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Kyle Janek

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.

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.

Perry keeps asking for the same Medicaid waiver he hasn’t gotten in the past

Same as it ever was.

Corndogs make bad news go down easier

Free corndogs with every approved treatment!

Gov. Rick Perry is preparing for yet another battle in his war against Obamacare.

In a letter to the state’s health agency on Monday, the governor laid out his plan to request a federal waiver to reform Medicaid as Texas sees fit — without expanding eligibility.

“Seemingly, the president and his administration are content to simply throw money at a problem and hope that any problems will resolve themselves,” Perry wrote in a Monday letter to Kyle Janek, the executive commissioner of Texas’ Health and Human Services Commission. “My response, and the response of the Texas Legislature, has been crystal clear: Texas will not expand Medicaid under Obamacare.”

Instead, Perry has asked that the agency request flexibility in the form of a block grant — a fixed amount of money, rather than matching dollars for Medicaid services — from the federal government to fundamentally reform Medicaid. Specifically, Perry requested that the agency seek a waiver that allows the state to make changes to the program without receiving federal approval, continue asset and resource testing to determine eligibility, and initiate cost-sharing initiatives, such as co-payments, premiums and deductibles, among other reforms.

The waiver “should give Texas the flexibility to transform our program into one that encourages personal responsibility, reduces dependence on the government, reins in program cost growth and efficiently improves coordination of care,” Perry wrote.

[…]

In a second letter sent to HHSC on Monday, Perry requested that the agency develop a mechanism to continue collecting and analyzing income, asset and resource information on Texans who apply for Medicaid benefits. That’s despite a provision in the Affordable Care Act — one that takes effect on Jan. 1 — that requires the state to stop asset testing to determine Medicaid eligibility.

A copy of the letter requesting the block grant is here, and a copy of the letter on asset testing is here. Texas has been asking for a Medicaid block grant since at least 2008, when the Bush administration rejected the request. Perry knows full well what the answer will be, he’s just going through the motions out of spite and the continued delusion that he’ll be appealing to Iowa voters in 2016. If the CMS assigned me the task of writing the response, I’d start out by noting that in any negotiation, there must be good faith and a willingness to give something to get something. As the primary purpose of block granting Medicaid is the limit services, and the primary purpose of the Affordable Care Act is to enroll more people in health insurance plans, Perry’s proposal demonstrates neither of those things. Just this week, we’ve seen two examples of other Republican governors agreeing to expand Medicaid. They both wrung some concessions out of the feds in doing so, but the end result will be more people getting access to health care. And Lord knows, we need a commitment to providing access to health care in Texas.

Texas continued to have the highest rate of people without health insurance in 2012 at 24.6 percent, according to the Current Population Survey estimates released by the U.S. Census Bureau on Tuesday.

“Texas has often had the highest uninsured rate throughout the country,” said David Johnson, chief of the Census Bureau’s Social, Economic and Housing Statistics Division. He added that additional data from the American Community Survey that the Census Bureau plans to release later this week would provide more specific information on health insurance rates in states and metropolitan areas.

The Current Population Survey estimates revealed that the national uninsured rate declined in 2012, to 15.4 percent from 15.7 percent in 2011. The national real median income and official poverty rate were not statistically different in 2011 and 2012, according to the estimates.

Thanks to the insurance exchanges and the ACA subsidies, Texas’ unacceptably high level of uninsured people will decline, though as always Perry is doing everything he can to keep as many Texans as possible sick and unable to do anything about it. Perry and his fellow Republicans just don’t give a damn about the problem. Until they do, I see no reason for the feds to waste any time on these pointless requests.

What Obamacare will do for Texas

Even without Medicaid expansion, the Affordable Care Act will help millions of Texans get access to health care.

It’s constitutional – deal with it

Nearly 2.6 million Texans could qualify for tax credits to purchase health insurance in 2014, according to a report released Thursday by Families USA, a nonprofit that advocates for health care consumers.

