Bills restricting abortion, including one that bans procedure as early as six weeks, gets Texas Senate OK

The slate of bills must still go to the House for approval.

By Shannon Najmabadi, The Texas Tribune.

The Texas Senate on Tuesday approved five bills restricting access to abortion, including a priority measure that could ban abortions before many women know they are pregnant.

The measures, which abortion rights advocates call some of the most "extreme" nationwide, are among the earliest bills to be debated by the full Senate — whose presiding officer, Lt. Gov. Dan Patrick, has given two abortion proposals top billing this session. The bills were passed 19-12. They must still be approved by the House before becoming law.

Senate Bill 8 would ban abortions after a fetal heartbeat has been detected, which can be as early as six weeks, according to a legislative analysis. The bill has an exception for medical emergencies but not for rape or incest.

The bill would also let anyone in Texas sue an abortion provider if they believe they violated state laws, regardless of whether they had a connection to someone who had an abortion or to the provider. A person who knowingly “aids or abets” others getting abortions prohibited under state law could also be hit with lawsuits, according to a bill draft.

“We're setting loose an army of people to go sue somebody under a bill that will likely be held unconstitutional,” state Sen. Nathan Johnson, D-Dallas, said during a debate about the bill. “They could be sued over and over and over again having to pay $10,000,” which is the minimum proposed damages in the bill.

Similar “heartbeat bills” have been passed in other states but have been blocked by the courts.

State Sen. Bryan Hughes, R-Mineola, the lead author of SB 8, said unique legal language in the bill makes him believe it will be upheld. It’s intended to “protect our most vulnerable Texans when the heartbeat is present,” he said.

Senate Bill 9, another Patrick priority, would bar nearly all abortions if the U.S. Supreme Court overturned the Roe v. Wade decision or otherwise altered abortion laws. It would create a possible fine of $100,000 for doctors who perform abortions after the law goes into effect. Sen. Carol Alvarado, D-Houston, said the fine for sexual assault in Texas has a $10,000 maximum.

“Why would we punish a doctor who performs an abortion on a victim of rape or incest more than the actual rapist?” she asked.

“I would say that the problem here is not the amount of the fine on the doctor but on a rapist,” state Sen. Angela Paxton, SB 9’s author, responded.

Other legislation approved by the Senate Tuesday would bar later-term abortions in the case of severe fetal abnormalities — closing what the bill’s authors have likened to a “loophole” and forcing people to carry ill-fated or unviable pregnancies to term, according to experts and advocates. Women in that situation would be provided with information about perinatal palliative care, or support services, which they may not have been aware of, the bill’s author said.

Another bill, Senate Bill 394, would bar pill-induced abortions after seven weeks. Guidelines from the Food and Drug Administration approve the use of abortion pills up to 10 weeks. Nearly 40% of abortions performed on Texas residents in 2019 were medication-induced, according to state statistics.

Most abortions in Texas are banned after 20 weeks. Women seeking an abortion must get a sonogram at least 24 hours before the procedure, and their doctor must describe the sonogram and make audible any heartbeat.

Dozens of abortion-related measures have been filed this legislative session, including one that would open up abortion providers to criminal charges that carry the death penalty. Anti-abortion activists have urged lawmakers to challenge the Roe v. Wade decision, citing the new conservative makeup of the U.S. Supreme Court. Nearly every Republican in the Senate has signed on as an author of SB 8, one of Patrick’s priorities, as has Brownsville Democrat Sen. Eddie Lucio Jr., who said during a debate Monday that he believes life begins at conception.

A sixth abortion-related bill advanced Tuesday would require a contractor to offer counseling and other resources to a person seeking an abortion. That person would receive a pin to verify she received the offer, and the pin would then be destroyed, said Paxton, the bill’s author. Earlier bill drafts said the woman would get an identifying number that would be stored in a state database.

Sen. Sarah Eckhardt, D-Austin, asked what services the women would be referred to — pointing to how poor most parents must be to qualify for Medicaid in Texas. A parent with one child would need to make less than $200 a month to qualify, the strictest criteria of any state, according to the Kaiser Family Foundation.

“So we're going to spend $7 million annually for somebody who is less qualified than their doctor to give them advice on something that they probably aren't eligible for?” she asked Paxton.

Paxton said the bill could connect women to support services like housing, resume development, child care and adoption services, and said it could help women who would prefer to carry their pregnancy to term if the circumstances were different.

“If she wants to call” and ask for her code, she can get it and just hang up, Paxton said. Her bill was passed by the Senate 20-11.

Despite inactivity in the Legislature, Senator says Texas is moving closer to Medicaid expansion

By Eli Kirshbaum, State of Reform

This year’s legislation to expand Medicaid in Texas — neither the Senate or the House version of which have been scheduled for an initial committee hearing — has garnered notable support from some Republican lawmakers. Sen. Nathan Johnson, the sponsor of the bill’s Senate version, said he is hopeful about advancing his proposed “Live Well Texas” program this year, but acknowledged that it will be an uphill battle.

“Neither one of them has a hearing set, and that’s going to take some doing … It’s not only opposed by powerful people — it scares a lot of people.”

He affirmed he is still actively pushing to get a hearing date set, and is optimistic about the bill’s increasing Republican support.

A legislative insider familiar with the issue shared a similar perspective with State of Reform. They believe a committee hearing has a reasonable chance of happening before the end of the session. Regarding any further legislative advancement, however, they said chances are very slim.

