Author Archives: Sophie Novack

With Trump Cuts, Obamacare Enrollment is a Volunteer Affair in Rural Texas

In a back room of the Smithville Public Library, Ginger Redden passes around a donation jar to the volunteers gathered around the conference table. They take turns dropping coins and a few bills into the container, which is labeled “Lucky Pennies.” It’s November 1, the first day of open enrollment for health insurance through the Affordable Care Act, and all the funding to spread the word in Bastrop County is contained in the jar. So far, they’ve raised just over $100.

The group’s work is a direct response to attempts by President Trump to single-handedly dismantle the Affordable Care Act. After Congress failed to repeal Obamacare this year, Trump cut funding for advertising nationwide by 90 percent, slashed the budget for in-person assistance by 34 percent in Texas and cut the enrollment period in half.

“Ordinary people are doing the government’s job because Trump is trying to sabotage the ACA,” said Redden, a volunteer organizer with Bastrop County Indivisible, which is part of the progressive Indivisible movement that erupted in response to Trump’s election. It’s a job that’s particularly difficult in rural areas of Texas such as Bastrop County, home to 83,000 Texans. Redden and other volunteers are contending with spotty internet, few resources and a community that’s largely misinformed or reticent to utilize Obamacare. Just one location in the county, the Lone Star Circle of Care clinic, has ACA “navigators” who offer free help enrolling in health insurance. “We really have to go low-tech,” said Redden. That means volunteers posting fliers on community bulletin boards as well as in libraries, city hall, health clinics and churches.

“We’re in such a difficult place in Texas because the state doesn’t support people getting enrolled at all, either philosophically or financially,” said Lisa Goodgame, who is president of Indivisible Austin and works on communication for Cover Texas Now, a coalition of advocacy organizations working on boosting insurance coverage around the state.

Texas has the highest uninsured rate in the country, but the state rejected a Medicaid expansion under the ACA that would have covered more than 1 million Texans. Governor Greg Abbott has repeatedly called for the repeal of the health care law.

“Other states might be picking up the slack for missing funds, but Texas is not going to do that,” Goodgame said. “There’s really no money coming from anywhere for this.” The groups are recruiting a small army of volunteers, mostly clustered in cities, to help with ACA outreach.

ACA enrollment fliers  Sophie Novack

ACA enrollment volunteers around Texas are focused on five main messages: The ACA is still alive and well; financial help is available; the enrollment window is from November 1 to December 15; in-person assistance is still available; and everyone needs to shop around for coverage to find the best deal.

“Our biggest challenge right now is that there are so many misconceptions,” said Melissa McChesney, who works on health care policy for the left-leaning Center for Public Policy Priorities, which is part of the Cover Texas Now network. A recent national poll from the Kaiser Family Foundation found that just 15 percent of the uninsured know when open enrollment begins. “There’s a lethal combination of things: People are not sure the law is there; they have only six weeks to enroll; there are not funds or resources to get the word out that the law is still here and affordable for people,” McChesney said.

Simply figuring out where to do outreach has proved challenging. Bastrop County volunteers are targeting high-traffic areas with signs and fliers. At the library meeting, the volunteers celebrate a minor victory — the Walgreens is allowing a stack of fliers at the pharmacy register.

One man suggests asking at the local hospital.  “Quick, while we still have one,” a woman responds.

The Dollar Store? “They’ll shut us out.”

A thrift store run by nearby churches? “I don’t expect to get a yes.”

The advocates wish health insurance wasn’t political, especially since one in every five Bastrop County residents is uninsured, twice the rate of the United States overall. But in the solidly red Texas county where Trump won with 57 percent of the vote, it’s hard to separate Obama’s name from his signature policy. “We go to school, church, work, with people that also see us on the bridge protesting,” said Michelle Rutherford, a volunteer with Bastrop County Indivisible. “We have to be concerned about our safety when we do outreach.”

The group jokes like old friends, but they’ve only just met after the election last year. The volunteers have come out of the woodwork to form a kind of underground progressive community, ready to fight anything the Trump administration throws their way. ACA outreach is just the latest challenge.

“It’s all part of the resistance,” said Robin Rieck, another volunteer. “They try to sink it, we’ll try to save it.”

