News Health Systems

Louisiana Governor Moves Forward With Hospital Privatization Plan Without Federal Agency’s Approval

Teddy Wilson

Gov. Bobby Jindal’s administration is moving forward with a plan to privatize some of Louisiana’s state-run hospitals, despite the Centers for Medicare and Medicaid Services rejecting the use of federal funds that would have provided a significant source of financing for the plan.

Louisiana Gov. Bobby Jindal’s administration is moving forward with a plan to privatize some of Louisiana’s state-run hospitals, despite the Centers for Medicare and Medicaid Services (CMS) rejecting the use of federal funds that would have provided a significant source of financing for the plan.

The six hospitals within the LSU Health Care Services Division (HCSD) that are being privatized under Jindal’s plan include hospitals in Baton Rouge, Bogalusa, Houma, Lafayette, Lake Charles, and New Orleans. 

Because Jindal did not wait for federal approval before shifting the management of the hospitals, the source of the funding of the plan, a reported $1.1 billion this budget year, is currently uncertain.

The state is appealing the CMS decision and, reports say, working to negotiate alternative financing in order to move forward with the plans. In a letter to the CMS, state Commissioner of Administration Kristy Nichols urged the agency to expedite the process. “I cannot emphasize enough the importance of settling on an alternative structure as quickly as possible so that the improvements that are underway in Louisiana as a result of the public-private partnerships can continue,” wrote Nichols. 

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Jindal, who this year has already been struggling to deal with a $1 billion budget gap, is facing criticism for how he has managed the plan to privatize the hospitals. “Gov. Bobby Jindal’s reckless pursuit of using federal Medicaid funds in an ill-conceived scheme to privatize state-run hospitals has backfired, and now the people of Louisiana will pay a dear price,” said state Rep. Robert Johnson (D-Marksville), according to The Town Talk.

Even after questions were raised by State Treasurer John Kennedy about whether or not CMS would approve the plan, Nichols made assurances that the plan was sound. “We have researched this very carefully. We went through a very exhaustive review,” Nichols told The Advocate.

Nichols told lawmakers in the the house and senate budget committees that the rejection will not have implications for the state budget until August or September of 2015, reports the Associated Press. A former health department official, Jerry Phillips, told lawmakers that appealing the CMS decision would take a minimum of six months.

Issues surrounding the privatization plan were discussed by lawmakers during a hearing related to the closure of a hospital not involved in the privatization plan. The House Health and Welfare Committee voted Tuesday to close the Huey P. Long Medical Center in Pineville. Rep. Johnson reportedly lobbied legislators to vote against the closure, which passed the committee by a 10-8 vote, citing concerns about the committee’s integrity. “If we are casting a vote, I think we have a right to know what we are voting on,” he said.

News Abortion

GOP Fact-Check: Hospital Transfers Don’t Signal Abortion Dangers

Christine Grimaldi

Hospital transfers are not necessarily a cause for alarm, multiple sources told Rewire.

Rep. Marsha Blackburn (R-TN) justified her recent subpoenas of a prominent later abortion provider and first responders in the community where he works by pointing to “public reports” that people who sought abortion care from the doctor required hospital transfers.

Hospital transfers are not necessarily a cause for alarm, multiple sources told Rewire. In fact, the rare instances signal a continued commitment to appropriate patient care that begins in an abortion clinic. A patient may not require further treatment upon arrival at the hospital, indicating a proactive clinic rather than a dangerous one. Regardless of the circumstances, anti-choice activists often hijack so-called emergencies to fuel their coverage of the alleged dangers of abortion care.

Freestanding clinics manage most immediate abortion-related complications, including those that occur during later abortions, said Dr. Daniel Grossman, a provider and professor in the department of obstetrics, gynecology, and reproductive services at the University of California, San Francisco.

Abortion-related complications are rare throughout all stages of pregnancy. The even rarer event that such complications necessitate a hospital transfer doesn’t indicate the work of a bad abortion provider, Grossman explained in an interview with Rewire.

