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Medicaid and the “heartbeat” law

Of interest.

Texas’ new abortion ban makes no exceptions for pregnancies that result from rape or incest. Nearly a month after it was enacted, state health officials still won’t say whether that includes Texans on Medicaid, a small but critical population that they are required to help access the procedure.

Under federal Medicaid rules, states are obligated to cover abortions in rare circumstances, including for victims of sexual abuse. The new Texas law prohibits abortions after six weeks of pregnancy and allows nearly anyone to sue those who defy the restrictions. It is at least temporarily in place while state and federal courts review whether it is constitutional.

The law appears to have forced the state Health and Human Services Commission into a predicament: either it flouts the state ban or it violates the longstanding federal guidelines.

The agency has not said how it is complying with either directive; a spokeswoman declined to comment, citing the pending litigation. In its Medicaid handbook, the agency still provides instructions for submitting abortion claims for reimbursement.

The Department of Justice pointed to the Medicaid impact in a lawsuit it filed earlier this month against the Texas ban. A hearing on that suit is scheduled for Friday.

“The statute arbitrarily denies Medicaid beneficiaries coverage of a procedure for which Medicaid coverage is mandatory,” lawyers for the department wrote in their complaint.

See here and here for some background on the DOJ lawsuit. The subject of Medicaid did come up in oral arguments on Friday, but it didn’t appear to be a main topic of interest. As this story notes, the main lever the federal government has to enforce this is to threaten to withhold Medicaid funding, but that would mostly hurt Medicaid recipients, and it is not at all clear that Greg Abbott would be inclined to give an inch. Some states like South Dakota have routinely violated this law, without consequence. Maybe it matters in this lawsuit and maybe it doesn’t, I don’t know. But there it is.

Trying again to get SCOTUS to stop SB8

Good luck.

A coalition of Texas abortion providers went back to the Supreme Court Thursday, asking the justices to expedite a review of the state law that bars abortions after six weeks of pregnancy.

The law has been in effect for 23 days, but the federal appeals court hearing the challenge has only set a tentative hearing schedule for December. The providers are asking the justices to — in effect — step in and decide a key issue in the case now, instead of waiting for a federal appeals court to rule on the issue.

The new court papers mark the latest furious attempt on behalf of providers to stop a law that bars most abortions before a woman even knows she is pregnant. The law, which challengers say was drafted with the specific intent to evade judicial review, is now being challenged by providers in federal and state courts, as well as by the Department of Justice.

In the new brief, the providers say the law is written in a way that makes it almost impossible to challenge because it bars Texas officials from enforcing it and instead allows private individuals to bring suit against anyone who may assist in helping a person obtain an abortion performed after six weeks. The clinics are asking the Supreme Court to decide “whether a State can insulate from federal-court review a law that prohibits the exercise of a constitutional right by delegating to the general public the authority to enforce that prohibition through civil actions.”

Separately, they have filed papers asking the court to put their request on a fast track. Under normal circumstances supporters of the law would have had about 30 days to respond, and the process could drag into the winter months. Instead, the clinics want the justices to consider the case October 29 and hear oral arguments in December.

That timing would coincide with the Supreme Court hearing another, completely separate challenge to a Mississippi law that bars most abortions after 15 weeks. Mississippi is asking the court to overturn Roe v. Wade and the court has set arguments for December 1.

If the court were to grant the request from the Texas providers, it could hear the two challenges in the same month.

[…]

In making the unusual request, the clinics noted that providers in neighboring states have reported increases of patients traveling across state lines and other states have begun to push copycat laws.

The clinics had previously asked the justices to block the law before it went into effect, but the high court declined to do so on September 1.

Back then, in an unsigned 5-4 order, the majority wrote that while the clinics had raised “serious questions regarding the constitutionality of the Texas law,” they had not met a burden that would allow the court to block it due to “complex” and “novel” procedural questions. Chief Justice John Roberts joined the three liberal justices in dissent.

Just as a reminder, as this is another one of those situations where there’s so many lawsuits it’s hard to keep track, these are the plaintiffs who had originally sued in July and had to appeal to SCOTUS in late August after some serious shenanigans from the Fifth Circuit. This time they’re asking the court to rule on constitutional grounds, not just allow for a temporary restraining order. I have no idea what their odds of success are, but it can hardly hurt. Maybe now that SCOTUS has seen the sharp downturn in the public’s opinion of them following their cretinous and cowardly refusal to block SB8 in the first place they’ll have a bit of a rethink. We’ll see. Reuters and The 19th have more.

Readin’ and writin’ and gettin’ COVID

Welcome back to school, kids.

Positive COVID-19 cases among Texas public school students rose by more than 9,000 last week, the highest number ever recorded in a seven-day period, state data shows.

As of Aug. 22, there were 14,033 reports of positive COVID cases in students across the state, according to data released by Texas Health and Human Services on Friday. The number represents a 182 percent increase from the 4,976 student cases reported through Aug. 15.

There were another 3,425 positive cases reported in school staff across the state, an increase of 712 from the previous week.

In some districts, more than half the new infections are among elementary school students, who are not eligible for any of the available vaccines.

“This school year is gonna look a whole lot different than last year,” said Dr. Katelyn Jetelina, an assistant professor of epidemiology at UTHealth School of Public Health in Dallas. “We have a whole lot more transmission now in the community and we have the delta variant.”

The cumulative number of cases in students since the 2021-2022 school year began is 20,256. The total staff cases so far this school year is 7,488.

In case you were wondering why so many parents are pissed about the fight against mask mandates. Now that all schools are open I would hope we won’t see any more big jumps like that, but we are going to see the case levels rise for now. I hope that at some point, when there’s enough data to be reasonably confident in the results, we can get a comparison of COVID rates in districts that have mandated masks versus those that have not.

On a related note:

People under 50 are being admitted to hospitals with COVID-19 in larger numbers than at any point during the pandemic as the latest surge of the coronavirus continues to tighten its grip on Texas.

According to data released by the Texas Department of State Health Services, as of Aug. 22, adults 30 to 49 now account for roughly 29% of all COVID-19 hospital admissions in Texas, up from 15% on Jan. 11 during the height of the winter surge.

The data shows that people in the 18-29 age group increased their share of admissions during that period from 5% to 7%, while the percentage of children under 18 admitted to hospitals with COVID-19 increased by 1 percentage point — an average of 46 children each day were hospitalized during the week ending Aug 22.

Meanwhile, fewer people over 70 are landing in hospitals with COVID-19. During the winter peak, about 41% of hospitalized COVID patients were over 70. As of Aug. 22, that dropped by almost half, to 23%.

