of evidence” for the termination. He cited that the Center for Medical Progress video, the evidence against Planned Parenthood Gulf Coast and dragging in other Planned Parenthood affiliates were “three overarching bases for termination.”

Sparks said that “for those not blessed with eight free hours to watch” the video, it mostly contained a Planned Parenthood Gulf Coast employee and Center for Medical Progress representatives talking in “unclear and ambiguous dialogue” that was open to interpretation. He said the Texas Health and Human Services Commission did not provide evidence that they had authenticated the video before going forward with termination efforts.

While state attorneys tried to show that the reproductive health organization had “a willingness” to profit from procuring fetal tissue, Sparks said he did not find evidence of that.

“The Court is unconvinced mere willingness, without any evidence of attempt, is enough to deprive a Medicaid beneficiary of the right to her otherwise qualified provider,” the ruling read.

See here for the previous update. Shockingly, the fraudulent anti-PP videos made by the lying liars at the Center for Medical Progress turned out to have no evidentiary value for the state. Who’d a thunk it, am I right? I presume the state will appeal from here, and if the Trump scandal machine ever lets up enough to allow legislation to be passed by Congress, a federal bill could be passed to change the law that PP relied on here to get this action overturned. It’s a little premature to celebrate, is what I’m saying. Still, this is a big deal, and it’s always nice to see Ken Paxton lose in court. The Chron, the AusChron, and Trail Blazers have more.

Here we go again with Planned Parenthood and Medicaid

Rooting for another injunction.

Right there with them

Texas officials are back in federal court this week over abortion-related policy, this time to defend efforts to oust Planned Parenthood from Medicaid.

Planned Parenthood has asked U.S. District Judge Sam Sparks to block the ouster as illegal, unjustified and unfair — an improperly political move that could deprive about 11,000 low-income Texans of access to contraceptives, cancer screening, breast exams and testing for sexually transmitted infections.

Lawyers for Texas argue that a 2015 video, shot by abortion opponents using a hidden camera, showed a pattern of “gross violations of medical and ethical standards” — as well as human decency — in the fetal tissue donation practices of a Planned Parenthood clinic in Houston.

“The state should not have to wait until it is too late before it can act to protect Medicaid recipients and taxpayers,” lawyers for Attorney General Ken Paxton told Sparks in a legal brief.

Sparks will hear three days of testimony beginning at 9 a.m. Tuesday in his Austin courtroom in a case with a tight deadline. Planned Parenthood is scheduled to be dropped from the Texas Medicaid program Saturday.

One option for the judge is a temporary order blocking the ouster — keeping the status quo until he can research and write an opinion.

That’s what Sparks did when abortion providers sued to block a state rule requiring clinics and hospitals to bury or cremate fetal remains from abortions or miscarriages. After hearing two days of testimony earlier this month, Sparks promised a ruling by the end of next week.

No matter how Sparks rules — in either case — the losing side is expected to appeal, meaning it could be months before the fate of Planned Parenthood or the fetal burial rule is determined.

See here for the background. Yes, the state is actually using those utterly fraudulent Center for Medical Progress videos as evidence for tossing Planned Parenthood from Medicaid. This is basically the equivalent of arguing that because you found a dollar under your pillow this morning, the Tooth Fairy must really exist. I don’t think there’s anything one can add to that. The Trib has a first day of testimony report, and Trail Blazers and the Texas Standard have more.

Back to court for Planned Parenthood

Here we go again.

Right there with them

Planned Parenthood late Friday asked a federal judge in Austin to block plans by Texas officials to kick the organization out of Medicaid.

Calling state plans “nothing more than a politically motivated witch hunt,” Planned Parenthood asked U.S. District Judge Sam Sparks to issue an injunction or temporary restraining order allowing an estimated 11,000 Texans to continue receiving contraceptives, well-woman exams and screenings for cancer and HIV from the organization.

Planned Parenthood received $4.2 million in Medicaid funding in fiscal year 2015, the latest information available, to provide the services to low-income Texans.

A hearing in the case had previously been set for 9 a.m. Jan. 17 in Sparks’ Austin courtroom.

Citing undercover videos shot by abortion opponents and made public last year, Texas officials announced Dec. 20 that Planned Parenthood would no longer be an approved Medicaid provider as early as Jan. 21.

[…]

Planned Parenthood also argued that Medicaid, a joint federal-state program, operates under U.S. rules that allow patients to receive care from the qualified provider of their choice.

Similar efforts to oust Planned Parenthood from Medicaid programs in Louisiana, Alabama, Arkansas, Kansas and Mississippi have all been blocked by courts for violating the federal provider-choice rule, the organization’s lawyers said.

See here for the background. The video is bullshit, produced by known liars, but it’s sufficient as a pretext for the state to do what it has wanted to do for over a year. The only question is whether they’ll get away with it or not. The DMN has more.

Texas follows through on threat to pull Medicaid funds from Planned Parenthood

More than a year after the initial threat was made. Clearly, you can’t rush these things.

Right there with them

After more than a year of delays, Texas is officially kicking Planned Parenthood out of the state’s Medicaid program.

In a move that could affect thousands of low-income women, state health officials on Tuesday delivered a final legal notice to defund the organization from the Medicaid program through which it provides family planning and women’s health services to the poor. Planned Parenthood had previously received $3.1 million in Medicaid funding, but those dollars will be nixed in 30 days, according to the notice which was obtained by The Texas Tribune.

That cut-off day will only be delayed if the organization appeals the state’s decision in the next 15 days by requesting an administrative hearing with the Texas Health and Human Services Commission. But Planned Parenthood officials say they will instead turn to the courts to block the cuts.

“Planned Parenthood continues to serve Medicaid patients and will seek a preliminary injunction in an ongoing lawsuit filed in November 2015, following the state’s original threats to take action against Planned Parenthood’s patients,” said Yvonne Gutierrez, executive director of Planned Parenthood Texas Votes, the organization’s political arm.

[…]

In the final notice, Texas Health and Human Services Inspector General Stuart Bowen said the undercover videos — which depicted Planned Parenthood officials discussing the use of fetal tissue for research — showed “that Planned Parenthood violated state and federal law.”

Bowen claimed in the letter that the videos revealed Planned Parenthood has a history of “deviating from accepted standards” to procure tissue samples for researchers and a “willingness to charge more than the costs incurred for procuring fetal tissue,” among other violations.

“Your misconduct is directly related to whether you are qualified to provide medical services in a professionally competent, safe, legal and ethical manner,” Bowen wrote in the letter. “Your actions violate generally accepted medical standards, as reflected in state and federal law, and are Medicaid program violations that justify termination.”

Planned Parenthood has vehemently denied those claims, and it has criticized the videos the state is pointing to as evidence as being heavily edited to imply malfeasance. Its health centers in Texas have also said they do not currently donate fetal tissue for research. Their Houston affiliate did participate in a 2010 research study with the University of Texas Medical Branch.

State health officials initially alleged they also had “reliable information indicating a pattern of illegal billing practices” by the organization. But Tuesday’s letter made no mention of billing fraud.

The “videos” in question are the ones made by the fraudsters in Houston, who wound up being indicted themselves before those charges were dropped in an oddly-timed fashion. The fact that the state is still citing these fraudulent videos and still making the same wild claims they have never even tried to back up tells you everything you need to know about the strength of their case. There’s already been a lawsuit filed over this, and now that the state has sent a final letter it will move forward, which among other things means the state will have to produce whatever evidence it has. Good luck with that. I should note also that multiple other states have tried this in the recent past, and all of them have lost in court. Some lessons have to be learned the hard way. The Austin Chronicle has more.

The thing you need to know about the guy behind the “three million illegal votes” claim

He’s a known liar and grifter.

When President-elect Donald Trump tweeted Sunday — without evidence — that “millions” of people voted illegally in the race for the White House, he invited a wrath of condemnation for again stoking doubts about the U.S. election system.

But in Texas, he found at least one fan: Gregg Phillips, a former Health and Human Services Commission executive who appears to be the source of the unsubstantiated claim. In the days following the election, the self-styled voter integrity activist said on Twitter that he has discovered that more than 3 million people who voted were not citizens — a claim which was later highlighted by InfoWars, a conspiracy theory website run by fellow Texan and Trump ally Alex Jones.

Phillips, who described himself on social media as founder of VoteStand, an election fraud reporting app, has declined to provide proof to the media, saying he will instead “release all methodologies, data and analysis directly to the public.” He does not appear to have given any indication when that will happen, and efforts to reach him early Monday were unsuccessful.

While Phillips is re-emerging in the news following Trump’s tweet Sunday, Texans may be more familiar with his tenure as an executive deputy commissioner at the state’s Health and Human Services Commission. According to his LinkedIn profile, he held the position from March 2003 to August 2004, playing a big role in shaping the 2003 bill to privatize large parts of the state’s social safety net.

By 2005, Phillips was beset with allegations of cronyism stemming from contracts signed at both HHSC as well as the Texas Workforce Commission. At the time, a Houston Chronicle investigation found he helped craft the privatization legislation in a way in which he personally profited along with a private consultant.

