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The lawsuit to kill Obamacare has its hearing at the Fifth Circuit today

Brace yourselves.

It’s constitutional – deal with it

Last year, after a federal judge in Texas declared the entirety of the Affordable Care Act unconstitutional, throwing into question millions of Americans’ health coverage, the state’s Republican leaders promised they would come up with a plan to replace it.

But on Tuesday, after a legislative session that seemed to have no room for issues other than property tax reform and school finance, Texas will ask a federal appeals court in New Orleans to end the law in its entirety — without offering a replacement plan.

The conservative crusade against portions of the act, known as Obamacare, has spanned a decade. But Texas’ latest lawsuit, filed in February 2018, became an existential threat to the law after U.S. District Judge Reed O’Connor ruled in December that it is unconstitutional in its entirety. At stake: the subsidized health coverage of roughly 1 million Texans, sweeping protections for patients with preexisting conditions, young adults staying on their parents’ insurance plans until age 26 and a host of low-cost benefits available to all people with health insurance, including those covered through their employers.

Texas already has the highest uninsured rate in the nation.

In a highly unusual — if not entirely surprising — move, the U.S. Department of Justice has declined to defend the federal law, leaving a California-led coalition of blue states to protect it. As the case proceeds, Obamacare has remained in place, and likely will until the litigation is finally resolved.

Attorneys for the state of Texas argue the health law cannot stand since the Republican-led Congress in 2017 zeroed out Obamacare’s individual mandate — a penalty imposed on people who chose to remain uninsured. Democrats had favored the penalty as a way to induce more people to purchase health insurance, with the goal of reaching near-universal coverage. Without it, Texas argues, the whole law must fall.

But the state’s Republican leaders have offered few ideas about what should replace Obamacare, a law that touches practically every aspect of health care regulations and includes several popular protections for patients. Gov. Greg Abbott — a vocal critic of the law — pledged in December that if the law remained struck down on appeal, “Texas will be ready with replacement health care insurance that includes coverage for pre-existing conditions.”

Since then, he’s been quiet on the issue, including during this year’s 140-day Texas legislative session. Abbott did not respond to questions for this story.

See here for the background. And of course Greg Abbott doesn’t have a single thing to say about reducing the extremely high uninsured rate in Texas. That’s because Abbott’s plan to reduce the uninsured in Texas, supported by Dan Patrick and Ken Paxton and the rest of the Republicans, is for more of them to die. Just as a reminder, Republicans have been in complete control of Texas government since 2003. Not once during that time have they taken any steps to improve access to health care in the state. Indeed, on multiple occasions, beginning in 2003 with the savage cuts to CHIP and continuing through their assault on women’s health via attacks on Planned Parenthood, they have time and time again make accessing health care harder. That’s what is at stake here. The only fix, regardless of the ruling in this case, is to vote them out. The WaPo, the Chron, and Think Progress have more.

Maybe rural counties don’t want hospitals

That’s what the evidence says.

The voters of Fayette County have spoken, and they’ve said that they don’t need a hospital in this rural community of 322,000 people, one hour southeast of Austin — or at least not enough to pay for it. In a landslide vote Thursday night, county residents overwhelmingly rejected a proposition to create a taxing district for St. Mark’s Medical Center in La Grange, which would have kept the deeply indebted hospital open for the foreseeable future. As the polls closed, it was clear that the idea of propping up the institution with public money didn’t have a snowball’s chance in Central Texas. The final tally was 1,360 for, 5,600 against.

“I’m very proud of the grassroots effort that stood against the taxes,” Deborah Frank, the chair of Fayette County’s Republican Party and a member of Concerned Taxpayers of Fayette County PAC, told the Observer Friday. Her group swiftly mobilized an opposition campaign against the proposition after it was put on the ballot in April, holding public meetings and distributing yard signs reading “NO NEW TAXES.” Their message: People here are already taxed enough and shouldn’t be forced to bail out a private institution simply because it’s made what they see as bad financial decisions.

Voters apparently took the message to heart.

The resounding loss is expected to push the 65-bed hospital, which is at least $14 million in debt, even closer to financial collapse. And it comes at a time when the headwinds against rural hospitals in Texas are especially strong.

Across the state, roughly 20 rural hospitals have shuttered since 2013 — casualties of low patient volumes, stingy Medicaid and Medicare reimbursement rates, and the burden of operating in Texas, which has more uninsured people than any other state. Seventy-five more are at risk of closing down.

One point to note: I have no idea where that “rural community of 322,000 people” figure comes from. Fayette County had 24,554 people as of the 2010 Census, and while it’s been growing over the past few decades, I’m pretty sure it hasn’t grown that much since then. I don’t live in La Grange and I don’t know anything about St. Mark’s Medical Center, so maybe it was a fiscally sound decision to not try to prop it up with a taxing district. I do know that if I lived in La Grange and faced the prospect having to travel 20 miles to Smithville or 26 miles the other direction to Columbus to find an emergency room, I’d be a little concerned about the risks to my health going forward. But hey, at least their taxes won’t go up.

A starter agenda for when we have a Democratic state government

I’ve been pondering the recent legislative session, which as we have discussed wasn’t great but also wasn’t nearly as bad as some other recent sessions have been. The qualification for all this is that the key defining factor for our legislative sessions is defense. How well did we do preventing bad bills from becoming law? Oh, there are occasional good bills, on things like criminal justice reform and medical marijuana and the injection of money into public education this session, which should be good until the lack of a funding mechanism becomes an issue. But actually moving the ball forward, on a whole host of items, is a non-starter.

That’s not a surprise, with Republicans in control of all aspects of state government. But Dems picked up 12 seats in the House and two in the Senate, and came close in several statewide races in 2018. There’s a decent chance that Dems can win the House in 2020, and I have to believe we’ll have a stronger candidate for Governor in 2022. The Senate remains a challenge, but after the 2021 redistricting happens, who knows what the landscape may look like. Dems need to aim for the House in 2020, and have a goal of winning statewide in 2022. It won’t be easy, and the national landscape is a huge variable, but we know we’re moving in the right direction, and if not now then when?

And if these are our goals, and we believe we have a reasonable chance at achieving them, then we need to talk about what we want to accomplish with them. It’s a cliche that our legislature is designed to kill bills and not to pass them, but having a unified, overarching agenda – which, let’s not forget, can get a boost by being declared “emergency items” by the Governor – can help overcome that.

So towards that end, I hereby propose a starting point for such an agenda. Moving the ball forward is the ultimate aim, but I believe we have to first move the ball back to where it was before Republicans assumed full control of the government in 2003 in order to really do that. That’s the idea behind this list, which I want to stress is a starting point and very much open to discussion. There are a lot of things a Democratic government will need to do, from health care to voting rights to equality to the environment to climate change and so much more, but we can’t overlook fixing the bad things first.

My list, therefore, covers bills passed since 2003 when Republicans took over. I am skipping over constitutional amendments like the 2003 tort “reform” item, because they will require a supermajority to pass, which we surely will not have. I’m aiming for simplicity, in that these are easy to understand and rally around, and for impact. So without further ado, here are my ideas:

1. Repeal voter ID.
2. Repeal “sanctuary cities”.
3. Repeal anti-Planned Parenthood legislation, from prohibitions on PP receiving Medicaid to this session’s ban on cities partnering with PP on anything, and restore the previously used Women’s Health Program.

Like I said, simple and straightforward, with a lot of impact. The first two are obvious and should have unanimous Democratic support. The third is more of a challenge because even with a Democratic majority in the Senate, we won’t necessarily have a pro-choice majority. Eddie Lucio, and to a somewhat lesser degree Judith Zaffirini, are both opponents of reproductive rights, though Zaffirini is more nuanced than Lucio and ought to be gettable on this kind of bill via an appeal to health care access.

As I said, this is a starting point. There are things I have deliberately left off this list, though I am not by any means discounting or overlooking them. The “Save Chick-fil-A” bill from this session, whose real life effect is not yet known, needs to go but might be better handled as part of a statewide non-discrimination law. (Also, too, there’s the Eddie Lucio problem in the Senate.) Campus carry and open carry are terrible laws, but might be better handled via comprehensive gun control legislation. Tuition deregulation, a big cause of skyrocketing college costs at public universities, which was passed in 2003 as one of many cut-the-budget effort over the years, will be a more complex issue that may require time to study before a consensus solution can be brought forward. All these things and more need to be on the agenda, but some things are more involved than others.

Again, this is a starting point. I make no claim that this is a be-all or end-all. Hell, I make no claim that I’m not forgetting anything equally simple and substantive. I welcome all constructive feedback. Ultimately, what I want out of this is for Dems to recognize the need to decide what our priorities are before we get handed the power to affect them, and to make it part of the case we will be making to the voters to give us that power. I believe having some uniformity to our message will help us. Now it’s up to us to figure out what that message needs to be.

Another dive into the Heidi Group grift

The Observer is on it this time, and as before if you’re not mad by the time you’ve finished reading you’re doing it wrong.

Right there with them

The state of Texas has poured hundreds of thousands of taxpayer dollars into [Carol] Everett’s clinic, which opened in a strip mall in Round Rock last spring, and millions through her anti-abortion organization, the Heidi Group. Everett’s group was tapped as a test case in the effort to defund Planned Parenthood and lift up faith-based, anti-abortion clinics in state and national family planning programs. It didn’t go well. In September, the state announced it would end Everett’s funding, two weeks after the Observer reported that the group had served just 5 percent of the patients promised in its first year.

Now, internal documents, communications and financial statements obtained by the Observer, along with state records and interviews with half a dozen former Heidi Group employees and with Everett, paint a picture of mismanagement, contract violations, lack of oversight and misuse of taxpayer funds — problems that state officials knew about even as they continued to extend the Heidi Group’s contract for more than two years.