The data confirmed what many doctors have been saying in recent weeks about the delta variant sending younger people into hospitals at a higher rate than earlier in the pandemic.

“We are seeing certainly younger patients hospitalized and younger patients on ventilators where we haven’t seen that before,” said Dr. Ron Cook, chief health officer at the Texas Tech University Health Sciences Center.

This variant has spread faster among unvaccinated Texans of all ages. As of last week, between 93% and 98% of hospitalizations have been unvaccinated people, depending on the area of Texas, officials said.

More than 70% of Texans over the age of 50 are fully vaccinated, compared to only about half of Texans between the ages of 16 and 49 and one-third of those ages 12-15. Children under age 12 are not eligible for vaccination.

And as the hospitals fill up with COVID patients, people who have other serious but treatable conditions are put in jeopardy. No amount of horse de-wormer is gonna fix that.

The nursing home vaccination mandate

This just seems obvious to me.

President Joe Biden announced on Wednesday that he is directing all nursing homes to require their staff be vaccinated against Covid-19 in order to continue receiving Medicare and Medicaid funding.

Biden said he is directing the Department of Health and Human Services to draw up new regulations making employee vaccination a condition for nursing homes to participate in Medicare and Medicaid. The decision on nursing home staff represents a significant escalation in Biden’s campaign to get Americans vaccinated and the tools he is willing to use, marking the first time he has threatened to withhold federal funds in order to get people vaccinated.

“Now, if you visit, live or work at a nursing home, you should not be at a high risk of contracting Covid from unvaccinated employees. While I’m mindful that my authority at the federal government is limited, I’m going to continue to look for ways to keep people safe and increase vaccination rates,” the President said during a speech at the White House.

[…]

The move comes as the more transmissible Delta variant now accounts for 99% of Covid-19 cases in the United States and as data shows a link between low vaccination rates in certain nursing homes and rising coronavirus cases among residents.

The Delta variant has spurred a jump in daily new cases from a low of 319 on June 27 to nearly 2,700 on August 8, according to Centers for Medicare & Medicaid Services. Many are in facilities in areas with the lowest staff vaccination rates.

In the seven states in which less than half of nursing home staff is vaccinated, weekly cases were 7.9 times higher in the week ending August 1 than they were in the week ending June 27. Meanwhile, in states that have vaccinated a larger share of staff than average (more than 60%), cases reported in the week ending August 1 were only three times higher than cases reported in the last week of June.

The new regulations could go into effect as early as next month, but Johnson said the CMS will work with nursing homes, employees and their unions to ramp up staff vaccinations before the regulations go into effect.

About 1.3 million people are employed by the more than 15,000 nursing homes that participate in Medicare and Medicaid. Some 62% of those workers are vaccinated nationwide, according to CMS data, but the figure ranges from 44% to 88% depending on the state.

“We have seen tremendous progress with low Covid rates within the nursing home population and I think we’re seeing signs that it is starting to tip the other direction. We don’t want to go backwards,” said Jonathan Blum, CMS’ principal deputy administrator.

Blum said CMS officials are “confident we have the legal authority” to implement the new regulation, noting that the law allows CMS to take action as it relates to the health and safety of nursing home residents.

As the story notes, this came a day after Biden directed the Education Department to get involved in the mask mandate fight. You would think, given how devastating the first wave of COVID was to the residents of nursing homes, that their staffers would be highly vaccinated as well, but you would be wrong.

Nationwide, most of the elderly and vulnerable in long-term care facilities have taken the coronavirus vaccine, but many of the staff caring for them have refused it. The federal program responsible for bringing vaccines to the vast majority of nursing homes and similar settings inoculated roughly half of long-term-care workers in the nation, and in some states a much slimmer percentage, as of March 15, according to new data from the Centers for Disease Control and Prevention provided to the Center for Public Integrity.

In seven states and the District of Columbia, the program vaccinated less than a third of staff members.

Now the federal program is winding down in the coming days, leaving states and facilities to figure out how to vaccinate the remainder of workers in settings where COVID-19 has already taken a heavy toll.

Though they represent a tiny fraction of the American population, long-term-care residents made up 34% of the nation’s COVID-19 deaths as of March 4, according to the Covid Tracking Project. Low vaccination rates among staff at these facilities mean that workers continue to have greater risk of contracting COVID-19 themselves or passing the virus to their patients, including residents who can’t be inoculated for medical reasons. Low staff uptake can also complicate nursing homes’ attempt to reopen their doors to visitors like Caldwell, who are striving for some sense of normalcy.

“Going into it, we knew it was going to be a problem,” said Ruth Link-Gelles, who led the team at CDC working on the federal initiative that’s now closing up shop, the Federal Pharmacy Partnership for Long-Term Care Program.

She cited past years’ low vaccination rates among long-term-care workers for diseases such as the flu. “We were disappointed, but I don’t think anyone was shocked to see the low uptake. … There is a stubbornly large portion of the population that really doesn’t want to get vaccinated, and we have a lot of work to do generally and in this community in particular.”

Federal agencies and states have poured resources into a #GetVaccinated educational campaign, hosting listening sessions, live chats and virtual town halls for long-term-care staff to get their questions answered.

In spite of all these efforts, many workers are reluctant to take the shots because they don’t trust information about the vaccines’ safety or they don’t wish to be among the first to take them, experts said.

“There are many reasons to blame nursing homes and the federal government,” said David Grabowski, a professor of health care policy at Harvard Medical School who studies long-term care. “We knew this coming in — that this was a group that was not very trusting of leadership and frankly not very trusting of the vaccine so it was going to take some work in terms of building that trust.”

That story was from late March, so things may be better by now. According to the map embedded in this story, as of that time about 54% of the long-term care workers in Texas who have been vaccinated got their shots through this federal program. But as usual, the overall story in Texas is not great.

The number of nursing homes across the state with at least one active COVID-19 case has shot up nearly 800% in the past month — while nearly half of nursing home employees in Texas remain unvaccinated.

Nursing home residents were among the hardest hit by COVID-19 last year as the virus tore through facilities at an alarming rate. More than 400 Texas nursing home residents died during a single week in August 2020; since the pandemic began, 9,095 have died after contracting COVID-19, according to the Texas Health and Human Services Commission. As of Aug. 11, that’s 17% of the state’s COVID-19 deaths.

To slow the virus’s spread, Gov. Greg Abbott shut down nursing home visitation in March 2020, then eased those restrictions five months later for facilities that didn’t have active cases in the previous two weeks. HHSC’s current visitation guidelines for nursing homes require visitors to wear a mask at all times and limits visitation to no more than two “essential caregivers” per resident.

