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The Latest Planned Parenthood Dustup

Why Texas may have a hard time removing Planned Parenthood from Medicaid.

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AP Photo | San Angelo Standard-Times, Patrick Dove

You probably saw the latest headlines about Planned Parenthood. On Monday, Texas health officials—applauded by Governor Greg Abbott—announced that they’re seeking to exclude Planned Parenthood from the state’s Medicaid program.

The state sent notice of termination letters to the major Planned Parenthood affiliates in the state, writing that the group will soon be barred from providing women’s health services under Medicaid. The move follows the release of undercover videos made by an anti-abortion group, which accuses Planned Parenthood of selling aborted fetuses. (If that last sentence didn’t make much sense to you, I strongly suggest reading Dan Solomon’s post from yesterday that explains how exactly we got to this point.)

The news led groups on both sides of the abortion debate to launch a volley of press releases—and probably more than a few fundraising emails.

But despite all the bluster, there’s good reason to believe that Texas will have a tough time actually booting Planned Parenthood out of Medicaid. In fact, the deeper you delve into this issue, the more the whole thing looks like political grandstanding.

Consider the following facts:

1. This isn’t about abortion.

OK, it’s kind of about abortion. The political context is all about the decades-long struggle over abortion rights and more recently about the secret videos of Planned Parenthood staffers and clinics.

But the issue of whether Texas can cut Planned Parenthood out of Medicaid isn’t really about abortion, because Medicaid money doesn’t pay for elective abortions—no taxpayer money does. Planned Parenthood keeps its abortion facilities separate, physically and financially, from family-planning services and cancer screenings paid for by Medicaid; patients seeking abortions go to clinics that are separate from where Medicaid recipients receive care.

So Texas must center its argument not on abortion or the recent videos, but on whether Planned Parenthood clinics are competent providers of services to people on Medicaid. That’s mostly because….

2. Texas can’t arbitrarily kick Planned Parenthood out of Medicaid.

Texas’s elected leaders may not like Planned Parenthood, but they can’t cut the group off for no reason. Federal law states that any willing and competent provider should be eligible to serve Medicaid patients. The government can’t pick and choose based on political favoritism.

Louisiana is trying to expel Planned Parenthood from Medicaid based largely on the recent anti-abortion videos, and the feds are having none of it. In a court filing, federal officials wrote that Louisiana was attacking Planned Parenthood for “reasons unrelated to the ability of that provider to perform Medicaid covered services or to properly bill for those services.” And that Louisiana’s effort wasn’t just at odds with the law, but is “not even a plausible reading of the statute.”

Doesn’t sound promising for Bobby Jindal.

The lesson is that Texas will need some good reasons. It must show that Planned Parenthood—after many years of adequate care—doesn’t competently provide women’s health services. And Texas officials probably won’t make the final call because…

3. The feds have leverage.

Texas administers its Medicaid program, but the federal government, which puts up about 60 percent of the money overall, has final say.

The notices of termination that the state sent on Monday laid out a process for removing the Planned Parenthood from Medicaid. But federal health officials will eventually get involved.

At that point, Texas will have to prove that Planned Parenthood has engaged in wrongdoing so serious that it can no longer remain in the program.

And the feds hold the ultimate sledgehammer: If they determine that Texas is violating Medicaid law, they could withdraw all federal matching funds for Medicaid from the state. How much is that? Try more than $17 billion per year.

That’s obviously the nuclear option, but it does mean if officials with the federal Centers for Medicare and Medicaid Services determine that Texas can’t legally kick out Planned Parenthood, then Texas must fall in line—or lose all its federal Medicaid money.

In fact, a somewhat similar scenario played out a few years ago, when Texas banned Planned Parenthood from one small piece of Medicaid—called the Women’s Health Program. The feds objected, arguing that Texas couldn’t arbitrarily kick a provider out of the program. Texas did it anyway, and the feds made good on their threat by ending federal matching funds for that sliver of Medicaid. In that instance, it wasn’t that much money—relatively speaking—about $40 million. Texas made up the money with state dollars, and went on its merry way without Planned Parenthood in the Women’s Health Program.

But Texas can’t go it alone this time. There’s too much money at stake. We don’t have $17 billion lying around—not without tax increases. Nor can Texas feasibly just forego the money. If you’re wondering why, state lawmakers actually studied the possibility back in 2010 and the results were ugly. If it withdrew from Medicaid, Texas would lose billions in economic stimulus, with devastating effects on doctors and hospitals. Not to mention the loss of health coverage for millions. Medicaid pays for about two-thirds of nursing home residents in Texas and more than half of the births.