[…]

State lawmakers have funnelled millions into the kind of clinics that Everett has championed. The budget for Texas’ Alternatives to Abortion program, which funds faith-based pregnancy centers, has grown 16-fold since its inception in 2006, following this legislative session, with a total investment of about $170 million through 2021. In 2011, Republican lawmakers slashed the state’s family planning budget by two-thirds, shuttering 82 clinics. Two years later, they kicked Planned Parenthood and other abortion provider affiliates out of the state’s low-income women’s health program, forgoing millions in federal dollars to begin a state-funded program instead. At the time, less than a quarter of the estimated 1.8 million poor Texas women in need of publicly funded contraceptive services were getting them. The cuts resulted in tens of thousands more women losing access to reproductive health services like gynecological exams, birth control, cancer screenings and STD testing.

Then, in 2016, the state’s goals and Everett’s aligned in what she called “the greatest possibility for expansion of pro-life care for the poor ever.” Texas’ health agency had scrambled for years to rebuild the reproductive health care safety net without established family planning providers like Planned Parenthood. Now, the Health and Human Services Commission (HHSC) was launching a replacement program called Healthy Texas Women, which would provide reproductive health care and preventive screenings to low-income women. Officials needed someone to fill the gap left by Planned Parenthood, which had previously served 40 percent of patients in Texas’ women’s health program.

Everett had no experience with state family planning programs. But officials awarded her multimillion-dollar contracts to find and oversee providers in Healthy Texas Women and in the Family Planning Program, the state’s other reproductive health program that also covers men and undocumented patients. Everett pledged to serve an astounding 69,000 patients in the two programs during her first year — more than Planned Parenthood.

The experiment failed dramatically. For fiscal year 2017, the Heidi Group was awarded $1.6 million to serve 51,000 patients in Healthy Texas Women; it spent $1.3 million and served 2,300, according to HHSC data. In the Family Planning Program, the group got $5.1 million to serve nearly 18,000 people. After realizing the Heidi Group was falling short of those targets, the state clawed back and reallocated funds mid-year. It ended up spending $605,000 to serve just over 1,000 patients. HHSC released data for fiscal year 2018 in May, but did not specify the number of patients served by contractors. According to an Observer analysis, which added the patients served by Heidi Group subcontractors and the Heidi Clinic in each program in 2018, roughly 4,000 patients were served through Healthy Texas Women and about 2,700 through the Family Planning Program. The state ended Everett’s contracts in December, and launched an investigation into more than $1 million in questionable spending. Her own clinic, which has served just a few hundred women, faces an uncertain future.

Read the rest. The Chron wrote a similar story a couple of months ago, and it’s just as infuriating. Ultimately, I think Carol Everett was a true believer who got way in over her head by being in the right place at the right time with the right things to say. She’s not evil, she’s just Forrest Gump’s incompetent anti-abortion zealot cousin. It’s everyone who enabled the system to throw millions of dollars at her, all the while consigning thousands of poor women to crappy-at-best health care, who deserve all the scorn. That’s Greg Abbott, his appointed flunkies at HHSC like Stuart Bowen, Dan Patrick, Ken Paxton, and every Republican legislator who voted to kick out Planned Parenthood. They made this mess, and some day it will be up to the rest of us to clean it up.

Who cares about new mothers?

Not the Lege.

The new mothers contracted infections. They overdosed on drugs. Their hearts failed. They committed suicide.

The women died in different ways, but all perished within a year of giving birth. Rising rates of maternal mortality spurred Texas leaders in 2017 to reauthorize a special task force to study the deaths and figure out what to do.

But at the end of this year’s legislative session, public health advocates are frustrated that lawmakers left Austin without adopting the task force’s top recommendation: giving women access to health care for a full year after they give birth.

The Legislature agreed to spend $15 million over the next two years on postpartum depression and substance abuse treatment for some low-income women. But a far more sweeping and higher cost plan to expand Medicaid coverage for all eligible new mothers failed, despite having support from Republicans and Democrats.

“We’re disappointed state leaders basically ignored the needs of uninsured moms and uninsured low wage workers this session, by not taking action on bills to extend postpartum coverage,” said Adriana Kohler, a senior health policy associate for the Austin-based advocacy group Texans Care for Children.

[…]

The funding, however, will likely cover only some of the roughly 136,000 pregnant women on Medicaid in any given month. And pregnant women who relied on Medicaid for their diabetes medication or other prescription drugs could still lose those benefits in the transition, some public health advocates said.

Other bills filed by Republicans and Democrats to expand the state’s Medicaid coverage for new mothers from two to 12 months, post delivery failed. The change would have cost the state upwards of $75 million a year, according to a fiscal note. The legislation passed the House, but died after not receiving a public hearing in the Senate.

Rep. Garnet Coleman, D-Houston, chalked it up to politics. “Republicans don’t want to be viewed as expanding Medicaid,” he said.

Just as a reminder, Greg Abbott made a last-minute attempt to put an extra $100 million into the budget for “border security”. The budget as adopted is spending over $5 billion to buy down property taxes. The Lege passed a tax cut on yacht sales, which won’t actually cost that much money but is still a tax cut on yacht sales. My point here is that this was not a decision based on a lack of available funds. It was a failure to act because the Republican leadership had no interest in doing it, for the reason Rep. Coleman cites. It was a choice they made, one that reflected their values. Keep that in mind when you hear the usual blather about being “pro-life”.

House approves budget, and other news

Always a major milestone.

In Dennis Bonnen’s first major test as speaker of the Texas House, the chamber he oversees resoundingly passed a $251 billion budget Wednesday after a long but largely civil debate — a departure from the dramatics that have typically defined such an affair.

Though lawmakers proposed more than 300 amendments to the spending plan, Bonnen, an Angleton Republican, and his chief budget writer, state Rep. John Zerwas, R-Richmond, finished the night with their budget plan largely intact. After 11 hours of relatively cordial discussion, lawmakers agreed to withdraw the vast majority of their amendments or move them to a wish list portion of the budget, where they are highly unlikely to become law.

The budget passed unanimously on the final vote. The legislation, House Bill 1, now heads to the Senate, whose Finance Committee was set to discuss its budget plan Thursday.

“I’m proud of where we are in the bill that we are sending to the Senate,” Zerwas said at the end of the marathon debate. “Each and every one of you should be incredibly proud of the work that you’ve put in here.”

The two-year spending plan’s highlight — a $9 billion boost in state funding for the public education portion of the budget — remained unchanged. Of that, $6 billion would go to school districts, and the remaining $3 billion would pay for property tax relief, contingent on lawmakers passing a school finance reform package.

The budget plan would spend $2 billion from the state’s savings account, commonly known as the rainy day fund, which holds more than $11 billion.

“I’m not here to compare it to previous sessions,” Bonnen told reporters after the House budget vote. “But I’m here to tell you we had a great tone and tenor tonight, and I’m very proud of the business that we did.”

[…]

So while Bonnen’s first budget night as speaker was hardly free of controversy — an argument over the effectiveness of the state’s “Alternatives to Abortion” program, for example, derailed movement on amendments for nearly an hour — the occasional spats paled in comparison with those of years past. There were no discussions at the back microphone of lawmakers’ sexual histories, as happened in 2015, and no one had to physically restrain House members to prevent a fistfight over the fate of a feral hog abatement program, as happened in 2017.

Still, state Rep. Jonathan Stickland, R-Bedford, continued his long-running campaign against the feral hog program. And though the exchange ranked among the evening’s rowdiest, it was more than tame by last session’s standards.

State Rep. Drew Springer, R-Muenster, again opposed Stickland’s amendment to defund the program, which reimburses local initiatives to eradicate wild hogs. Stickland responded, “Members, although I respect the thoughtful words of Rep. Springer … let’s end this program right here, right now.”

Stickland’s amendment failed, with just four votes in favor.

See here for more on last session’s House budget debate. One should never miss an opportunity to illustrate Jonathan Stickland’s failures. The House also approved a supplementary budget for the previous biennium, to cover expenditures that were not previously appropriated, such as the traditional underestimating of Medicaid’s costs and all of the Harvey recovery funding.

Speaking of revenues:

House Republicans muscled a heavily altered version of their property tax reform bill through a committee early Thursday, notching a single Democratic vote and swiftly shooting down attempts to further modify the draft.

A top priority for state leaders, House Bill 2 would require cities, counties and other taxing units to receive voter approval before levying 2.5 percent more property tax revenue than the previous year. A vote was expected to come Wednesday morning on a new draft of the legislation, which contains changes likely to appease small and special taxing units but leave big municipal leaders staunchly opposed.

But the hearing on the new version was postponed until past midnight. The 16-hour delay gave an unusual cluster of critics time to trumpet their concerns with the measure — and then for top House leaders to respond in an informal late-night news conference.

“Sometimes when everyone’s a little bit upset with you, maybe you have a good balance — that’s probably a good sign,” said House Ways and Means Committee Chair Dustin Burrows, the author of the legislation and a Lubbock Republican. “We worked really hard; we talked to a lot of different constituencies” and a lot of members. “I think you’ll see in the committee substitute, the work product and a lot of collaboration.”

As amended, HB 2 now exempts community colleges, emergency service districts and hospital districts from abiding by the 2.5 percent election trigger. Another provision lets certain districts, including cities and counties, bank unused revenue growth, so long as they average below 2.5 percent over five years. And new “revenue enrichment” language could cushion some taxing units by letting them raise $250,000 in new property taxes a year, even if it exceeded the growth rate. The threshold, set at $250,000 for 2020, would be adjusted by the state comptroller annually, based on inflation.