“There are sometimes things that happen that are unforeseeable,” he said.

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Evidence Contradicts Blackburn Subpoena Claims

Grossman, his University of California, San Francisco colleague Dr. Ushma Upadhyay, and other reproductive health care practitioners and policy experts studied just how often those unforeseeable instances occur in a review of nearly 55,000 abortions covered under the fee-for-service California Medicaid program from 2009-2010. The state data allowed researchers to track subsequent follow-up care sought after an abortion.

Among all abortions, about one of 5,491, or 0.03 percent, involved ambulance transfers to emergency departments on the day of the procedure, the researchers found.

For procedures in the second trimester or later, major complications that required hospital admissions, blood transfusions, or surgery amounted to 34 cases, or 0.41 percent.

Many hospitals don’t provide abortions, which essentially forces providers to perform the procedure at a freestanding clinic or turn away patients, Grossman said. Providers would not do something unsafe, he stressed, “but that puts a lot of pressure on them because they don’t have that option of deciding to do the procedure of a higher-risk patient in a hospital.”

States that have enacted targeted regulations of abortion providers, known as TRAP laws, may force providers to gain hospital admitting privileges, even though hospitals can’t refuse to care for transfers and emergency arrivals. Many hospitals don’t want to issue admitting privileges to abortion providers, Grossman said, in part because their patient admissions are so infrequent—putting the onus back on clinics to provide abortion care.

Data supports Grossman’s assessment about abortion and clinic safety. Abortion care is one of the safest medical procedures performed in the United States, according to Planned Parenthood and the American Congress of Obstetricians and Gynecologists. “The rate of complications increases as a woman’s pregnancy continues, but these complications remain very unlikely,” the groups said in a joint fact sheet.

Blackburn, the chair of the U.S. House of Representatives’ Select Investigative Panel on Infant Lives, framed such instances differently when she shifted the panel’s focus from fetal tissue research practices to later abortion care, issuing subpoenas in mid-May to Dr. LeRoy Carhart and various local and state entities in Maryland.

“Public reports indicate at least five women have been sent to the hospital since December while seeking an abortion in this clinic,” Blackburn said in a press release. Blackburn expressed concern for “the sake of the women who have been rushed from that clinic to the hospital with increasing frequency.”

Blackburn Allegations Rooted in Dubious Sources

Blackburn’s press release cited the five hospital transfers since December 2015, but her subpoenas demand documentation dating back to 2010—signaling a deeper scope to her investigation.

The National Abortion Federation (NAF), the professional association of abortion providers, countered Blackburn’s basis for the subpoenas.

“Abortion opponents have been targeting Dr. Carhart for years because he is a very vocal and visible abortion provider,” NAF spokesperson Melissa Fowler told Rewire in an email. Following the 2009 murder of Dr. George Tiller, Carhart arguably became the country’s most prominent provider of later abortion care.

The Maryland Board of Physicians, one of the targets of Blackburn’s subpoenas, indicates that Carhart is in good standing. The board’s online practitioner profile system lists no Maryland disciplinary actions, no pending charges, and no reported malpractice judgments and arbitration awards within the past ten years. Malpractice settlements are another measure of provider competence, and Carhart hasn’t had three or more malpractice settlements of at least $150,000 in the past five years, according to the system. Additionally, the courts have not reported “convictions for any crime involving moral turpitude,” which the board defines as “conduct evidencing moral baseness” and determines on an individual basis under common law.  

Absent allegations on the board’s website, the “public reports” smearing Carhart appear to come from anti-choice news outlets. In March, LifeSiteNews.com cited eyewitness accounts from anti-choice activists in reporting that Carhart sent a fourth woman to the hospital in four months. A leader of the radical anti-choice group Operation Rescue covered the same allegations for LifeNews.com.

The same website in 2013 alleged that the Washington Post downplayed the death of a young woman who sought a later abortion at the clinic. However, the Maryland medical examiner’s office found that the woman died of natural causes from a rare complication that can also occur in conjunction with childbirth, and state health officials found “no deficiencies” in the care she received at the clinic. Blackburn’s subpoenas include Adventist HealthCare Shady Grove Medical Center, formerly Shady Grove Adventist Hospital, where the woman died.