The tax credits will be offered through the health insurance exchange — an Orbitz-style online marketplace for health insurance — that the federal government plans to launch as part of the Affordable Care Act in October. Beginning in January, families with an income of up to 400 percent of the federal poverty line, between $47,100 and $94,200 for a family of four, will be eligible for a tax credit subsidy to purchase insurance through the exchange. The tax credits will be offered on a sliding scale, so that lower-income families will receive larger credits.

“These are typically the families where folks are working, sometimes more than one job,” U.S. Rep. Pete Gallego, D-Alpine, said of the report. “Regardless of where you are on the political spectrum, I think that’s something we can all support.”

Nearly 5.8 million Texans — nearly a quarter of the state’s population — are uninsured. The Health and Human Services commission estimates the tax credits offered through the health insurance exchange and other provisions in the Affordable Care Act will lower that rate to 16 percent. If Texas also expanded Medicaid — an unlikely scenario given Gov. Rick Perry’s opposition — the uninsured rate could be lowered to 12 percent.

“Given the large number of people in Texas that are uninsured, many of whom are poor, this is an extraordinary opportunity,” said Ron Pollock, executive director of Families USA. He said it was “short-sighted” for the state’s leadership to oppose Medicaid expansion, as it would bring billions of federal dollars to the state, and increase job opportunities.

You can see the report for Texas here, and for other states here. That still leaves about a million people who would be able to get Medicaid if the state agrees to expand it, but we know how little Rick Perry cares about these people. Trail Blazers has more on the Families USA report.

Elsewhere on the Medicaid front, HHSC Commissioner Kyle Janek has been given the go-ahead to negotiate with the U.S. Centers for Medicare & Medicaid Services. At the time, he wasn’t given any direction about what to negotiate for or toward, but perhaps now that the Zerwas bill has been discussed in committee there’s something tangible for him to talk about. We’re unlikely to hear much about his effort and any progress he may make since apparently talking about it in public spooks people, the way saying the name “Voldemort” does in the Harry Potter books. Lord only knows what might happen, but hey, at least they’re talking. EoW has more.

Straus wants someone to do something on Medicaid

Don’t we all, Joe. Don’t we all.

Rep. Joe Straus

Seeking to light a fire under fellow Republicans to provide health care to more uninsured Texans, House Speaker Joe Straus said Wednesday that it is time to “get our heads out of the sand” and find an alternative to Medicaid expansion that would bring billions of federal dollars to the state.

Straus said he and other Republicans have made it clear that they oppose expansion of Medicaid as the program now stands.

“But I think it’s time that we said more than that,” he said. “It’s time that we put forth a good-faith effort to find a Texas solution. We need to move beyond the word ‘no’ to something that the administration might entertain. There are no winners if nothing is agreed to. We have a very large state, a significant population of uninsured people … and I think it could be an opportune time to put some proposals on the table that could be supported by Texas leadership.”

Straus, R-San Antonio, said elements to focus on include subsidies to allow people to obtain private coverage, promoting personal responsibility and cost-sharing, such as co-pays and deductibles.

Straus said there may be a way to tie a plan to a reduction in local taxes, since a key argument for expansion is that it would relieve local taxpayers of some of the burden they now bear to cover the cost of treating uninsured people in public hospitals.

[…]

It is unclear exactly how the conversation will move forward, but Straus said it is important to gear up talks with the aim of building consensus behind a Texas solution.

“We need to make the right business decision for Texas taxpayers,” Straus said. “Local governments have to carry a very heavy burden and look, poor people are going to get sick. They’re going to be treated. And somebody’s going to pay for it.”

Nice talk, if plenty vague. But let’s keep these things in mind:

– Medicaid is going to be cheaper than private insurance. If there’s a problem with doctors not accepting Medicaid, that’s entirely within the Lege’s discretion to fix, since the Lege sets the amount that doctors get paid from Medicaid. But even with more generous reimbursements, Medicaid is going to be less expensive than insurance provided by a profit-seeking enterprise.