[…]

Currently, voters can petition for an election if property tax revenue growth exceeds 8 percent, a rate set during a period of high inflation in the 1980s. State leaders have touted the lower chamber’s proposal and a Senate companion as an overdue correction and as a needed check on spiraling property tax bills. But critics say the reform efforts would not reduce tax bills, just slow the rate at which they grow — and, in the process, hamper local officials’ ability to provide public services for growing populations.

As you know, I oppose revenue caps, no matter how well intentioned. The reason the Lege ties itself into knots every two years in a vain attempt to limit property tax growth is that a taxing system that so heavily relies on property taxes fundamentally relies on a system that is divorced from people’s ability to afford their taxes. As I muse every two years, if only there were some system of taxation that was proportional to how much money people made in a given year, that would solve so many of these problems. Too bad no such system exists anywhere in the world.

Of course, another way to limit property tax growth for homeowners would be to ensure that everyone is paying their fair share of property taxes.

As state leaders promote their property tax reform package as needed relief for everyday Texans, some Democrats and county appraisers suggest a provision in the tax code has stacked the system in favor of corporations that can appeal their valuations with a combativeness most homeowners can’t muster.

At issue: a 1997 amendment, drafted by a prominent tax attorney, that critics say has allowed business and industry to lower their property tax burden at the expense of other taxpayers. The provision offers all Texans a way to fight their appraisals by arguing they were treated unfairly compared to other properties. But critics say large property owners have capitalized on it to drive down their costs, while residences and small businesses can’t afford to do the same.

“If you have a whole category of property that is nonresidential systematically paying less, well who do you think is paying more?” said Bexar County chief appraiser Michael Amezquita.

Amezquita is one of several officials who say their districts have been inundated by appeals and lawsuits from commercial owners trying to lower their appraisals, which determine what taxes are owed on a property. Supporters of the “equity” provision say it’s a critical tool for all property owners, and that commercial properties aren’t afforded the tax exemptions many home and agricultural land owners receive. Critics counter only well-funded property owners can afford to sue — and when they do, there’s often little an appraisal district can do to fight back.

“The deck is stacked against us,” said Amezquita, who has been sued by a J.W. Marriott resort seeking to have its taxable value reduced. A spokeswoman for the hotel declined comment.

I’ve written about this before. This issue of equity appeals was a cornerstone of Mike Collier’s campaign for Lt. Governor. We’d be having a much broader conversation about fairness and equity in taxation if he had won that race, but he didn’t and so we aren’t. Better luck next time, I guess.

Anyway. The Senate still has to approve its budget, and school finance reform remains a work in progress. There’s a decent amount of harmony now, but plenty of opportunities for tension, drama, and good old fashioned nastiness remain. Which is as it should be.

Rideshare for Medicaid?

This could make sense.

Rep. Dade Phelan

Texas would soon start relying on Uber, Lyft and other ridesharing services to shuttle Medicaid patients to and from the doctor, if a new House bill becomes law.

The state is one of several eyeing rideshare as a way to save money and ensure Medicaid patients make it to their health care appointments. Each year an estimated 3.6 million people delay or forgo care due to lack of transportation, studies have found, leaving providers with cancellations and patients with potentially more costly medical issues in the future.

“It’s about better outcomes for patients, health care providers and, at the end of the day, much better outcomes for the taxpayers,” said state Rep. Dade Phelan, R-Beaumont, who authored the bill, HB1576.

The proposal, which has wide support in the Texas House, comes roughly a year after Uber and Lyft broke into the health care market with services that let hospitals order rides for patients. With some 4.3 million low-income residents on Medicaid, most of them children, the bill could dramatically expand the business in Texas.

The state already pays several transportation firms roughly $160 million a year to arrange free rides for Medicaid patients to visit the doctor, dentist and pharmacy. But the trips must be scheduled at least two days in advance, Phelan said.

His bill would let Medicaid managed care companies order a ride for patients who can’t give advanced notice, including those who come down with a sudden illness or are discharged from the hospital early. The legislation would also let the existing transportation firms use rideshare, in addition to their own vehicles.

[…]

Under the bill, Medicaid managed care companies would take on the responsibility of ordering rideshares for patients. The Texas Association of Health Plans, which represents many of the managed care companies, didn’t return a request for comment.

Hannah Mehta, with the group Protect TX Fragile Kids, said there’s no question the Medicaid transportation system needs improvement. A 2017 report by the Legislative Budget Board found the shifting of rides to private firms increased costs and client complaints, while decreasing access.

But Mehta is worried about handing the coordination of rideshares over to Medicaid managed care companies, which a recent Dallas Morning News series found have denied patients critical care. Mehta, whose son is covered by Medicaid, also questioned which patients would qualify and how that would be determined.

“Accessibility is a great goal,” she said. “But the devil’s in the details.”

Here’s HB1576, which as you can see has a slew of co-authors. The story notes that ensuring accessible rides for people with disabilities would be necessary; having the managed care companies in charge of arranging the rides, which would include the existing transportation companies as options, should handle that. The basic idea here is to make transportation to medical services for people who need it easier to arrange, which is something Uber and Lyft are good at, and presumably also to reduce costs. This at least sounds good in theory, but we’ll see how it develops.

The Heidi Group grift

You’re not mad enough right now. Read this, that’s fix it.

Right there with them

On a Monday evening in May 2016, Carol Everett sent an email to fellow anti-abortion activists detailing “an extraordinary pro-life opportunity.” Her nonprofit, the Heidi Group, she said, had spent the past year pushing for nearly $40 million in funding to help Christian pregnancy centers “bless many poor women” across Texas.

“It is no exaggeration to say this is the greatest possibility for expansion of pro-life care for the poor ever,” she wrote.

The enthusiasm might have sounded familiar to those who knew Everett, whose decades of work in the anti-abortion movement had earned her accolades from the state’s leading conservatives. But this wasn’t an advocacy project she was describing, and these weren’t private dollars. It was an application she had just submitted to become one of the state’s leading family planning providers.

Everett had never contracted with the state and had no clinical background. Many of the pregnancy centers she cited don’t provide contraception, a core service. Yet state health officials gave her much of the money anyway, ignoring warning signs and overruling staff who recommended millions less in funding, according to a review of the contracting by the Houston Chronicle. When Everett’s clinics began failing, the state delayed for months in shifting money to higher performing clinics, instead devoting vast amounts of time to support Everett and her small, understaffed team.

Though it’s impossible to say how many more women could have been served had the resources been shifted sooner, several competing clinics burned through their funding early in the grant cycle, surpassing their targets for both spending and patients treated. Had they been sent some of the $6.75 million sitting in wait for the Heidi Group, the door could have opened for thousands more women to receive access to contraception, STD screenings and breast exams.

It goes from there, and you should read the rest. I’ve blogged about the Heidi Group before. They’ve wasted millions of your tax dollars not providing health care to women who desperately need it, all in the service of ideology. If this doesn’t make you mad, I don’t know what it’s going to take.

Texas is not going to expand Medicaid

Don’t get me wrong, Texas should have expanded Medicaid at its first opportunity. It would do so much to improve health care in the state, including and especially mental health care, which would have significant spillover effects on criminal justice. Other states have passed voter referenda mandating Medicaid expansion, but those states can do that via citizen petition. They don’t have to go through their legislature, which is a requirement here and the place that the effort will go to die.

Rep. Celia Israel

Seeing other states take Medicaid expansion to voters is what Rep. Celia Israel, D-Austin, says gave her the idea to file House Joint Resolution 40. She said she’s frustrated that Texas “has not shown the political fortitude” to expand the program and that giving the decision to voters may take political pressure off of Republicans.

Expanding Medicaid through the Affordable Care Act — also known as Obamacare — has been a nonstarter in the GOP-dominated Texas Legislature. Republicans including Gov. Greg Abbott, Lt. Gov. Dan Patrick and former Gov. Rick Perry have argued that expanding Medicaid would increase health care costs for the state — especially if the federal government ever breaks its promise to help pay for the surge of newly eligible people.

Israel’s strategy so far has included courting Republicans in districts that have lost rural hospitals. Nineteen rural hospitals have closed permanently or temporarily since 2013, according to the Texas Organization of Rural & Community Hospitals.

“I’m getting mixed responses,” Israel said of her progress. “I’m making the case that we have lost so many rural hospitals in Texas, and one of the reasons we wouldn’t have lost those rural hospitals is if we had said yes to expanding Medicaid.”

Anne Dunkelberg, associate director of the Center for Public Policy Priorities, a left-leaning policy organization, said the 2018 election cycle and polls showed that health care is a top issue for voters.

“The bottom line is even though individual members have seen desirability moving in this direction, it’s not something they’re going to fall on their sword and buck their leadership over,” Dunkelberg said.

[…]

State Rep. John Zerwas, chairman of the House Appropriations Committee, attempted an alternative to Medicaid expansion during the 2013 session. The Richmond Republican’s House Bill 3791 would have allowed Texas to receive federal money in the form of block grants to enroll individuals in a private health plan using a sliding-scale subsidy, rather than expanding Medicaid to cover them. The bill also had a “pull the plug” provision if the federal government failed to continue funding. It had some bipartisan support but never reached the House floor for a vote.

He said Medicaid expansion in general still “comes with political radioactivity” that Republicans are hesitant to deal with. Just pursuing a waiver is still “a pretty steep hill to climb.” Zerwas said he doesn’t plan on bringing his bill back and also doesn’t believe Medicaid expansion needs to be taken to voters. He acknowledged that Texas has the highest number of uninsured people in the country but says there’s not a cost-effective way to provide care for the Medicaid population.

“It’s just politics, you know, and I’ve lived through this by virtue of carrying the bill in 2013 and was portrayed as someone who just loved Obamacare and was looking to grow it in the state of Texas,” Zerwas said. “Politically and in my party especially at that time and still so … it continues to be one of those things that Republicans rail against because they see it as a very heavy cost to the state.”