After leaving HHSC, Phillips went on to run AutoGov, a health care analytics firm where he still works. In 2015, AutoGov was mentioned in reports questioning the state’s $20 million Medicaid fraud tracking software deal with Austin-based 21CT, which was not competitively bid. Jack Stick, the former top HHSC lawyer at the center of the scandal that led to a string of resignations and prompted multiple investigations, briefly worked for AutoGov.

Politifact has already debunked this, not that fact-checking has any meaning anymore. What I want to do here is give you a bit more information about Gregg Phillips, the main character of this story, as he has been mentioned a few times on thi blog in the past. The Trib story does a pretty good job of introducing him and his self-enriching character, so consider this to be some extra reading:

What they didn’t tell you
Let me be your sweetheart dealmaker
Chron investigates Gregg Phillips
Making money on both ends

There are more posts in my archives if you want to search for Gregg Phillips, but you get the idea. Forget about professional fact-checking sites and just ask yourself, is this the kind of person who is basically honest in his words and deeds, or is he not? Let that inform how you perceive anything else he has to say, and anything that others say based on what he said. The Chron has more.

Auditor asked to investigate Heidi Group health care grant

Good.

Right there with them

Right there with them

The left-leaning nonprofit Progress Texas is asking the state auditor’s office to investigate a $1.6 million state contract awarded to an anti-abortion group under the state’s new Healthy Texas Women program.

[…]

The Heidi Group does not currently provide medical services or employ medical staff, but founder Carol Everett has said that her group will coordinate with medical providers in rural areas to provide contraception, cancer screenings and other services.

According to Progress Texas advocacy director Lucy Stein, that raises some red flags about whether the Texas Health and Human Services Commission (HHSC) improperly awarded the funds to Everett’s group.

[…]

In its request for an investigation, Progress Texas notes that Everett serves on the Women’s Health Advisory Committee, which provides input to the state health department on the implementation of its retooled reproductive health care safety net. Texas has spent the last year or so reorganizing after anti-abortion lawmakers barred Planned Parenthood from receiving public funds, and the $18 million Healthy Texas Women program is the result.

Progress Texas questioned whether a group that until a few weeks ago operated with the stated mission of “helping girls and women with unplanned pregnancies make life-affirming choices” because abortion is “contrary to God’s will” could provide the medical services promised by the new program.

See here for the background. I can’t find the aforementioned statement anywhere, but Progress Texas does have this call to action on their webpage, along with a video introduction to Heidi Group founder Carol Everett. Any time a group with no experience in a particular field receives a grant to provide services in that field, there ought to be questions about how that happened. Add in the Heidi Group’s political advocacy and you can see the potential for shenanigans. I hope the auditor agrees to take a look at this.

Texas finds a new way to be hostile to women’s health

I feel like it must be someone’s job somewhere to come up with stuff like this.

Right there with them

Right there with them

A group led by an anti-abortion advocate appears to be one of the largest recipients of state funding from the “Healthy Texas Women” program, which lawmakers recently created to help women find health care services paid for by the state.

The Heidi Group, a Round Rock-based center that has promoted alternatives to abortion to low-income women, is set to receive $1.6 million from the women’s health program, according to the comptroller’s office. That makes it the second-highest grant recipient on the current list, behind the Harris County public health department, which will receive $1.7 million.

[…]

The Heidi Group “will now be providing women’s health and family planning services required by Healthy Texas Women, including birth control, STI screening and treatment, plus cancer screenings to women across Texas,” state agency spokesman Bryan Black said in an email.

Black said the group had already recruited doctors to begin establishing family planning clinics across the state. He also said the women’s health program’s contracts were not final and that there were “more to come.” The program offers $18 million each year.

Abortion-rights supporters lambasted the Heidi Group’s contract.

“It’s very inappropriate that the state would contract with an organization that has never performed the services required by the contract,” said Heather Busby, executive director of NARAL Pro-Choice Texas, in a statement. “The Heidi Group is an anti-abortion organization; it is not a healthcare provider.”

This is a political advocacy group that has been given a contract to provide health care. What could possibly go wrong with that? The Observer gives another reason to be concerned:

[Heidi Group founder Carol] Everett made headlines in early August following her testimony at a Texas Department of State Health Services meeting on new rules about fetal tissue disposal in Texas. There, she asserted that currently allowable means of fetal tissue disposal could result in HIV and other sexually transmitted infections being released into public water supplies, which she later repeated to an Austin Fox affiliate. Her concerns are not echoed by any major medical or public health groups.

So this is like hiring Jenny McCarthy to run your immunization program. This is what the state of Texas under Greg Abbott thinks about women’s healthcare. The Press, which has a more sympathetic portrait of Everett, and the Current, which is harsher, have more.

Feds grant 15 month Medicaid waiver extension

I sure hope they keep the pressure on to expand Medicaid during this time.

It's constitutional - deal with it

It’s constitutional – deal with it

The Obama administration has agreed to temporarily keep some federal Medicaid money flowing into Texas to help hospitals treat uninsured patients, a relief to health care providers that feared losing the funds over state leaders’ refusal to provide health insurance to low-income adults.

State health officials said Monday they have struck a deal with the federal Centers for Medicare and Medicaid Services to keep the program going for another 15 months, with hospital reimbursements remaining at their current level.

Those were the exact terms the Texas Health and Human Services Commission asked for last month. Agency leaders said the negotiations were a “big win for Texas.”

“We’re pleased these innovative programs will have the opportunity to continue,” Chris Traylor, the agency’s executive commissioner, said in a statement. “These programs are improving health care for Texas’ Medicaid clients and creating cost-savings for taxpayers.”

[…]

The 15-month extension also includes an additional $3.1 billion for DSRIP initiatives.

The Obama administration had previously signaled it was likely to stop footing the bill for at least some of Texas’ uncompensated care costs. Under the Affordable Care Act, the president’s signature health law, Texas was encouraged to expand its Medicaid program to cover nearly 1 million additional adults living in poverty — a move that would have given more poor patients a means to pay for care. The state’s Republican leadership hasvehemently opposed that option, criticizing Medicaid as an inefficient government program.

Federal health officials were unswayed by that argument, repeatedly telling state leaders they had no desire to use waiver funds to pay for costs that would otherwise be covered by a Medicaid expansion.

[…]

Texas health officials say they will continue negotiating a longer term extension of the funding over the next 15 months.

Those negotiations will likely be influenced by a study of the effectiveness of the uncompensated care pool, which the federal government asked Texas to commission. The Texas Health and Human Services Commission contracted with outside firms Health Management Associates and Deloitte to submit the study by the end of August. It will address questions such as how hospitals’ uncompensated care costs would be reduced under a Medicaid expansion.

If Texas and the federal Centers for Medicare and Medicaid Services do not reach an agreement at the end of the 15-month extension, in December 2017, the Obama administration said it “expects” that uncompensated care funding would be reduced after that.

“Specifically, the reduction will limit the size of the Uncompensated Care pool to the costs of uncompensated and charity care for low-income individuals who are uninsured and cannot be covered” under a Medicaid expansion, wrote Vikki Wachino, a senior federal health official, in a letter to the Texas Health and Human Services Commission.

Additionally, the DSRIP pool would be reduced by 25 percent in 2018 and by an additional 25 percentage points each year after that, according to federal officials.

See here, here, and here for some background, and here for a copy of the letter CMS sent to Texas. I don’t really have anything to say that I haven’t said before. Texas needs to expand Medicaid, and if the state continues to refuse to do so, the federal government should not take any steps to mitigate the consequences of that decision. It’s up to the next Legislature now. State Rep. Garnet Coleman, Trail Blazers, and the Austin Chronicle have more.

State cuts off funds to Planned Parenthood for HIV testing

Seriously?

Right there with them

Right there with them

Amid an ongoing battle over Planned Parenthood’s participation in the state Medicaid program, Texas health officials are cutting off funding to a Planned Parenthood affiliate for an HIV prevention program.

In a notice received by Planned Parenthood Gulf Coast late Monday, an official with the Department of State Health Services informed the Houston-based provider that it would not renew its contract for HIV prevention services.

The long-standing grant, which funds HIV testing and prevention services, was set to expire on Dec. 31, according to the notice which was obtained by the Texas Tribune.

“There will be no further renewals of this contract,” a DSHS official wrote in the notice to Planned Parenthood.

The contract is federally funded through the Centers for Disease Control and Prevention but managed by the state. A spokeswoman for the CDC said she was unaware of the state’s notice and did not immediately provide comment.

By ending Planned Parenthood’s contract, the state is cutting off almost $600,000 in annual funding, which the health care provider used for HIV testing and counseling, condom distribution and referral consultations.

Incredible. At least with the cutoff of Women’s Health Program funds, the state made some arrangements for alternate options. It was half-assed and still caused a huge unnecessary upheaval for thousands of women, but there was at least a token gesture towards maintaining the service. That doesn’t appear to be the case here, or at least the flunkies at the HHSC had no comment at the time the story was published. Unless PPGC decides to continue this on its own dime, this service just goes away. Because why would Greg Abbott care about people who might have HIV? And remember, the root of all this is a pack of lies that the state is hoping you’ll all forget.