– The single biggest obstacle in all this is Rick Perry, with Greg Abbott right behind him. These guys just don’t care about this issue. I can’t state it any more plainly than that.

– Of course, after ten years of complete Republican control of Texas government, the only reason people like Joe Straus are even talking about this is because they have to, thanks to the efforts of President Obama and Congressional Democrats. Texas leads the nation in uninsured people, a situation that has only gotten worse under the Republicans. What little progress there has been has been in spite of the Republicans. It didn’t have to be that way, but it was and is. I’m glad that Straus wants to do something, but I don’t take it as a change of mind, just as a recognition of the lay of the land. He hasn’t exactly been powerless to effect change before now, after all.

Be that as it may, there was a hearing in the House on Friday to talk about just what Texas might do to expand health care access, whether Medicaid or something else.

There are thousands of scenarios that the state could take to expand and reform Medicaid, Kyle Janek, executive commissioner of the Texas Health and Human Services Commission, told the committee. But “we don’t have something on paper,” he said. Janek said he is awaiting further direction from the Legislature to craft a specific plan.

Rep. Sylvester Turner, D-Houston, referenced a compromise Arkansas’ Republican-led Legislature reached with the federal government, and said if “the people in Arkansas are much more capable of designing a system than the people in the state of Texas, that has taken us to a different level.” He called on his colleagues to stop being critical of the Medicaid expansion presented by the Affordable Care Act and to ask themselves “whether or not Texas has the ability to design something that works for Texas.”

Requiring Medicaid patients to make co-payments for their care — an option that has received support from Perry, Straus and other GOP members — is allowed under the Affordable Care Act, Janek said. He said if Texas took a different route and attempted to subsidize private health plans through an Orbitz-style health insurance exchange like Arkansas, the state would need to set up policies to ensure benefits offered by Medicaid that weren’t covered by private plans didn’t disappear.

“I think the public has a misconception that Medicaid expansion will get us the greatest bang for our buck,” said Rep. Lois Kolkhorst, R-Brenham, who chairs the House Public Health Committee. “For Texas, the bang for our buck is really in the exchange, the subsidy [for] people going into private insurance.”

Kolkhorst said without expanding Medicaid, other tenets of the Affordable Care Act would reduce Texas’ uninsured rate from 24 percent — the highest in the nation — to 16 percent. Including the Medicaid expansion would drop the uninsured rate slightly more, down to 12 percent.

As noted above it’s actually almost 29 percent. But who’s counting?

In total, unreimbursed charity care creates a $4.3 billion annual tax burden on local government entities and public hospitals, Billy Hamilton, the state’s former chief budget estimator, told the committee. Overall, he said, there is enough local and state spending in the current system to cover the state’s share of Medicaid expansion costs.

“I know this is a controversial issue… but I don’t really think you’re going to see a more overwhelming fiscal opportunity during your service here,” said Hamilton. “I served this Legislature for 30 years and I’ve never seen anything like it.”

The committee also heard testimony from judges from Harris and Dallas counties who spoke in favor of expanding Medicaid, and from John Davidson, a policy analyst from the conservative Texas Public Policy Foundation, who spoke against Medicaid expansion.

Rep. John Zerwas, R-Simonton and an anesthesiologist, said Texas needs to ensure that any expansion of reform of Medicaid include ways to incentivize more health care providers to accept those patients. If it doesn’t, those patients will end up in the highest-cost environments, emergency rooms. Zerwas pointed out that only 32 percent of doctors are willing to take Medicaid patients in the existing program, under current reimbursement rates.

Rep. Donna Howard, D-Austin, said the Legislature should be held responsible for this lack of Medicaid providers, because lawmakers set those reimbursement rates. “The provider capacity is a real issue for this system, whether we expand or not,” she said.