But Sen. Nathan Johnson, D-Dallas, who filed Senate Joint Resolution 34, which also would create a constitutional amendment to expand Medicaid, said that “it should not take a leap of courage to put this on the ballot.” Amid Texas’ problems with the opioid epidemicmaternal mortality and access to mental health services, he said, it would be difficult for lawmakers to go back to their constituents and tell them why they refused to put Medicaid expansion on the ballot.

“It starts to become a bit of an embarrassment,” Johnson said. “I think we have the potential to be a leader in health care. … We have vast resources and tremendous amount of power and will when we decide to employ it.”

I agree with everything Rep. Israel and Sen. Johnson say. As you know, I’ve been beating the drum for Medicaid expansion in Texas since 2011. It’s just that there’s zero Republican support for it – Rep. Zerwas’ watered-down version went nowhere, and no one is coming up behind him with something else. A constitutional amendment, which is what a Joint Resolution is and the only way the Lege can send something to the voters, requires a two-thirds majority in each chamber to pass. It’s highly unlikely there’s a simple majority for this in the House, and zero chance of that in the Senate. What Israel and Johnson and others are doing is valuable and necessary and sure to be a big campaign issue again in 2020. What it’s not is legislation that will pass, not while Republicans are in charge.

The state of the state 2019

Sometimes it’s what you don’t say that gets noticed.

Gov. Greg Abbott, in his biennial State of the State address Tuesday, stayed on message about schools and taxes, continuing state leaders’ so far unified focus on bread-and-butter policy reforms in a forum where he has in the past served up red meat.

Speaking in the Texas House to both chambers of the Legislature, Abbott named as emergency items the consensus priorities of school finance reform, teacher pay raises and property tax relief, the issues he and the state’s other top two Republican leaders have trumpeted almost single-mindedly in the months since the midterm elections. In doing so, he carefully avoided controversial social issues like the ones that headlined last session’s speech.

Also topping the governor’s priority list: school safety, disaster response and mental health programs. Abbott’s designation of those priorities allows lawmakers to take up such measures sooner, lifting the usual constitutional limitation that prevents the Legislature from passing bills within the first 60 days of the session.

“Our mission begins with our students,” Abbott said as he began to lay out his legislative priorities. To improve lackluster student outcomes — only 40 percent of third-graders are reading at grade level by the end of their third-grade year, he said, and less than 40 percent of students who take the ACT or SAT are prepared for college — “we must target education funding.”

[…]

Unlike in his first two State of the State addresses, Abbott did not deem ethics reform an emergency item. He tagged that issue with top priority status in 2015 and 2017, but didn’t mention it this year. Nor did he raise any proposals related to abortion. And there was hardly any other mention of health care, an expense that takes up nearly as large a share of the state’s budget as does education.

House and Senate Democrats called it “disappointing” that the governor didn’t propose expanding access to pre-K or lowering the costs of teachers’ health care.

And state Rep. Toni Rose, D-Dallas, who serves as the caucus’ second vice-chair, said that Abbott, for all his bragging on the state of Texas during his speech, failed to mention the state’s high uninsured rate for health care.

“Texas needs to expand Medicaid,” Rose said during the conference, “and we need to expand it today.”

Still, Democrats were optimistic about some of the notable absences. Two years ago, Abbott’s address was headlined by his call for an anti-“sanctuary cities” bill that Democrats would staunchly oppose. This year, the governor mostly stayed away from hot-button social issues.

“It certainly was a different speech than we heard two years ago,” state Rep. Chris Turner, the Democrat who heads his party’s caucus in the House, said after the speech. “It seems as though election results have consequences.”

Another conspicuous absence from the speech was the voter rolls debacle that has dogged state leaders in recent weeks. Last month, Texas Secretary of State David Whitley flagged for citizenship review nearly 100,000 Texas voters; in the weeks since, the list has been revealed to be deeply flawed, and civil rights groups have sued the state three times.

There’s still plenty of reason to be wary of the property tax proposals Abbott has made, and one reason why there are fewer red meat items on his agenda is that a lot of them – voter ID, “sanctuary cities”, campus carry – have already been passed. I will agree that this was much more temperate than the address from two years ago – there’s no way Abbott would admit this, but I think Rep. Turner is right in his assessment – and there are issues on Abbott’s list that will get broad bipartisan support. Let’s be glad for the small victories, and work to make them bigger. Ross Ramsey, Texas Monthly, and the Observer have more.

Fifth Circuit does it again

Another terrible ruling by a terrible judge on a terrible court.

Right there with them

A federal appeals court has lifted a lower court order that blocked Texas from booting Planned Parenthood out of Medicaid, potentially imperiling the health care provider’s participation in the federal-state health insurance program.

A three-judge panel on the U.S. 5th Circuit Court of Appeals ruled Thursday that Sam Sparks, the federal district judge who preserved Planned Parenthood’s status in the program in February 2017, had used the wrong standard in his ruling. The appeals court sent the case back to him for further consideration.

The case stems from a long-running flap over a misleading video released in late 2015 by the anti-abortion group Center for Medical Progress, which suggested that abortion providers at Planned Parenthood sold fetal tissue for profit. The sting video included edited clips of Planned Parenthood officials discussing the use of fetal tissue for research. A string of investigations that followed the video’s release were unable to confirm its claims, but it energized a crusade against the health care provider and sparked outrage from the state’s Republican leadership.

[…]

In February 2017, a federal judge in Austin ruled that Texas clinics affiliated with Planned Parenthood could continue to care for patients under the state’s Medicaid program. The state’s arguments, Sparks wrote in a 42-page ruling, 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.”

But a panel on the conservative-leaning appeals court said Thursday that Sparks had used the wrong standard in his ruling, taking the arguments as a novel, or “de novo,” review and by “giving no deference” to the findings of the state agency that opted to expel Planned Parenthood in the first place. The Office of Inspector General, an arm of the state’s health and human services agency charged with rooting out fraud and abuse, claimed the videos “showed “that Planned Parenthood violated state and federal law.”

“OIG is the agency that the state of Texas has empowered to investigate and penalize Medicaid program violations. The agency is in the business of saying when providers are qualified and when they are not,” Judge Edith Jones wrote. “It is [odd] to claim that federal judges, who have no experience in the regulations and ethics applicable to Medicaid or medical practice, much less in regard to harvesting fetal organs for research, should claim superior expertise.”

See here for the background. Of course Edith Jones would insist that we have to take seriously the lying video of lying liars when it suits her agenda. She’s as predictable as the sunrise. Now we go back to district court and try again to knock down the bullshit. What an utter disgrace.

Planning to fail

Big surprise.

Right there with them

Anti-abortion activist Carol Everett had no experience running a family planning program when the state of Texas awarded her millions in taxpayer funds to help rebuild a network of low-income women’s health providers. The state knew that. So it should have been no surprise when Everett’s organization, the Heidi Group, failed to provide services to thousands of women after the Legislature slashed family planning funds and kicked out Planned Parenthood.

Last year, officials with the Texas Health and Human Services Commission (HHSC) acknowledged that the Heidi Group hadn’t met its contractual obligations, and the agency clawed back some of the money. But, until now, HHSC has refused to reveal how many patients Everett served, or just how much was spent on their care. Data obtained by the Observer shows that in fiscal year 2017, the Heidi Group served just over 3,300 clients, less than 5 percent of the nearly 70,000 Everett had pledged to cover. Nonetheless, the state renewed the group’s multimillion-dollar contracts for a third year.

“It’s outrageous. In what other area of state government would this kind of incompetence be rewarded over and over and over again?” said Dan Quinn, communications director at Texas Freedom Network, which called for an investigation into the Heidi Group contracts. “It’s a betrayal of taxpayers and especially of women who need these services and aren’t getting them.”

[…]

One of Heidi Group’s contracts is for the Healthy Texas Women program, which provides family planning services and preventive screenings for poor Texans. For fiscal year 2017, Heidi was initially awarded about $1.6 million to build a network of providers — a mix of clinics, individual doctors and crisis pregnancy centers — to serve nearly 51,000 patients enrolled in Healthy Texas Women. Despite spending more than $1.3 million, Heidi Group only managed to serve 2,300 clients, according to the new data.

Through a second contract, HHSC awarded the Heidi Group $5.1 million to serve nearly 18,000 clients through the Family Planning Program, the state’s other reproductive health program. Last year, the health agency conceded that the Heidi Group was falling short and cut back its contract by just over $4 million, reducing Heidi’s proposed client totals to about 3,500 and reallocating the remaining funds to other contractors. The Heidi Group missed that mark too, spending about $605,000 to serve just over 1,000 clients.

The Heidi Group was the only contractor in either program to have funds revoked in 2017.

See here and here for the background. We need to be clear that the Heidi Group’s incompetence, in conjunction with its anti-choice pedigree, is a feature and not a bug. As such, from the perspective of our state leadership, they’re doing a heck of a job. The Trib has more.

Where best to attack Culberson?

Flooding is an obvious issue, but it’s hardly the only one.

Lizzie Fletcher

After Hurricane Harvey flooded much of Houston – including the hotly contested Seventh Congressional District – Republican incumbent John Culberson used his position on the House Appropriations Committee to stamp his name on billions of dollars in disaster recovery funds.

By February, he could claim a leading hand in securing $141 billion in congressional appropriations to help the victims of the 2017 hurricanes in Texas, Florida and Puerto Rico.

But as the nine-term congressman faces an unusually tough reelection against Democratic challenger Lizzie Pannill Fletcher, the city’s troubled history of flooding and the federal government’s long backlog of flood control projects has come under sharp political attack.

