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The GOP Pulls Off the Medicaid Band-Aid. Ouch.

A con­se­quence of last year’s Supreme Court rul­ing that upheld Oba­macare — but allowed states to opt out of the Med­ic­aid expan­sion — is that we would see GOP state gov­er­nors placed in a real dilemma: They could either accept the Med­ic­aid expan­sion and receive bil­lions of dol­lars for their state health care sys­tems from the Fed­eral gov­ern­ment at the risk of enrag­ing their far-right base of sup­port­ers. OR the gov­er­nors could reject the Med­ic­aid expan­sion, leav­ing mil­lions with­out cov­er­age but still being able to say they stood up to that evil social­ist plot to destroy Amer­ica. Deci­sions, deci­sions...:

Talk­ing Points Memo
What The ‘Oba­macare’ Deci­sion Means For Med­ic­aid
Sahil Kapur June 28, 2012, 4:58 PM

In a sur­prise move in its deci­sion to uphold the ‘Oba­macare’ man­date, the Supreme Court declared that states may opt out of the law’s Med­ic­aid expan­sion with­out los­ing all fed­eral funds for the pro­gram.

“In the 47 year his­tory of the pro­gram, there has never been a suc­cess­ful chal­lenge to any of the Med­ic­aid expan­sions, so this was rather unusual,” said Ron Pol­lack, direc­tor of the con­sumer group Fam­i­lies USA.

The deci­sion is expected to at least slow down imple­men­ta­tion of the new Med­ic­aid pro­vi­sions. If states refuse to par­tic­i­pate en masse, it could lead to sig­nif­i­cantly fewer peo­ple than the pro­jected 17 mil­lion being cov­ered under the Med­ic­aid expansion.

The Supreme Court held that the Med­ic­aid expan­sion in itself con­sti­tu­tional. But it essen­tially decreed it a new pro­gram, which means states can­not be pun­ished for turn­ing it down. The court rejected the Obama administration’s argu­ment that states must accept the expan­sion or risk los­ing all fed­eral Med­ic­aid funds.

“The prac­ti­cal effect is that it will make the Med­ic­aid expan­sions go more slowly,” said Sara Rosen­baum, a pro­fes­sor of health law at George Wash­ing­ton Uni­ver­sity. She added that it may be left to future courts to deter­mine which parts of the Med­ic­aid expan­sion count as a new pro­gram and which parts are merely addi­tions to the exist­ing one.

Repub­li­can gov­er­nors will face pres­sure to reject the Med­ic­aid expan­sion or risk being accused by con­ser­v­a­tives of will­ingly embrac­ing a big part of ‘Oba­macare.’ But there’s an incen­tive in the other direc­tion; namely: a huge cash gift from the fed­eral gov­ern­ment, which cov­ers the full cost of the first three years of expansion.


One of the prob­lems with not accept­ing the Med­ic­aid expan­sion is that a key assump­tion behind the cost-cutting in Oba­macare cen­ters around the idea that Med­ic­aid receipts to hos­pi­tals would go down per patient but there would be more peo­ple cov­ered by Med­ic­aid over­all. Hos­pi­tals could make up the lower per-patient rev­enue with higher vol­umes. In the states that don’t expand their Med­ic­aid cov­er­age, how­ever, the hos­pi­tals will still get paid less per Med­ic­aid patient but they won’t get the increased vol­ume of patients due to the increased cov­er­age. So it isn’t just unin­sured poor peo­ple that are in the cross-hairs of this fight. The hos­pi­tals get hurt too, along with their staff and patients. Non-profit hos­pi­tals that serve large num­bers of Med­ic­aid patients will be espe­cially hurt:

Hos­pi­tals Pre­pare to Cut Care in Med­ic­aid Opt-Out States
By Stephanie Armour — May 14, 2013 12:06 PM CT

With 15 U.S. states opt­ing out of Pres­i­dent Barack Obama’s Med­ic­aid expan­sion, hos­pi­tals that treat poor and unin­sured patients are ask­ing the gov­ern­ment to delay $64 bil­lion in planned fund­ing cuts.