But after seeing infections remain relatively low in recent months, the state’s more than 1,200 nursing homes are seeing a new wave of infections as COVID-19 cases explode around the state, driven by the highly contagious delta variant:

  • The number of Texas nursing homes with active COVID-19 cases has risen by 773% in the past month, from 56 in mid-July to 489 on Aug. 11. That’s still well below the peak in January, when more than 900 facilities had at least one active case.
  • Deaths are increasing as well. From July 21 to Aug. 11, 84 nursing home residents died from COVID-19, compared to seven deaths during the four-week period before.
  • Roughly 76% of nursing home residents in Texas have been fully vaccinated, putting the state 46th nationally. The national average is 82%.

But the current surge in nursing home cases hasn’t triggered renewed restrictions by the state.

“We continually assess what actions are necessary to keep people safe in the facilities we regulate,” HHSC spokesperson Helena Wright-Jones said in a written statement.

Meanwhile, just over half — 56% — of nursing home staff have been fully vaccinated, below the national average of 59%, which puts Texas 33rd nationally for nursing home staff vaccination rates.

In other words, the usual indifference from state government and general mediocrity, which puts a whole lot of people at risk. What do the nursing homes have to say for themselves?

Kevin Warren, the president and CEO of the Texas Health Care Association, whose members include both for-profit and nonprofit long-term health care facilities, said nursing homes are hesitant to require staff to be vaccinated because they are fearful of losing employees who might look for other jobs that don’t require vaccinations.

“Right now, we have a severely stretched workforce,” Warren said. “And when we see this surge occurring again, the stress and the emotional toll it places on staff and others that are in the building, the concern is: ‘If I put this vaccine mandate on, am I potentially going to lose staff?’”

The percentage of nursing home staffers who are unvaccinated is similar to the general population, Warren added, “so let’s not set them out to the side.”

Except they’re in close contact with the most vulnerable people in the state, and not enough of them are vaccinated, either. The DMN has a whole story on that, and while I can believe it to some extent, there’s a quote from a nursing home operator whose staff is 70% vaxxed, and I cannot see how this is any less urgent than getting hospital staff vaccinated. We’ve tried the carrot, now there needs to be a stick. There’s plenty of polling data to suggest that a non-trivial number of people who are vaccine hesitant will give in and get the shot if their workplace mandates it. Let’s put that to the test.

Lawsuit filed against “heartbeat” abortion law

Normally, I’d say this has an excellent chance of success, given that all previous litigation over such bans have been wins for the plaintiffs. But we are in uncharted territory here.

Two months after Gov. Greg Abbott signed a law banning abortion as early as six weeks, more than 20 abortion providers responded with a lawsuit against top Texas officials aimed at stopping one of the country’s strictest abortion measures to date.

The suit was filed Tuesday in the U.S. District Court for the Western District of Texas.

Known as the “heartbeat bill,” Senate Bill 8 was heavily criticized because it limits abortion to two weeks after a missed menstrual cycle, a time when some women don’t yet know they’re pregnant. It aims to ban abortion after a fetal heartbeat has been detected, which is considered a misnomer as a fetus doesn’t possess a heart at six weeks’ gestation.

Around 85% of those who obtain abortions in Texas are at least six weeks into their pregnancy, according to a press release from the Whole Woman’s Health Alliance, a lead plaintiff in the suit.

“We’ve beaten back these attacks before. We can and we will do it again,” Amy Hagstrom Miller, executive director of Whole Woman’s Health, said at a press conference. “These are dark days, and it’s easy to feel like the extremists in the Texas Legislature are running the table.”

A particularly controversial provision of the law allows private citizens to sue abortion providers and others who help someone get an abortion after six weeks.

Republican legislators removed responsibility for enforcement from state officials; instead, the law allows any Texan to sue providers they think are not complying with state abortion laws, thus pushing enforcement to the civil court system. This is intended to make the bill harder to block in courts.

Marc Hearron, senior counsel for the Center for Reproductive Rights and lead attorney on the suit, said this provision could produce “endless lawsuits,” leave abortion clinics vunerable to harrassment and possible closure, intimidate pregnat women, and leave them with fewer avenues of help.

“It allows complete strangers, anti-abortion activists, to sue and interfere with the patient’s decision,” Hearron said. “Those people may try to essentially hijack the courts for their ideological agenda.”

Citizens who file such suits would not need to have a connection to an abortion provider or a person seeking an abortion or even reside in Texas. Those who win lawsuits would be awarded a minimum of $10,000 in damages, as well as attorney’s fees.

This isn’t the first time a private-citizen suit provision has been included in a Texas abortion law.

It was first tested in Lubbock, with a voter-approved city ordinance that outlaws abortions and empowers “the unborn child’s mother, father, grandparents, siblings and half-siblings” to sue for anyone who helps another person get an abortion. A federal judge dismissed a lawsuit seeking to overturn the ordinance last month, finding that Planned Parenthood of Greater Texas, the plaintiff, did not have standing to sue the city.

Hearron said that his organization hopes to overcome that obstacle in the suit against the state law by naming state officials as defendants. Eight state officials were sued in the new lawsuit, including Attorney General Ken Paxton, Texas Board of Nursing Executive Director Katherine A. Thomas, and Texas Health and Human Services Commission Executive Commissioner Cecile Erwin Young.

Plaintiffs’ attorneys said they named officials who are not charged with directly enforcing Senate Bill 8 but still have authority to enforce related laws.

“If this is not blocked, if this is successful, it would set a truly dangerous precedent, because states could eviscerate their own citizens’ federal constitutional rights by creating a private lawsuit to do what their own officials couldn’t do,” Hearron said.

See here and here for more on that Lubbock situation. I don’t know if this approach will be any more successful, but I trust these folks know what they’re doing. It’s nuts to think there could be no proactive remedy against such a law, but who knows what the courts will do.

The Chron adds some details.

[Whole Woman’s President and Chief Executive Officer Amy] Hagstrom Miller said the Texas law has already impacted her facilities, making it harder to recruit new staff who worry about the near-term viability of the work and creating aggressive interactions between patients, employees and anti-abortion rights activists.

She described one scenario in which activists entered a clinic and began soliciting for whistleblowers who could provide information for future civil suits. The lawsuit names the director of Right to Life East Texas, Mark Lee Dickson, as a defendant in the case, and includes a letter purportedly distributed at one of the Whole Woman’s Health four clinics in the state.

[…]

The litigation filed Tuesday could face a difficult legal path.