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Thousands of Poor Texans Could Lose Health Care With Congress Distracted by ACA Repeal

A patient gets her blood pressure checked at the Waco Planned Parenthood.
A patient gets her blood pressure checked.  Jen Reel

Safety net health centers in Texas have been scrambling for attention from Congress as they face a funding cliff Saturday that could leave hundreds of thousands of poor Texans without care. But lawmakers in Washington have been distracted by Republicans’ latest Obamacare repeal bill, which would cut billions in federal funds to states and leave millions more Americans uninsured.

On Tuesday, the GOP repeal bill was declared dead (for now), but the heated, weeks-long debate sucked time and energy from lawmakers and advocates. Now, four days ahead of the funding deadline, lawmakers are preparing to leave for the week without any action on bipartisan legislation to continue a federal grant for community health centers, leaving them in what they say is a dangerous limbo.

Without congressional intervention, safety net providers will face a 70 percent cut to their federal funding beginning October 1 — an estimated $150 million reduction in Texas, according to the Texas Association of Community Health Centers (TACHC). The centers provide primary care to underserved communities and have stepped in to offer care in areas devastated by Hurricane Harvey. More than 1.3 million people — most at or below the poverty level — receive care annually at about 460 sites around Texas, which has the highest uninsured rate in the country. Of those, about 200,000 Texans could lose care if the funding in question is not continued.

The federal grant at issue, established under the Affordable Care Act, primarily funds care for uninsured patients. According to national estimates, allowing the federal grant to expire could lead to a $3.6 billion decrease in funding for centers in fiscal year 2018, the departure of 51,000 doctors and other staff and loss of access to care for 9 million patients.

Action this week is unlikely, but Congress can elect to bring back the funding grant after the September 30 deadline. That would need to happen quickly, though. Centers in Texas have enough funding to continue full operations for an average of about 44 days, according to TACHC. Well ahead of those funds running out, they would need to start preparing for reductions. The longer Congress waits, the greater the uncertainty for the centers, and the more services will be cut, advocates say.

Lawmakers’ procrastination has already taken a toll. Community health centers in Texas have reported that some doctors have elected not to take jobs there because they didn’t know if services would continue, according to TACHC. The organization worries about banks declining loans, staff leaving, infrastructure projects coming to a halt and patients being turned away because of uncertainty, even if the grant is later approved.

“The greatest threat we face is instability … most health centers don’t have enough cash reserve to deal with it,” said José Camacho, executive director of TACHC, adding that it costs health centers about $40,000 to recruit a new doctor, a particular challenge in rural areas. “It’s taken us over 50 years to build the network of services for patients that we have right now. If that’s interrupted or destroyed, it will take years to rebuild. We’ve seen it happen with family planning clinics, and we’ll see it happen as a result of Harvey. It’s not easy to rebuild.”

As the state has cut funding to family planning clinics and kicked Planned Parenthood out of the low-income women’s health program, the centers have seen demand for care increase. Texas’ decision not to expand Medicaid means centers are not getting that revenue from many uninsured patients who otherwise would have been eligible for the coverage, so they rely more on the federal grant. Proposed GOP cuts to Medicaid, and the failure of Congress to reauthorize the Children’s Health Insurance Program (CHIP) by September 30, could add further instability, advocates say.

Ten Texas representatives — seven Democrats and three Republicans — are signed on as co-sponsors of the bill introduced earlier this month to extend health center funding. It was referred to the House Energy and Commerce Committee, but no hearing has been scheduled, and there’s nothing on the House or Senate calendar to address the issue. Texas Republican Joe Barton, of Ennis, is vice chair of the committee, while Lewisville Republican Michael Burgess chairs the health subcommittee and Gene Green, D-Houston, is its ranking member. None has signed on to the legislation.

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Thanks to their State Rep, Friendswood Family Rushes to File Insurance Claim for their Flooded Home

A view of the Emigs’ Friendswood street while the family was rescued by boat during Hurricane Harvey.  Courtesy Courtney Emig

Gerry Emig had just been rescued from the roof of his flooded home in Friendswood when his phone started buzzing. Friends and family were calling and texting, urging him to immediately file an insurance claim for damage from Hurricane Harvey. Submit your claim before a new law starts September 1, they warned, or risk losing out on damages. He’d just escaped his neighborhood by boat with his family. He hadn’t even showered yet.