Med­ic­aid funds to hos­pi­tals with a dis­pro­por­tion­ate share of low-income patients will be cut 50 per­cent, or $14.1 bil­lion, from fis­cal 2014 through 2019, accord­ing to draft reg­u­la­tions to be pub­lished in the Fed­eral Reg­is­ter tomor­row. The Amer­i­can Hos­pi­tal Asso­ci­a­tion wants to delay by two years the start of the cuts for Med­ic­aid and for $49.9 bil­lion in reduc­tions by Medicare, the health pro­gram for the elderly and disabled.

“They decided not to look at the effect of health care reform,” Tom Nick­els, senior vice pres­i­dent for fed­eral rela­tions in Wash­ing­ton for the hos­pi­tal asso­ci­a­tion, said in a tele­phone inter­view today. “They don’t penal­ize states that have cho­sen not to expand.”

The reduc­tions are man­dated by Pres­i­dent Barack Obama’s Afford­able Care Act, and were sup­posed to be off­set by an increase in the num­ber of patients who would gain insur­ance through an expan­sion of state Med­ic­aid pro­grams. With some Republican-led states decid­ing not to coop­er­ate, a loss of fund­ing with­out a gain in more insured patients would ham­per hos­pi­tals abil­ity to keep car­ing for under­served populations.

“It’s a kick in the gut,” said John Blu­ford, chief exec­u­tive offi­cer of Tru­man Med­ical Cen­ters in Kansas City, Mis­souri, which esti­mates it may lose as much as $150 mil­lion in Med­ic­aid pay­ments over seven years. “These are real dol­lars. It would wipe out our margins.”

Tenet Profit

The rules being cir­cu­lated this week show Med­ic­aid would reduce the so-called DSH pay­ments by $500 mil­lion in the fis­cal 2014 year start­ing in Octo­ber. For 2015, $600 mil­lion more would be cut with the annual reduc­tions reach­ing $5.6 bil­lion in 2019.

For the first two years, the fund­ing cuts won’t be based on whether states have opted to expand Med­ic­aid. Tenet Health­care Corp. (THC), the third-largest for-profit hos­pi­tal chain in the U.S., esti­mated in Feb­ru­ary the Med­ic­aid and Medicare cuts would cost it $35 mil­lion in gov­ern­ment pay­ments in the fourth quar­ter. Dallas-based Tenet has 26 per­cent of its beds in Florida and 20 per­cent in Texas, both states where the Repub­li­can gov­er­nors have opted not to expand Medicaid.

HCA Hold­ings Inc. (HCA), the largest for-profit U.S. hos­pi­tal chain, has 25 per­cent of its beds in Texas and 25 per­cent in Florida, accord­ing to said Brian Tan­quilut, an ana­lyst at Jef­feries LLC in Los Angeles.

Sav­ing Grace

For-profit hos­pi­tals like Tenet are unlikely to pass along the costs of the cuts to con­sumers in the way of rais­ing rates to non-government pay­ers, Tan­quilut said. “They’ll eat it.”

Cuts in the Medicare DSH pay­ments also will be off­set by a sep­a­rate April 26 reg­u­la­tory pro­posal that would lead to a 0.8 per­cent net raise in over­all Medicare pay­ments for ser­vices that elderly and dis­abled patients get after being admit­ted to hos­pi­tals, Tan­quilut said by telephone.

The over­all Medicare rate — which includes the Medicare cuts to hos­pi­tals that treat a large num­ber of low-income patients — should keep HCA’s earn­ings before inter­est, taxes and amor­ti­za­tion expenses within its Feb­ru­ary 2013 guid­ance, R. Mil­ton John­son, pres­i­dent and chief finan­cial offi­cer, said on an April con­fer­ence call with investors.

The sav­ing grace for for-profit hos­pi­tals, Tan­quilut said, is that the Afford­able Care Act will bring finan­cial ben­e­fits that non­profit and pub­lic hos­pi­tals like Tru­man Med­ical won’t see. Large, urban hos­pi­tals that pro­vide the biggest share of char­ity care and treat more Med­ic­aid patients are most at risk, Moody’s Investors Ser­vice Inc. said in a March 14 report.