Johnson and Republican lawmakers have been communicating on what the bill should look like for over a year. He and other advocates have been speaking to people throughout the state, attempting to correct misunderstandings about what expansion would do. He said these conversations were necessary given state leaders’ history of strict opposition to it.

Johnson said the bill’s use of a Medicaid 1115 Waiver to control its expansion of Medicaid is the reason behind some of the novel Republican support. The waiver would give Texas permission to conduct the program with considerable independence from the federal government, which Johnson said is more likely to appeal to his conservative colleagues.

“It simulates a private sector experience with health insurance rather than the traditional model …  Many believe traditional models of state-run health care systems create a culture of dependency, and whether or not that’s true, I wanted to go with a system that has been tried in other states that more closely simulates the experience of the private sector, and therefore doesn’t foster dependency, but rather, fosters independence.”

The waiver will also provide recipients of Medicaid with a state-funded health savings account, which will help support them as they transition out of Medicaid into a private plan. Recipients, their employers and community organizations can also add to the account under certain conditions for the recipient to receive enhanced benefits like dental coverage.

While he believes a couple of Republicans would see the fiscal benefit of expanding Medicaid and sign on to “straight Medicaid expansion,” he said these key differences are likely the only reason some Republicans are starting to consider the measure.

“Politically, it matches some beliefs and values that they hold very important, and it allows them to communicate to their own voters why this program is consistent with their values.”

Johnson highlighted that notable progress has still been made, albeit not in the Legislature. Two years ago, Republican legislators would barely even agree to discuss Medicaid expansion. The fact that both sides of the aisle and numerous media outlets are talking about it today points to how far the idea of expansion has come in just a couple years, he said.

Public support for Medicaid expansion among Texans is substantial, with nearly 70% of the population in support. According to Johnson, state lawmakers nonetheless oppose it primarily for political reasons. He said electoral politics play a significant part in how these lawmakers approach the subject, and Republicans with constituencies that would likely disapprove of support for a government-sponsored program refuse to risk losing constituent support — even if they themselves acknowledge the benefits of the program.

“I’m sympathetic to people who are nervous about election consequences. But I think this issue is so clearly right that you’ve got a duty to take the risk. Bring your voters with you.”

“We’ve had years of misunderstanding this issue, and it takes a long time to disabuse people of a deep conviction about something, and people have deep convictions about the Affordable Care Act. Anything associated with it was deemed to be terrible.”

He said the first Medicaid expansion conversations among Texas leaders weren’t based in fact and cemented a false perception of the measure that remains in place today.

“Back when the story was first told, the story kind of stuck, and it didn’t change, even while the rest of the country was experiencing the changes that Medicaid expansion could bring.”

With less than 70 days left in the session, committee leaders have limited time to place the bill on the calendar and initiate a hearing.

With this change, Texas can save the lives of new moms

Women who lose Medicaid health coverage soon after giving birth are at high risk of bad outcomes

By Dallas Morning News Editorial

Childbirth is a joyous time for a mother, but also can lead to medical crises, postpartum depression, and premature death, including suicide.

At a time when new mothers are so vulnerable, access to medical resources and counseling that could save lives should be available. However, if a new mother is poor, several post-childbirth risk factors sharply increase, and a key safety net is available for only the first two months after delivery. Medicaid health insurance currently provides coverage for new mothers for just 60 days despite the fact that medical experts say new mothers are at risk of suffering psychological and medical setbacks related to childbirth for at least a year.

It is heartwarming that womens’ health issues have caught the attention of some lawmakers. With slight differences, SB 141 by Sen. Nathan Johnson, SB 1187 by Sen. Carol Alvarado, HB 107 by Rep. Senfronia Thompson, HB 133 by Rep. Toni Rose, HB 146 by Rep. Shawn Thierry, and HB 98 by Rep. Lina Ortega all extended Medicaid health insurance for new mothers from 60 days to one year after pregnancy.

We urge lawmakers to extend benefits for a year and not put more women at risk. Roughly, 89% of pregnancy-related deaths reviewed since 2013 were preventable and 31% occurred 43 days to one year after the end of pregnancy, according to the state’s Maternal Mortality Review Committee. The committee also determined that Black and Hispanic new mothers were at elevated risks of bad outcomes.

In 2018, for example, the severe maternal morbidity rate for Black women in Texas was 299.4 cases per 10,000 delivery hospitalizations, significantly higher than the overall state rate of 182.3, as were the statistics for Hispanic mothers. The severe maternal morbidity rate includes “unexpected outcomes of labor and delivery that result in significant short-term or long-term consequences to a woman’s health,” according to the Centers for Disease Control and Prevention.

Texas ranks an embarrassing last, at 25.5% in the rate of uninsured women of childbearing age, according to a Georgetown University study, so expanding Medicaid coverage to 12 months would be a step forward. Women who lose health coverage soon after giving birth are likely to stop taking medication or obtain support for postpartum depression and treatable maladies such as infection, hemorrhage, preeclampsia, eclampsia, and cardiovascular and coronary conditions.

Texas lawmakers have known that this is a major problem but have come up short in previous sessions. Two years ago, the state House approved legislation to provide 12 months of Medicaid coverage to mothers following childbirth only to watch that bipartisan bill fail when the state Senate didn’t take action before the deadline to consider legislation.

Texas temporarily paused removing mothers from Medicaid coverage during the COVID-19 emergency, undoubtedly saving lives. Lawmakers must deliver a bill that extends benefits for one year, and the governor should sign it.

This article originally appeared in the Dallas Morning News at https://www.dallasnews.com/opinion/editorials/2021/03/17/with-this-change-texas-can-save-the-lives-of-new-moms/.