Earlier this year Planned Parenthood, which has several clinics in the state, sued to block a new Lubbock ordinance that uses a similar enforcement strategy. The suit was dismissed after a judge ruled that the provider had not shown it was harmed yet by the measure. Planned Parenthood has since asked the court to reconsider, and says it has stopped providing abortions in Lubbock.

Hagstrom Miller said she and others involved in the suit, including fellow abortion providers, abortion funds, clinic staff and clergy, have been following the Lubbock case closely, and are preparing for all outcomes. While some legal scholars have suggested that providers could protest the law by continuing to perform post-six-week abortions come September, Hagstrom Miller said that would be logistically difficult, and she was not willing to ask her staff to defy a law that could leave them vulnerable to malpractice claims.

Like I said, I have no idea what to expect. I am fervently hoping for success for the plaintiffs, but to say the least it’s a tough road they have ahead of them. The Press has more.

Kids still get COVID, too

And they need to get vaccinated if at all possible.

Since the Food and Drug Administration approved emergency use of the Pfizer vaccine for 12 to15 year olds on May 10, more than 300,000 Texas adolescents and teenagers have received at least one dose. Girls in this age range are receiving the vaccine at a higher rate (153,000) than boys (149,000), according to Texas Health and Human Services. Nationwide, more than 626,000 12 to 15 year olds have received two doses, according to the CDC.

Though young people can now receive shots, the number of children and adolescents being hospitalized is increasing. The Centers for Disease Control and Prevention released data from the first half of 2021 that shows nearly one-third of adolescents who are hospitalized with COVID-19 require intensive care. Five percent of those patients need to be put on ventilators with supplemental oxygen, as well.

The CDC reports that nearly 400 children and adolescents are currently in hospitals across the country with COVID or complications from the virus. More than 16,000 under the age of 18 have been hospitalized from COVID since the start of the pandemic, and more than 300 of them have died from it, said Dr. Jim Versalovic, interim pediatrician-in-chief at Texas Children’s Hospital.

“This is a huge setback for a child or adolescent with time spent out of school or activities,” Versalovic said. “There’s a long recovery time even if the infection is mild initially.”

He attributes the increase to fewer masks and stagnating vaccination rates.

More than half of all Texans are vaccinated with at least one dose, but that doesn’t mean Houston is free of several coronavirus variants that are more transmissible and deadlier than the original virus.

In the last month, fewer people are masking up in public outdoors and indoors after the CDC said it was safe for vaccinated people to go masklessThree-day holiday weekends and the onslaught of summer weather has turned Houston into the partying swamp city it was before the pandemic, too.

[…]

Versalovic said about 10 percent of children diagnosed with the virus at his hospital require hospitalization. This rate is nearly three times greater than the seasonal flu, which the CDC reported killed nearly 600 children between 2017 and 2018.

Child survivors sometimes have a whole new set of problems when the initial infection clears. Several weeks after other symptoms have gone away, children who had mild COVID develop other symptoms that typically require hospitalization. This is called Multisystem Inflammatory Syndrome in Children, or MIS-C.

MIS-C symptoms include fever, stomach pain, diarrhea, vomiting, neck pain, random rashes and bloodshot eyes. Extreme fatigue is also a symptom, but it’s usually blamed on other problems.

Texas Children’s has vaccinated more than 18,500 12 to 15 year olds since early May. Any person age 12 and older is eligible for a free Pfizer vaccine from the hospital, regardless of whether they are currently a patient. Vaccines are available at six Texas Children’s sites across Houston Monday through Saturday.

The hospital is partnering with Houston-area school districts now to immunize their students, so middle and high schools can open safely for the fall semester, he added.

“We are going to be very busy during the summer months as we seek to immunize as many children as possible,” Versalovic said. “It’s important to protect adolescents to stop the spread of COVID as they get ready for summer activities, camps, sports and the school year in August.”

Not much to say here that we haven’t said already, many times. Get your kids vaccinated. As long as there are unvaccinated and/or immunocompromised members of your household, you should continue with pre-vaccination safety protocols as much as possible, which I know is vastly more difficult now that masks are being removed all over the place. It is true that the health risks to kids from COVID are lower than they are with adults, but they are not zero and they can be serious. For all the progress we’ve made, we’re not out of danger yet.

How about we sue you for a change?

The state of Texas has sued the federal government more times than I can count in recent years. There may be examples of the reverse happening, but offhand I can’t think of any. As such, this may be a first.

The Biden administration is threatening to sue Texas over its plans to stop state-licensed facilities that are contracted with the federal government from housing migrant children, with a federal attorney calling the state’s move a “direct attack” on federal refugee resettlement efforts.

The federal response comes after Gov. Greg Abbott ordered last week that Texas child care regulators revoke the licenses of state-licensed facilities that house migrant children. The move, the latest by the Republican governor as he spars with President Joe Biden over immigration policies, would force the facilities to stop serving unaccompanied minors or lose their license to serve any children.

Texas officials have already begun instructing the 52 state-licensed facilities serving migrant children to wind down operations by Aug. 30, following Abbott’s order, according to a notice sent to shelters by the Texas Health and Human Services Commission.

In a letter sent Monday to Abbott and other Texas officials, Paul Rodriguez, a top attorney for the federal Department of Health and Human Services, said Texas’ move violates the U.S. Constitution’s Supremacy Clause, which says federal law supersedes state laws. He asked the recipients to clarify whether they intended that the order be applied to those shelters, which are overseen by HHS and its refugee resettlement branch, the Office of Refugee Resettlement.

He wrote that the federally contracted shelters “comprise a significant portion of ORR’s total operational footprint, and represent an indispensable component of the Federal immigration system.”

If Abbott’s May 31 order includes those ORR facilities, it “would be a direct attack on this system,” Rodriguez said in the letter. He gave the state until Friday to clarify whether the order will affect those facilities.

If so, he said legal action could follow.

[…]

The governor’s office did not respond to questions about the potential relocation of children who are housed in the state-licensed shelters or whether the state was considering backing down on its order in light of the HHS letter.

Abbott pointed to the state’s foster care capacity woes as one of the reasons for his order. Hundreds of foster children have spent nights in hotels, community organizations or Child Protective Services offices because there weren’t enough suitable placements as dozens of foster care providers relinquished their contracts with the state due largely to higher scrutiny on the system.

“The unabated influx of individuals resulting from federal government policies threatens to negatively impact state-licensed residential facilities, including those that serve Texas children in foster care,” Abbott wrote in the order.

Only 134 migrant children were housed in federally contracted Texas facilities that also serve foster children as of May 10, according to the data gathered by the Associated Press.