Fletcher, a Houston attorney making her first run for office, argues that Houstonians are paying the price for Culberson’s small government philosophy and a Republican-led Congress that she says has been slow to fund critical improvements to the Addicks and Barker dams, both aging structures that were deemed to be at “high risk” of failure as early as 2004.

She also has homed in on key votes cast by Culberson, who she labels a climate change skeptic, saying that they undermined flood prevention efforts in Texas and across the country.

“We can’t just look at the last nine months,” she said in an interview. “We need to look at the last nine terms.”

It’s a long story and I encourage you to read the whole thing. Culberson has done some things and was the only Texas Republican to avoid making himself a sniveling hypocrite when he supported federal relief funds for New York and New Jersey following Superstorm Sandy, but the fact that the rest of his caucus opposed such funds, and the fact that his party has so greatly prioritized cutting taxes and slashing spending over investing in infrastructure and solving problems just highlights why he doesn’t deserve a pass for a handful of decent votes. He’s part of the problem regardless, and the only way forward is a change of leadership in Congress. He can push the occasional bill and make the odd budget appropriation, but as long as he’s a vote for a Republican Speaker and a body in the count for a Republican House majority, nothing’s going to get done.

All this said, health care was the issue everyone was talking about earlier on, when the House – including John Culberson – was trying to kill the Affordable Care Act. That battle has shifted from Congress to the courthouse again, and that should bring this issue, on which Democrats enjoy an electoral advantage, to the fore. It’s never going to be a bad idea to remind people that Culberson has worked tirelessly to take their health care away. And since we’re only ever allowed to talk about mental illness when there’s another mass shooting, it’s also always a good time to remind people that the single biggest thing Texas can do to boost mental health care is to accept Medicaid expansion, which again John Culberson opposes with every fiber of his being. Flooding is a great and vital issue, with lots to talk about, but it’s not the only one.

Health care needs to be a twofer

Lt. Governor candidate Mike Collier is on the right track here, but he needs to keep going.

Mike Collier

Lieutenant governor hopeful Mike Collier announced his health care reform plan Tuesday, which aims to reduce costs and increase access to health care in Texas.

“Achieving these goals will not be easy,” Collier said in a statement. “But it’s time to get cracking. Doing nothing — the only skill our current governor and lieutenant governor seem to possess — is no longer acceptable.”

Colliers faces incumbent GOP Lt. Gov. Dan Patrick in November’s general election. Patrick has been a fierce opponent of the Affordable Care Act and any move to expand Medicaid, the health care program for the poor and disabled, to include the working poor.

Collier said Texas’ decision not to pay for health care costs for Texans who cannot afford health insurance is “unbelievably stupid,” and said that using federal dollars to close the coverage gap will bring Texas an estimated $9 billion per year in federal dollars and create as many as 250,000 jobs.

Collier said his plan also includes deploying state money to encourage Texans to buy insurance, which he said will drive down the cost of health care.

Additionally, Collier emphasized price transparency and a “Patient Financial Bill of Rights,” which would require insurance companies to provide health care prices in advance, show the availability of less expensive drugs and procedures, and itemize bills “in plain language,” among other requirements.

This is all good, but it’s missing an opportunity. You’ve heard me say this before, but it bears repeating – over and over and over again – that if we’re really going to talk about improving mental health care, which is all we ever talk about after another mass shooting, then we have to talk about expanding Medicaid, because it’s by far the biggest and best way to pay for mental health care for the people who need it. If we’re not talking about expanding Medicaid, then we’re just flapping our lips when we bring up the “mental illness” shibboleth. We need to keep saying this until it starts to sink in. You took a good first step, Mike Collier. Now please take the next steps.

Senate considers mostly symbolic ideas on school safety

Once again, see if you can tell what’s missing from this discussion.

Nearly three weeks after a shooter killed 10 people at a high school southeast of Houston, lawmakers gathered at the Texas Capitol on Monday to discuss new school safety measures that might prevent another tragedy — and stopped short of rallying behind ideas like adding metal detectors to schools or updating school architecture.

“It’s going to be very difficult to stop every incident,” said state Sen. Larry Taylor, R-Friendswood, discussing the variety of situations in which students could be harmed.

Monday’s meeting came after Lt. Gov. Dan Patrick, a Republican, created the Senate Select Committee on Violence in Schools & School Security to study ways to limit violence in Texas public schools before they reopen in August. Prior to those orders, Abbott had released a 40-page school safety plan with dozens of proposals of his own in response to the shooting at Santa Fe High School.

Lawmakers studied many of Abbott’s ideas Monday, including ensuring that teachers are trained through Mental Health First Aid, a day-long course that trains individuals on how to spot and respond to mental illness and substance abuse. State Sen. Charles Schwertner, R-Georgetown, said around 25,000 school staff members in Texas have already been trained through the program.

[…]

In addition to metal detectors, lawmakers discussed designing schools to prevent threats, like by keeping administrative offices at the front of schools. Legislators also briefly discussed monitoring cameras, limiting school access points and improving locks.

It’s better than blaming everything on doors and video games, but not much more productive. I will take all the usual mutterings about mental health seriously when there’s a real proposal on the table to expand Medicaid, since expanding Medicaid will be by far the single most effective thing we can do to actually help many of the people who have mental health issues in Texas. As for the rest of it, I’m sure they could have some marginal benefit, but it all has the feel to me of talking about installing new windshield wipers when there’s smoke coming from the car engine and you have two flat tires. When are we going to address the real problems?

It’s hard being pregnant in Harris County

We need to figure this out.

Life-threatening, pregnancy-related complications — the iceberg beneath the surface of the U.S. maternal health crisis — are on the rise in Harris County, according to a new report.

The report not only confirmed the Harris County rate is worse than that of the state and nation, it found that it increased more than 50 percent between 2008 and 2015. Texas’ rate of life-threatening, pregnancy-related complications went up 15 percent in the same time period.

“In subtle and unintentional ways, women’s health in Harris County has been subjugated to the health of babies so profoundly that the health of women of childbearing age is often not prioritized,” says the report, a project of the Houston Endowment.

Dr. Lisa Hollier, a Houston obstetrician-gynecologist and a co-chair of the task force that produced the report, said Harris County’s high rates “point to the need for greater intervention to promote safety around the time of delivery. Such complications are 50 times more common than pregnancy-related deaths, but don’t get near the amount of attention.”

Hollier and Dr. Cecilia Cazaban, the report’s principal investigator, said it is unclear why Harris County’s rate is increasing at such a high rate. They said that analysis is next on tap for the task force.

[…]

The new report focuses on severe maternal morbidity, the term for conditions that require such treatment as a respirator or blood transfusions or hysterectomy during delivery or in the immediate hours thereafter. It can lead to maternal death, but even when the patient survives, it can cause damage, such as kidney or heart failure, sometimes requiring lifelong treatment. It also is costly to the patient and health care system.

Harris County’s rate of severe maternal morbidity in 2015 was 2.4 percent, meaning there were 238 cases for every 10,000 deliveries. The 2015 rate was 1.97 in Texas and 1.46 in the United States.

See here for some background. The task force website is here, though I don’t think this report is on there. I hope there’s no need for me to say anything more than we really need to understand this problem so we can solve it.

Texas’ maternal mortality rate not as bad as previously reported

Good news, if a bit puzzling.

Several of the state’s top health experts released a report in the medical journal Obstetrics & Gynecology on Monday showing that by using the new method, the number of women who died dropped from 147 to 56.

The study uses an enhanced method of counting maternal deaths that involves cross-referencing birth certificates, death certificates, hospital discharge data and medical records to confirm that a woman who died was pregnant before she died. The state’s current method of calculating maternal deaths includes using specific medical codes and requiring officials to check a box on death certificates indicating whether a woman was pregnant before she died.

The study said the state’s 2012 maternal death numbers inflated the number of women 35 and older who were classified as a maternal death and included reporting errors in which women who had not been pregnant were reported as maternal deaths. The researchers said they also found 2012 deaths that were not included in the state’s original maternal death numbers.

The authors noted that other states have used the same methodology to calculate maternal deaths. They said they chose 2012 for the new analysis because it was the year when maternal deaths peaked in Texas.

The study’s authors said they plan to use the new method to confirm maternal deaths and calculate maternal mortality rates for additional years.

See here for the background. The story notes that even with the revision, which the authors of the new study attribute to “data error” in the initial report, the mortality rate for black women was still double what it was for white women. There are still other serious concerns as well, as expressed by Lisa Falkenberg:

“I would hate to see us lose the momentum that we’ve gained,” said Dr. Lisa Hollier, an obstetrician and gynecologist at Texas Children’s Hospital.

“We still have women dying of preventable causes,” she said. “We still have a two-fold, a doubling, in the risk of death for African-American women. Those things need to change. I don’t think we should accept where we are.”

Hollier, who co-authored this week’s report and also chairs the Texas Maternal Mortality and Morbidity Task Force, points out that deaths aren’t the only measure of the problem. For every maternal death, Hollier says there are 50 women who experience severe complications that can lead to hysterectomies, breathing problems requiring ventilator support and kidney failure, to name a few.

“If there are 50 women who die in a particular year, there are 2,500 women who had severe complications,” Hollier said. “There are so many more women who are affected than just that tiny tip of the iceberg which is mortality.”

All this happens in a state where as Falkenberg reminds us our Republican leadership has refused to expand Medicaid – something like half of all births in Texas are paid for by Medicaid – and have cut back on access to healthcare for women by gutting Planned Parenthood. The definition of “pro-life” in this state is so narrow you could slide it under a lobbyists’ door. So go ahead and be happy that things aren’t as bad as we feared, but don’t be satisfied with it.