The floodwaters began to seep into their home at 2 a.m. on Sunday morning. Three hours later, the water had risen several feet, nearly to Emig’s chest. He and his wife, Courtney, grabbed their four children — the youngest just 4 months, the oldest, 6 years — and headed to the attic, where they watched the murky water swallow the home they’d owned for fewer than three years. They feared it would swallow them, too.

Frantic calls to 911 and the National Guard were met with instructions to cut a hole in the roof to escape, and look for boats on the street to rescue them. The family was eventually picked up by Emig’s brother and his friend, and taken to his brother’s home half a mile away.  

Emig filed an insurance claim the following day.

Lawyers have urged Texans whose property suffered hurricane damage to file insurance claims before a new law goes into effect September 1. The measure, attorneys say, will make it harder for individuals to sue their insurance companies for late payments for weather-related damage. The law lowers the interest rate that insurers would be required to pay as penalty, and makes it easier for them to avoid attorney fees. Supporters claim it is necessary to prevent frivolous lawsuits, but critics say it’s a favor to the insurance industry that loosens consumer protections and makes it more difficult to hold companies accountable. And, they say, the timing couldn’t be worse.

The Emig family’s dining room after the flooding from Hurricane Harvey.  Courtesy Gerry Emig

Emig’s home is in Friendswood, a city southeast of Houston that happens to be represented by the new law’s author, Representative Greg Bonnen, a Republican elected in 2012. Bonnen insists that House Bill 1774 doesn’t affect the insurance claims process and only applies in rare cases when a lawsuit is filed. The law does not apply to claims with the National Flood Insurance Program or the Texas Windstorm Insurance Association. The legislation “prevents property owners from being swindled by a select few unethical roofers, public adjusters and lawyers,” he said.

Contrary to social media rumors that flew this week, the majority of Texans with flood damage won’t be affected by the law — which applies to the small percentage of residents who have private flood insurance. Unfortunately for the Emigs, they’re in that small group. Their family managed to buy private coverage last year after a long search for an affordable plan.

Emig considers his family lucky that they have flood insurance at all. An estimated 80 percent of homes with flood damage in the Houston area do not. Emig thinks it’s closer to 90 percent on his block, which was badly hit because of the flooding from Clear Creek and runoff from nearby neighborhoods. “When you step outside, you can tell which people have insurance or not,” he said. “The people who don’t are already pulling the stuff out of their homes and throwing it on their front lawns.”

Knowing that their home could be deemed uninhabitable, Emig said he would have come back to take care of the damage quickly anyway. But concerns about the new law have made an already harrowing experience far worse, Emig said. He’s panicking that despite his requests, he has not been given written documentation that his claim was filed before September 1.  

“It’s already hard to get claims taken care of,” Emig said. “It’s kind of silly that this law is going into effect to give more power to insurance companies. … The thought that our representative would do that is a little scary.”

Emig went back to his house on Thursday to document the damage for his insurance claim.

“It looks like a bomb went off,” Emig told the Observer from inside the home. The couches are in the wrong places and soaked through, he said. The entertainment center in the living room looks like it’s been melted. The ceiling in the kitchen caved in and the room smells like spoiled food. There’s that hole in the roof. Children’s books and drawings, falling apart, cover the floor. A wall in the bedroom is buckling where the washing machine in the garage floated into it.

The Emig family grabbed a few things before their home was underwater: a binder of Social Security cards, an external hard drive full of photos, their daughter’s favorite doll, Emig’s textbooks for the high school math class he teaches. Nearly everything else is ruined, covered in a layer of water, sewage and gasoline that filled their home.

Still, Emig said his family is “tremendously blessed” that they have coverage and a strong support network. “Folks in this area need a lot of help.”

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Texas Bill Would Revoke Medical License of Doctors Who Perform Abortions

Members of the House Freedom Caucus, including Swanson, gather around state Representative Matt Schaefer, R-Tyler, as he defends a controversial amendment to SB 8.  Sam DeGrave

A bill filed in the Texas Legislature’s special session would revoke the licenses of doctors who perform abortions in the state, with limited exceptions.

The measure, filed by far-right Representative Valoree Swanson, R-Spring, would expand the “prohibited practices” that result in a physician’s license being revoked, a category that already includes several abortion-related measures. Under House Bill 86, almost all abortions would be prohibited, with very narrow exceptions for the health of the woman and fetus: when necessary to save the life of the woman or prevent “substantial and irreversible physical impairment of a major bodily function, other than a psychological condition,” or when the procedure is necessary to ensure the viability of another fetus she’s carrying.