The Chron story on this is here. I don’t know if this action can be wrapped into the ongoing litigation over the state cutting off Medicaid funds for Planned Parenthood, but regardless perhaps some political pressure can be applied.

Texas Democrats in Congress sent a letter to the Centers for Medicaid and Medicare Services this month asking that they “explore all options available at the federal level” to stop the State of Texas from blocking Planned Parenthood from receiving Medicaid funding for health services.

[…]

“Members of the delegation understand that there is a precedent for intervention, and several options available for the federal government to bring Texas into compliance with federal law,” said Congressman Marc Veasey, D-Fort Worth. “In the past, CMS has decreased or removed federal funding from Texas, which we do not want to happen again as doing so would decrease access to care instead of expanding it.”

Click over to see the letter, which was signed by ten members of the Texas Congressional delegation. The Observer and the Press have more.

The state was full of it all along on Planned Parenthood

Shocked, shocked I am.

Right there with them

Right there with them

Almost two months after Texas Republican leaders announced they would kick Planned Parenthood out of Medicaid, it hasn’t happened.

The organization is still receiving federal and state funds to provide health care for about 13,500 low-income women a year, and the state officials who called for a cutoff, including Gov. Greg Abbott, have fallen silent on why the funding continues.

But the state’s hesitance to pull the trigger reflects a recent pattern in its dealings with an organization that is a lightning rod for any political debate that even remotely touches on abortion. Repeatedly, raising claims of fraud or wrongdoing, conservative Texas politicians have vowed to fine or punish the organization.

And repeatedly, when the smoke cleared there was no fire.

[…]

On Oct. 21, Planned Parenthood affiliates in Texas received a “notice of termination” from the state Health and Human Services Commission announcing it was axing the organization’s Medicaid contract, citing the videos and unspecified allegations of Medicaid fraud.

The agency’s inspector general, the letter said, had “reliable information indicating a pattern of illegal billing practices” that would disqualify Planned Parenthood from participating in Medicaid.

The commission’s chief fraud investigator, Stuart Bowen, gave Planned Parenthood 30 days to respond and request an “informal resolution meeting” with health commission attorneys. If it didn’t, the state said it would issue a “final notice of termination” formally booting Planned Parenthood from Medicaid — an order that would go into effect 15 days after the organization received it.

Worried they would be cut from the Medicaid program as early as Dec. 8, Planned Parenthood affiliates in November filed a federal lawsuit seeking to block Texas’ efforts. In it, Planned Parenthood argued that terminating its Medicaid contract would prevent low-income women, including 10 unnamed patients that signed on to the case, from obtaining services from a “qualified, willing provider” as required by law.

But when U.S. District Judge Sam Sparks considered the organization’s request for a restraining order on Dec. 8, a curious fact emerged. Despite its claims that it had proof of misconduct, state health officials never delivered the final legal notice to defund the organization.

Lacking a final notice of termination, Sparks canceled the hearing.

“Planned Parenthood has not received official notice from the state for termination of our health centers’ continued participation in Medicaid so our court case is delayed,” said Sarah Wheat, a vice president for Planned Parenthood of Greater Texas.

The state’s efforts to nix the Medicaid dollars have been “political from the start,” Wheat said.

[…]

In a previous interview with the Tribune, Bowen emphasized that the “notice of termination” sent to Planned Parenthood in October was the start of a civil enforcement process — not a final determination of the organization’s status as a Medicaid provider.

“We did not terminate them,” he said. “We began a process … inclusive of the development of evidence.”

Bowen’s explanation appeared at odds with the wording of the notice sent to Planned Parenthood and public statements made by Abbott and other top state officials indicating that Planned Parenthood would indeed be ousted from the program.

It remains unclear why Planned Parenthood has yet to receive the final notice, and the Office of Inspector General has declined to provide any details about its investigation into the organization.

It’s not unclear at all. Sarah Wheat explained it quite succinctly and sufficiently. But Abbott and his ilk got what they wanted, even if they won’t get what they promised. The people they were really speaking to, including a few shamefully gullible “journalists”, heard what they wanted to hear. Truthfulness wasn’t a factor, all they wanted was the rah rah. It’s up to the rest of us to remember that.

Refugee group defies Abbott

It’s on.

A nonprofit organization that resettles refugees in the United States says it will move forward with the placement of Syrian refugees in Texas, despite warnings from officials in the Lone Star State not to do so.

The New York-based International Rescue Committee said in a Monday letter to Texas health and human services chief Chris Traylor that its Dallas affiliate would continue to provide resettlement assistance to all refugees “who have been admitted lawfully to the United States.”

The nonprofit had received a letter earlier on Monday from Traylor urging the International Rescue Committee’s Dallas branch to discontinue resettling Syrian refugees or risk losing its state contract “and other legal action.” The International Rescue Committee – one of about 20 nonprofits that have a state contract to resettle refugees in Texas — had previously informed the state that it would resettle two families in the Dallas area in early December. Both families have relatives in North Texas, the nonprofit said.

See here for the background, here for the letter from HHSC to refugee groups, here for the IRC’s response letter to the HHSC, and here for their public statement. I’ve said before that I have a hard time believing that Greg Abbott would go to the mat against faith-based organizations like the IRC, but these are the time we live in. The next question is how much company the IRC will have in litigation against the state of Texas, if indeed it does come to that.

At least 242 Syrian refugees have been resettled in Texas since 2012. That number is relatively small for Texas — a hotbed for refugee resettlement — but the count of Syrian refugees was expected to increase significantly in the next year as the United States prepares to take in 10,000 Syrian refugees.

At least one other resettlement nonprofit, Catholic Charities of Dallas, had said it would continue to provide resettlement assistance to Syrian refugees. But as of Monday afternoon, that organization had not received a letter from the state similar to the one received by the International Rescue Committee, a Catholic Charities spokeswoman said.

[…]

The Texas Health and Human Services Commission was unable to provide a list of resettlement nonprofits that have agreed not to assist Syrian refugees.

At least two such nonprofits in Texas say they haven’t made a decision about whether to continue settling Syrian refugees.

A spokeswoman for Interfaith Ministries for Greater Houston said in a statement that it had not received a letter from the Texas Health and Human Services Commission, “so no final determination has been made regarding our next steps for resettling Syrian refugees.”

Likewise, Refugee Services of Texas had not received a letter from the state about Syrian refugees, said Aaron Rippenkroeger, the president and CEO. The organization plans to “seek guidance on the ramifications” of federal and state requirements,” he said in a statement.

The more organizations that stand with the IRC, the harder I think it will be for Abbott to follow through. There’s got to be a way to ease up and find a compromise, but I have no faith that Abbott wants to do that. TFN Insider has more.

Texas threatens to sue religious groups over refugees

Amazing.

Texas officials are escalating their opposition to Syrian refugees with a new order aimed specifically at resettlement groups that have indicated they will accept people fleeing the war-torn country: change your mind or risk getting sued by the state.

Texas health commissioner Chris Traylor issued the first lawsuit threat over the Thanksgiving holiday weekend in a letter to the Dallas branch of the International Rescue Committee, which said earlier this month that it supports accepting Syrian refugees.

“We have been unable to achieve cooperation with your agency,” Traylor wrote in the letter, which was released to the Houston Chronicle, adding that, “Failure by your organization to cooperate with the State of Texas as required by federal law may result in the termination of your contract with the state and other legal action.”

Similar letters are expected to be sent to any refugee resettlement group that takes a similar position against Gov. Greg Abbott.

[…]

Bee Moorhead, executive director of Texas Impact, a faith-based organization that has ties to refugee groups and has expressed concern about Abbott’s position, decried the letter in an interview with the Chronicle.

“This letter should raise serious concerns for refugees currently receiving assistance in Texas, and also for legislators – who should be asking what fiscal impact the Texas Health and Human Services Commission could be bringing down on the state through its increasingly contentious communications,” Moorhead said. “The health commission interacts collegially and effectively every day with multiple federal agencies, so it’s astonishing to see these kinds of communications coming from the agency.”

See here, here, and here for the background, and see the Chron story for a copy of the letter. I continue to be utterly gobsmacked by this. Again, these are faith-based organizations that Abbott is blithely threatening to sue. We all know how this would play out if the federal government were doing something like this, right? I mean, we’re all familiar with the apocalyptic rhetoric surrounding the contraception mandate. At what point does the Catholic Church in Texas quit pussyfooting around and condemn Abbott for this in no uncertain terms? That might loosen things up a bit. Beyond that, I still have no idea how this ends. Trail Blazers, the Press, and the Current have more.

Feds say No to Abbott on refugees

What now, Greg?

The federal government on Wednesday informed refugee resettlement agencies in Texas and across the country that states do not have the authority to refuse to accept Syrians.

The statement, made in a letter obtained by the Houston Chronicle, appears to mark the first time federal refugee program officials formally have rejected statements by governors, including Greg Abbott of Texas, that their states will not accept any Syrian refugees.

It also may signal that federal officials will place Syrians here and elsewhere regardless of governors’ wishes.