Tight Bind

With only about one-fifth of their patients hav­ing com­mer­cial insur­ance, these safety-net hos­pi­tals typ­i­cally have profit mar­gins of about 2.3 per­cent, a third of the indus­try­wide aver­age for all hos­pi­tals, accord­ing to 2010 data from the National Asso­ci­a­tion of Pub­lic Hos­pi­tals and Health Sys­tems. Los­ing Med­ic­aid fund­ing and not gain­ing more insured patients would swing that mar­gin from a profit to a loss of 6.1 percent.

Hos­pi­tals may try to recoup losses by lim­it­ing the amount of care they pro­vide to the unin­sured or reduc­ing staff, John Graves, an assis­tant pro­fes­sor at the Van­der­bilt Uni­ver­sity School of Med­i­cine in Nashville, Ten­nessee, said by telephone.

“They’re in a tight bind,” Graves said. “They have to recoup those losses through fewer ser­vices, shut­ting down.”


Death By A Thou­sand Cuts Indi­rect Hostage-Taking

To the sur­prise of many, the Obama admin­is­tra­tion called for a delay in the Med­ic­aid cuts for states that opt-out of the expan­sion. So are the hos­pi­tals out of the dan­ger zone? Well....another pre­dictable con­se­quence of all this is that, given the choice to expand health­care cov­er­age for poor peo­ple vs stick­ing it to Obama, stick­ing it to Obama was going to be a clear win­ner in a lot of states. What wasn’t obvi­ous, how­ever, was that the GOP might be will­ing to shut down the Fed­eral gov­ern­ment in order to stop Obamacare’s imple­men­ta­tion. Granted, they were most likely going to threaten to shut down the gov­ern­ment over some­thing, but lim­it­ing health­care access to poor peo­ple was never the obvi­ous play from the GOP’s play­book:

Talk­ing Points Memo
Con­ser­v­a­tives Step Up Push To Under­cut GOP On Oba­macare
Sahil Kapur Sep­tem­ber 13, 2013, 6:00 PM

Oba­macare is becom­ing a huge headache for the Repub­li­can Party.

Con­ser­v­a­tive advo­cacy groups are ral­ly­ing behind House leg­is­la­tion backed by 43 Repub­li­cans to threaten a gov­ern­ment shut­down unless Oba­macare is defunded, under­cut­ting GOP lead­ers’ efforts to lock in low spend­ing lev­els by goad­ing the party into a self-defeating confrontation.

Within 24 hours of its Thurs­day release, Sen. Mike Lee (R-UT) threw his sup­port behind the bill, as did the well-funded groups Club For Growth, Free­dom­Works and Her­itage Action.

“The Club for Growth strongly sup­ports the leg­is­la­tion offered by Con­gress­man Tom Graves to save Amer­ica from Oba­macare,” said Chris Chocola, the group’s pres­i­dent, boast­ing that “momen­tum is build­ing” to stop the health care reform law.

House GOP lead­ers, who have few votes to spare, are deter­mined to pass their pro­posal to con­tinue spend­ing at seques­tra­tion lev­els and force a Sen­ate vote to defund Oba­macare with­out risk­ing a shut­down. House lead­er­ship is open to tweak­ing the specifics but they want to achieve three goals: con­tinue the sequester, give Sen­ate Repub­li­cans a chance to fight Oba­macare and main­tain lever­age against the health care going into the debt limit fight. The 43 Repub­li­cans behind the Graves bill haven’t implic­itly com­mit­ted to oppos­ing lead­ers’ version.


Con­ser­v­a­tives, mean­while, are under­cut­ting — and infu­ri­at­ing — Repub­li­can lead­ers who want to be prag­matic about what they can achieve in the con­tin­u­ing res­o­lu­tion. Democ­rats, they rec­og­nize, are vul­ner­a­ble on spend­ing lev­els but won’t cave on Oba­macare. As a result, if the hard right’s desires get in the way of reaf­firm­ing seques­tra­tion cuts (even tem­porar­ily), the GOP may lose on all fronts. Vet­eran Repub­li­cans real­ize the party out of power will be blamed if the gov­ern­ment shuts down, and their nego­ti­at­ing hand weak­ened over how much it should spend upon re-opening.