So that’s Ed Emmett and Clay Jenkins, two guys who live in the real world and have to deal with the real world consequences of having thousands of uninsured people needing medical services their counties provide, versus some pampered, well-paid shill from a right-wing think tank. In a just world, that would be no contest. I’m glad to see Rep. Turner address the Arkansas plan, as that’s the first comment I’ve seen from a Democratic official about it. Again, it’s not my preference but if it’s that or nothing I’ll grab it with both hands.

In the end, as the updated story from the Trib notes, the Lege punted to the HHSC for now.

Rep. Zerwas filed legislation Friday that would grant the Health and Human Services Commission authority to craft “a Texas solution” to Medicaid reform and negotiate with the Obama administration to draw down billions in federal financing to expand Medicaid services.

As debate in the House Appropriations Committee on Medicaid expansion revealed Friday morning, the House remains divided on how Medicaid should be reformed and whether the program should be expanded. Currently, House Bill 3791 is a shell bill that will be altered as state legislators continue to negotiate how Medicaid should be reformed.

“We felt like it was time to start to get the ball moving on this. We’ve made it pretty clear that we’re not for current Medicaid expansion, but we do need to be for something else,” said Zerwas on Saturday, “because I think its very important for the state that we determine a way to cover this group of people that are currently uninsured.”

HB 3791 directs the HHSC to negotiate with the Obama Administration, so that Texas can draw down Medicaid expansion financing while implementing Medicaid reforms that enhance “personal responsibility” of Medicaid recipients, such as copayments or deductibles. It also includes a severability clause to end the agreement if the federal government reduces it share of Medicaid expansion financing.

As it stands, the HHSC does not “have a legislative directive or mandate to go forward on this, and that’s what this is intended to be,” said Zerwas, explaining the bill gives state lawmakers the opportunity to weigh in on how Texas should tailor a Medicaid expansion agreement with the federal government. The bill prompts the HHSC “to move forward on something that the Legislature, the [state] leadership is comfortable with that is in the best interest of Texans and allows us to pull down those dollars, which ultimately are our dollars,” he said.

In other words, they still don’t know what they want, but some of them at least have decided that doing nothing isn’t the best idea. I’m confident the Obama administration will be flexible in the negotiations given what we’ve seen them allow so far. It remains to be seen how flexible the state of Texas will be.

Finally, Sara Kliff provides some useful information about what the Arkansas plan really means, via an interview with George Washington University’s Sara Rosenbaum, an expert on Medicaid policy.

Sarah Kliff: Right now, you have a number of governors looking at the idea of using Medicaid expansion funding to buy private health insurance for enrollees. How novel of an idea is that?

Sara Rosenbaum: It’s been treated as this brand, new thing, but I don’t actually think it’s completely revolutionary. Keep in mind that states have been using Medicaid to buy managed care plans since the beginning of Medicaid. The whole notion of this as a conceptual breakthrough for Medicaid feels a bit off for me.

It does happen though that this is in Arkansas, which traditionally has not been a buyer of managed care, not a place like Arkansas, and not somewhere like Texas which has been buying managed care.

One of the good things about it, from my perspective, is that it gives you more stability of coverage, or gives you the chance at stability. You’re brought into a plan to stay.

SK: So the idea is, if your Medicaid expansion population is in private insurance, they won’t have to bounce back and forth between private and public plans.

SR: It does address a problem of churn. Four years ago I raised this and put this forward to House and Senate committees as a model. It was met with a lot of opposition from Medicaid advocates, which I didn’t totally understand having worked in Medicaid for almost four years now.

The need for stability of coverage is so great. These are the youngest, healthiest and lowest-income workers. All they have to do is churn from different insurance plans two or three times, and they’re going to say I’m through with this. And these are the exact people we want to enroll.

There’s more about the costs and other aspects of this that are worth your time to read. I still don’t believe the Republicans care enough to actually do something about this – note Kyle Janek’s remark about not having something on paper – but I will be happy to be proven wrong. EoW has more.