Patrick Crimmins, a Texas Department of Family and Protective Services spokesperson, said unaccompanied immigrant children don’t enter the state’s foster care system directly. They would only be in the system if they had to be removed from family members with whom federal employees placed them.

“There are no children in foster care simply because they are an unaccompanied minor. Children are only in foster care because of abuse or neglect that is reported to us and investigated by us,” Crimmins said.

Asked how Abbott’s order might affect the foster system’s placement shortages, Crimmins replied, “We don’t know that yet.”

Abbott’s claim is that the feds have foisted an unfunded mandate on Texas, which strikes me as a perennial complaint that is made whenever it’s convenient. It’s also a little rich given the recent “certain cities can never spend less money on the police” legislation. This is a political squabble more than anything, though with the higher stakes of having a direct effect on some number of children. Putting those very real effects aside for a moment, the political fight will turn on the question of who gets blamed for any harm that results to these children. (Yes, I know exactly how awful that sounds.) We have one possible data point from this Chron story:

Texans back President Joe Biden’s approach to immigration over Gov. Greg Abbott’s by nearly 10 percentage points, according to a new poll released as the clash between the governor and Biden administration over border policy continues to escalate.

The poll, conducted at the end of May, found 44 percent of Texans approve of Biden’s handling of immigration compared to 35 percent who approve of Abbott’s. The online poll of 506 Texas residents was conducted by Spectrum News and Ipsos and had a margin of error of plus or minus 5.2 percentage points.

The poll link appears to be broken. I’d be dubious of it even if I could inspect it, as Biden has generally polled worse on immigration and the border than he has overall. It’s also one poll result, with all the usual caveats. That said, if this comes down to video images of possibly crying children being relocated, even if it’s just from one shelter to another, “Abbott gave the order to close the shelters” will outweigh “Abbott blames Biden for not giving the state enough money for the children in the shelters”. I could be wrong about that, of course, and if it turns into litigation I suspect a judge would step in and halt any closures for the time being, until the legal questions can get sorted out. I suspect Abbott knows that part as well, so again this comes back to being a partisan fight. Abbott doesn’t generally back down from those when he’s opposite the feds. Expect this to take awhile to come to a resolution. Daily Kos has more.

Reopening roundup redux

More news about that thing that Greg Abbott is making us do.

Health experts give Abbott’s plan to reopen Texas mixed reviews, warn state should revive stay-at-home order if surge emerges:

Diana Cervantes, director of the epidemiology program at the University of North Texas Health Science Center, said Monday’s announcement came too soon — and did not give businesses enough time to prepare precautionary measures before opening Friday.

“That’s a concern,” she said.

Health leaders in some Texas cities said it was too soon to relax social distancing precautions that have helped keep the coronavirus outbreak manageable in Texas. Abbott moved toward reopening about 10 days sooner than health leaders in Houston had hoped for, according to the Houston Chronicle. The governor said his order supersedes any local restrictions.

“This is too soon for us,” Mark Escott, Austin’s interim health authority, said Tuesday during a city council meeting. “As we’re still preparing contact tracing, ramping up testing, working to protect vulnerable populations, now is not the time to flip on the light switch.”

At the same meeting, Lauren Ancel Meyers, an epidemiologist at the University of Texas at Austin, shared a model she created showing that Austin could surge past its hospital capacity as soon as this summer if social distancing regulations are eased indefinitely.

In Dallas County, which marked its deadliest day on Tuesday, Health and Human Services Director Philip Huang said some area hospitals have seen increases in COVID-19 populations.

“These are the trends we’re worried about even before the governor’s order,” he said, standing in front of a screen that read “Stay Home, Stay Safe.” As businesses reopen, he said, it is all the more important that Dallas continue to socially distance, wear masks and “make smart choices.”

Health experts said Abbott must be careful in determining whether it’s safe to continue to expand business openings in coming weeks. The success of the economic reopening depends on increasing the state’s capacity for testing and contact tracing.

Moving forward to the second phase of reopening — when certain businesses could serve customers at 50% capacity — depends on the outcome of the first stage. Abbott said it is “only logical” that the restrictions he’s easing this week will cause an increase in the number of positive coronavirus cases. That alone will not be “decisive,” he said.

The governor and his advisers will look closely at hospitalization rates and death rates to decide whether it is safe to move on to phase two. But Abbott’s plan, outlined in a 65-page booklet, does not offer specific figures or thresholds.

[Luis Ostrosky-Zeichner, a professor of infectious diseases and epidemiology at UT Health] said “any sort of uptick in cases would be worrisome to me.”

A distinct lack of metrics was a concern to me as well, but what do I know?

Texas sending restaurant and retail employees back to work without child care:

Restaurant servers, retail cashiers and movie theater concession workers in Texas could be called back to work as soon as Friday, in the first phase of the state’s emergence from a coronavirus shelter-at-home order.

But parents working in those industries who have young children will be turned away from licensed child care centers, which remain open only for children of essential workers such as grocery clerks and nurses. And public and private schools across the state are closed for all students through the end of the school year.

As Republican state leaders move to re-energize the economy, already a controversial decision, they are forcing some parents into a near-impossible choice: find a place to leave your child or risk losing your source of income. Under the state’s current rules, Texans who choose not to go to work when their business reopens will no longer be eligible for unemployment payments.

“Public health needs indicate that child care operations may remain open only to serve children whose parent is considered an ‘essential’ worker under the Governor’s executive order,” said Cisco Gamez, a spokesperson for the Texas Workforce Commission, in a statement. “Just because a business is now open does not necessarily mean that it is considered ‘essential.’”

But the Texas Workforce Commission has since said in a follow-up statement that it is considering case-by-case waivers that would allow some people to continue receiving unemployment benefits even if they choose not to return to a reopened business.

“Under longstanding TWC policy, if an employer offered an individual a job and they refused the job offer without good cause the employee would not be eligible for unemployment insurance benefits,” the statement said. “Recognizing this, extraordinary situation, TWC is reevaluating good cause situations that take into consideration the governor’s direction towards reopening the economy.”

It’s almost as if the problems that had been identified for working people in good times were exacerbated in a time of crisis. No one could have seen that coming.

Montgomery County commissioners call Abbott’s plan to reopen Texas economy ‘vague’:

Gov. Greg Abbott responded to Montgomery County Judge Mark Keough late Tuesday and acknowledged his order to reopen Texas businesses on Friday needed clarification after Keough called the plan vague and said it didn’t mandate businesses such as hair and nail salons, bars and gyms remain closed.