The con­ser­v­a­tive oppo­si­tion to Oba­macare has become unap­peasable and it’s tear­ing the GOP apart. The base is anx­ious to make a stand now because imple­men­ta­tion of the law is set to accel­er­ate on Oct. 1 and its major com­po­nents poised to take effect on Jan. 1. Advo­cates pri­vately gloat about their chances of stick­ing it to GOP lead­ers as they mobi­lize in favor of a stand­off. Stare down Pres­i­dent Barack Obama until he blinks on his own sig­na­ture achieve­ment, they demand of the GOP, even if it means shut­ting down the gov­ern­ment. But Repub­li­can lead­ers aren’t opti­mistic that he’ll blink, and worry that ini­ti­at­ing this bat­tle could dam­age their already weak brand and threaten their oth­er­wise secure House majority.

The House GOP lead­er­ship pro­posal entails a two-pronged bill to fund the gov­ern­ment until Dec. 15 at seques­tra­tion lev­els and force the Sen­ate to vote on defund­ing Oba­macare. The Sen­ate can reject the Oba­macare com­po­nent, as is expected, and send the rest of the con­tin­u­ing res­o­lu­tion straight to the president’s desk.

Repub­li­can lead­ers ten­ta­tively plan on bring­ing up a stop­gap mea­sure next week, and aides main­tain an air of con­fi­dence about suc­cess. They face a tough road to secur­ing the votes for just about any bill to keep the gov­ern­ment open. Will they succeed?

“That remains to be seen,” said a House GOP lead­er­ship aide.

The lat­est pro­posal by House Major­ity Whip Eric Can­tor to threaten a default on the US debt in place of a gov­ern­ment shut­down threat is another very non-obvious play for the GOP to call at this point. It’s not actu­ally all that out of char­ac­ter for the GOP, but threat­en­ing to default on the national debt unless we all agree to keep lim­it­ing health care to the poor isn’t the obvi­ous best move for the GOP in this sit­u­a­tion. Every­one is used to a lit­tle zealotry for the GOP at this point but this just might be another over­reach:

Can­tor: If We Can’t Defund Oba­macare, Let’s Delay It
Sahil Kapur Sep­tem­ber 12, 2013, 10:40 AM

In order to per­suade con­ser­v­a­tives law­mak­ers to vote to keep the fed­eral gov­ern­ment funded past Sept. 30, House Repub­li­can lead­ers are propos­ing to stare down Pres­i­dent Barack Obama over the debt ceil­ing by seek­ing a one-year delay of Obamacare.

At a closed-door meet­ing Tues­day, House Major­ity Leader Eric Can­tor (R-VA) floated a strat­egy to delay the roll­out of Oba­macare for one year in exchange for lift­ing the debt ceil­ing. The meet­ing was focused on pitch­ing a plan that lets Repub­li­cans vote to defund Oba­macare with­out risk­ing a gov­ern­ment shut­down if the Sen­ate rejects the idea, a move that is meet­ing fierce resis­tance on their right flank, which wants to go further.

A senior Repub­li­can aide famil­iar with Cantor’s remarks said he was essen­tially try­ing to per­suade his mem­bers that the debt limit, which the fed­eral gov­ern­ment is expected to hit in mid-October, pro­vides a bet­ter oppor­tu­nity than a threat­ened gov­ern­ment shut­down to under­mine Obamacare.

“He didn’t draw any red lines,” said the GOP aide. “He said it’s a bet­ter oppor­tu­nity than [the con­tin­u­ing res­o­lu­tion] and a delay there is very doable.” The aide added that the con­ces­sion wouldn’t nec­es­sar­ily just involve Oba­macare; there could be other reforms. The aide admit­ted that it depends in part on what the pres­i­dent is will­ing to give up.

It all sounds far-fetched. After all, trad­ing a gov­ern­ment shut­down for default would be like trad­ing a com­mon cold for can­cer. And it remains to be seen whether GOP lead­ers would let the econ­omy col­lapse if they don’t get their way, or if they’re merely say­ing what they have to say to get through the shut­down crisis.