“States may not deny (Office of Refugee Resettlement)-funded benefits and services to refugees based on a refugee’s country of origin or religious affiliation. Accordingly, states may not categorically deny ORR-funded benefits and services to Syrian refugees,” wrote Robert Carey, director of the office, adding that states and agencies that do not comply would be violating the law and “could be subject to enforcement action, including suspension or termination.”

Carey’s two-page letter also emphasized that refugees seeking to come to the United States undergo heavy scrutiny over an average of two years of waiting, a point that President Barack Obama and other federal officials have been trying to make in recent days.

[…]

Carey’s letter came the same day that Obama made a special statement at the White House to reassure Americans that there is no specific and credible threat to the country right now. It also came the same day that the Texas Catholic Conference announced that its refugee resettlement agencies would continue to accept Syrian refugees and would work with agencies to ensure safety is upheld.

“The Texas Catholic Bishops encourage all parties – including governmental leaders, political officials, and advocates – to avoid impulsive judgments in setting public policies regarding the placement of Syrian refugees, the organization said in a statement. “The horrors of modern terrorism are frightening, but they demand from us a strong renewal of our faith and our commitment to Christian teachings and the common good.”

Another faith-based group, Texas Impact, has said it believes there is momentum toward finding a way to accept the refugees.

See here and here for some background. On the one hand, I can’t see Abbott caving in to the feds. His whole career is built on this kind of obstinate petulance. On the other hand, I doubt he wants to get into a pissing contest with religious groups, even if they’re mostly of the do-gooder variety and not suburban megachurches, who care about refugees about as much as he does. I still can’t quite see Abbott bringing down the hammer on faith-based organizations, but if that’s his line in the sand, it’s his bluff that’s getting called. I have no idea how this one ends.

Planned Parenthood sues Texas

Here we go.

Right there with them

Right there with them

Planned Parenthood’s Texas affiliates on Monday filed a federal lawsuit to keep state health officials from booting them from the state’s Medicaid program.

Following Texas’ announcement in October that it would stop funding any care for poor women at Planned Parenthood clinics — a response to what state officials called “acts of misconduct” revealed in undercover anti-abortion videos — the women’s health organization is asking the courts for a reprieve.

Ten patients joined Planned Parenthood in the lawsuit, according to the organization. One of those is Kendra Hudson of Houston, who said a pap smear she got at a Planned Parenthood clinic allowed her to identify an abnormal growth and prevent it from developing into cancer.

“They were the provider that I trusted and felt comfortable with,” Hudson told reporters on Monday. By cutting off Medicaid funding to the women’s health organization, Planned Parenthood argues that thousands of other women could lose access to similar services they couldn’t get elsewhere.

The state’s move wouldn’t just end state funding for Planned Parenthood services like pregnancy tests, contraception and cancer screenings. It would also end the allocation of federal dollars to Planned Parenthood through Medicaid, the joint state-federal insurer of last resort that is administered by Texas. In 2015, Texas spent $310,000 of its own money on the women’s health organization while distributing $2.8 million in federal dollars.

[…]

The legal challenge in Texas is the latest in a series of lawsuits filed across the country over how Medicaid dollars are disbursed to Planned Parenthood clinics. Texas’ move comes weeks after a federal district court in Louisiana temporarily halted similar efforts there until the courts could better examine the issue. Other lawsuits are also making their way through the courts in Alabama and Arkansas.

Federal health officials notified the Texas Health and Human Services Commission late last month that kicking Planned Parenthood out of Medicaid could be a violation of U.S. law.

See here, here, and here for the background, and here for a copy of the lawsuit. The Observer adds a few details:

Republican lawmakers and anti-abortion groups have long claimed that other providers would be able to fill the void left by any Planned Parenthood ouster. Not so, said Dr. Hal Lawrence, CEO at the American Congress of Obstetricians and Gynecologists, during a press call announcing the lawsuit.

In fact, he said, it’d be “next to impossible” for non-Planned Parenthood providers to provide the same volume and quality of care. “It’s very difficult in many states to get Medicaid patients in to see other providers, schedules are already full,” Lawrence told reporters.

Planned Parenthood officials, who were given 30 days to respond to the Texas health commission’s Medicaid termination, said Monday that they are bypassing the commission’s appeals process in favor of filing their lawsuit. But attorneys did say that Planned Parenthood is complying with the inspector general’s requests for thousands of pages of billing and patient documents and subpoenas issued days after the termination letters.

One irony of all this is that one of the often-proffered reasons for not expanding Medicaid is that there aren’t enough doctors in the state who are willing to take new Medicaid patients. So of course kicking out a big Medicaid provider and forcing all its patients onto the mercies of the open market for doctors who will take them makes all kinds of sense.

I presume we all know how this is going to go: Planned Parenthood will win at the district court level, the ruling will be overturned on dubious grounds by a couple of the worse judges on the Fifth Circuit, and then we all get to sweat out another appeal to SCOTUS. Lather, rinse, repeat. In the meantime, this may speed up the timeline for the HHSC Inspector General to produce whatever report he’s going to produce on the claims that PP has been fraudulently billing Medicaid, the investigation of which was spurred by those latest ridiculous “sting” videos. Round and round she goes. Trail Blazers, the Statesman, the Chron, the AusChron, the Press, the Current, Daily Kos, and ThinkProgress have more.

Now who’s messing with religious freedom?

What is Greg Abbott’s beef with faith organizations?

A prominent Texas faith organization signaled Friday that refugee resettlement agencies in the state may not comply with Gov. Greg Abbott’s order to turn away Syrian refugees, writing a letter “to express shock and dismay” with the directive.

The governor’s order “constitutes an unprecedented attempt on the part of a state agency to pressure private, nonprofit organizations to violate federal law and their federal contractual obligations,” wrote Bee Moorhead, executive director of Texas Impact, which works closely with resettlement agencies affiliated with religious institutions.

The letter asked the state to convene a meeting with resettlement agencies and federal authorities to clarify whether Abbott has the authority to issue such a directive.

Moorhead told the Houston Chronicle that among resettlement groups, “there seems to be some energy developing around convening them as a coalition to work on this issue.”

Moorhead’s letter came hours after the state’s top health official wrote refugee resettlement agencies in the state to say Texas was invoking its legal right to “require that you provide immediate and ongoing consultation with the Health and Human Services Commission Office of Immigration and Refugee Affairs (OIRA) regarding any plans that may exist to resettle Syrian refugees in Texas.”

“If you currently have plans to participate in the resettlement of any Syrian refugee in Texas, please notify us immediately, but not later than 4:00 p.m. Friday, November 20, 2015,” executive health Commissioner Chris Traylor wrote, adding the agencies should discontinue those plans and “further, please notify us immediately if, in the future, you learn that a Syrian refugee is proposed for resettlement with your organization.”

See here for some background, and here for a copy of the letter. The Statesman adds on.

Gov. Greg Abbott’s office appears headed toward a legal showdown with refugee resettlement agencies and their sponsoring faith organizations over Abbott’s efforts to keep any Syrian refugees from resettling in Texas in the aftermath of the Paris terrorist attacks.

Following Abbott’s directive, Health and Human Services Executive Commissioner Chris Traylor on Thursday sent a toughly worded letter to 19 refugee resettlement agencies in Texas — including Caritas and the Refugee Services of Texas in Austin — asking that they scrap any plans to resettle Syrian refugees in Texas and that they notify his office by 4 p.m. Friday if they had any plans to resettle Syrians in the state.

Refugee resettlement is generally a federal matter done in cooperation with national and local nonprofit, often church-based, resettlement agencies. The states play a supportive role and pass federal money onto the local agencies.

However, in his effort to make good on his pledge to keep Syrian refugees from coming to Texas, Abbott, a former state attorney general, is relying on a section of the 1997 legislation authorizing the refugee resettlement program. It states that it is the intent of Congress that “local voluntary agency activities should be conducted in close cooperation and advance consultation with state and local governments.”

Traylor cites that provision in his letter, and warns, “We reserve the right to refuse to cooperate on any resettlement on any grounds and, until further notice, will refuse to cooperate with resettlement of any Syrian refugees in Texas.”

“It’s a very disturbing effort by the state to coerce nonprofit organizations into ceasing the important services that they normally provide to vulnerable refugees to allow them to integrate into our community,” said Denise Gilman, director of the Immigration Law Clinic at the University of Texas School of Law.

“The agency is seeking to force nonprofits to join the governor’s misguided policies that discriminate on the basis of national origin,” Gilman said. “Most disappointing of all is that those harmed will be families who have fled unspeakable violence in Syria, who have undergone a lengthy and cumbersome process to ensure that they present no threat, and who desperately need protection and support to recover some stability in their lives here in the United States.”

That’s religious nonprofits that Abbott is trying to coerce. At a time when for-profit corporations have been granted the right to impose the religious beliefs of their owners on their employees and when plaintiffs in a lawsuit who happen to be pastors getting subpoenaed is taken as an assault on freedom on religion. Again, this is Greg Abbott exerting government power to influence what religious organizations can do. I’m at a loss for words here. Thankfully, Lisa Falkenberg was able to find a few.

