President Donald Trump is in a tight spot, behind in national polls and barely ahead in Texas, where no Democrat has won a presidential race since 1976. When he said the other day that “nobody likes me,” nobody disagreed with him.
His situation sets the environment for Republicans and Democrats up and down the November ballot in Texas. If the Republican president does well, that’s probably to the benefit of other Republicans on the ballot, even if the state doesn’t have straight-ticket voting anymore. If he does poorly, it could spell a good day for the Democrats. And in an election where a half dozen seats in Congress and the Republican majority in the Texas House are at stake, the top candidate’s performance is critical.
On Thursday morning, the president retreated to his safe space — Twitter — where he ruminated on the impending election that could make him the first one-term president in almost three decades.
“With Universal Mail-In Voting (not Absentee Voting, which is good), 2020 will be the most INACCURATE & FRAUDULENT Election in history. It will be a great embarrassment to the USA. Delay the Election until people can properly, securely and safely vote???,” Trump tweeted.
That sent a shudder through the political world. Democrats predictably started hacking away — or continued hacking away — at Trump. But Republicans, who’ve been very cautious about creating any distance between themselves and a president with strong support from their party’s voters, made room for themselves this time.
You can’t delay an election with a tweet, and you can’t delay one from the White House, either. That’s not what this is about. Trump is feeding doubts about the reliability and trustworthiness of U.S. elections, leaning on urban legends about the frequency of voter fraud — yes, it exists, and no, it’s not pervasive. Those doubts support the notion that any election that doesn’t reelect the incumbent is illegitimate.
But doubts like that don’t start and stop with the presidential race. Everybody on the ballot — winners and losers — agrees to accept the results when they enter the contest.
Trump isn’t proposing to get rid of mail ballots. He casts them himself. He’s making a false distinction between absentee ballots, which are cast in the mail, and universal voting by mail, which is a version of the same process, with different rules about who is eligible.
But this is clearly a threat to the system we use to choose the people who represent us. Want to knock over a building? Destroy the foundation. Want to tear down a democracy? Destroy confidence in free elections.
It’s disquieting when the kooky stuff in politics comes straight from the top.
But the system almost always sorts seeds from stems on the way to the top. The 2016 election, starting in the Republican primary, didn’t do that. One refrain from that contest — that here, finally, was a candidate who wasn’t afraid to burn it all down — was dead on.
The voters who wanted to kick the establishment aren’t upset about the president’s tweeting.
The voters who thought any Republican at all would be better than Hillary Clinton kicked their problems down the road and now confront the consequence.
If Trump were to lose the general election while successfully planting widespread doubts about the results, he’d be leaving the country in shambles for his successor — and for anyone elected to Congress or a state legislature in what could then be framed as a shady election that put illegitimate officials in place.
If he’s not winning, nobody’s winning. He’s willing to risk the whole establishment of government to prove it.
That’s not a new story in history, but it’s new to us.
Republican Texas state Representative Tony Tinderholt — a right-wing politician who has vocally opposed Texas Governor Greg Abbott's statewide shutdown and mandatory mask orders — has nearly died from the COVID-19 coronavirus. He is the first-known case of the Texas state legislator contracting the potentially lethal respiratory virus.
Tinderholt, who had previously compared the shutdown and mask mandate to "government overreach" and "socialism," said that his first symptoms of COVID-19 consisted of mild joint pain that turned severe, bad headaches and a loss of taste and smell. Then, his symptoms took a turn for the worse.
"I would like for people to try to mitigate risk by wearing masks," he said. "But wear them because you think it's right. I'm sure it works to some degree — it just didn't for me."
He remains in recovery with nausea, a cough, and breathing difficulties.
Tinderholt is known as one of the state's most conservative legislators. He wrote of the state's COVID-19-prevention measures:
“Therefore, if we allow government to continue to grow one more iota over this level of threat, then we are ushering in the very foundations of socialism. The question I would encourage you ask yourself is this: do you want to be the governor who helped socialism take root in Texas or one who stood for freedom in the midst of great pressure? I know we both stand for freedom and personal liberty over socialist ideals. However, they will take root if we do not permanently change this course now.”
Tinderholt is just the latest anti-mask Republican to catch COVID-19. Jason Rapert, an anti-gay Republican Arkansas state senator who called face mask mandates “draconian” and shared articles calling COVID-19 a hoax, tested positive for COVID-19 last week after speaking at a church service and other recent events without a face mask.
On Saturday, The New York Timesprofiled conservative and Republican suburban voters around the country who have become fed up with President Donald Trump and the entire party that has enabled him — voters essential to the GOP's survival in November.