State Rep. Valoree Swanson, R-Spring  Facebook/Valoree Swanson

Swanson’s “Texas Physician Abortion Ban” is one of several anti-abortion measures filed for consideration during the 30-day special session called by Governor Greg Abbott, which began Tuesday. Abbott included three anti-abortion measures on his list of 20 must-pass agenda items that failed in the regular session. Swanson’s legislation did not make the list, but critics still fear legislative maneuvers and loopholes could give anti-abortion proposals outside the agenda a chance to pass the Republican-controlled Lege.

At a Texas Tribune event Wednesday, Representative Matt Schaefer, R-Tyler, suggested that the sunset bill extending the operation of the Texas Medical Board “is a great vehicle for pro-life measures,” according to anti-abortion lobbyist Emily Horne.

Swanson’s original bill was the first filed by the freshman lawmaker during the regular session. It did not get a House committee hearing, but Swanson, who did not return requests for comment, is trying again during the special session.

The 85th Legislature has already been among the bleakest for abortion rights. Far-right legislators are no longer claiming their bills are in the interest of “women’s health,” with one House Freedom Caucus member even proposing to make obtaining an abortion a felony.

While that bill failed, lawmakers did pass a sweeping anti-abortion measure requiring the cremation or burial of fetal remains and banning the most common form of second-trimester abortions. The law, known as Senate Bill 8, takes effect September 1 and could send people who tangentially assist women in getting these soon-to-be-illegal abortions to jail. Reproductive-rights advocates are preparing a legal challenge this summer.

Last year, the Supreme Court struck down two major provisions of another sweeping Texas anti-abortion law, known as House Bill 2, which closed more than half the abortion clinics in the state. But the ruling has not deterred Swanson — the sole female member of the Freedom Caucus — or her colleagues, who aim to abolish abortion entirely.

“The time to end abortion is here,” Swanson told Breitbart in January. “As we approach the anniversary of the Supreme Court decision in Roe v. Wade, it is clear from science that the Court erred 44 years ago. While that remains the law of the land at present, Texas should not be in the business of licensing and thus endorsing its practice.”

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How the GOP Health Plan Would Give Governor Abbott Power Over Your Coverage

Governor Greg Abbott
Governor Greg Abbott at the Texas Capitol  Patrick Michels

The Senate Republicans’ health care plan would give governors virtually unchecked discretion over health insurance plans. In red states with governors hostile to health care expansion, such as Texas, that could mean loss of coverage and skyrocketing costs for patients. Governor Greg Abbott would be able to determine what is covered in Texans’ health insurance, and how much they pay.

Nestled near the bottom of the Senate legislation is a provision that would allow governors and state insurance commissioners to waive health insurance requirements without the consent of the state’s legislative body. The bill would require federal officials to approve proposed changes as long as they don’t add to the deficit, even if they would result in price increases or coverage losses for constituents.

“It’s very easy to spend less on health care, you can cut benefits and save a lot of money,” said Stacey Pogue, senior policy analyst at the left-leaning Center for Public Policy Priorities. “It’s kind of shocking the degree to which this waiver includes no insurance standards. The state could submit a waiver without legislative approval, kick millions off their insurance and the federal government would have to approve it.”

These waivers could include allowing insurers to stop covering essential health benefits such as maternity care and emergency services, or getting rid of caps on out-of-pocket costs.

Currently, the Affordable Care Act allows states to apply for a waiver from the federal government to do away with certain provisions of the health care law. The waiver plan must first pass the state legislature and be approved by the governor. Then state officials are required to prove that their plan meets a strict set of criteria: It can’t reduce the insured population, the robustness of the insurance, or its affordability, and it can’t add to the federal deficit. If these standards are met, federal officials may choose to approve the state proposal.

U.S. Capitol  KidTruant/Flickr

The draft Senate bill, called the Better Care Reconciliation Act, states that the federal government shall approve any state waiver requests, and requires only that they not increase the federal deficit.