On issues like birth control, abortion and gay marriage, conservative politicians routinely charge into the fray like moral warriors, vowing to protect the sacred constitutional right to religious liberty.

Hobby Lobby. Kim Davis. They got your back.

But when it comes to a basic tenet of Christianity – caring for the stranger – the warriors have turned their swords against Scripture.

What would Jesus do, Greg? Feel free to ask a bishop if you need help with that.

Feds warn Texas about Planned Parenthood

We’ll see what happens.

Right there with them

Right there with them

The Obama administration has warned state officials that pushing Planned Parenthood out of the state’s Medicaid program could put Texas at odds with federal law.

Officials with the federal Centers for Medicare & Medicaid Services contacted the state Medicaid director on Tuesday to give notice that removing Planned Parenthood from the program “may be in conflict with federal law” because poor women who obtain family planning services through Medicaid would be limited from receiving health care from the qualified provider of their choice.

“Longstanding Medicaid law prohibits states from restricting individuals with Medicaid coverage from receiving their care from any qualified provider,” a U.S. Department of Health and Human Services representative said in a statement. “Every year, millions of women benefit from critical preventive services, such as cancer screenings, that Planned Parenthood provides. State efforts to restrict women from using qualified providers puts these important health care services at risk.”

The feds’ intervention comes a week after Texas health officials announced they were working to boot Planned Parenthood from Medicaid, the joint state-federal insurer of the very poor and disabled. This would cut off taxpayer dollars to Planned Parenthood clinics that provide well-woman care, like cancer screenings, birth control and pregnancy tests. Planned Parenthood clinics that accept Medicaid dollars are already barred from performing abortions.

A spokesman for the Texas Office of Inspector General, which is handling the Planned Parenthood investigation, said state officials on Tuesday “had a very productive call” with the feds about the Medicaid announcement.

“Some concerns were voiced, and the state was able to responsively address them,” said OIG spokesman Chris Cutrone.

See here and here for some background. Hard to know what to make of this. Stuart Bowen recently dropped hints about a whistleblower being the basis of the state’s actions, which could be something or could be more smoke. At the same time this was happening, US Health and Human Services Secretary Sylvia Burwell was taking a conciliatory tone about the state expanding Medicaid, which may have played into that “very productive call” or may be completely separate. I personally think the feds should continue to play on this, but I suppose someone has to be the good cop. Meanwhile, another state that has tried to follow the same path that Texas is taking lost in court, as a federal judge blocked efforts in Alabama to kick Planned Parenthood affiliates out of the state Medicaid program. Until the state puts its cards on the table, who can say what if any actual evidence they’ve got?

What you can say is this.

“Everyone is entitled to due process under the law. As a former judge, I recognize this is the first step in a lengthy process and will respect that process as it moves forward.”

—Gov. Greg Abbott

The quote is Abbott’s response to the criminal indictment accusing Attorney General Ken Paxton of having deceived investors, some of whom lost tens of thousands of dollars they risked because they trusted him. Abbott of all people should know about due process, having served as attorney general for 13 years in addition to having been a Texas Supreme Court justice.

But Abbott had no qualms about abandoning his ethical-lawyer respect for due process when it came to the current case the state has trumped up against Planned Parenthood. The state moved last week to end Planned Parenthood’s Medicaid funding based on the propagandic video snippets that have been making the rounds nationwide from anti-Planned Parenthood zealots purporting to show illegal deal-making for aborted fetal tissue.

Abbott declared Planned Parenthood guilty without benefit of an investigation, much less a trial. “The gruesome harvesting of baby body parts by Planned Parenthood will not be allowed in Texas and the barbaric practice must be brought to an end,” he said in a statement from his office issued under the headline “Texas eliminates taxpayer funding to Planned Parenthood providers.” See how the sentencing in this case appears to precede all else?

[…]

This foray against Planned Parenthood is a staged event to disrupt an organization whose Medicaid reimbursements primarily are for basic health services to low-income patients, including cancer screenings and testing for socially transmitted diseases. That is a wrong thing to interrupt just to make a political show of opposing abortion.

An objective review of the state’s actions and Abbott’s utterances against Planned Parenthood by a high-ranking law school would be interesting to see. We fear that Texas wouldn’t come off any better than the government of Iran. We wish that weren’t hyperbole.

Well, at some point we’ll get an objective review by a judge, and that will tell us a lot. The Chron and BOR have more.

State goes fishing against Planned Parenthood

Here we go.

Right there with them

Right there with them

Days after Texas health officials announced they want to kick Planned Parenthood out of the state Medicaid program, state investigators on Thursday visited Planned Parenthood facilities in San Antonio, Houston and Dallas.

Investigators with the Texas Health and Human Services Commission’s investigative arm delivered requests to Planned Parenthood facilities in all three cities asking for Medicaid records, billing information and personnel information, according to Planned Parenthood officials. A request delivered to a Dallas facility included request for files from clinics in Austin and Waco.

State health officials would not confirm details about investigators’ visits. A spokesman for the health commission’s Office of Inspector General said he could not “provide comment on any oversight or investigative activities.”

[…]

Planned Parenthood officials said in a statement that Thursday’s visits by state investigators were “political grandstanding” by the state’s Republican leadership, particularly Gov. Greg Abbott, who had previously called for cutting off all taxpayer dollars the organization received.

“Representatives from the Texas Office of Inspector General showed up at Planned Parenthood health centers in Houston, Dallas and San Antonio looking for an excuse to take health care away from thousands of women and men who rely on Planned Parenthood for preventive care,” said Yvonne Gutierrez, executive director of the organization’s state political arm Planned Parenthood Texas Votes. “But what they will see is professional, compassionate and quality health care. Despite their efforts to distort the truth, health care — no matter what — is what happens at Planned Parenthood.”

In a statement earlier this week praising the move to cut off the funding for Planned Parenthood, Abbott said, “Texas has stepped forward and shown its unyielding commitment to both protecting life and providing women’s health services.”

Among the documents investigators are requesting are Medicaid records dating back to 2010. At Planned Parenthood’s facility in Spring, Texas, which does not perform abortions, state investigators are requesting records related to specific services provided to Medicaid patients, employee information and appointment books, according to a letter obtained by the Texas Tribune.

See here for the background and here for a copy of the letters. I’m going to let Dave Mann, who goes through the details of the latest attack on Planned Parenthood point by point, sum this up:

4. Based on what we know, the state’s case seems a little thin.

This one comes with a major caveat: We don’t know exactly what evidence the state possesses. The letters reference “reliable information indicating a pattern of illegal billing practices by Planned Parenthood affiliates across the State.” And that may well be. If state officials have uncovered evidence of widespread Medicaid fraud at Planned Parenthood clinics, then Texas may well succeed in cutting the organizations out of the program—and deservedly so.

But the specifics offered by the state so far don’t exactly blow you away. In their letters to Planned Parenthood, Texas officials contend that the organization is “no longer capable of performing medical services in a professionally competent, safe, legal, and ethical manner.”

The allegations center on Planned Parenthood Gulf Coast (PPGC), based in Houston, just one of the major Planned Parenthood affiliates in the state. (There are no specific allegations in the letters against other groups, such as Planned Parenthood of Greater Texas, which serves D-FW, Austin and Waco, or Planned Parenthood South Texas. They’re apparently guilty by association.)

The state contends that PPGC has engaged in Medicaid fraud. These allegations largely stem from a 2009 whistleblower suit by a former clinic worker who accused PPGC of fraudulent billing. PPGC settled the case in 2013, though admitted no wrongdoing. The Texas Attorney General’s office—headed at the time by one Greg Abbott—announced that the case was closed.

So the state’s argument—at least as laid out in the letters of termination—is based on six-year-old allegations against one Planned Parenthood affiliate—a case the Texas AG’s office closed more than two years ago. That seems kind of thin.

Is that enough to convince federal health officials or a federal court that a major provider of health services to thousands of Texas women should be booted from Medicaid? State officials seemingly will have a tough time winning that argument— unless they’ve obtained some new, damning evidence of widespread fraud by Planned Parenthood. In other words, the fate of Planned Parenthood in Medicaid will be decided on the merits, not the politics.

So the question is, are they looking for corroboration of evidence they already have or reliably believe they will find, or is this an example of “we know there are weapons of mass destruction in there somewhere and we’ll find them if we just look hard enough”? I have a hard time believing it’s not the latter, but we’ll find out soon enough when the state is forced to put up or shut up. The Statesman, the Observer, Juanita, the Current, Wonkblog, and Trail Blazers have more.

Texas vs Planned Parenthood, part one million

This was going to happen sooner or later.

Right there with them

Right there with them

Texas health officials say they are kicking Planned Parenthood out of the state Medicaid program entirely over what they called “acts of misconduct” revealed in undercover videos filmed earlier this year.

Republican state leaders, who vehemently oppose abortion, have worked for years to curb taxpayer funding of Planned Parenthood — despite the fact that its clinics may not receive such funding if they perform the procedure.