UPDATE: Sophie Novack in the Observer makes a lot of really good points about this revised study. Go read what she says.

From the “Grab that cash with both hands and make a stash” files

Same song, second verse.

If budget writers don’t come up with money to address a state employee pension shortfall and mounting needs for public schools, health care and transportation, credit agencies are likely to downgrade Texas’ AAA rating in the near future.

That was the warning Comptroller Glenn Hegar gave lawmakers at a Tuesday hearing of the Senate Finance Committee in Austin. Though the Texas economy is growing at a healthy pace, Hegar said, the state’s budget is riddled with enough unfunded liabilities to worry credit rating agencies such as Moody’s and Standard and Poor’s.

“We’re not at a crisis,” Hegar said, but “we’re going in the wrong direction.”

A downgrading of Texas’ credit rating would make it more expensive for the state to borrow money — and perhaps damage state leaders’ credibility when advertising Texas as “open for business.”

“I want to avoid that, because I think that’s a black eye on the state of Texas,” Hegar said.

Rebounding oil prices, natural growth and migration to Texas have led to an increase in tax collections, according to the comptroller’s office. But much of that new revenue is already dedicated to historically underfunded programs such as the state highway fund, meaning that Texas lawmakers likely won’t have more money at their disposal in 2019 when crafting the next two-year budget.

At the same time, lawmakers will need to plug holes in the pension system for state employees, and they’ll face pressure to make solvent a health insurance program for retired teachers. On top of that, big bills coming due for Medicaid, the federal-state health insurance program for the poor and disabled that is perennially underfunded by the Legislature, could put the state budget $2.5 billion in the red before lawmakers even convene in 2019. (The state’s current two-year budget is about $217 billion.)

In addition, state leaders will have to tackle the bills from Hurricane Harvey recovery.

I’ll just say again here what I said in January: The vast majority of these issues are the result of deliberate choices made by our Governor, our Lieutenant Governor, and our Republican-controlled Legislature. Instead of seriously addressing the needs of the state, current and future, our Republican leaders have been obsessed with trivia, from bathrooms to plastic bags to trees. We have gotten by and done all right because times have been good, but we are in a far more precarious position for when the economy goes south than we should be. In the meantime, we are squandering this opportunity to ensure a better future for all of us by making such cavalier and ill-advised fiscal choices. Every Democratic candidate running for state office needs to internalize and articulate that message going forward.

From the “Nothin’ but good times ahead” department

Given the good economic conditions in Texas right now, you’d think the budget outlook would be better than it is.

The Texas economy is growing healthily, but that doesn’t mean state budget writers will have more money at their disposal next year, state officials said Tuesday.

In fact, though unemployment is low and tax revenue is on the rise, big bills coming due for the state’s highways and health care programs are giving Texas lawmakers reason for concern.

“I would like to offer a few words of caution for reading too much into the positive recent economic numbers,” Texas Comptroller Glenn Hegar told lawmakers at a Senate Finance Committee hearing.

As they often do, state budget writers last year underfunded Medicaid, the federal-state insurance program for the poor and disabled, which, alongside public education, makes up one of the largest shares of the state’s $217 billion two-year budget.

Then, during a special session called by Gov. Greg Abbott over the summer, state lawmakers shifted another $500 million away from the Texas Health and Human Services Commission to pay for public education programs.

As a result, lawmakers could face a $2.5 billion Medicaid bill shortly after they reconvene in Austin in 2019. Then there are the additional drains on Texas coffers from Hurricane Harvey recovery efforts, Hegar said.

That’s bad news for lawmakers given the comptroller’s prediction that the state will only have a $94 million “beginning balance” when lawmakers convene in 2019. By comparison, lawmakers had an $880 million beginning balance in 2017, which was ultimately a tight year for the state budget. Two years before that, lawmakers enjoyed a $7.3 billion beginning balance.

[…]

Another source of heartburn for budget writers is the ravenous state highway fund. In 2015, amid complaints of a highway system in disrepair, Texans voted to amend the state Constitution to require that up to $2.5 billion in sales tax revenue be dedicated to the highway fund.

That means that even as Texas collects more money from sales taxes — Hegar testified that sales tax revenue grew by an average of 10.3 percent over the last three months — the rest of the state budget will not benefit from that revenue since it is earmarked for the highway fund.

That was also an issue for budget writers in 2017. Last year, in order to free up some of that money for other purposes, Senate lawmakers pushed for an accounting trick that delayed a payment to the state highway fund into the next two-year budget cycle. That freed up about $1.6 billion for lawmakers last year, but it means there will be another bill to pay in 2019.

“In short, despite a strong economy and positive outlook for revenue growth in this biennium, it seems likely the next budget will be much like the one crafted in 2017, having to contend with restricted revenue relative to the spending trends of the state,” Hegar said.

Just a reminder: Underfunding Medicaid was a choice. Shifting money away from HHSC was a choice. The amendment to require all that highway spending was ratified by the voters, but it was there to be ratified because the Lege chose to put it there. Deferring that payment to the highway fund was a choice. And though the story doesn’t include it in its litany, spending nearly a billion dollars on boondoggle “border security” stunts was a choice, too.

We’ll probably be fine in the 2019 session, though the potential for shenanigans is always high. But remember, winter is coming, because it always does. When it does, we’re going to have a mess to clean up, one that was caused by the Republicans in charge of our state, one that could have been mitigated in many ways. I hope we’re ready for it.

(Note: This is the inspiration for the post title.)

State of the County 2017: Ed Emmett versus state leadership

That sound you heard was a fight breaking out.

Judge Ed Emmett

Harris County Judge Ed Emmett on Tuesday used his annual State of the County speech to blast state leaders who he said attack local governments and seek to cut needed taxes but offer no real solutions to the myriad problems Texas’ large urban counties face.

Before a crowd of hundreds at NRG Center, Emmett called on state officials to invest roughly $500 million in a third reservoir and dam to boost area flood control efforts, fund a beleaguered indigent health care system, and revamp “broken” tax policies that force the county to rely on property taxes to serve an unincorporated area that, on its own, would be the fifth-largest city in the country.

In addition to helping with the county’s flood control efforts, Emmett called on the state to contribute more for mental health care and transportation improvements, citing the need for an Interstate 69 bypass on the east side of the county and renewed emphasis on railroads and technology to move freight from area ports.

He also reiterated his call for state leaders to accept increased Medicaid funding from Washington.

“The next time a state official makes a big deal about a fraction of a cent cut in the property tax rate, ask them why they won’t help Harris County property taxpayers fund indigent health care,” the judge said. “State leaders who are eager to seek for disaster relief should also be willing to accept federal dollars to provide health care for poor people. That would be real property tax relief.”

The state, he said, should treat the county more like a city, which by law can levy a sales tax and pass ordinances. The county is an arm of state government and relies on property taxes for most of its revenue.

“The whole point of today’s speech was to say ‘enough is enough,'” Emmett said afterward. “We need to be able to provide the services and the government that people expect in an unincorporated area.”

[…]

Emmett criticized the bills that would have forced the county to get voter approval on taxes and spending.

“Such a populist approach might sound reasonable, but the late British Prime Minister Margaret Thatcher, who nobody ever accused of being a liberal, described direct referenda as ‘a device for dictators and demagogues'” he said.

He also lit into lawmakers’ attempts to limit property tax collections during the last legislative session, saying leaders “attacked counties and cities and other local governments, all the while offering no real solutions.”

“County government relies almost completely on property tax revenue, but the property tax is widely hated, and wholly inadequate as a means of financing the unique urban government that we have. Unfortunately, narrow-minded politics has pushed unfunded mandates from the state onto county government,” Emmett said.

“It is just pure ugly politics. And, by the way, the portion of county taxes paid by business is, I don’t need to tell the business community in this room, growing. We are reaching the point where tax policies are a drag on economic development.”

You can read the whole speech here. Most of the criticisms Emmett made about state leadership and recent political actions are in the story, but the whole thing is worth a read. Oh, and he was introduced by outgoing House Speaker Joe Straus, which was a further provocation. Like the useless demagogues they are, Dan Patrick and Paul Bettencourt responded petulantly in the story. This is another skirmish in the culture wars of the Republican Party, and Republicans who are in the Ed Emmett/Joe Straus camp – including Emmett himself – are going to have to decide next year if they really want the likes of Greg Abbott and Dan Patrick dictating to them. A vote for the status quo is a vote for four more years of the things that Emmett was railing against in his speech.

2017 results: National

Here’s a pretty good indicator of what kind of day it was yesterday for Democrats:

Big win in the Virginia Governor’s race (and the other VA statewide races), despite a couple metric tons of pearls being clutched going into Tuesday. A minimum of 14 seats picked up in the VA House of Delegates, moving that chamber from 66-34 GOP to no more than 52-48, with chances for further gains. Oh, and the single best election result of the day:

Democrat Danica Roem will become the first openly transgender person to be elected and serve as a state legislator, after ousting one of the country’s most anti-LGBT lawmakers in a closely watched Virginia House of Delegates race Tuesday. Her opponent, GOP Delegate Bob Marshall, has served in the state legislature for 26 years. He’s known for writing Virginia’s constitutional amendment banning gay marriage. This year he introduced a “bathroom bill”—intended to prohibit transgender individuals from using the restroom matching their gender identity; his own party killed that proposal in committee.

Roem isn’t the first transgender candidate to win a legislative race, but she will be the first to actually take office. Her campaign focused on issues like fixing the “miserable” traffic on local highways, increasing teacher pay, and bringing jobs to the region. When I asked her last week about the historic nature of the race, Roem said that the truly historic development was that Route 28 will finally be fixed.