We’ve already seen what the individual market in Texas looks like absent essential health benefit requirements, Pogue notes. In 2013, before the Obamacare exchanges, not a single insurance plan on the individual marketplace in Texas included maternity coverage. Before the ACA set out-of-pocket maximums ($7,150 this year for an individual plan before subsidies), some of the cheapest policies had $10,000 deductibles and didn’t cover the most expensive services.

The nonpartisan Congressional Budget Office said in a report Monday that most of the people affected by these additional waivers would be in states that limit the health benefits insurers are required to cover. This would lead to lower premiums overall, but coverage for high-cost services like maternity care and mental health care “would become extremely expensive,” CBO said. The waivers could also allow states to use the federal funds for purposes outside health care, the agency notes.

Once the waiver is granted it can’t be taken back for several years, even if there’s evidence that a state egregiously misused its funds. Even if “state officials blow the Obamacare money on cocaine and hookers, there’s apparently nothing the federal government can do about it,” wrote University of Michigan Law School professor Nicholas Bagley.

Texas has the highest uninsured rate in the United States, and Abbott declined a federally funded Medicaid expansion that would have covered 1.1 million more Texans. Nearly 2.5 million Texans could lose their health insurance under the Senate bill by 2026, including about 1.9 million Medicaid enrollees, according to a report from the left-leaning Center for American Progress released Tuesday.

The governor’s office did not respond to a question about what kinds of coverage waivers, if any, Abbott would pursue under the Senate health proposal. Texas is currently without an insurance commissioner, a post appointed by the governor, after David Mattax died in April.

Republican Senate leaders are scrambling to gather support for their health care bill, ahead of a planned vote after the July 4th recess. Texas Senator John Cornyn, who is the majority whip, had been pushing for a quick vote this week, but leadership does not currently have enough votes. Fellow Texas Senator Ted Cruz is part of a small group of Republicans advocating for a more conservative health care bill.

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Who Really Gets Government Benefits In Texas?


Texas already has some of the strictest eligibility requirements of any state for poverty relief programs. More than 4 million Texans live in poverty — about 16 percent of the state’s population — but programs such as Medicaid, the Supplemental Nutrition Assistance Program (better known as food stamps), and Temporary Assistance for Needy Families (aka cash assistance) are all but off-limits to able-bodied, childless adults, even those who are extremely poor.

About 3.4 million of the 4.5 million Texans currently enrolled in Medicaid or the Children’s Health Insurance Program (CHIP) are children, and Medicaid covers more than half of all births in Texas.

The program assisting the poorest, sickest and most needy Texans is facing an estimated $15 billion cut in federal funding over the next 10 years under the U.S. House plan. The proposal, which passed last month, would dramatically restructure the 52-year-old low-income public health program that covers about one-fifth of Americans.

Texas already struggles with the highest uninsured rate in the United States and the highest maternal mortality rate in the developed world.

The U.S. Senate health care bill — known as the Better Care Reconciliation Act and released Thursday — would cap the amount of money the federal government will give states for each enrollee, rather than leaving funding open-ended. Critics say that will likely lead to more limited coverage for fewer people — with kids, pregnant women, seniors, and people with disabilities bearing the brunt of the cuts.

The House plan would reduce federal funding for Medicaid by $834 billion over 10 years, according to the Congressional Budget Office. The nonpartisan agency said it will try to determine the full impact of the Senate bill by early next week, ahead of a possible vote before the July 4 recess.

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How Texas’ Anti-Abortion Lawmakers Win Even While Losing in Court

United States Supreme Court  Phil Roeder

“Why don’t we just stop passing unconstitutional laws?” asked an exasperated Representative Chris Turner, D-Grand Prairie. He spoke in May as the House debated a sweeping new anti-abortion bill that Governor Greg Abbott has since signed into law. Turner didn’t really get an answer to his question and he probably didn’t expect to, but it is an interesting one. So why do anti-abortion lawmakers keep passing unconstitutional laws? One answer is: because it works.

Five hours and 25 amendments after the debate started, what began as a limited set of requirements emerged as Senate Bill 8, an omnibus measure that mandates burdensome clinic regulations and outlaws a safe, common abortion procedure. Abortion-rights advocates and their opponents alike call Texas’ new anti-abortion law the most sweeping since House Bill 2 was passed four years ago. It comes less than one year after the U.S. Supreme Court struck two major provisions from the 2013 law for placing an unconstitutional burden on abortion access. Reproductive-rights attorneys say the state will face a similar lawsuit against SB 8 this summer.