Monday’s decision means even Planned Parenthood clinics that only provide well-woman care, like cancer screenings, pregnancy tests and birth control, will also be cut out of receiving dollars from Medicaid, the joint state-federal insurer of the poor.

The vast majority of Medicaid funding for Planned Parenthood clinics in Texas comes from the federal government. Texas spent just $310,000 from its own coffers on the women’s health organization in 2015, but it also dispersed $2.8 million in federal dollars to those clinics. A spokesman for the federal Centers for Medicare and Medicaid Services did not immediately respond to a request for comment.

[…]

On Monday, the Texas Health and Human Services Commission’s inspector general, Stuart Bowen, wrote to Planned Parenthood Gulf Coast that the women’s health provider had violated state Medicaid rules and put Texans at risk of infection. Citing the sting videos, Bowen said Planned Parenthood officials disregarded federal law by agreeing to change the timing or method of abortions in order to procure fetal tissue for medical research.

As a result, the state will no longer allow any Planned Parenthood clinics in Texas to receive Medicaid funding. Last year, Planned Parenthood clinics in Texas received $3.05 million in federal funds through Medicaid for family planning services like birth control and pregnancy tests.

Planned Parenthood Gulf Coast spokeswoman Rochelle Tafolla described the state’s efforts to block Medicaid patients from receiving care from any of the organization’s clinics as “politically motivated.” Planned Parenthood Gulf Coast does not currently participate in fetal tissue donation, the organization says, but did in 2010, in conjunction with a University of Texas Medical Branch study on miscarriage.

“Tens of thousands of women are already going without care after years of policies aimed at blocking access to care at Planned Parenthood,” Tafolla said. “Now Texas politicians are using a thoroughly discredited, bogus attack against Planned Parenthood as a shameful excuse to attack Texas women’s health yet again.”

This has been the end goal for Texas Republicans for several years now, so like I said, no surprise, and one excuse is as good as another. I would point out that multiple states have investigated these videos and found nothing – Texas, as well as Harris County, is doing its own investigation, and one presumes they have nothing worthwhile to show for it as yet. As such, this may be their consolation prize, since coming away empty-handed was not an option. What comes next is almost certainly a lawsuit, since Texas doesn’t exactly have the authority to do this. If they could have, they would have done this much earlier than this. In the meantime, still more women will lose their access to healthcare. That’s the reality we unfortunately live in, and much as I hate to say it, nothing will change until our state leadership does. BOR, Newsdesk, and the Observer have more.

No, seriously, expand Medicaid or else

Bring. It. On.

It's constitutional - deal with it

It’s constitutional – deal with it

The federal government is officially holding state leaders’ feet to the fire, hoping to get Texas to expand its Medicaid program to provide health insurance to more low-income Texans.

Federal officials called the state’s health agency this week to say that Texas’ reluctance to expand Medicaid — a key tenet of President Obama’s signature health law — will play into whether his administration extends a waiver that helps the state’s hospitals cover uninsured patients.

The development follows news from Florida, where a similar tug-of-war is playing out between the federal government and a Republican-controlled statehouse that opposes Obamacare but hopes to renew billions of dollars in hospital funding. This week, federal officials sent a letter to Florida lawmakers that said Medicaid expansion “would reduce uncompensated care in the state,” making it “an important consideration in our approach regarding extending” the state’s hospital waiver.

Linda Edwards Gockel, a spokeswoman with the Texas Health and Human Services Commission, confirmed Friday that federal health officials called the Texas agency Thursday afternoon to relay a similar message.

Officials from the federal Centers for Medicare and Medicaid Services “said they recognize each state is different, but they intend to use the same three principles outlined in their letter to Florida as they evaluate uncompensated care funding pools in all states,” Edwards Gockel said in an email. “We don’t have more details than that at this point.”

Tom Banning, chief executive of the Texas Academy of Family Physicians and an advocate for Medicaid expansion, said in an email that the call “should be a wake up.” Annually, Texas hospitals receive billions of dollars combined by way of the federal “transformation waiver.” Losing that money “will have a crippling effect throughout Texas,” Banning added.

The Texas hospitals waiver runs through September 2016, but the 2015 legislative session is the last chance for state lawmakers to negotiate a renewal before then. The current session is slated to wrap up on June 1, barring a governor-called special session.

Estimates for the value of that waiver vary. The Texas Hospital Association, which supports some form of Medicaid coverage expansion under the Affordable Care Act, estimates the waiver’s five-year value at $29 billion.

See here for the background. As noted in the story, the feds are similarly putting the screws to Florida. There’s basically zero chance that anything will get passed this session – Sen. Rodney Ellis tried to get a Medicaid expansion amendment through during the budget debate and failed, while Greg Abbott is holding firm and whining about how mean the feds are being to him – so it’s just a matter of whether the feds follow through in 2016 and if enough pressure can be brought to change things in 2017. Anyone want to place a bet on that? The only semi-retired Burka has more.

State-run Women’s Health Program continues to be a failure

Quelle surprise.

Right there with them

Right there with them

Thousands fewer women are getting health services through the now state-run Women’s Health Program after Planned Parenthood was barred from being a provider.

A report released Monday by the state Health and Human Services Commission showed that almost 30,000 fewer women were served through the program in 2013 than in 2011, and 63,581 fewer claims were filed for birth control.

The program became fully state-funded in 2013 after lawmakers voted to prohibit taxpayer dollars from going to abortion providers or their affiliates. Planned Parenthood served about 40 percent of the women in the program before it was excluded for being affiliated with separate, privately funded abortion clinics.

Texas lost federal matching money that kicked in $9 for every one dollar the state spent, now costing the state about $36 million annually.

The program provides well woman’s exams, cancer screenings, contraception and tests for sexually transmitted diseases and infections to low-income women between the ages of 18 and 44.

“These numbers are so distressing and I think it shows Texas moving backwards pretty quickly,” said Sarah Wheat, spokeswoman for Planned Parenthood of Greater Texas.

Several Planned Parenthood family planning clinics closed after they lost funding. The report showed that the areas with the highest drops in the number of women served by the program occurred in areas where Planned Parenthood clinics shuttered.

I’ve blogged about this plenty – see here and here for a couple of examples – and by this point it should be clear to everyone that this is a feature, not a bug. The Republicans who did this were told, repeatedly and in detail, exactly what would happen when the cut the funding, gave up the federal match, and kneecapped Planned Parenthood. They went ahead and did it anyway, for the basest of political reasons. And after last year’s elections, who can blame them? It’s not like anyone has been held accountable for it. They should have the courage of their convictions and embrace studies like this with pride. It’s what they wanted to do, and they’ve been hugely successful at it. Newsdesk and the Observer have more.

Expect to hear more about Perry vetos and no-bid contracts

Bring it on.

Corndogs make bad news go down easier

Corndogs make bad news go down easier

Democratic lawmakers and government watchdog groups on Saturday called for the reopening of an investigation into no-bid state contracts that ended in 2013 after Gov. Rick Perry vetoed funding for the team conducting it.

The critics decried the millions of dollars in Department of Public Safety contracts and another set of similar deals given by the state health commission under Perry, who will step down Tuesday after 14 years in office and is considering a 2016 presidential run. They said a thorough evaluation of contracting is needed to assure taxpayers that their money is being spent responsibly.

“Hell, yes, we need to review everything,” said state Sen. John Whitmire, a Houston Democrat who has served in the upper chamber longer than any other member. “There seems to be an awful lot of no-bid this and no-bid that, and I just think we need to look at it all so we can tell where the problems are and what needs to be changed.”

[…]

Democratic state Reps. Garnet Coleman and Armando Walle of Houston were among those calling Saturday for the investigation of no-bid contracts to be reopened.

“Using state resources to bolster a political career by fomenting a non-existent border crisis, then giving no-bid contracts to a company that has limited experience in border security seems like an issue the Public Integrity Unit should be investigating,” Walle said.

Craig McDonald, director of Texans for Public Justice, an Austin-based government watchdog group whose complaint initiated the investigation that led to Perry’s indictment, agreed. He added that if the investigation had continued, it may have prevented some of the issues now surfacing with state health contracts.

Four high-ranking Texas Health and Human Services Commission officials have so far resigned as a result of those issues, stemming from no-bid Medicaid fraud detection contracts with Austin technology company 21CT that got tentative approval to balloon to $110 million before being canceled.

The deal is now being investigated by the Public Integrity Unit.

Unit director Gregg Cox on Saturday cited that investigation as a reason why it was unlikely that his office could reopen the probe into DPS contracts.

“I just don’t have the horsepower right now to open new investigations, with everything else we have going,” said Cox, who added that he would review the option next week. He added that for now, he “would prefer to see other agencies investigate this, and then we can work with them.”

See here for the background. If nothing else, one hopes this is the fulcrum by which the Public integrity Unit gets its funding restored, which is something the House budget would do but not what Dan Patrick wants. Regardless, this is a giant turd that Rick Perry is leaving in Greg Abbott’s punch bowl, and I plan to enjoy watching the fallout.

Texas Obamacare enrollments top 850K

And counting.