Where are the doctors?

The Morning News tries to verify that the Dallas-area providers listed for the new Texas Women’s Health Program are in fact providing health care services to the women in this program as advertised. It goes about as well as you’d expect.

Right there with them

A Dallas Morning News survey of 336 contacts listed online for the program showed that 18 percent of the 55 unrepeated physicians and offices surveyed knew they were a part of the program and are accepting new patients. Two listings point people to businesses with no connection to the program — a sports medicine clinic and a title company.

A spokeswoman for the Health and Human Services Commission, which operates the new program, acknowledged that the list has problems.

“It’s not that it’s a list that they shouldn’t be using, it’s that there are addresses on that list that shouldn’t be there, so we’re going to have to do some work to clean that list up,” said Linda Edwards Gockel.

Gockel said the list, which has been available on the program website for more than three months, is not the same list of 3,500 approved providers the state has touted. It represents all the locations a potential provider billed from in the past.

She said the commission hopes to have the list corrected by next week. Gockel could not say why it was not removed sooner, but that women can always call the 1-800 number listed on the website. After The News pointed out the list’s failings, subsequent press releases from the commission avoided mention of the website.

In fact, if you go to the Texas Women’s Health Program website now and click the Find A Doctor link, you will not see any providers listed at all:

According to Trail Blazers, the site “will be fixed sometime this week”, though it looks now like that has been pushed out a few more days. Reps. Donna Howard and Lon Burnam had previously found the same problems that the DMN reports on here in Austin and Fort Worth. Now other Democrats are getting in on the action.

“It is unacceptable that thousands of Texas women may be cut off from access to the program due to the program’s inability to meet demand,” said Rep. Jessica Farrar, D-Houston, the House Democratic Caucus chairwoman, in a prepared statement. “My main concern is to ensure that women may be given the opportunity to affordable and accessible health care.”

Using the Texas Public Information Act, Farrar requested that the agency release a list of the available providers enrolled in the Texas Women’s Health Program along with the number of patients they anticipate serving, the number of patients served by the former Medicaid Women’s Health Program and the geographical areas in the state where provider enrollment does not meet demand.

Good on you, Rep. Farrar. What all this says to me is that the list that had been given on the website was complete and unadulterated junk and that they have taken it down in a desperate attempt to fix it. Remember that the state has been bragging for months about how they’re all fired up and ready to go without Planned Parenthood and with a list of 3,000 providers all set to step in. Is there any reason now to believe that was anything but a lie? Further, given the obvious problems and the complete disconnect between what the state has been saying and what everyone who has bothered to check has discovered, is there any reason to think the state will get this fixed any time soon? I say no and no.

I also say it’s time to get the people primarily responsible for this mess on the record about it. That includes State Sen. Bob Deuell, who requested the AG opinion that declared the state could sever ties with Planned Parenthood while still receiving federal money for the WHP (and how has that turned out so far?); Kyle Janek, the chair of the Health and Human Services Commission; and of course Rick Perry himself. Good on the DMN and Reps. Howard, Burnam, and Farrar for uncovering this lie, but it’s time for everyone else to get in the game as well. Rick Perry isn’t going to care about this until he’s forced to care about it.

Planned Parenthood files another lawsuit

Keeping the heat on the state.

Right there with them

As a tumultuous year in women’s health draws to a close, Planned Parenthood is turning up the heat on Texas, today filing a new lawsuit that challenge the state’s move to ban the nonprofit from participation in a state-run and funded Texas Women’s Health Program.

While previous lawsuits have focused on the state’s move to ban Planned Parenthood from the Medicaid-waiver Women’s Health Program, the suit filed this week focuses on the state’s efforts to ban the provider from a proposed state-run Texas WHP – meant to replace the successful and federally-funded program that the state has voluntarily sought to end solely to exclude Planned Parenthood from participation.