“I actually went back and looked at the order and I can understand why he’s saying that it needs clarification. And so we will provide that clarification,” Abbott said in a Fox 26 interview regarding Keough’s comments.

Keough said he appreciated the governor’s attention in the matter but said he is standing his ground that his interpretation of Abbott’s order only says those businesses “shall” be avoided, which, he said, does not mean the businesses can’t open. He added if and when Abbott clarifies the order in writing, he will abide by its guidelines.

During the commissioners court regular meeting Tuesday morning, Keough said the county has done all it can to follow guidelines from Abbott. However, he said the opening of some businesses over others “doesn’t make sense.” After reading Abbott’s order, Keough said it does not close or keep closed any businesses.

“He doesn’t close those,” Keough said of businesses such as hair salons, barbershops, gyms and nail salons. “It says you should avoid these businesses. It is uncommonly vague what he has said and there is a measure of confusion. I am not trying to push against the governor, I am just trying to free the people who have been chosen to be the losers.

“The object here is not to go rogue on the state of Texas or the governor. The object is we have until Friday to get clarification on this. As far as we are concerned, he has not declared these (businesses) closed.”

Still waiting on that clarification. People seem to be especially agitated over the haircut issue:

As Abbott made the rounds of TV news interviews Tuesday, it was clear that his hair edict had struck a strong and disappointed chord with some Texans.

“Now governor, by far the most calls we have been getting are from barbers and hairdressers who are trying to understand why they are not in phase one of your plan,” the interviewer on KFDX in Wichita Falls asked Abbott on Tuesday afternoon. “People feel that personal grooming is essential and if proper precautions are taken, why isn’t the hair industry in phase one?”

“Well, first I agree with their sentiment 110%. And I know that fellow Texans do also,” Abbott replied. “But once again, the decisions that we made yesterday were decisions based upon recommendations by doctors, and so some doctors concluded that because of the close proximity between a barber and a customer and a hair salon and a customer, even though they’re wearing face masks, we’re still looking for best strategies.

“But it’s so important for your audience to know this,” Abbott said. “After my announcement yesterday, we began working on the issue immediately, and we are continuing to work on it and we will be looking forward to try to make an announcement really soon as we come up with safe strategies for barbers and hair salons to be able to reopen.”

I mean, my hair is approaching levels of shagginess not seen since my grad student days, but that hasn’t broken my spirit yet. My hair will still be there to be cut in a couple of weeks, you know?


Go click and read the thread, and also read this Eater story if you haven’t already.

Office space: How to keep Texas workers safe as they return:

The office refrigerator? Better take it away. The office coffee pot? Ditto. Even shared copiers and printers have become biological hazards, thanks to the spread of the coronavirus.

Workplace culture as we knew it in January is disappearing as companies prepare for the return of employees as early as Friday in Texas.

Many companies have focused on separating employee workstations so workers remain 6 feet apart to comply with government social-distancing recommendations. They’re also buying masks and gloves to prevent the virus from spreading. But what about not-so-obvious dilemmas, such as whether to station someone on each floor to help maintain distancing in office elevators. And what to do about the germ-covered door knobs on bathroom doors?

“It’s the simple things, like unfortunately and sadly, maybe eliminate the handshake,” Jason Habinsky, an employment lawyer with Haynes and Boone, told employers this week during a telephone seminar. Instead, maybe workers could point and a nod at each other, a manner that before the conoravirus pandemic might have been awkward but now makes sense.

I don’t drink coffee and I almost never generate paper, but I do bring my lunch more often than not. Guess I’ll have to plan to start bringing a cooler or something. This world we’re going to re-enter is going to be so very different from the one we left.

Statewide restrictions on public gatherings

This was expected.

Gov. Greg Abbott on Thursday took sweeping action to contain the spread of the novel coronavirus across Texas, issuing an executive order that will close restaurants and schools, among other things.

During a news conference at the state Capitol, Abbott announced an executive order that will limit social gatherings to 10 people, prohibit eating and drinking at restaurants and bars while still allowing takeout, close gyms, ban people from visiting nursing homes except for critical care and temporarily close schools. The executive order is effective midnight Friday through midnight April 3, Abbott said.

The executive order reflects federal guidance that came out earlier this week.

[…]

Abbott also announced that state health commissioner John Hellerstedt declared a public health disaster earlier Thursday. Abbott said it is his understanding that the last time such a declaration was made in Texas was 1901.

Not much to add here. Cities and counties have been taking action along these lines, though there have been holdouts. (Harris County is considering further action as well.) That makes state action the appropriate solution, so good for Abbott though we can certainly debate what took so long. Be that as it may, here we are. The Chron has more.

The robot nurse

We are living in the future, for better and for worse.

https://www.instagram.com/p/B01H56Fn8_0/

A friendly one-armed, bright-eyed robot is roving the hallways of Medical City Dallas’ Heart and Spine hospitals, helping nurses with routine tasks that previously took time away from patient care.

Nicknamed Moxi and regarded as one of the staff, the robot is equipped with sensors to help it navigate, and even anticipate people’s movements, as it travels across hospital floors. Medical City Dallas partnered last fall with Austin-based artificial intelligence firm Diligent Robotics Inc. to become the first North Texas hospital to employ a robot full time in a clinical setting.

“When we were opening up the hospital back in October, one of the things we wanted to really focus on was being an innovation center and bringing new technology to the health care setting,” Medical City Chief Operating Officer Josh Kemph told The Dallas Morning News.

When a nurse is interacting with it in a way that would normally trigger an error message, Moxi instead emits pleasant beeps and chirps to notify them. Some patients even have their own names for the assistant, which has its own Instagram account run by Diligent.

But Moxi is so much more than just a pretty face.

Texas will face a shortage of more than 71,000 nurses by 2030, according to the Texas Health and Human Services Commission. And with the demand for nurses expected to only continue increasing, Medical City Dallas director of surgical and procedural services Stefanie Beavers says she hopes it will also make it easier for the hospital’s existing workforce to optimize their day-to-day work.

“This really offers health care facilities an opportunity for the nursing workforce to focus on patient care and be directly at the bedside versus taking them away, and allowing their time to be truly dedicated to patient care tasks,” Beavers said.

It never crosses the threshold into patient care, instead delivering things like blood samples back and forth to a lab and updating patients’ medical records instantaneously for hospital staff.

“She’s really meant to be a team member that’s supporting you in the background,” Beavers said.

For now, at least, Moxie is a modern version of the FBI mail robot, which does simple drudge work like delivering specimens and allowing the human nurses to do more important things. It’s also a lot cheaper to employ than human nurses, or human nurses’ aides, and in the way of driverless cars, it’s just a matter of time before they have the capability to cross that threshold into patient care. That may be 20 or 30 years down the line, but it’s out there somewhere. I just hope we can have a productive conversation about what that will mean for the rest of us before it happens.

