Monitoring Biden and other Contemporary Events

They Say They Are Attacking Abortion. They Are Really Hurting the Poor.

For people who live in poverty in America, getting medical care is never easy. In Texas, health care for the poor is particularly challenging: Medicaid rules are among the most stringent in the country. A family of four with two parents must earn less than $285 per month to qualify. And for those who do receive Medicaid, finding a provider can present even greater challenges. It’s about to get worse.

For the past several years, Texas politicians have worked to cut off Medicaid recipients’ access to the wide range of services offered by Planned Parenthood. Now, barring an extension of a state district court’s temporary block on their efforts, they may have gotten their way.

Gov. Greg Abbott, a Republican, and like-minded state officials targeted Planned Parenthood because it offers abortion services. But abortion services account for just a fraction of the care we provide, which means the consequences of a new policy would be far more sweeping.

If it goes into effect, this policy would block patients’ access to blood pressure checks, cancer screenings, birth control, S.T.D. treatment and other medical care routinely provided at Planned Parenthood health centers in Texas, where I serve as a medical director for primary care. Nationally these other essential services, not abortion care, account for 96 percent of Planned Parenthood’s patient visits; in Texas, for example, some 24,000 Medicaid patients received non-abortion care over the past four years.

Already, federal Medicaid funds cannot be used for abortion care. The 1976 Hyde Amendment banned federal funding for abortions, except in cases of life endangerment, rape or incest. But most states allow patients with Medicaid to use their coverage to get other essential care at our health centers.

Republicans in Texas have been trying to cut Planned Parenthood from its Medicaid program for several years. In February 2017, a federal judge temporarily blocked these efforts, but last November, the U.S. Court of Appeals for the Fifth Circuit reversed the lower court’s ruling. A temporary stay of that decision has left our patients in limbo, not knowing whether they will lose access to our services. Though the final decision has been postponed once more due to Texas’ sudden blackout calamity, the concern still looms.

I’ve seen up close patients’ struggles to get medical care and the harms that result from lack of access. A woman I care for stopped taking her medication for hypertension after losing her insurance coverage; her blood pressure spiked to life-threatening levels and rendered her ineligible for a needed surgery.

Another one of my patients needs monthly monitoring for a rare precancerous condition. Until this month, Medicaid covered the cost of her monthly testing with us; under this policy, she would be forced to try to find another doctor.

That’s not as easy as it sounds. Larger cities, like the one where I practice, have plenty of other medical providers. However, Texas’ Medicaid program pays less than most private insurance. Surveyed in 2016, some 55 percent of primary care providers said they would not accept Medicaid patients in their practice. As a result, what should be a straightforward process of finding a new provider is all but impossible for a patient with Medicaid coverage.

When I told my patient that Texas would no longer allow her to use Medicaid to pay for her cancer screenings with us, she was shocked and angry that the medical care she was counting on was suddenly off limits.

One way to avoid this problem would be for Texas to expand Medicaid under the Affordable Care Act. If it did, some 1.4 million uninsured Texans would finally have medical care within reach. Yet Texas, along with 12 other states, still refuses to do so. It would save thousands of lives, primarily in communities of color. Medicaid expansion would also protect low-income Texans from financially catastrophic medical bills after hospitalizations for medical complications — many of which could have been prevented if they had insurance. For example, one of my patients has epilepsy. Because she is uninsured and can’t afford her preventive medications, she continues to have life-threatening seizures that often land her in the hospital.

States’ denials of health care coverage, including Texas’ refusal to expand Medicaid, contributed to 461,000 excess deaths in 2018 that would have been averted if the United States had kept up with other wealthy countries, a tragedy documented in a report by my colleagues and me published this month in The Lancet. As we detailed in that paper, Texas’ Medicaid restrictions mirror broader public health failures under the Trump administration, including its handling of the Covid-19 pandemic. We found that the prior administration’s inept response led to Covid-19 death rates that are 40 percent higher than those of other wealthy countries, with the heaviest burden falling on people of color.

Texas isn’t the only state to try to keep public funds from Planned Parenthood — and it’s our poorest patients who suffer as a result. President Biden has vowed to stop states from such nakedly political attacks on health care providers that also offer abortions, such as Planned Parenthood. But short of timely new federal action, I’m worried my Medicaid patients will have lost a critical source of health care after the next hearing on the issue.

Ideologically driven attacks on health care access have extremely harmful real-world consequences. In these difficult times, we need to make medical care more available, not less.

The sad part is even on a thread about Biden we can only talk Trump. He's completely distorted our country.

ere in Dallas, my family and I have intermittently been without power for three days. On Monday night, the coldest night on record in three decades, we were without power for 12 long hours. I pitched a tent in my children’s bedroom, and all of us—Mom, Dad, three kids, Scout the dog—huddled together for warmth under sleeping bags and heavy blankets.

Most houses in Texas are poorly insulated, to put it mildly. Poor Scout’s water bowl in the kitchen froze solid overnight. Indeed, when power was restored for a few hours on Tuesday morning, my wife and I scrambled to unfreeze any pipes that had seized up in spite of the fact that we had left the faucets dripping. At one point, my wife—a tough woman, and a water and sanitation engineer by training—climbed under the house and thawed out a pipe with a blow-dryer.