Anti-choice organizations and their reports have played a prominent role in the current congressional inquiry. Troy Newman, Operation Rescue’s president, and David Daleiden founded the Center for Medical Progress (CMP), the anti-choice front group that triggered the select panel’s investigation into allegations that Planned Parenthood profited from fetal tissue donations obtained from abortions.

Blackburn referenced CMP’s heavily edited videos in her threat “to pursue all means necessary” to obtain documents from StemExpress, the tissue procurement company that worked with Planned Parenthood. The GOP’s exhibits at the panel’s April hearing on fetal tissue “pricing” reportedly duplicated or nearly duplicated the “evidence” in the CMP attack videos.

Blackburn’s select panel spokesperson denied that the subpoenas are based on information from anti-choice sources.

“The subpoenas we issued are not based on the sources you have cited,” the spokesperson told Rewire in an email. “However, due to confidentiality agreements, we are not at liberty to disclose the identities of our sources.”

Anti-Choice Activists Hijack Emergencies

Although Blackburn’s evidence may come from different sources, the fact remains that Operation Rescue and other radical anti-choice activists are known for surveilling abortion clinics and making repeated records requests, all to report similar claims about botched abortions necessitating hospital transfers.

duVergne Gaines, director of the Feminist Majority Foundation’s National Clinic Access Project, said surveillance tactics enable anti-choice activists not only to photograph and video emergency responders, but also follow up with Freedom of Information Act and equivalent state-level requests for records, including 9-1-1 tapes, if state laws permit their release.

“They collect data,” Gaines said in an interview. “They put that up on the websites themselves, on their own Facebook pages, and have no real knowledge about what or why an ambulance may have been contacted.”

Hospital transfers in some instances have nothing to do with the procedure. Contrary to initial anti-choice accounts, the Lincoln, Nebraska Journal Star reported that a woman transferred in 2015 from a local Planned Parenthood to a hospital “wasn’t suffering complications from an abortion, but had instead sought help at the clinic after being assaulted at her home nearby.”

At times, anti-choice activists may manufacture emergency scenarios, Gaines said. “The most obvious example is alleging that a minor is inside being forced to undergo a procedure against her will, and that can happen if they see a minor go in [to a clinic],” she said.

Rewire reported in March that police appeared at a Mississippi clinic and threatened to charge a single mother with fetal homicide after her daughter, a minor seeking a legal abortion, signed a bogus Life Dynamics document stating that she was being coerced into the procedure.

The prominent anti-choice group uses the document to deceive and intimidate patients and providers by threatening legal action should they go through with obtaining or providing abortion care.

NAF President Vicki Saporta said that many of her group’s members have experienced anti-choice tactics such as staking out clinics for emergency vehicles, placing calls to summon emergency responders, and trailing ambulances to hospitals with the aim of gathering confidential patient information. Preferred tactics depend on the local anti-choice community, she said.

Saporta pointed to a crisis pregnancy center that opened in the same complex as the Germantown, Maryland, clinic where Carhart practices. A Germantown Pregnancy Choices, which comes up as the Maryland Coalition for Life when entered into Google Maps, operates within less than 200 feet of the clinic. The Maryland Coalition for Life cited eyewitness accounts and a video in March to support allegations that an underage girl required a hospital transfer “due to medical emergencies related to a late term abortion.”

Anti-choice activists targeting clinics over safety share a common denominator. “Once their bogus claims are investigated, for the most part, no action is taken because nothing is actionable,” Saporta said.

Analysis Politics

Florida Governor Race Pits Candidates With Notorious Records on Choice

Nina Liss-Schultz

As Democrats struggle to take back the heavily Republican-dominated state legislature, reproductive rights and health-care access are sure to play out as central issues for both Republican Gov. Rick Scott and his likely opponent Charlie Crist.