Let this finally be the end of the Heidi Group’s grift

And you should all be thoroughly appalled at the waste, fraud, and abuse committed in the name of screwing Planned Parenthood.

Right there with them

An anti-abortion group that came under fire for failing to provide services to thousands of Texas women must repay $1.5 million in overpayments and prohibited costs, state investigators said Thursday.

The findings, announced by the office of the health inspector general, are a new blow to the Heidi Group. The organization had hoped to replace Planned Parenthood as a top family planning provider, but was cut off from millions in funding last year after failing to serve tens of thousands of low-income women.

The office said on Thursday it had uncovered “serious contractual violations” and is expanding its inquiry to the entire span of the Heidi Group’s contracts, going back to 2016. That could mean additional repayments.

Forensic accountants found the group had paid medical providers hundreds of thousands in excess fees, had overspent on payroll and fringe benefits, and had expensed thousands in unallowable costs like food, gift cards, clothing and retail membership fees, according to a copy of the internal investigation obtained by the Houston Chronicle.

The inquiry covered a seven month period, from September 2017 to March 2018.

“It’s a travesty when you look at all the women who should have been receiving services and were not because of this,” said Rep. Donna Howard, D-Austin. “We’re talking about women who don’t have means to afford health care like many of us do.”

See here for a deeper dive on the Heidi Group’s utter failure, and here for all previous blog posts. As the Observer notes, the state finally canceled their contracts last month, after three years of shoveling good money after bad. In the meantime, thousands of women were denied the health care the needed and deserved. This is what happens when you put rabid ideology over reality. Until we get better government in this state, there’s always a chance it will happen again.

“I’m haunted by their eyes”

We should all be haunted, and outraged, by this.

Immigrants held in a McAllen-area U.S. Customs and Border Patrol processing center for migrants — the largest such center in America — are living in overcrowded spaces and sometimes are forced to sleep outside a building where the water “tastes like bleach,” according to an attorney who recently interviewed some of the migrants.

“It was so bad that the mothers would save any bottled water they could get and use that to mix the baby formula,” attorney Toby Gialluca told The Texas Tribune on Saturday.

But when she recalls the conditions described to her by the immigrants she interviewed at McAllen’s Centralized Processing Center, Gialluca said she goes back to one thing.

“Their eyes. I’m haunted by their eyes,” Gialluca said.

Gialluca and a slew of other lawyers have been meeting with children and young mothers at facilities across the state this month as pro bono attorneys. At the McAllen Center, Gialluca said everyone she spoke with said they sought out Border Patrol agents after crossing the Rio Grande so they could request asylum.

Gialluca said the migrants, all from Honduras, Guatemala, and El Salvador, told her they aren’t receiving proper medical care and children don’t have enough clean clothes. Unable to clean themselves, young mothers reported wiping their children’s runny noses or vomit with their own clothing, Gialluca said. There aren’t sufficient cups or baby bottles, so many are reused or shared.

“Basic hygiene just doesn’t exist there,” Gialluca said. “It’s a health crisis … a manufactured health crisis,” she said.

[…]

On Saturday, state Sen. Carol Alvarado, D-Houston, issued a letter to the Texas Health and Human Services Commission inquiring about the reportedly inhumane conditions at a Clint facility where another group of lawyers told the Associated Press about a group of 250 infants, children and teens who spent nearly a month without adequate food, water and sanitation.

Attorneys who visited the El Paso-area station said they found at least 15 children sick with the flu and described a sick and diaperless 2-year-old boy, whose “shirt was smeared in mucus,” being taken care of by three girls all under 15.

“HHSC has a responsibility to these children and individuals to ensure they are receiving, at a minimum, basic care,” Alvarado wrote, acknowledging that the facilities are managed at a federal level, but still imploring the state to do more. “As these facilities are in our state, the conditions under which they operate is a reflection of our values and commitment to the humane treatment of all within our borders.”

There are a lot of elected officials in this state who support passing laws greatly restricting access to abortion because they say they believe in the sanctity of life. Most of those same officials oppose laws that grant equal treatment under the law to LGBTQ people, and support laws that allow “sincerely held religious beliefs” to be a legal reason to not do business with LGBTQ people, because they believe that LGBTQ people are engaged in immoral behavior. These same elected officials, who care so much about life and morality, don’t have so much as an unkind word to say about the appalling, inhumane treatment of thousands of people, many of them children and babies, right here in Texas. I don’t know why any moral authority is granted to these officials, whose names include Greg Abbott, Dan Patrick, Ken Paxton, John Cornyn, Ted Cruz, Chip Roy, Dan Crenshaw, Ron Wright, Lois “Bathroom Bill” Kolkhorst, Jonathan “Former Fetus” Stickland, Tony “Death Penalty For Abortion” Tinderholt, and many many more. They have clearly shown that they don’t deserve it.

UPDATE: In addition to voting all of these useless assholes out of office, you can donate to or volunteer for any of these organizations if you want to help do something about this.

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.

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.

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.

“Fetal remains” law tossed

Very good.

U.S. District Judge David Alan Ezra struck down a Texas law on Wednesday that would have required hospitals and clinics to bury cremate fetal remains, causing another courtroom setback for state leaders and anti-abortion groups.

Under Senate Bill 8, passed in 2017, health care facilities including hospitals and abortion clinics would be required to bury or cremate any fetal remains — whether from abortion, miscarriage, stillbirth, or treatments for ectopic pregnancy regardless of patients’ personal wishes or beliefs. Legislators passed the bill following a ruling that year by U.S. District Judge Sam Sparks that struck down a similar rule implemented by the Texas Department of State Health Services. At the time Sparks said it was vague, caused undue burden on women and had high potential for irreparable harm.

Over the course of a nearly 30-minute hearing at a federal court in Austin on Wednesday, Ezra gave a synopsis of the ruling, calling the case “a very emotional topic.” The requirement would have been challenging for health providers, in part because it would be difficult to find medical waste vendors willing to participate. In addition, Ezra expressed wariness about the state having to reach out to private cemeteries to help with fetal remain disposals.

“The implementation of this law, as I have pointed out, would cause and, if allowed to go into effect, would be a violation of a woman’s right to obtain a legal abortion under the law as it stands today,” Ezra said.