“Tonight voters chose a smart, solutions-oriented trans leader over a divisive anti-LGBTQ demagogue—sending a powerful message to anti-trans legislators all across the nation,” Aisha C. Moodie-Mills, President & CEO of the Victory Fund, an organization dedicated to electing LGBT lawmakers that supported Roem’s campaign, said in a statement. “Danica defeated ‘Bigot Bob’ Marshall not because she is transgender, but because she presented a positive vision for her constituents that will improve their lives.”

Virginia isn’t Texas, and that was a district that Hillary Clinton carried in 2016, but I have to think that a few anti-trans Republicans, maybe even here in this state, will take a look at that result and have a second thought or two. We need a whole lot more people to lose elections over being anti-LGBT.

Meanwhile, New Jersey elected a Democratic Governor and made gains in that state’s legislature (both chambers of which Dems already controlled) as well. The state of Maine voted to expand Medicaid over the strenuous objections of their troglodyte governor. And there’s this:

Pushback against Donald Trump helped lift Democrats to governorships in the two highest-profile U.S. elections since the 2016 presidential contest. In Virginia, voters by a 2-1 margin said they were casting their ballot to show opposition to Trump rather than support for him. In New Jersey the margin was nearly 3-1. And Trump’s weak approval rating among voters in Virginia, 40 percent, was weaker still in New Jersey, a dismal 34 percent.

Relatedly, a surge in turnout by politically liberal voters boosted Virginia Lt. Gov. Ralph Northam, as did a broad advantage on health care, which voters by a wide margin identified as the top issue in the vote.

So, maybe being against Trump can be a winner? Just a thought. Yes, of course, you have to stand for something, and the Democratic brand needs some work on that. But Dems are really mad about what happened last year, and that was clearly enough to help push a bunch of them to the polls. I can’t wait to see all the hot takes on this one.

The “death by a thousand cuts” strategy

How To Kill A Health Insurance Market, Non-Legislative Division:

It’s constitutional – deal with it

The move by the White House to quietly end the contracts of two companies key to assisting people enrolling for insurance under the Affordable Care Act caught Houston health advocates off guard – but not by surprise.

Given the temperature in Washington these days and efforts by Congress and President Donald Trump’s administration to let the law fail, they said it was just the latest in a string of actions to sabotage the law known as Obamacare.

“It’s clearly by design,” said Elena Marks, president and CEO of Episcopal Health Foundation and proponent of the ACA and its impact on the uninsured and health access for Texans.

Last week, contracts for Cognosante LLC and CSRA Inc., which helped in signup efforts for the past four enrollment periods in 18 cities, including Houston, were not renewed for a final option year, the Associated Press reported.

[…]

Tiffany Hogue, policy director for Texas Organizing Project, an advocacy group for low- and moderate-income Texans, said she had not heard about the contract cancellations but felt, “in the scheme of things it’s not really a surprise.”

“The intent is to let the law die,” she said.

She said the administration from its first day has seemed determined to undercut the law. Hours after inauguration, the new president signed an executive order directing federal agencies to loosen any regulations surrounding the law that were considered “burdensome.”

Days later, as the 2017 enrollment period was coming to a close, the new U.S. Department of Health and Human Services withdrew funding for the final advertising push traditionally aimed to lure a surge of last-minute enrollees.

Additionally, the 2018 enrollment period is being shortened, cut in half to run from Nov. 1 to Dec. 15 instead of until Jan. 31.

The idea is to push enrollment down so that when it does go down you can point at it and say “look, see, it’s in a death spiral” and then take more obvious action to finish the job. Which may not be necessary now, but it’s Plan B as needed. And all those people who will be sicker and poorer as a result? Just a bit of collateral damage. I’m sure they’ll understand.

Trumpcare would be a hospital killer

This is hardly a new problem, but it’s yet another aspect of Trumpcare that gets too little attention.

Texas hospitals stand to lose billions under the Republican-backed health plan, as federal Medicaid dollars shrink, leading to a rise in uncompensated care, according to a new analysis by the Commonwealth Fund, a national health policy foundation.

The study looked only at the U.S. House plan passed last month. It has not yet examined the impact of the U.S. Senate’s version unveiled late last week, which experts have predicted will bring even deeper cuts to Medicaid.

In Texas, uncompensated costs in the state’s 304 acute care hospitals could increase by 7 percent, rising to $38.4 billion over the next decade, the study found.

That compares with an estimated $35.8 billion over the next decade under the current Affordable Care Act.

At issue is a spike in the number of the nation’s uninsured whose care is often absorbed by hospitals. As many as 23 million Americans could become uninsured over the next decade under the House bill because of cuts to Medicaid, and the recalculation of insurance plans and how people afford them, the Congressional Budget Office estimated late last month.

[…]

Texas already leads the nation in the number of uninsured and hospital executives have cautioned that their institutions would be hard pressed to take a bigger hit should the uninsured rate go higher.

“If people think Harris Health can absorb this, that is a miscalculation,” said George Masi, president and CEO of Harris Health System, in a January interview with the Chronicle.

This is basically what the world was like before the Affordable Care Act. People who had no insurance would use hospital emergency rooms for care when they really needed it, which is inefficient and dangerous and super expensive and many other negative things, all of which get picked up by local taxpayers. There are so many things that are wrong with and bad about the GOP’s “health care” plan that it’s hard to focus on any one thing and even harder to prioritize, but this one is really big. And it will hurt rural areas at least as much as urban areas. Not that the Republicans who represent rural areas care, and it’s not clear that the voters who would be affected have figured it out, or if they have if they’re capable of getting past their faith in the Charlatan in Chief. But the facts are stubborn things. The Rivard Report has more.

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.

House passes its budget

Mostly shenanigan-free, with a nice little side order of shade for a few people who deserve it.

After 15 and a half hours of debate on hundreds of amendments to the Texas House budget, lawmakers in the lower chamber passed the two-year, $218 billion document, with 131 votes in favor and 16 votes against.

The House vote included using $2.5 billion from the state’s savings account, colloquially known as the Rainy Day Fund. State Rep. John Zerwas, R-Richmond, thanked lawmakers for exhibiting “true leadership” with their willingness to tap the fund, “instead of electing to use an unconstitutional transfer from the transportation funding.”

That was a jab at the Senate, which last week approved its version of the two-year budget using a $2.5 billion accounting trick to free up funds dedicated to highway spending. The House must now work with the Senate, which is under the leadership of Lt. Gov. Dan Patrick, who vehemently opposes using the Rainy Day Fund, to reconcile their budget differences.

House lawmakers, debating the budget late into Thursday night, took several jabs at Patrick and other statewide elected officials throughout the evening.

Included in the fray were Gov. Greg Abbott, who saw one of his prized economic development programs defunded; Patrick, who heard a resounding “no” when his favored proposal to subsidize private school tuition with public funds was put to a vote; and Attorney General Ken Paxton, who lost more than $20 million from his agency’s budget for lawsuits.

On the winning side of the House budget debate were child welfare advocates, who saw funding for foster care and Child Protective Services tentatively boosted; social conservatives, who scored $20 million for the Alternatives to Abortion program; and the lieutenants of House Speaker Joe Straus’ leadership team who, in a display of unity, easily brushed aside most challenges from far-right Republicans.

Statewide GOP leaders took some of the heftiest blows in the House chamber. Lawmakers there voted to strip $43 million from the governor’s Texas Enterprise Fund, the “deal-closing” fund the state uses to lure businesses from elsewhere, and divide it into two equal pots: one for Child Protective Services and foster care funding, the other for a program that pays for disabled children’s physical, occupational and speech therapy services. Both are hot-button issues that have dominated the House’s budget negotiations during this legislative session.

[…]

Private school subsidies, a pet issue of Patrick and his Senate, also suffered a perhaps fatal wound on Thursday. House lawmakers voted 103-44 to prevent state money from being spent to subsidize private school tuition in the form of vouchers, education savings accounts or tuition scholarships. The proposal’s author, state Rep. Abel Herrero, D-Robstown, said it was “in support of our public schools and our neighborhood schools.”

[…]

Paxton’s attorney general’s office also saw funding gutted by House lawmakers who opted to instead fund programs that serve vulnerable children. Foster care funding would receive $21.5 million that was previously intended to pay for Paxton’s legal services budget under a proposal by state Rep. Ina Minjarez, D-San Antonio, that passed 82 to 61.

See here for more on the Enterprise Fund de-funding, which made me smile. Despite promises of shenanigans and roughly a gazillion amendments filed, there was more good done to the budget than bad. Which is not to say it’s a good budget, but it’s far from the worst we’ve ever seen. Take your positives where you can.

Especially when they involve Dan Patrick getting pwned.

In late March, lobbying group Texans for Education Opportunity used an online campaign to generate thousands of letters to 29 state representatives lobbying them to back education savings accounts, one of the subsidy programs in SB 3. Though the group claimed the letters were credible, the letters stirred up suspicion after no representative could find a constituent who remembered adding their name to that correspondence.

Of the 29 representatives targeted in the campaign, 26 voted Thursday to block money from funding “private school choice” programs.

RG Ratcliffe called it a “mugging”. As former Houston Rockets radio announcer Gene Peterson used to say, how sweet it is. Also, too, going back to the first story, there’s this:

Stickland had filed an amendment defund a state program for the abatement of feral hogs, which he’s become known for championing at the Legislature each session. Stickland railed predictably against the program, calling it “ridiculous” and a waste of money.

“It has not worked, and it never will work,” Stickland said, his voice rising.

That apparently offended rural lawmakers, notably state Rep. Drew Springer, R-Muenster. In response, Springer attached an amendment to Stickland’s proposal that would cut the same amount of funding for the Texas Department of Transportation, but only for roads and highways in Stickland’s hometown of Bedford.

Stickland took to the back microphone to cry foul.