It's constitutional - deal with it

It’s constitutional – deal with it

Officials at the Department of Health and Human Services Wednesday announced nearly 860,000 Texans so far have enrolled in health insurance marketplace coverage with a month left still left to go until the 2015 open enrollment period ends.

It’s unclear how many of those signups are new marketplace customers. Last year, nearly 734,000 Texans, many of whom had never been insured, signed up for coverage. About 198,000 of them were in the Houston area.

“As of Jan. 9, 859,377 Texans have access to quality, affordable health coverage for 2015 through the Health Insurance Marketplace,” said Health and Human Services Secretary Sylvia Burwell in a written statement.

Good to hear. National enrollments have been strong as well. It seems eminently reasonable to me that Texas could top one million signups by February 15, given the likelihood (as was the case last year) of some number of people waiting till the last minute to get it done.

There’s also an intensified focus on the Latino community.

Officials plan more than 600 enrollment events nationwide, including a few in the Houston area, that target Hispanics in an effort to get more signed up for coverage under the Affordable Care Act. In the meantime, grass-roots organizations and the Department of Health and Human Services are spreading the word about the marketplace by using webinars, Twitter, advertising and Spanish television telethons.

“We’re doubling down,” Health and Human Services Secretary Sylvia Burwell told reporters Wednesday, noting that the agency has dedicated a third of its advertising budget to Spanish speakers. “The Latino community is one of the fastest growing communities in the country. We’re specifically focused on this community because of the health disparities that exist for them and we think having insurance will help.”

[…]

Researchers have found Texas Latinos were more than twice as likely as Anglos to enroll in marketplace coverage. They also discovered Hispanic adults in Texas have more difficulty affording health care and are three times as likely to be uninsured.

Burwell repeatedly has said Spanish speakers would be targeted for more outreach this enrollment period. Insurers and enrollment organization trained more application assisters to accommodate Latino applicants and marketplace officials simplified the insurance application process, expanded the number of documents people could use to verify their identities and income and made it easier for applicants to use hyphenated names, which are common in Latino communities.

“We’re working to meet Latino consumers where they are, whether that’s online, over the phone or in person,” Burwell said.

There’s a lot of potential there, and one thing we learned from the first round of enrollments was precisely that these customers needed more engagement to get signed up. I hope this has the desired effect, and that we can learn more for the next time.

What would happen to all these people if SCOTUS takes the opportunity to gut subsidies for the national exchange? My guess is that as are the million or so folks that would qualify for Medicaid under a normal expansion plan, they’d be SOL. Oh, I’m sure that Rep. John Zerwas will put forth a bill to create a Texas state exchange, as he has done before. He’ll have the support of all the Dems, a few honorable Republicans, every non-crazy local official, and the business establishment, but it won’t be enough. Nothing will change till we start to win more elections. I wish I had a sunnier outlook than that, but I don’t. Sorry.

The veto that keeps on giving

I haven’t closely followed the burgeoning scandal at the Texas Health and Human Services Commission, which involves no-bid contracts, up front tuition reimbursements for top level staffers, and rampant cronyism. It’s already cost three people their jobs and will likely eventually result in the HHSC Commissioner, Kyle Janek, either falling on his sword or getting defenestrated. If nothing else, it’s been a nice little stink bomb for Greg Abbott and a timely reminder as Rick Perry exits the main stage that there’s a damn good reason why everyone should be glad to see him go. And since this is a scandal that happened on Rick Perry’s watch, there is as always more to it than meets the eye.

Corndogs make bad news go down easier

Corndogs make bad news go down easier

A year and a half before a no-bid state contract collapsed in scandal last month, a criminal investigation into tens of millions of dollars worth of deals awarded through the same process by Rick Perry’s administration was derailed by the funding veto that got the governor indicted, according to the prosecutor who led the probe.

The earlier inquiry, which concerned Texas Department of Public Safety contracts for Perry’s highly touted and controversial border-security program, lasted more than a year before abruptly shuttering, said Gregg Cox, director of the Public Integrity Unit at the Travis County District Attorney’s office.

“We lacked the resources to continue that investigation,” Cox said. “Because the staff was cut when our budget was vetoed.”

[…]

The news also raises questions about whether a continuation of the inquiry could have alerted officials much earlier to vulnerabilities in the so-called “Cooperative Contracts” process.

The process, which allows state agencies to bypass competitive-bidding, but was designed for smaller purchases, was used for both the Department of Public Safety contract and the scandal-ridden Medicaid fraud detection deal given by the Texas Health and Human Services Commission to Austin technology company 21CT.

That contract, which eventually was set to cost $110 million before abruptly being canceled last month, already has led to the resignations of four high-ranking state health officials, led some lawmakers to call for Executive Commissioner Kyle Janek to step down and triggered investigations by Cox’s Public Integrity Unit, Gov.-elect Greg Abbott and the State Auditor’s Office.

Officials said the earlier Public Integrity Unit investigation focused on more than $20 million in no-bid contracts given to Virginia defense contractor Abrams Learning and Information Systems, Inc., to help Texas develop its border security strategies.

The Virginia firm, founded by retired Army Gen. John Abrams, initially got a $471,800 contract in March 2006 to help the state establish a Border Security Operations Center in Austin, according to a state documents. The deal went through the no-bid process because officials said it was in response to “an emergency.”

An internal memo that later surfaced in news reports showed that the declaration of an emergency was based on public statements by Perry, who at the time was in a tough re-election campaign in which border security was a big issue.

Three months after its first contract, Abrams received a second emergency deal, for $679,600, that greatly expanded the company’s responsibilities.

Over time, state records show, officials quietly added more and more responsibilities to the contracts until they grew to more than $20 million and covered work in most segments of the state’s growing border-security programs.

See, that’s the sort of thing that happens when the one law enforcement authority over state government gets declawed. At the time that the threat and the veto were happening, the conspiracy theory was that Perry wanted to cut any investigations into the scandal-plagued Cancer Prevention and Research Institute of Texas (CPRIT). I don’t think there was any specific intent like that – though if some evidence turned up to suggest there was, I would hardly be shocked – I think Perry just didn’t care about any collateral effects of his actions. He had his own objective, and that was all that mattered. And stuff like this is the result. Thanks for interminable years of service, Rick.

Even Rick Perry appointees back Medicaid expansion

It’s just the right thing to do.

It's constitutional - deal with it

It’s constitutional – deal with it

A board of medical professionals appointed by Gov. Rick Perry said Wednesday that the state should provide health coverage to low-income Texans under the Affordable Care Act — a move the Republican-led Legislature has opposed.

The 15-member Texas Institute of Health Care Quality and Efficiency recommended that the state’s health commissioner be authorized to negotiate a Texas-specific agreement with the federal government to expand health coverage to the poor, “using available federal funds.”

“We’re trying to look at actions whereby more Texans can be covered,” said board chair Steve Berkowitz, the president and founder 0f SMB Health Consulting. “We’re trying to take the politics out of it.”

[…]

Members of the Institute of Health Care Quality and Efficiency — which was established by lawmakers in the 2011 legislative session to identify evidence-based approaches to improving health care and cutting costs — said Wednesday that Texas’ rate of uninsured was “unacceptable,” and that state leaders should look for an alternative way to expand health coverage. The board’s recommendations are not binding and any such decision is up to the Legislature.

“We should be maximizing available federal funds through the Medicaid program to improve health care for all Texans,” said Joel Allison, a board member who is chief executive of the Baylor Scott & White Health System.

I don’t remember anything about the legislation that created the Institute of Health Care Quality and Efficiency and I don’t have anything in my archives about them, but seeing this was a pleasant surprise. If only the 2015 Legislature will listen to them.

Just don’t call it “Medicaid expansion”

It’s the public policy that dare not have its name spoken, at least by Republican legislators.

It's constitutional - deal with it

It’s constitutional – deal with it

State lawmakers renewed efforts Thursday to find a “Texas solution” to expand health-insurance coverage for low-income residents without accepting the Medicaid expansion in President Barack Obama’s signature health care law.

Social-services advocates and local officials are among those pushing for a compromise measure that gives the state more flexibility than in the law to spend the money available from the federal government to cover more residents.

On Thursday, the state Senate Health and Human Services Committee met to “start a conversation that will give us an accurate picture of who the uninsured are, what services are available to them and what we can do to help them,” said chairman Charles Schwertner, R-Georgetown.

Katrina Daniel of the Texas Department of Insurance said about 6.5 million state residents do not have health insurance, although some of those can afford insurance and have chosen not to purchase it. An estimated 1.3 million uninsured Texans earn less than the federal poverty level, leaving them in the so-called “coverage gap.” The president’s law assumed all states would expand Medicaid, so it left those eligible for Medicaid out of its subsidies to help poor residents buy insurance.

Caring for those and other uninsured residents is costing counties billions of dollars a year, according to a letter sent to Schwertner on Wednesday by the judges in Harris, Bexar, Dallas, Tarrant, Travis and El Paso counties.

“We write not to complain about this fiscal burden or duty, but to urge your committee to use this interim to find a Texas way forward to fund and increase access to healthcare coverage for low-wage working Texans,” the judges wrote.