[Tuesday] in state court Marcela “Marcy” Balquinta joined Planned Parenthood family-planning providers from across the state to sue Texas in Travis County district court, arguing that she will effectively be left without access to health care if the state goes through with excluding Planned Parenthood from providing women’s health care in the revamped TWHP. “Without the affordable care I receive through Planned Parenthood and WHP, I would have to make tough decisions between paying for my cancer screenings and birth control, or buying groceries or gas for my car,” Balquinta said in a statement. “If I couldn’t go to Planned Parenthood, I don’t know where I’d turn. And there are tens of thousands of Texas women like me.”

Indeed, Balquinta lives in the Valley, one of the areas of the state that will be hardest hit if state officials make good on a promise to ban Planned Parenthood from participation in the new TWHP. Balquinta, a 26-year-old graduate student at University of Texas–Pan American who works part-time teaching students about preventing sexual violence, will continue to try to pay for services at Planned Parenthood, because that is her “trusted provider where she feels comfortable seeking reproductive health services,” though “because of her limited means, she believes it would be highly unlikely that she could pay for the same range of services that has been covered by WHP and would be covered by TWHP,” reads the lawsuit.

See Trail Blazers and POstcards for more on this story, and here and here for more on the other state lawsuit, which is on hold as Texas appeals the temporary injunction that halts it from keeping Planned Parenthood out of its replacement Women’s Health Program. As this story notes, it is far from clear that the state really has a functioning replacement program ready to go when the federal funds are scheduled to cease, given its inability to meet its own deadline in rolling it out. A hearing on this new suit will happen sometime before the end of the year. A statement from Planned Parenthood Gulf Coast about this is here.

Planned Parenthood gains a stay in state lawsuit

If you’re confused by where the Women’s Health Program stands in Texas, I don’t blame you.

Right there with them

Planned Parenthood will continue participating in the Women’s Health Program — for now. Travis County District Judge Stephen Yelenosky on Thursday approved a temporary injunction to delay the state’s implementation of the “Affiliate Ban Rule,” which would bar the nonprofit from participating in the program, until a full trial can be held in December.

Planned Parenthood is “likely to prevail on their claim that the rule is inconsistent with the instructions of the Texas
Legislature,” wrote Yelenosky in a letter authorizing the temporary injunction.

“This is another victory for the women of Texas that Planned Parenthood is proud to serve,” said Pete Schenkkan, the lawyer representing the group.

Multiple court proceedings have delayed and complicated the implementation of the Affiliate Ban Rule and the Texas Women’s Health Program, which the state previously planned to start on Nov. 1. In October, a three-judge panel of the 5th Circuit Court of Appeals shot down Planned Parenthood’s claim that the Affiliate Ban Rule is unconstitutional and set the stage for the state to move forward with its plan. But a few days after that ruling, another Travis County district court judge issued a temporary restraining order requiring the state to continue the program until it could be determined whether state law made the rule inoperative, because it caused the state to lose federal funding for the program.

[…]

“We’ve got the state program ready to stand up at any time, and that transition would be seamless for patients and their doctors,” Kyle Janek, Texas’ executive commissioner of health and human services, said in an earlier statement announcing that Texas would continue the federally funded Women’s Health Program until funding stops or a state court decision is made.

TM Daily Post has a primer on how we got here, which will bring you up to speed. See here for background on the lawsuit, and here for my opinion on Janek’s claim of readiness. The state will of course appeal this ruling, so I’m going to save myself the ride on the emotional roller coaster and wait to see how that shakes out.

No, they can’t

You just need to ask yourself one simple question about this.

Right there with them

Planned Parenthood will remain part of the Women’s Health Program for now, state officials said Wednesday, putting off the organization’s ouster as critics questioned whether enough health-care providers would exist without it.

Gov. Rick Perry and Texas Health and Human Services Executive Commissioner Kyle Janek cited court action and a desire to hold on to federal funding in putting off Thursday’s anticipated start of a new Texas Women’s Health Program, which would be run only with state dollars and without Planned Parenthood.