“Someone else has chosen to make a mockery of this system and play gotcha politics,” he said before being interrupted. Laughter had erupted in the gallery.

“It’s funny until it happens to you,” he continued.

Springer and Stickland then confronted each other on the middle of the House floor and had to be separated by colleagues. Springer’s amendment ultimately passed, 99 to 26, forcing Stickland to withdraw his own proposal to which it had been attached.

What is best in life is to crush your enemies, see them driven before you, and hear the lamentations of Jonathan Stickland. And Briscoe Cain, too, the Chester to Stickland’s Spike, except without the victorious denouement for Chester. Look, just because the House passed a budget doesn’t mean this is the budget we’ll get. The Senate passed a budget, too, and there are lots of differences to be worked out between the two. The final version will be different, and some of the things we are cheering now may be undone in that. But that’s no reason not to cheer for the things that deserve it now. The Observer and the Press have more.

Of course Obamacare repeal would have a big negative effect on Texas

I mean, duh.

Right there with them

As many as a half-million Texans could become uninsured under the Republican plan to replace the Affordable Care Act, wiping out at least half the gains the state has made in reducing the number of uninsured residents in recent years, according to health care analysts.

Texas still has the nation’s highest percentage of people without health insurance, but that uninsured rate has dropped significantly, falling to about 19 percent from 26 percent over the past four years. About 1 million more Texans gained coverage under the health care overhaul known as Obamacare, which became law in 2010.

Under the Republican plan to repeal and replace the health care law, 500,000 could lose coverage by 2020, either through changes in federal assistance to purchase coverage and Medicaid, the government health care program for the poor, or the end of individual mandates that require people to have insurance, said Ken Janda, president and CEO of Community Health Choice whose company offers insurance plans on the federal exchanges.

Analysts such as Vivian Ho, health economist at Rice University’s Baker Institute for Public Policy, advocates like Elena Marks, CEO of Houston’s Episcopal Health Foundation, and insurers, such as Molina Healthcare, confirmed Janda’s estimates.

“Certainly, Texas is going to have more uninsured people again,” Janda said. “I don’t see much positive coming out of Congress.”

[…]

Dr. Mario Molina, CEO of the California-based Molina Healthcare, a Fortune 500 company, said in an interview he cannot yet commit that his company will be in the Texas market next year on the exchange because of the uncertainty that currently exists surrounding the promise to repeal and replace the ACA. Currently his company is one of only three insurers who offer ACA coverage in Houston.

“I am very nervous,” he said. “There is little that Congress has done so far that indicates the insurance market will be stable.”

Blue Cross and Blue Shield of Texas, which offers plans on the exchange in every Texas county, including Harris, also expressed concerns about the uncertainty of federal health care policy.

“It’s imperative that we have market stability and regulatory certainty,” the company said in an emailed statement. “We will make decisions about our product offerings for 2018 once we have more information about any legislative or regulatory changes that will be made impacting the individual health insurance markets.

Health care providers, meanwhile, worry what will happen if hundreds of thousands of Texas residents lose insurance. Katy Caldwell, executive director of Houston’s Legacy Community Health, which serves many low-income patients, said fewer insured patients will mean longer wait times as clinic staff become overwhelmed. But a jump in the uninsured rate would create more than inconvenience, she said.

“The thing that really concerns me is people foregoing their medication. I hear it all the time now: ‘I have to choose between food and my medicine’ or ‘I cut my pill in half because I can make a 30-day supply last 60 days,'” Caldwell said. “This has every potential to get worse.”

Honestly, I think that half million estimate is very much on the low end, possibly the optimal scenario under the Ryan bill, which to be sure has no obvious path forward at this time. The provision that would not only freeze Medicaid enrollments but prevent anyone who fails to re-enroll for any reason from ever re-enrolling would surely force many more people off, just as the six-month re-enrollment period for CHIP that was passed by the 2003 Legislature contributed to so many more children going without health insurance. And all that is before we consider the possible chaos in the broader healthcare market. So yeah, if a few years from now we come out of this with only a half million people having lost coverage, I’d consider that to be better than I expected.

House considers a bigger ask from the Rainy Day Fund

Needs must, as they say.

The proposal from state Rep. John Zerwas, a Richmond Republican and the House’s chief budget writer, would withdraw about $2.4 billion from the Rainy Day Fund as part of a supplemental budget to pay bills coming due for programs like Medicaid, the federal-state insurance program for the poor and disabled, and to pay for repairs to state-run institutions including mental hospitals and the School for the Deaf.

Previously, Zerwas advocated spending about $1.4 billion from the fund, which holds about $10 billion currently. He updated his proposal at Thursday’s meeting of the House Appropriations Committee, saying that without making a “modest withdrawal” from the savings fund, budget writers would be forced to make draconian cuts to public programs.

Entities that face budget cuts absent a cash infusion include the state’s public education system, pensions for retired teachers, and the Texas child welfare and foster care system charged with protecting vulnerable children from abuse and neglect, Zerwas said.

“Some members of our body have said publicly that our situation isn’t really that bad,” he said. “I can’t disagree more with that.”

Most legislative sessions, the Texas Legislature does not fully fund the cost of state programs, so lawmakers must typically pass a supplemental bill to cover the rest. Zerwas’ proposal would net some matching federal dollars, bringing the total value of the bill to $5.2 billion, officials said. About $3 billion would plug funding holes left by lawmakers in 2015, mostly in Medicaid and in a health care program for the state prison system.

The rest would go toward current needs, such as “deferred maintenance” costs at state-run institutions including mental hospitals, many of which are in disrepair.

See here for the background. I approve of Zerwas’ approach and appreciate what he is saying, but I would be remiss if I didn’t point out that a big part of the problem he is trying to solve is self-inflicted. As the story notes, tax cuts passed in the last session, at a time when oil and gas prices were low and the state’s economy wasn’t doing so well, cost $4 billion this biennium, while the referendum to dedicate a portion of sales tax revenue to the state highway fund has taken $5 billion out of the general fund. Zerwas had to file a separate bill to claw some of that money back. These were choices made by the leadership and the Legislature, the former because tax cuts are Republican crack, and the latter because we absolutely, positively refuse to consider raising the gas tax to meet our road needs. Budget gimmicks are just that, and whatever they purport to do, there’s always another gimmick to undo it. As a certain former President once said, reality has a way of asserting itself.

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.

Planned Parenthood still in Medicaid

For now, pending judgment.

Right there with them

U.S. District Court Judge Sam Sparks on Thursday delayed Planned Parenthood’s ouster from the state’s Medicaid program until Feb. 21.

[…]

During closing arguments Thursday hearing, attorneys from both sides cited clips from the video. Sparks said he wanted all involved to review the video footage and present their findings to him Jan. 30.

“I don’t know if I’ll be able to give an opinion [without further review of the video],” Sparks said.

During the final day of testimony, the state continued to make its case that Medicaid patients would still have access to health services without Planned Parenthood’s help.

Jami Snyder, associate commissioner for Medicaid and CHIP, said on the stand that there were 141,000 providers available in the program, including 29,000 primary care physicians and 3,300 OBGYNs. She said the program has “a very robust network” thanks to strict network adequacy requirements for the managed care organizations that help with Medicaid and patients have a variety of tools to help them find a new doctor. She said the available providers dwarf Planned Parenthood’s presence.

“What we know to be true is that a variety of providers in our network offer family planning services,” Snyder said.

But Planned Parenthood lawyers pressed Snyder on provider availability, forcing her to admit she was unsure if all of the Medicaid providers offer weekend hours or walk-in appointments like the reproductive health organization does. Snyder also admitted Medicaid providers do not necessarily offer the exact same services as Planned Parenthood.

Snyder also elicited gasps in the courtroom when she admitted she did not know about surging maternal mortality rates in Texas.

See here and here for the background. The video in question is of course the bullshit Center for Medical Progress video. Way to be on top of breaking women’s health news there, Jami Snyder! With skills like that I don’t know how you weren’t picked to head up HHS in Washington. Trail Blazers, the Current, Newsdesk, and the Chron 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.

An awful lot of Texans could lose health insurance

It sure will suck to be them.

It's constitutional - deal with it

It’s constitutional – deal with it

New public-health studies warn that hasty congressional action toward repealing the Affordable Care Act could have dire consequences for the poor and uninsured both in Texas and nationwide.

The dismantlement of portions of the law, known as Obamacare, without a comparable substitute could mean 2.6 million more Texans would be uninsured, raising the total to 6.9 million by 2019, the Urban Institute, a Washington, D.C.-based think tank for economic and social policy, said Wednesday in a new report.

Texas already leads the nation in the number of uninsured.

“There is good deal of fear,” said Vivian Ho, a health economist at Rice University’s Baker Institute of Public Policy, who has tracked the health care law’s implementation in Texas. “The uninsured rate will be going up under any scenario.”

The fallout from even a partial congressional repeal through a process known as budget reconciliation could also nearly double the national uninsured rate to 21 percent by 2019, the report found. That would be higher than the rate before the ACA went into effect.

[…]

“The rush for repeal, certainly without replacement, is a huge risk for the health and financial stability for Texas. Not just for the poor but for everyone,” said Stacey Pogue, a senior policy analyst for the Center for Public Policy Priorities.

“We don’t just go back to the uninsured rate before the Affordable Care Act,” she said, “the entire individual market becomes destabilized.”

There are two things you can be sure of. One is that any replacement scheme will cover fewer people than are covered now. That’s because Republicans want to cut taxes, and if that means a bunch of people lose access to health care, well, too bad for them. And two, our state government does not care at all about the uninsured population. They’ve had fifteen years to do something about it, and the only thing they have ever done is make cutbacks. If this is what you voted for, then congratulations, you’re gonna get it.