An upside to propos­ing the debt ceil­ing idea now is that it helps per­suade Repub­li­can law­mak­ers not to with­hold their sup­port for keep­ing the gov­ern­ment open. Cantor’s sug­ges­tion this week comes as Repub­li­cans are tak­ing heavy fire from con­ser­v­a­tive advo­cates for refrain­ing from risk­ing a gov­ern­ment shut­down over Oba­macare. House lead­ers have post­poned con­sid­er­a­tion of the con­tin­u­ing res­o­lu­tion until next week to build support.

Last month, Speaker John Boehner (R-OH) floated the idea of delay­ing or defund­ing the health care reform law in a debt ceil­ing pack­age. But he, too, stopped short of draw­ing any red lines. A lead­er­ship aide described it at the time as an “option.”

Despite the anti-Obamacare frenzy con­sum­ing their right flank, Repub­li­can lead­ers rec­og­nize that both a shut­down and default would be a dis­as­ter for their party, poten­tially threat­en­ing their House major­ity ahead of a mid-term elec­tion when they hope to win back the Sen­ate. Their bal­anc­ing act to sat­isfy con­ser­v­a­tives enough to avert a shut­down but not to cre­ate expec­ta­tions that threat­en­ing debt default is the way to go.


Then again, maybe this isn’t over­reach at all that we’re look­ing at. Maybe it’s really an incred­i­bly sneaky plan to simul­ta­ne­ously limit access to health­care for peo­ple (a core value held by much of the con­tem­po­rary GOP base) AND blame it all on Oba­macare. At least in some states...states that don’t accept the Med­ic­aid expan­sion. Because by threat­en­ing to shut­down the gov­ern­ment or default­ing on the debt over their oppo­si­tion to Oba­macare the GOP is still going to destroy the finances of hos­pi­tals in the states that refuse to accept the Med­ic­aid expan­sion. That’s because that delay in the Med­ic­aid cuts that the Obama admin­is­tra­tion agreed to in May can’t actu­ally be imple­mented until Con­gress passes a bud­get. Now all they have to do is ensure that the pub­lic blames all the hos­pi­tal clo­sures and health­care prob­lems that results from these cuts on Oba­macare and not the per­pet­ual bud­get and health­care war­fare waged by the GOP which shouldn’t be too hard to do. If this wasn’t an acci­dent, it was kind of bril­liant. Except for the part about how the GOP has to explain shut­ting down the gov­ern­ment or default­ing on the national debt. So it’s pos­si­ble that the GOP is oper­at­ing in “Mad Dog” mode right now, and given the larger debt bat­tles that are swirling around this issue, this is poten­tially a much scarier story about polit­i­cally and ideologically-driven attempts to restrict health care to poor peo­ple than sto­ries about polit­i­cally and ideologically-driven attempts to restrict health care to poor peo­ple nor­mally are:

With­out New Bud­get, HHS Final­izes $1.1 Bil­lion in Med­ic­aid Hos­pi­tal Cuts
Dylan Scott 4:58 PM EDT, Fri­day Sep­tem­ber 13, 2013

Because a grid­locked Con­gress won’t be pass­ing a new bud­get any­time soon, the U.S. Depart­ment of Health and Human Ser­vices final­ized a rule Fri­day for $1.1 bil­lion in Med­ic­aid cuts to hos­pi­tals under the Afford­able Care Act, cuts that could hit hos­pi­tals par­tic­u­larly hard in states that don’t expand Med­ic­aid through the law.

Pres­i­dent Obama pro­posed post­pon­ing the cuts one year in his FY 2014 bud­get because not every state is expand­ing Med­ic­aid as orig­i­nally planned. The cuts, which are to pay­ments for hos­pi­tals that per­form a lot of uncom­pen­sated care, were included in Oba­macare because the law would cover more peo­ple, decreas­ing the over­all amount of uncom­pen­sated care.

The president’s pro­posal reflected the real­ity that 20-plus states have refused to expand Med­ic­aid cov­er­age under the health care reform law. If the cuts went into effect, hos­pi­tals in those non-expanding states would receive smaller reim­burse­ments from HHS with­out the com­pen­satory expan­sion of cov­er­age.