In 2010, Republican Rick Scott won the governor’s seat in Florida after beating his opponent Alex Sink by a narrow margin of 62,000 votes. Since then, Scott and the Sunshine State have made the news for illegal voter purges, the killing of Trayvon Martin under the state’s “stand your ground” law, the refusal to expand Medicaid and implement the Affordable Care Act, several pieces of anti-choice legislation, and more executions than any other first-term governor in Florida’s modern history.

This November, Scott will likely face off against an unlikely candidate: former governor of Florida and Republican-turned-Independent-turned-Democratic contender Charlie Crist. Though the Florida primaries are in August, both sides agree that Nan Rich, a Democratic contender and former state senator, has little chance of beating Crist to the election in November. As Democrats struggle to take back the heavily Republican-dominated legislature, reproductive rights and health-care access are sure to play out as central issues for both candidates.

Reproductive Rights

Since taking office in 2011, a slew of anti-choice legislation has made its way to Scott’s desk. According to Lillian Tamayo, chair of the Florida Planned Parenthood PAC, 30 pieces of anti-choice legislation were introduced during Scott’s first term, four of which the governor signed into law.

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In June, Scott, a venture capitalist and former chief executive of the largest private for-profit health-care company in the United States, signed a bill that harshened the state’s existing later abortion ban, prompting some backlash from women within the state’s Republican Party. Along with narrowing the exceptions under which a woman can get an abortion after 24 weeks of pregnancy, the bill, HB 1047, also bans abortion at any point during the pregnancy if a doctor deems the fetus viable.

Pro-choice advocates say that Gov. Scott’s stance on abortion is more conservative than most Republicans’ in the state, and that he’ll pay for his far-right stance in the election. “Gov. Scott is so out of step, even with his own party,” said Tamayo, who pointed to the dissenting positions of state Republicans on several abortion bills Scott has signed into law.

In 2011, the Florida legislature passed a bill mandating that an ultrasound be given to a woman prior to her abortion. Several Republican senators spoke out against the legislation, including Sen. Nancy Detert (R-Venice), who said it insulted her. “I personally resent writing legislation that acts like I’m too stupid to confer with my own doctor on what I should do,” she said in a statement. Scott signed the bill into law, and it became effective in July of that year.

In 2013, Scott signed into law the so-called Infants Born Alive Act, which “provides that an infant born alive during or immediately after an attempted abortion is entitled to the same rights, powers, and privileges as any other child born alive.” As Rewire has reported, laws like the one signed by Scott rest on a myth: “[T]here is no evidence of a pattern of infants being ‘born alive’ after an abortion, much less of doctors killing infants in those circumstances.”

Tamayo says that the conservative legislature is out of touch with the views of Floridians, who in 2012 soundly defeated an anti-choice ballot initiative, Amendment 6, which would have prohibited the use of public funds for abortion. According to Tamayo, more Floridians voted against Amendment 6 than voted for president that year, evidence that Scott and the Republican legislature “pretending to be physicians” won’t gain them public support this election.

Crist, who was attorney general at the time of his eventually successful 2006 bid for the governor’s mansion, has a long and fraught history in Florida politics. Having first served in the state senate from 1993 to 1999, Crist lost his seat during the 1998 midterms. After regaining his position in Florida politics as attorney general from 2003 to 2007 and then governor, Crist made a run for U.S. Senate in 2010. After initially coming up short in the polls, Crist ran as an Independent, but eventually lost to young Tea Party Republican Marco Rubio. In December 2012, Crist announced via Twitter that he was joining the Democratic Party.

Crist’s action on abortion while governor was varied, changing, and convoluted. According to PolitiFact, throughout his career in Florida politics, “Crist has been all over the map on abortion.”

While running for governor in 2006 as the Republican candidate, Crist told reporters on the campaign trail that he would sign a ban on abortion except in cases of rape, incest, or medical emergencies. Later that year he clarified, “I’m pro-life. I don’t know how else to say it. I’m pro-life, pro-family, pro-business, pro-Republican.”