Two of those county judges are Republicans, of course, and frankly I think they have every right to complain. The cost of health care for those uninsured people comes out of their budgets, not the state’s. A lot of that cost includes treatment for folks with mental illness, who generally get that treatment in county jails. Medicaid expansion solves a whole world of problems, we just have to be smart enough to take it. If that means calling it something else, or coming up with something that’s almost but not quite exactly Medicaid expansion so we can claim it’s a “Texas solution”, then so be it. Either is better than what we’re doing now.

From the files of privatization failures

A story from last week.

State officials have decided to slow the rollout of a controversial overhaul of the foster-care system after the private contractor running a pilot program abruptly pulled out Friday.

Judge John Specia, commissioner of the state Department of Family and Protective Services, said a second pilot of the overhaul will continue but other planned expansions will not move forward until his agency studies what went wrong.

“It would be foolish of us to not look at this situation, look at the contract being terminated, talk to the legislative leadership, talk to the providers and advocates and then fully make a decision about moving forward,” said Specia, hours after receiving notice that Providence Service Corp. intended to opt out of a five-year contract after just 18 months. “That’s necessary at this point.”

Lawmakers said the cancellation of the contract would force them to take a closer look at the overhaul, called “Foster Care Redesign.” There will be no disruption of services for the children, as the state will take over the work after a transition period of at least 30 days.

But the development marked a setback for the “redesign” program, which was approved in 2011 as a way to improve the system without increasing costs.

[…]

“As we move forward, the Legislature should carefully examine whether Foster Care Redesign still represents the best solution to the challenges facing our state’s foster care system,” said state Sen. Charles Schwertner, a Georgetown Republican who chairs the Senate Health and Human Services Committee.

Providence, based in Tucson, Ariz., had been failing to meet some of its performance metrics and recently unsuccessfully sought more money from the state, officials said.

Mike Fidgeon, the company’s chief operating officer, said it had proved impossible to provide services for roughly 1,100 children in the pilot’s 60 West Texas and North Texas counties without spending more than the state had spent in previous years, as the contract required.

“The contract guiding us doesn’t adequately address the needs of the children and families,” Fidgeon said. “The most responsible way forward is to conclude the current arrangement and work to help the Legislature more adequately fund the state’s foster care system.”

Providence started work last February after winning its $30 million annual contract. ACH Child and Family Services of Fort Worth was tapped for a second pilot, in Tarrant and six nearby counties. More contracts were expected to be put out to bid soon.

But Providence struggled from the start to produce better outcomes or even stay afloat financially.

Emphasis mine. Funny how these things work, isn’t it? The free market can always do it better and more cheaply than the government, and spending must always be cut. It would be funny if there weren’t real people – children, to be specific – on the business end of it. The Legislature created this mess as part of its orgy of budget slashing in 2011, the Legislature can figure out how to fix it. See this Observer story from May for more.

Expanding Medicaid the hard way

A lot smaller than it should have been, but it’s still something.

It's constitutional - deal with it

It’s constitutional – deal with it

More than 80,000 additional Texans have enrolled in Medicaid or the Children’s Health Insurance Program since the rollout of the Affordable Care Act last fall despite Republican state leaders’ decision not to expand eligibility to poor adults, according to federal figures.

The 80,435 new enrollees as of May — mostly Texans who already qualified for coverage but did not previously seek it — represent a 1.8 percent increase over pre-Obamacare figures. That places Texas, which has the nation’s highest uninsured rate, in the middle of the pack among states that chose not to expand access to those programs to everyone under 138 percent of the federal poverty line under the president’s signature health law. The expansion, a key tenet of Obamacare, was deemed optional by the U.S. Supreme Court.

This “woodwork effect” or “welcome mat effect” — in which people hear about Medicaid expansions around the country and learn they qualify in Texas — has not been huge. Roughly 874,000 Texans eligible for Medicaid or CHIP have still not enrolled, according to Kaiser Family Foundation estimates. That includes more than 700,000 children, said Christine Sinatra, state communications director for Enroll America, a group seeking to get the uninsured covered under the federal health law.

Stephanie Goodman, spokeswoman for the Texas Health and Human Services Commission, said her agency started seeing enrollment rates rise a couple of years ago, when the conversation on Obamacare was heating up. After the act took effect, and parents took to the federal marketplace to purchase private insurance plans, many discovered that their children were eligible for Medicaid, Goodman added.

[…]

Get Covered America and Enroll America, which are leading the charge to bring more people into the coverage fold across the country, also cited the Affordable Care Act’s simplification of the sign-up process as a driver of Texas’ recent enrollment growth, which took off in the spring.

And though Texas leaders did not expand Medicaid, the criteria for eligibility here and elsewhere did broaden slightly: The act raised from 21 to 26 the age at which people formerly in the foster care system have to give up their Medicaid coverage.

Absent the Medicaid expansion that Texas chose not to join, Medicaid and CHIP eligibility in the state is generally limited to members of several vulnerable groups, including children under 200 percent of the federal poverty line and some low-income seniors, pregnant women and parents, Sinatra said.

Texas has historically put up a lot of obstacles to enrollment in Medicaid and CHIP. In addition to the exceedingly stingy income requirements, there has been a six-month enrollment period at times, meaning you have to sign up twice a year. The state, and in particular the Republican leadership, does all this in a deliberate effort to keep enrollment down, since that allows for less spending. By the state, anyway – sucks to be you, counties and hospital districts. I for one would consider it justice if every currently eligible person managed to get themselves enrolled, however much it wound up costing the state. We’d be far better off overall regardless of the price. Texas Leftist has more.

We really should have expanded Medicaid

We know it would have done a lot of good, at a very reasonable cost. Turns out that cost was even less than what we had been told.

It's constitutional - deal with it

It’s constitutional – deal with it

News reports and state officials have commonly stated that expanding the Medicaid program in this fashion would cost the state about $15 billion over 10 years. Except, that figure, provided by the state Health and Human Services Commission, is actually an estimated total cost for all aspects of the Affordable Care Act, many of which the state is going to have to pay for even though state leaders have remained steadfastly opposed to almost all aspects of the law.

“What?!?,” you say?

In a presentation given to lawmakers in March 2013, state Health and Human Services Executive Commissioner Kyle Janek estimated that because of the publicity and outreach involved with the Affordable Care Act, more people who are eligible for Medicaid but not currently part of the program would likely enroll. The estimated price tag? About $6 billion over 10 years, or approximately 40 percent of the total Affordable Care Act implementation cost.

According to that presentation, the estimated cost for expanding Medicaid eligibility to all adults who make less than the 138 percent of the poverty level was about $8.8 billion over 10 years. However, the Legislative Budget Board, the Legislature’s budget arm, came up with a far lower cost estimate of about $4 billion over 10 years. The differences can be attributed to two factors, HHSC spokeswoman Stephanie Goodman said. First, HHSC projects that more people will join the Medicaid program than the LBB does; and second, HHSC projected it would cost more to provide the coverage than the LBB does.

Secondly, assume that $1.5 billion figure is correct and that adding it to the state budget would cause taxes to skyrocket and the state’s economy to crumble. However, it begs the question why that hasn’t already happened. Taxpayers in the five major urban counties in Texas — Harris (Houston), Dallas, Tarrant (Fort Worth), Bexar (San Antonio) and Travis (Austin) — already shell out more than $1.5 billion a year in hospital district taxes to provide care and facilities for their largely indigent populations. A study commissioned by Methodist Healthcare Ministries and Texas Impact estimated total local government spending on providing health care at roughly $2.5 billion a year.

Thirdly, expanding Medicaid would produce additional revenue for hospital districts, potentially allowing county governments to cut their tax rate. In Bexar County, hospital district officials estimate that expanding Medicaid would save them $52 million a year, roughly 20 percent of the amount of revenue they get from the hospital district tax, and County Judge Nelson Wolff said he would cut property taxes to pass on the savings if it were approved. In Harris County, hospital district officials say the expansion of Medicaid would mean they would receive an additional $77.5 million in reimbursements, or roughly 15 percent of their tax revenue, based on 2013 financials.

Sure would have been nice to get that extra revenue to help pay for what we’re already paying for, wouldn’t it? We can still take advantage of it if we want to. All it takes is a different set of leaders in our state government.

On a side note, remember that the 7.1 million figure you’ve been hearing for Obamacare signups is just for people going through the healthcare.gov webpage. It doesn’t count state exchanges, Medicaid enrollments, or people who got ACA-compliant policies outside of the exchange. Those first two numbers would surely have been a lot higher nationally had it not been for the cruel and mulish refusal by governors like Rick Perry to create state exchanges and expand Medicaid. There was an increase in Medicaid enrollments across the country, as people who had been eligible all along but didn’t know it or hadn’t gone through it did so thanks to the publicity push from Obamacare. Of course, the total enrollment count was much higher in states that expanded Medicaid, but Texas saw new enrollments as well. That 7.1 million number will likely be higher as well when all is said and done, thanks to some lag in the system. I’ll say it again – just imagine how many more people this law could have helped if only everyone agreed that providing coverage to as many people as possible was a worthy goal and not something to fight against. EoW has more.