Perry on Wednesday said Texas remains committed to barring the clinics from the program, saying state law excludes those affiliated with abortion providers. He also said the remaining health-care providers will have the capacity to serve women in the program, saying 3,000 providers have signed up.

[…]

Mara Posada of the Planned Parenthood Trust of South Texas said the delay in launching the state program suggests “they are not ready to start this program, which by all accounts has been deemed a disaster. There are simply not enough providers with the capacity to see the same number of patients as Planned Parenthood.”

The Wednesday announcement is “an important victory for every woman who relies on the Women’s Health Program for basic, preventive health care,” said Melaney A. Linton, president and CEO of Planned Parenthood Gulf Coast.

Texas officials on Wednesday said that the state-funded program is ready, but it is unclear when they will abandon the federal program. They said federal officials have suggested they can’t provide funding past Dec. 31.

Janek said the state will continue to operate the program with Medicaid funds until that federal funding is stopped or a final court decision requires the state to include Planned Parenthood, violating state law.

Is it even remotely likely that Rick Perry would wait one minute longer than necessary to tell the feds to take their filthy Medicaid money and stick it where the sun don’t shine if the state’s replacement Women’s Health Program were ready to go? Not only would it be a giant middle finger to Planned Parenthood and all of the naysayers who have been predicting – correctly, it would seem – that the state would not be able to pull this off, it would be a nice little base rallier to wrap up early voting. Would Rick Perry turn down that opportunity? The question answers itself. They’re not ready and they don’t want to admit it. Now the question is whether they’ll be ready by January. I wouldn’t bet on it.

It only hurts when it happens to you

This story is about the likely death of the Wentworth nonpartisan redistricting committee bill, which wasn’t unexpected, but the real story is about how it went down.

A move to put redistricting into the hands of a bi-partisan public commission instead of partisan lawmakers was derailed today in the Texas Senate, as conservative Republicans flexed their muscle against moderate members of their own party.

The rare display of a GOP split came when state Sen. Jeff Wentworth, a San Antonio Republican who represents parts of southern Austin and Travis County, tried to bring up for debate his long-delayed Senate Bill 315.

Five senators were absent, several of whom were against the measure. Conservative Republicans immediately jumped up to object.

“It appears this is an end-around movement,” complained Sen. Dan Patrick, R-Houston. This is a bushwhacking.”

Yes, Lord knows we can’t have any attempts to get around Senate rules to push through legislation that doesn’t have two-thirds support of the chamber. That just won’t do.

Patrick said he opposed today’s maneuver by Wentworth to take a vote with several members absent.

“Trying to sneak one through. That’s not how its supposed to work in the Senate,” he said.

Oh, Danno. You’re so frigging precious I could just pinch your cheeks.

Carlos Uresti came down with a serious bout of the flu Monday, and left the Capitol after fellow senators noted how bad he looked shivering in the Senate lounge. In particular, Dr. Kyle Janek advised him to get to bed, amidst joking from others present: “What do you think is going to happen? That we’ll call up the Voter ID bill?”

It now appears that Uresti’s illness may have prompted David Dewhurst to recognize Troy Fraser on the controversial bill, which set in motion an emotional outburst midday Tuesday over Dewhurst’s refusal to count John Whitmire’s vote.

Oddly enough, I don’t remember Sen. Patrick expressing any outrage at the time of that attempt to sneak one through. He’s always advocated for letting the majority have its way in the Senate (though he aimed a bit lower this session, trying to drum up support for a three-fifths rule instead), and for doing away with the two-thirds rule altogether – the whole opening day voter ID rules change was a dream come true for him. But when he needs the protection of the two thirds rule to prevent something he doesn’t like from going through – indeed, in a situation where he himself was the difference between there being two-thirds support and not – boy will he whine about any sneaky attempts to subvert that rule. Way to be a man of principle, Danno!