We have been, we must admit, very lucky. Each night, as we have said our prayers, we have thanked God for the many blessings that have been bestowed upon us. As has been apparent since the start of this emergency, the worst effects of this storm have been visited upon the most vulnerable. I shudder to think about the ways in which the poor, the homeless, and the elderly have suffered in this crisis.

Major cities across the state have opened “warming centers,” and churches and schools have opened their doors, but when the roads are so treacherous, one wonders how the vulnerable are supposed to reach shelter. The entirety of North Texas has just 30 snowplows—or about as many as you would expect to see deployed in a single neighborhood in Chicago.

The biggest story for Texans, however, is the failure of our state’s electrical grid, managed by the inaccurately named Electric Reliability Council of Texas, or ERCOT. Texas, as part of its regular and continuing efforts to distance itself from federal oversight, maintains its own electrical grid—unique in the nation—which has been overwhelmed by the storm’s effects.

You might be surprised to learn that Texas is the Saudi Arabia of wind energy, and that wind turbines in the panhandle generate much of our power. Many of those turbines have failed in the low temperatures, and conservatives both in Texas and across the country have gleefully claimed as a result that renewables cannot be trusted to provide power in emergencies. There is, as ever, a very small grain of truth to that.

But the data—forever inconvenient to those looking to confirm their priors—suggest the failure goes well beyond renewables. If anything, wind and solar have overperformed in this crisis relative to fossil fuels, and to natural-gas-fired generation in particular. The irony of Texas—the natural-gas capital of the Western Hemisphere, where technological advances in hydraulic fracturing have remade the world’s energy map over the past decade—failing to generate enough natural-gas-fired power is lost on none of the state’s 29 million citizens.

Well, almost none of its 29 million citizens.

There is a certain kind of conservative politician here in Texas who spends a sizable part of his day obsessing about the state of California. Such politicians have spent much of the past few years mercilessly teasing the progressive leadership of California for the failures of the state’s power grid.

These politicians have been, for the most part, conspicuously quiet since the crisis began here. The state’s governor, Greg Abbott, has mostly popped up on reliably friendly media outlets—local news stations, the evening shows on Fox News—where he knows he will not face hard questions.

But hard questions will be asked, because the failures of ERCOT ultimately belong to the leaders of a state who insisted that, by design, the buck must stop with them and not with the federal government. “The ERCOT grid has collapsed in exactly the same manner as the old Soviet Union,” one expert told the Houston Chronicle. “It limped along on underinvestment and neglect until it finally broke under predictable circumstances.”

Fixing ERCOT will require actual governance, as opposed to performative governance, and that is something the state’s leadership has struggled with of late. Rather than address the challenges associated with rapid growth, the state’s elected leaders have preferred to focus on various lib-owning initiatives such as the menace of transgender athletes, whether or not NBA games feature the national anthem, and—in a triumph of a certain brand of contemporary “conservatism”—legislating how local municipalities can allocate their own funds.

I’m anxious to see how our governor, in particular, will respond to this crisis, because I have never witnessed a more cowardly politician. When Abbott faces a challenge—and he has faced several in the past year alone—you can always depend on him to take the shape of water, forever finding the path of least resistance. I have no idea why the man became a politician, as I can discern no animating motive behind his acts beyond just staying in office.

During the coronavirus pandemic, which has taken the lives of 41,000 Texans so far, the governor first delegated as much responsibility—and political risk—as possible to the state’s mayors and county judges. When those same local officials decided that things like mask mandates and restaurant closures might be good ideas, which became unpopular with the governor’s donors, he overruled them. But when deaths spiked, Abbot decided that—surprise!—local leaders had retained the power to enforce mask mandates all along and that it was their fault for not solving his coronavirus riddle.

I am anxious to see how the governor weasels his way out of responsibility for what happens next. I wouldn’t want to be Texas’s new speaker of the House, Dade Phelan, to whom the governor will likely attempt to shift all the blame.

In the meantime, Texans, being Texans, are not waiting for politicians to solve their most immediate problems. Neighbors who might have fallen out during the Great Yard Sign Wars of 2020 are shoveling one another’s driveways, sharing power from their generators, and opening their homes to those less fortunate. We have all had a good laugh at the gloriously unhinged Facebook post by the now-former mayor of Colorado City, Texas, who—writing as if he were one of the first Anglo-Texan frontiersmen—told Texans to fend for themselves. “Only the strong will survive,” he thundered, “and the weak will parish [sic].”

That’s the spirit.

Yesterday, in fact, my heavily pregnant co-worker—whose own home never lost power—offered to drive by my darkened house with food for my children. I told her to stay off the roads for her own safety, but as I write this, she is in labor at a local hospital. By the time you read this, her daughter may already have been born.

What a welcome to Texas she is receiving.

The legislation faces an uphill climb in a narrowly divided Congress, where House Speaker Nancy Pelosi has just a five-vote margin and Senate Democrats do not have the 60 Democratic votes needed to pass the measure with just their party's support.

Action needs to be taken but it is probably too late.

All we've seen, is her slap happy attempts to impeach your president.

He was impeached - twice!