[…]

Multiple doctors and health advocates who testified said women often don’t ask what happens to their fetal tissue, since they assume it’ll be treated like medical waste. Providers also said they have experienced challenges trying to find medical waste vendors willing to work with their clinics. A top reason, they said, is that vendors are unwilling to endure backlash and harassment from anti-abortion advocates.

See here, here, and here for the background. I’m terribly amused by the fact that the zealotry of the anti-abortion movement was cited as a reason that this law they supported is illegal. If there’s a Greek goddess of irony, she’s pouring herself a glass of wine right now. Of course the state will appeal, and we know that the Fifth Circuit and soon SCOTUS are places where hope goes to be strangled in a back alley. But until then we have this, so let’s celebrate while we still can. The Observer has more.

“Fetal remains” trial ends

Now we wait for a ruling.

State and reproductive rights attorneys wrapped up a five-day trial in federal court on Friday that will determine whether a Texas law requiring health providers to cremate or bury fetal remains can go into effect.

U.S. District Judge David Alan Ezra told attorneys on Friday that he has “not made up my mind on how I’m going to rule on this case” and is awaiting written closing arguments due on Aug. 3.

He’s expected to rule around the end of August.

The law at the center of the case is Senate Bill 8, passed in 2017, which requires the burial or cremation of fetal remains. Legislators passed the bill following a ruling that year by U.S. District Judge Sam Sparks that struck down a similar rule implemented by the Texas Department of State Health Services. Sparks said that rule was vague, caused undue burden on women and had high potential for irreparable harm.

Throughout the five-day trial, a wave of patients, health providers, state agency officials, bioethicists, cemetery directors and religious leaders flowed through the witness stand.

Before dismissing attorneys Friday morning, Ezra rattled off a list of questions and concerns he wanted both sides to answer in his closing arguments, including: What authority does Texas have to pass laws around giving dignity to the unborn? What would happen to women’s access to care — for abortions and miscarriages — if health providers did not have a facility to handle fetal remains? And how many facilities — secular or otherwise — have committed to helping with burials and cremation?

Ezra noted that the case is unique because state attorneys waived the argument that SB 8 protects the health or safety of patients and plaintiff’s attorneys waived arguments about costs to patients and providers.

The dynamics involved “makes this case extremely unique in many ways and makes finding precedent all the more difficult because those issues are generally not only present in these kind of abortion-related cases — they’re often paramount in those cases,” Ezra said.

See here for the background. The judge’s questions, which the Observer examined in more detail, are the key to the case. During the trial, there was testimony by Blake Howard Norton, the daughter of State Rep. Donna Howard, about how she felt coerced by the Catholic hospital where she was going through a miscarriage into making a decision about disposing of the fetus, and there was more useless testimony from paid state witnesses who lacked any expertise in the subject matter and the law. I feel like the judge is skeptical of the law, but we’ll see what he has to say about it. The Chron has more.

“Fetal remains” lawsuit trial underway

Here we go.

State and reproductive rights attorneys are going head to head again in federal court on Monday to argue whether Texas should require health providers to cremate or bury fetal remains.

“It’s a tough case for everybody,” U.S. District Judge David Alan Ezra said Friday during a pretrial hearing. In January, he had granted an injunction blocking a state fetal remains burial rule, but he said last week that the previous decision is no indication of how he would rule in the trial.

“It’s a very emotional case, and so I would ask counsel to do the best job they can to try and tamp down some of the more zealous individuals in your respective camps so that we don’t get a lot of extraneous stuff going on,” Ezra said to attorneys for the state and the Center for Reproductive Rights, who are representing the plaintiffs.

Arguments in the trial are expected to run all week.

[…]

Ezra listened as both sets of attorneys spent nearly two hours going over logistics of the trial and other issues including whether certain witnesses would be allowed to testify about the emotional trauma of abortions and fetal remain burials and keeping information about vendors confidential for safety reasons.

Throughout Friday’s pretrial hearing, Ezra laid out for attorneys what was on the court’s mind about the case, including: if women may face an undue burden if there aren’t enough providers or facilities statewide; the logistics of how doctors and clinics would deal with the law if it went into effect; and if Texas has enough facilities available statewide to help dispose of the fetal remains.

“I have to deal with this as a law in Texas that will affect every woman in the state of Texas,” Ezra said.

Another point of contention during the hearing was what to do about a 5th U.S. Circuit Court of Appeals decision on whether the Texas Catholic Conference of Bishops would have to turn over confidential internal documents to the Center for Reproductive Rights and Whole Woman’s Health for the fetal remains trial. Ezra had previously ruled it would, but in the middle of the pretrial hearing the 5th Circuit informed him it had reversed his decision.

See here for the previous update. I have no idea how this one may go, but I’ll be keeping an eye on it. There’s certainly a chance that none of this will matter given the likely future composition of SCOTUS, but we have to go through the process anyway. The Chron has more.

“Fetal remains” law blocked in court

It’s deja vu all over again.

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

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

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

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

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

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

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

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

Just a reminder, CHIP is still running out

In case you were wondering.

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

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

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

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

[…]

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

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

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

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

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

By the way, CHIP is still running out

Just in case you were wondering.

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

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

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

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

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

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

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

Now is not a good time for HHSC to be dysfunctional

And yet here we are.

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

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

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

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

[…]

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

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

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

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

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

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

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

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

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

State seeks Medicaid money it gave up over Planned Parenthood ban

Ugh.

Right there with them

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

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

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

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

[…]

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

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

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

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

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

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

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

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

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

Because amateurs and zealots do a lousy job.

Right there with them

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Texas cannot bar Planned Parenthood from Medicaid

Good.

Right there with them

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

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

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

[…]

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

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

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

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

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

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

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

Here we go again with Planned Parenthood and Medicaid

Rooting for another injunction.

Right there with them

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

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

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

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

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

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

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

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

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

Back to court for Planned Parenthood

Here we go again.

Right there with them

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

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

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

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

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

[…]

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

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

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

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

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

Right there with them

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

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

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

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

[…]

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

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

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

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

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

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

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

He’s a known liar and grifter.

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

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

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

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

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

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

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

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

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

Auditor asked to investigate Heidi Group health care grant

Good.

Right there with them

Right there with them

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

[…]

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

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

[…]

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

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

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

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

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

Right there with them

Right there with them

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

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

[…]

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

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

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

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

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

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

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

Feds grant 15 month Medicaid waiver extension

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

It's constitutional - deal with it

It’s constitutional – deal with it

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

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

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

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

[…]

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

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

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

[…]

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

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

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

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

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

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

State cuts off funds to Planned Parenthood for HIV testing

Seriously?

Right there with them

Right there with them

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

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

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

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

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

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

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

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

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

[…]

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

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