The HB 2 saga left both sides something to claim as a victory. The Supreme Court gave reproductive-rights groups a decisive win, but plenty of damage was already done. HB 2 forced the closure of more than half the state’s abortion clinics, and only three have reopened since. The problem for abortion-rights advocates is that legislation often moves faster than the courts.

The fallout from SB 8 could be similar. “We’re looking at again the possibility of clinic closures and other restrictions that force women to leave the state if they need abortion care,” said Amanda Allen, senior state legislative counsel at the Center for Reproductive Rights, which filed the lawsuit against HB 2 and has pledged to fight SB 8. “In terms of access on the ground, this presents a huge threat to Texas.”

State Representative Donna Howard, D-Austin, speaks against SB 8 Friday evening.  Sam DeGrave

Reproductive-rights attorneys are focused on two provisions that would most restrict abortion access: a requirement that fetal remains be buried or cremated, and a ban on “dismemberment abortions” — a nonmedical term that refers to dilation and evacuation (D&E) abortions, the most common type of second trimester procedure.

Abortion clinics may not be able to find third-party vendors to comply with the funeral-like requirements for fetal tissue disposal, and costs could be prohibitive, attorneys say. Failure to comply could cause more clinic closures. Meanwhile, the D&E ban could effectively prohibit abortions after 13 weeks.

“This is going be another sweeping, sweeping anti-abortion restriction if it takes effect,” Allen told the Observer.  

Those who battled HB 2 take comfort in the fact that both measures have already been successfully challenged in court. In January, a federal judge blocked new Texas regulations that would’ve required burials for fetal remains. And D&E abortion bans have been halted in four other states.

These restrictions are “more of the same” as HB 2, so similar legal arguments can be expected, said Stephanie Toti, the former Center for Reproductive Rights attorney who argued last year’s Supreme Court case.

But if SB 8 plays out the same way as HB 2, that’s bad news for those who favor abortion access. Anti-abortion advocates are prepared for a long fight, and win or lose in court, SB 8 could have lasting consequences.

“I’m not concerned about [a lawsuit] at all. That’s what we need,” said John Seago, legislative director of Texas Right to Life, an anti-abortion advocacy group aligned with the far-right House Freedom Caucus. “The pro-life movement is ultimately set on overturning Roe v. Wade. You have to do that in court.”

Seago wants to push the D&E ban — his priority legislation — all the way to the Supreme Court. He says this would force a conversation centered around protecting the fetus rather than regulating clinics.

“The courts recognize state interests in prohibiting elective abortion that have nothing to do with maternal health, but with protecting unborn life,” he told the Observer, pointing to Gonzales v. Carhart, the 2007 Supreme Court case that upheld the partial-birth abortion ban.

Other anti-abortion advocates favor a more incremental approach. This faction wants to chip away at access with HB 2-like restrictions until the makeup of the Supreme Court changes in their favor.

Joe Pojman  Texas Alliance For Life/Facebook

“It’s very clear now that [Justice Kennedy] will not uphold any state or federal provision that makes abortion less accessible, that’s the unfortunate reality,” said Joe Pojman, executive director of Texas Alliance for Life, an anti-abortion group aligned with House leadership. His group lobbied the Texas Legislature against the D&E ban, saying it would be struck down and the state would again face hefty legal fees.

“Let’s not pass it at this time, but wait until we have more votes on the Supreme Court that understand the U.S. Constitution allows states to regulate abortion,” Pojman told the Observer. “We’re not at that point now.”

The fetal remains requirement was Pojman’s top priority this session. He says it will ultimately withstand a court challenge, even though a federal judge in Austin has ruled otherwise. The U.S. Fifth Circuit Court of Appeals is likely to be more sympathetic than the Austin district court, Pojman said.

“It’s typical modus operandi [for judges in the Western District of Texas] to strike down these laws,” he said. “But the 5th Circuit has done a very good job of overruling them, realizing the state has every basis for passing a law like this.”

“We need to push the case higher,” Seago agreed, his sights set on the Supreme Court.