But with­out a new bud­get from Con­gress, HHS wasn’t able to imple­ment the president’s proposal.

“HHS has no flex­i­bil­ity to insti­tute a delay of the DSH allot­ment reduc­tions with­out con­gres­sional action,” the rule released Fri­day said.


For those gov­er­nors that still fear a dystopian world free of unin­sured poor peo­ple It might worth remind­ing them that there would still unin­sured peo­ple left in their states even if they accept it. It’s a long shot, but it just might work.


52 comments for “The GOP Pulls Off the Medicaid Band-Aid. Ouch.”

  1. House­keep­ing Note: Com­ments 1–50 avail­able here.

    Posted by Pterrafractyl | December 25, 2015, 3:38 pm
  2. Check out the gift Texas’s health offi­cials deliv­ered to peo­ple of Texas just in time for Christ­mas: more HIV:

    Texas Tri­bune
    Texas Drops Planned Par­ent­hood From HIV Pre­ven­tion Program

    by Alexa Ura Dec. 22, 2015

    Editor’s note: This story has been updated throughout.

    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.


    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.

    Through the grant, which Planned Par­ent­hood Gulf Coast has received since 1988, the orga­ni­za­tion served indi­vid­u­als with HIV in five coun­ties in the Hous­ton area. Since 2014, the grant has funded more than 138,000 HIV tests and helped in iden­ti­fy­ing 1,182 peo­ple with HIV, accord­ing to Planned Par­ent­hood Gulf Coast. No other Planned Par­ent­hood affil­i­ate is cur­rently a recip­i­ent of the grant.

    “I don’t know who else is going to fill that gap, and I don’t know if any­one can, frankly,” said Rochelle Tafolla, a spokes­woman for Planned Par­ent­hood Gulf Coast. “Every time the state cuts these pro­grams in an attempt to score polit­i­cal points ... the true vic­tims here are tens of thou­sands of women and men who no longer have access to health care that they need.”

    It’s unclear whether the state will real­lo­cate the funds to a dif­fer­ent provider in the area. A health depart­ment spokesman on Tues­day said the state was “work­ing with local health depart­ments in the area to con­tinue to pro­vide these services.”

    The state’s move to end the HIV pre­ven­tion fund­ing is the lat­est in its ongo­ing efforts to cut off tax­payer fund­ing to Planned Par­ent­hood. It comes two months after Texas Repub­li­can lead­ers announced they would kick Planned Par­ent­hood out of Med­ic­aid, the joint federal-state insurer of the poor.

    That action was spurred by the release of under­cover videos of Planned Par­ent­hood offi­cials pur­port­edly show­ing that the orga­ni­za­tion improp­erly har­vested aborted fetal tis­sue for researchers — a claim the group has vehe­mently denied.

    While the group’s abor­tion ser­vices are sep­a­rate from its health care pro­grams, the flare-up pro­pelled Repub­li­can lead­ers to call for defund­ing Planned Par­ent­hood entirely, includ­ing the $3.1 mil­lion it receives through Med­ic­aid in Texas to help low-income women access fam­ily plan­ning and well-woman services.

    In mov­ing to cut the organization’s Med­ic­aid fund­ing, the state also cited unspec­i­fied alle­ga­tions of Med­ic­aid fraud. But despite its claims that it had proof of mis­con­duct, state health offi­cials have yet to deliver the final legal notice to defund the organization.

    This year, law­mak­ers also wrote a pro­vi­sion into the bud­get pro­hibit­ing clin­ics affil­i­ated with abor­tion providers from par­tic­i­pat­ing in the joint state-federal Breast and Cer­vi­cal Can­cer Ser­vices pro­gram, which pro­vides can­cer screen­ings for poor, unin­sured women in Texas.

    “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.“
    Well, pro­po­nents of more HIV are cer­tainly going to be able to ring in a happy new year in Texas.