Losing federal Medicaid dollars would be a political and economic disaster. That ain’t happening. (And if it does, we’ve got much bigger problems to deal with.) So the state really doesn’t have much leverage here.

If this effort is going to be anything more than political posturing, Texas must present some legitimate evidence of wrongdoing against the Planned Parenthood affiliates in Texas. But then there’s the issue that…

4. Based on what we know, the state’s case seems a little thin.

This one comes with a major caveat: We don’t know exactly what evidence the state possesses. The letters reference “reliable information indicating a pattern of illegal billing practices by Planned Parenthood affiliates across the State.” And that may well be. If state officials have uncovered evidence of widespread Medicaid fraud at Planned Parenthood clinics, then Texas may well succeed in cutting the organizations out of the program—and deservedly so.

But the specifics offered by the state so far don’t exactly blow you away. In their letters to Planned Parenthood, Texas officials contend that the organization is “no longer capable of performing medical services in a professionally competent, safe, legal, and ethical manner.”

The allegations center on Planned Parenthood Gulf Coast (PPGC), based in Houston, just one of the major Planned Parenthood affiliates in the state. (There are no specific allegations in the letters against other groups, such as Planned Parenthood of Greater Texas, which serves D-FW, Austin and Waco, or Planned Parenthood South Texas. They’re apparently guilty by association.)

The state contends that PPGC has engaged in Medicaid fraud. These allegations largely stem from a 2009 whistleblower suit by a former clinic worker who accused PPGC of fraudulent billing. PPGC settled the case in 2013, though admitted no wrongdoing. The Texas Attorney General’s office—headed at the time by one Greg Abbott—announced that the case was closed.

So the state’s argument—at least as laid out in the letters of termination—is based on six-year-old allegations against one Planned Parenthood affiliate—a case the Texas AG’s office closed more than two years ago. That seems kind of thin.

Is that enough to convince federal health officials or a federal court that a major provider of health services to thousands of Texas women should be booted from Medicaid? State officials seemingly will have a tough time winning that argument— unless they’ve obtained some new, damning evidence of widespread fraud by Planned Parenthood. In other words, the fate of Planned Parenthood in Medicaid will be decided on the merits, not the politics.

Meanwhile, everyone can continue to grandstand, and fire off fundraising appeals.

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  • Rules of Blazon

    Greg Abbott is a disgusting misogynist.

  • Indiana Pearl

    All hat and no cattle as usual from the Texas GOP.

    • wessexmom

      No balls is a more accurate and specific description. I hope the federal government DOES threaten to withdraw ALL Medicaid money from the entire state. Then we’ll see how long the GOP’s He-Man-Woman-Haters (and Federal-Government-Haters) Club in Austin is willing to play chicken when 17 BILLION DOLLARS and MILLIONS of VOTES are at stake!!! Yee-Haw.

  • dave in texas

    If this effort is going to be anything more than political posturing…

    hahahahahahahahaha

  • WUSRPH
  • nickthap

    The Texas GOP opposes anything having to do with public health. They’ve shown it time and time again, from the inaction after the West fertilizer plant explosion, to guns on the UT campus, to attempts at undercutting workers comp protections. The thing is, I’ve NEVER understood why the concept of “public health” is a “librul” value only. It’s weird how conservatives have allowed themselves to get boxed in on this issue.

    • dave in texas

      It’s weird, but it is the logical end point to the line of thinking that says anything done collectively by the people as a whole, i.e., anything done by government, is automatically suspect. The very notion of the common good is under attack in this country from a radical faction of right-wingers. It just baffles me.

    • Jim

      You are right in that true conservatives oppose all government health programs, but wrong in saying that all Republicans do. We are for public health, but that doesn’t mean what you think it means.

      • Unwound

        OK what does it mean then

        • Jim

          Public health means good health for the general public. Liberals have redefined it to be about the government providing something. …which never works well.

          • houstonrahoyt

            Well Jim, how do you feel about the US military? That’s government run, right? We have by far the most expensive phamaceuticals in the world gouging the infirm and elderly run solely by private industry. Never is a big word to toss around but go ahead and keep spewing your nonsense – don’t bother letting reality get in the way.

          • Jim

            I’m consistent, I have a problem with the centralization of military power. It is hard to fix because it is an international issue and other countries have centralized military too.

            Pharmaceutical prices are high due to government regulations increasing the costs and the cost of research and development that is born by US companies. If you want cheaper prices, then cut regulations and push free trade to allow companies in other countries to undercut prices.

          • nickthap

            You do know who instituted that policy, don’t you?