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Texas’ Maternal Mortality Rate: Worst in Developed World, Shrugged off by Lawmakers

Courtesy/Shawn Thierry

When she got pregnant four years ago, Representative Shawn Thierry knew she was at risk. She was 42 at the time, an age at which women are more likely to face pregnancy complications. “But I certainly didn’t know that I was three times more likely to die by virtue of being African-American,” she said, referencing a disturbing trend revealed in a state report last year.

Thierry nearly died in childbirth. In May, she shared her story for the first time in public at a briefing on reproductive justice for black women. Thierry said she had a severe reaction to a routine epidural. Her heart started racing and she couldn’t breathe. Doctors had to perform an emergency C-section. She and her daughter are healthy but Thierry, a first-term Democrat from Houston, told the audience that  she’s lucky to have had access to high-quality medical care that saved her life. “I would have been one of those statistics,” she said.

Three years later, in 2016, Thierry read with interest a report by a state maternal mortality task force that found that African-American women in Texas are much more likely to die of pregnancy-related causes in the year after birth than white or Hispanic women. That report came on the heels of research showing that Texas’ maternal mortality rate had doubled over a two-year period, and now exceeds that of anywhere else in the developed world.

In the 2017 legislative session, Thierry’s No. 1 priority was legislation requiring more research into why so many new African-American mothers in Texas are dying. But despite bipartisan support, the measure was indiscriminately killed by the far-right House Freedom Caucus last month as part of what came to be known as the “Mother’s Day Massacre.”

Maternal Mortality and Morbidity Task Force

Despite what appears to be an alarming crisis, lawmakers set only modest goals for the session. Most legislation focused on extending research efforts, rather than addressing what the maternal mortality task force has said is the underlying problem: lack of access to health care. Even the calls for more research languished during a legislative session in which trans people’s bathroom use was a top priority. In the end, only two piecemeal bills dealing with maternal mortality passed.

Legislators failed to even extend the task force itself; it’s now set to expire in September 2019. Lieutenant Governor Dan Patrick killed legislation that would’ve continued the research group through 2023 in order to try to force a special session over the so-called bathroom bill and property tax reform. (The task force bill was caught up in a last-minute standoff between the House and Senate. The House added an amendment that would have avoided a special session by continuing critical agencies, including the Texas Medical Board. Patrick balked and the bill never came up for a final vote.)

“Women’s health once again got caught in the political crossfire,” said Thierry.

A bill authored by Senator Borris Miles, D-Houston, to improve reporting of maternal deaths is on its way to the governor’s desk. But the task force now has only two years to use these new protocols, which supporters say is not enough time to finish their work.

Meanwhile, the Legislature barely addressed the lack of access to health care.

Texas has the highest uninsured rate in the United States, yet the state rejected a federally funded expansion of Medicaid that would have covered 1.1 million more Texans. The budget passed by the Legislature again underfunds Medicaid.

More than half of all births in Texas are paid for by Medicaid, but coverage for new mothers ends just 60 days after childbirth. The majority of the 189 maternal deaths the task force looked at from 2011 to 2012 occurred after the 60-day mark.

The task force recommended that lawmakers extend health care access for women on Medicaid from 60 days to one year after childbirth. One bill, from Representative Jessica Farrar, D-Houston, was filed to do so, and it didn’t get a committee hearing  — probably a reflection of how little appetite there is in the Legislature to spend any more money on health care for low-income people. Representative Garnet Coleman, D-Houston, proposed screening and treatment for postpartum depression for mothers whose babies are on Medicaid or the Children’s Health Insurance Program (CHIP) plan. But the cost — $76 million over two years — kept the measure from coming up from a vote on the House floor.

A less ambitious version did pass the Legislature and is awaiting action from Governor Greg Abbott. The proposal, by Sarah Davis, R-West University Place, only offers postpartum screening, not treatment. One-sixth of all new mothers experience postpartum depression, and half of the cases go undiagnosed, according to a recent report.

“To say I’m upset would be an understatement,” said Representative Armando Walle, D-Houston, who wrote the House bill that established the task force in 2013. “I’m disappointed we couldn’t tackle this issue in a much more thoughtful way. We debated bathrooms all night. There are women dying.”

Correction: This story initially reported that no bills were filed to extend Medicaid coverage for new mothers a year after birth. A bill from Representative Jessica Farrar, D-Houston, would have done this, but it did not get a committee hearing. Representative Coleman’s bill would also extend coverage but didn’t get a House vote. 

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