Almost ten years later, Crist’s current campaign for governor of the nation’s biggest swing state, this time as a Democrat, sends a different message about a woman’s right to choose. “Charlie believes that government should stay out of personal health decisions between a woman and her doctor,” according to Crist’s campaign website.

Political scientists and policy analysts say that Crist’s changing stance on issues like abortion might hurt him during the election. Sean Foreman, a political science professor at Barry University, told Rewire that “voters are sophisticated enough to know that candidates’ positions evolve, but when you seem to have a full-scale transformation over a short period of time, it will lead some to question Crist’s motives and if he stands for any principles.”

Medicaid and the Affordable Care Act

Florida is one of 24 states that have not expanded Medicaid under the Affordable Care Act, and one of 21 states where lawmakers aren’t planning to anytime soon. According to the White House, nearly 850,000 Floridians will remain uninsured because of the legislature’s failure to expand Medicaid. Families USA, a non-partisan research and advocacy organization, estimates that the number is likely to be even higher, noting that nearly 1.8 million Floridians will remain uninsured without Medicaid expansion.

By and large, poor Americans and people of color are most affected when states like Florida opt out of Medicaid expansion. According to the Kaiser Health Foundation, people of color are more likely to be uninsured than white Americans (the uninsured rate is 27 percent and 15 percent, respectively), with Hispanic Americans representing the most uninsured population in the United States (33 percent). The group estimates, however, that Black Americans will be most affected by lawmakers’ decisions not to expand Medicaid. “Four in ten uninsured Blacks with incomes low enough to quality for the Medicaid expansion fall into the gap, compared to 24 percent of uninsured Hispanics and 29 percent of uninsured Whites,” it found.

Before Rick Scott ran for governor, he was a leading Obamacare opponent. In 2009, the former hospital executive founded the group Conservatives for Patients’ Rights, an organization with $20 million behind it that’s designed specifically to oppose the Affordable Care Act. According to a Washington Post profile of the organization, Scott used $5 million of his own money to fund the group.

When the Supreme Court held in 2012 that Medicaid expansion, along with several other provisions of the health-care law, are optional for states, Scott announced that he would not implement them. Though Scott has still refused to set up a state-run online insurance marketplace since Obama’s re-election, the governor has walked back some of his opposition. Last February, Scott even went so far as to say he would expand Medicaid. In a statement on his website, Gov. Scott said his office would “support a three-year expansion of our Medicaid program under the new healthcare law, as long as the federal government meets their commitment to pay 100 percent of the cost during this time.”

Over a year later, however, Florida has failed to take any more steps toward Medicaid expansion, and whether or not Gov. Scott will be able to garner support for the expansion from within his own party remains an open question. As the Tampa Bay Times reported at the end of last year, Gov. Scott failed to press house Republicans to move forward with the plan. This year, the Florida legislature adjourned without accepting federal funds for expansion.

On Obamacare, Crist has gone from staunch opponent to fervent advocate. On the day President Obama signed the Affordable Care Act into law, Crist, who was then governor, tweeted: “Let’s keep up the fight and work to repeal this partisan, gov’t takeover of [healthcare].” He also tweeted, “Obama/Dems arrogantly trying to jam their gov’t run HC bill thru this week. Our country deserves a better, free market solution.” (A reporter at BuzzFeed took screen-shots of the tweets, which have since been deleted.)

But when Crist spoke to Ed Schultz on MSNBC in late 2013, Crist said he would help enact Obamacare, because it’s “the right thing to do.”

Sean Foreman told Rewire that Crist’s public allegiance to the health-care law is a politically calculated position, but could hurt him in the end. “Charlie Crist defending Obamacare is a risky position,” Foreman wrote in an email. “The Crist campaign has calculated that this is a major issue for him in proving his bona fides for Democratic voters,” but most other Democratic candidates, particularly for congressional seats, are distancing themselves with the law to seem more moderate.

Whether Crist will be able to distinguish himself from his former party through the issues of reproductive rights and the Affordable Care Act remains to be seen.

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