          • Unwound

            totally right. we need more freedom for human test subjects

          • nickthap

            No Jim “liberals” have not “redefined it” that way. Your own argument about drug prices is comically contradictory.

  • Jay Trainor

    Dan Patrick, Greg Abbott, Charles Schwertner et al are all hat and no cattle…. They pander to the far right without regard to what’s good for all Texans.

  • Jim

    Planned Parenthood rarely has a physical separation between their birth control business and their surgical abortion business. Most of the time, they use the same building and the same address with the same entrance for both. Financially, they argue that they keep things separate, but we all know that money is fungible.

    • houstonrahoyt

      We all do? You seen their books? I kinda doubt that. You seem to say whatever to suit your position. Notice I didn’t say argument because that implies at least an attempt at logical substantiation.

    • Tim Otheus

      Well now when did you last buy a burger somewhere? The person who served you may just go have an abortion with the money you paid for your burger. Now what?

  • Indiana Pearl

    More unwanted pregnancies . . . only a half-wit could think that’s a good idea for Texas.

    • John Johnson

      Unwanted pregnancies? Why do we have them? Busted condoms? Faulty diaphragms? Bad pills? Nope, it is all about irresponsibility. Nothing else. How about saying, “OK, young man and young woman, if you are party to a pregnancy and plan on aborting, we will take one of your kidneys for the national donor program. The day before it is announced, I suggest you go invest in companies producing rubbers.

      • Unwound

        Yeah that plan won’t fly.

        • John Johnson

          You thought I was serious???

          • Unwound

            Par for the course compared to some of your other comments.

          • John Johnson

            Well, you are right in one respect…I really like the idea…just know it would never be implemented.

      • Tim Otheus

        Well, so every road accident is also “all about irresponsibility.” If you wreck your car, John, I suggest you just be condemned to walk everywhere. And let’s take away your drivers license too.

        • Indiana Pearl

          It also has to do with punishing women who get pregnant, but not the male.

          • John Johnson

            life is not fair. If you know you are going to bare the brunt, I would suggest you need to protect yourself that much harder. How difficult is that to understand? Wish you were a man? Think you have been cheated?

          • Indiana Pearl

            This comment isn’t rational. No solutions. You’re getting as bad as Booksie.

          • John Johnson

            No…it is just not rational to YOU. The solution is not giving it up without birth control protection. Pretty simple unless you are drunk, drugged or lack self control. There are exceptions like force and product failure, but these are few. It’s all about personal responsibility and the consequences that often come with poor decisions. Your group wants to enable instead of pushing for change.

        • John Johnson

          So glad you brought that up, Tim. If the government requires you to put on a seatbelt, maybe they should require you to put on a rubber.

  • John Johnson

    The nonchalant butchering of viable fetuses changed my mind about PP funding. I am sure I am not the only one. This is not my war on women; it is my feeling that a beating heart signifies life and the planned stopping of that heart is murder. To murder and then dismember is heinous and despicable. Pretty cut and dried in my opinion. Want to abort a baby, do it…I just don’t want any of my money going to pay for it.

    • Unwound

      None of it is, unless you fund an abortion or donate.

    • houstonrahoyt

      You sure don’t read much. This very article tells you that none of your money does pay for it. So then you’re OK with PP as is.

      • John Johnson

        How naive. We give $ to PP, who is performing abortions. They say our $ is not being used for abortions. Well to insure it’s not, take it away. Then the $ that is going towards abortions might have to be spent on non abortion functions.

        • Dave Mann

          Medicaid is a fee-for-service program. So Planned Parenthood provides an approved service, then bills Medicaid. PP receives specific payment for specific service provided to a specific qualified patient. And if you’ve followed the debate over Medicaid reimbursement rates, you know they are very low—no real margin there.

          The only way government money could be paying for abortions is if PP is committing egregious Medicaid fraud. That’s the whole point of this investigation. As I wrote above, if PP is committing fraud, they deserve to be kicked out.

          But failing that, It’s not really possible for Medicaid money to pay for elective abortions in Texas (besides exemptions spelled out in federal law: rape/incest and when life of mother is endangered).

          • John Johnson

            I appreciate your dedication to the cause and your naive acceptance of how PP gets and uses their funding. We are talking about the federal government here, Dave.

          • Dave Mann

            I’m not sure to which cause you’re referring. I was simply pointing out a factual flaw in your argument. If PP is using Medicaid money for abortions, then it’s violating the law. And if that’s the case, we’ll soon know about it because the state is thoroughly examining PP”s medicaid claims.