    So how merry should the pro-HIV crowd be this Christ­mas over the news? Well, for that, we can take a look at what hap­pened in Austin. Not Austin, Texas. Austin, Indi­ana:

    Two Years After Shut­ting Down Planned Par­ent­hood, Here’s What Hap­pened to HIV in Indiana

    By Jon Levine April 01, 2015
    Like Mic on Facebook:

    March was not a good month for Indi­ana. With all the atten­tion on the fall­out over the con­tro­ver­sial pas­sage of the Reli­gious Free­dom Restora­tion Act (RFRA), you might have over­looked that the state is cur­rently fight­ing the worst HIV out­break in its his­tory. By the end of March, dozens of new cases had been reported in the small city of Austin, Indi­ana.

    But if you do have HIV in Austin, you may not even know it — Scott County, where the city is located, has been with­out an HIV test­ing facil­ity since 2013. The epi­demic, largely caused by ram­pant use of intra­venous drugs, prompted Indi­ana Gov­er­nor Mike Pence to reverse his ear­lier oppo­si­tion to nee­dle exchange programs.

    The county’s pre­vi­ous sole provider, a Planned Par­ent­hood, shut­tered in 2013. The Scott County Planned Par­ent­hood, along with four oth­ers that have shut down in the state since 2011, were all vic­tims of pub­lic health spend­ing cuts.

    Planned Par­ent­hood has been under attack in Indi­ana for years as part of a larger casu­alty in the strug­gle over abor­tion rights in the U.S. In 2013, the state leg­is­la­ture passed a law that expanded the def­i­n­i­tion of “abor­tion clinic” in an attempt to shut down a facil­ity in Lafayette. The facil­ity handed out the pill mifepri­s­tone, which allowed women to ter­mi­nate preg­nan­cies with­out surgery. A fed­eral judge ulti­mately threw the law out. In another effort in 2011, for­mer gov­er­nor Mitch Daniels, attempted to cut state fund­ing completely.

    Although the Scott County facil­ity had not pro­vided abor­tions, con­ser­v­a­tive zealots were aim­ing to dis­man­tle any­thing that was asso­ci­ated with the prac­tice. Shut­ting down Planned Par­ent­hood is a casu­alty in a larger war against health­care that’s had unex­pected con­se­quences by remov­ing the var­i­ous other life-saving ser­vices the clinic offered besides abortion.

    Indiana’s bone-headed approach to pub­lic health is only the lat­est chap­ter in a much larger story of how pol­i­tics often trumps sci­ence and leads to dis­as­trous consequences.

    We’ve seen this before. When HIV first broke into America’s pub­lic con­scious­ness in 1981, it was largely writ­ten off as a “gay dis­ease,” and trag­i­cally not given the atten­tion it should mer­ited at the time. Accord­ing to his own biog­ra­pher, Lou Can­non, Pres­i­dent Ronald Reagan’s response was “halt­ing and inef­fec­tive.”

    By the time Rea­gan first men­tioned the word “AIDS” pub­licly in 1985, thou­sands had already died. The polit­i­cal slug­gish­ness largely reflected the bent of his own polit­i­cal base. Gay men, who were among the disease’s first suf­fer­ers, were (and remain) roundly con­demned by evan­gel­i­cal con­ser­v­a­tives like Pat Rober­son and the late Jerry Fal­well, who often decried pub­lic inter­ven­tion by argu­ing that the virus came from God as pun­ish­ment for sin­ful behavior.


    While reli­gious free­dom is cer­tainly an impor­tant cor­ner­stone of Amer­ica, as a nation, the U.S. must find a bal­ance between accom­mo­dat­ing reli­gious prac­tice and good science.

    By not under­stand­ing the work of places like Planned Par­ent­hood and going after any­thing even remotely pro-choice, con­ser­v­a­tives are inad­ver­tently remov­ing the health ser­vices so many oth­ers rely on, like HIV test­ing. And with­out that, the prob­lems in Indi­ana are only going to get worse.

    “By not under­stand­ing the work of places like Planned Par­ent­hood and going after any­thing even remotely pro-choice, con­ser­v­a­tives are inad­ver­tently remov­ing the health ser­vices so many oth­ers rely on, like HIV test­ing. And with­out that, the prob­lems in Indi­ana are only going to get worse.”

    Yep, it must be a very merry Christ­mas this year for the pro-HIV crowd in Texas.

    Posted by Pterrafractyl | December 25, 2015, 3:40 pm

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