    • Tim Otheus

      That you see it as “nonchalant” shows how wrong you are. And there are many instances of “a beating heart” that are not people. Do you really mean to tell me that you would FORCE your own mother to provide for you a biological “hookup” for nine months, against her will, just because you needed it to survive? Would you force her to donate a kidney too? Of course you would do it “nonchalantly” I suppose.

      • John Johnson

        You must have missed the videos, Tim. In the one I watched, the woman talked about fetal butchering techniques as if she were talking about cutting up a chicken. I think “nonchalant” fits perfectly.

        • Tim Otheus

          It’s probably in the part that Carly Fiorina was talking about in the GOP debate.

          • John Johnson

            Have no idea what she watched and listened to. I watched one on social media and TV.

  • Indiana Pearl

    Every time access to reproductive health education and care is removed from a community, more unwanted pregnancies occur. This is a no-brainer.

    Rich women can afford the best of care. Poor women cannot.

    Texans pay one way or the other for forced birthing – increased TANF expenses, ER health care costs, Medicaid costs. This is also a no-brainer.

    This proposed legislation is simple pandering to pro-life Texans.

    • Tim Otheus

      And those “pro life Texans” have abortions too. But the doctors and nurses who see it happening can’t say anything because of privacy.

      • Indiana Pearl

        And they have the money to do so. Rich women get abortions. Poor women have unwanted offspring.

  • Stop me if you heard this one, a democrat lawyer lied….

    “A federal grand jury in Mississippi has indicted nationally recognized plaintiff’s lawyer and Democratic stalwart Mikal Watts of San Antonio, his brother and contract employees on charges of making false claims and identity theft in relation to the litigation involving BP over the 2010 oil spill in the Gulf of Mexico, the San Antonio Express-News has confirmed.

    The charges stem from allegations that Watts fraudulently bolstered the number of clients he had with claims against BP to get a seat on a steering committee, an elite group of lawyers appointed to manage the plaintiff’s side of the litigation.”

    http://www.mysanantonio.com/news/local/article/Democratic-San-Antonio-stalwart-Mikal-Watts-6581929.php

    I suspect democrats will give him an award for this, as in “wow did you see how much he looted?”

    I post this for one reason, does anyone believe PP when they say they don’t use tax dollars for abortions? How about when they say they don’t sell baby parts for profit? of course not.

  • Indiana Pearl

    Another edition of the JBB Right Wing Looney Tunes Newsletter . . .

  • Tim Otheus

    Look it up. Texas has already been prohibiting participation in the Women’s Health Program to any providers that “perform abortions or affiliate with an entity that performs or promotes elective abortions.” Where have the feds been all this time? Standing by and letting it happen.

    • Dave Mann

      That doesn’t square with the record. The feds had a huge fight with Texas over the Women’s Health Program. CMS refused to renew the program unless Texas included Planned Parenthood (at the time, the Women’s Health Program was a Medicaid waiver that was up for renewal). The feds determined that Texas had no justification for excluding PP. Texas wouldn’t budge, and the feds didn’t renew the program (which came with a 9-to-1 federal match).

      Now, the Women’s Health Program has nothing to do with Medicaid or the feds. it’s entirely state funded. Texas pays for it and can do what it wants. But to your question, the feds didn’t stand by. To the contrary, they took clear action and stood their ground.

      http://www.texasobserver.org/behind-the-headlines-the-real-story-of-the-womens-health-program/

      The difference this time is that while Texas could go it alone on the $40 million Women’s Health Program, it can’t go it alone on the $17 billion federal tab for Medicaid.

      • Indiana Pearl

        Some Texans promote secession. Lost cause . . .

      • Tim Otheus

        Didn’t know that. Thanks. Too bad the feds couldn’t find a way to take away the $17 billion back when TX decided to do that. Shows how “fiscally responsible” TX is when it spends $40 million just to carry on its religious political antiabortion extremism.

      • Tim Otheus

        Reading the law … even provider’s “affiliated” with any group that supports abortion are prohibited from participating in the WHP. So a large group of doctors/clinics would be banned if one of their members were, say, a registered Democrat!

  • 6660splendidday

    12/1/15 Senate GOP Planning How They’re Going To Repeal Obamacare — Again
    http://crooksandliars.com/2015/11/senate-gop-planning-how-theyre-going?utm_source=Crooks+and+Liars+Daily+Newsletter&utm_campaign=1b2796726b-RSS_EMAIL_CAMPAIGN&utm_medium=email&utm_term=0_d4904be7
    Citizens of Texas… SPEAK UP. LOUD & CLEAR. Do you want to live or die?