"Suburban districts ... have long been critical bases of Republican support, packed with affluent white voters who reliably chose Republicans to represent them in Congress," reported Emily Cochrane and Catie Edmondson. "Democrats seized control of the House in 2018 by making inroads in communities like these, and Republicans have tied their hopes of reclaiming power to preserving their remaining footholds there. But as Mr. Trump continues to stumble in his response to the pandemic and seeks to stir up racist fears with pledges to preserve the 'Suburban Lifestyle Dream,' such districts are slipping further from the party’s grasp, and threatening to drag down congressional Republicans in November’s elections."
Two of these longtime Republican voters are Cass and Samantha Madison, who live in Sugar Land, Texas, just outside of Houston and plan to vote for Democratic foreign service officer Sri Kulkarni for Congress in an open Republican seat. “The lack of accountability kills me,” said Samantha, noting the GOP's “very poor handling” of the coronavirus pandemic “from top to bottom.”
Another disaffected Sugar Land Republican is attorney Farha Ahmed. "The megaphone is really with the president and that is what has translated to all the Texas Republican leaders," she complained. "It makes it very difficult for them to carry out what they need to do for health and safety reasons."
“I have always been a mostly straight-ticket voter — I don’t think I will be this coming election,” said a Cypress, Texas Republican, Wade Miller, who is losing confidence in GOP Rep. Michael McCaul. “We’re talking about human lives here, and if people aren’t willing to do what it takes to save lives, what else aren’t they willing to do? I will definitely be changing my vote come November.”
Discussing Donald Trump's declining poll numbers and his suggestion that the election should be postponed, former Republican National Committee head Michael Steele said it is finally dawning on Republicans who have been backing Trump that he has no chance of winning and it is time to flee the president.
Asked by MSNBC host Jonathan Capehart why some Republicans are still sticking by the president, Steele was first stumped for an answer before making a joke that had the rest of the panel laughing.
"Michael Steele, as a former chairman of the Republican Party, where is your party?" host Capehart asked. 'Where are they? Where the defenders of the Constitution when the Constitution is in danger?"
"You know, it's where they've always been. you know, underneath Donald Trump's left cheek. I don't know. -- and that's butt cheek," Steele said as his fellow panelists laughed." Folks made a bargain with the devil and, I think to Tom Nichols' point [about Republicans acting like remora's attached to a shark], they're like 'that thing is going to stick and stay, we're just going to ride it.'"
"But what then happens at some point the fish realizes this shark ain't moving right it's dead or dying and I need to get off," he continued. "Self-preservation, at some point, kicks in that's why where they are. The American people have been watching for three years and self-preservation won't be enough to preserve yourself at this point."
According to Politico, the Trump administration's contracts with drug companies to produce a COVID-19 vaccine have transparency problems, with drug executives shielded from disclosing conflicts of interest.
"The arrangement, which is covered through a $611,500 contract for 'Operation Warp Speed,' raises more questions about the transparency of the pandemic response and the roles of outside contractors, including top coronavirus vaccine adviser Moncef Slaoui, who are helping steer the government's $10 billion development program," reported Dan Diamond. "It's also paying for several other consultants whose roles have not been previously reported, including Carlo de Notaristefani, a pharmaceutical industry veteran who the Department of Health and Human Services said is overseeing all of the program's manufacturing. As consultants, instead of political appointees, Slaoui and de Notaristefani can sidestep the ethics disclosures required of federal workers."
Slaoui's conflicts were first reported in May by The New York Times. He has declined to divest from his holdings, despite the controversy, and the Trump administration will not force him to do so.
According to the report, "The contract also covers William Erhardt and Rachel Harrigan, who are both former Pfizer executives. HHS declined to specify their tasks when asked about their roles; Harrigan is listed as a clinical adviser in the HHS directory."
“For a drug company executive with clear conflicts of interest who is already skirting government ethics rules to be given 'free' housing by a private contractor who was awarded a vague $600,000 government contract smacks of the kind of corruption that is unacceptable in any government program,” said Eli Zupnick, who is affiliated with progressive activist group Patients Over Pharma. “Examples like these are exactly why [Operation Warp Speed] needs to be brought out of the shadows.”
In a blunt-talking column for the Daily Beast, longtime political observer Mike Barnicle mocked Donald Trump for thinking he's a "wartime president," saying the president has done nothing but run from his responsibilities as the country is wracked by the coronavirus pandemic and millions have lost their jobs in an economy that is collapsing.
According to the MSNBC contributor, Trump is a "pretender in chief" who has never been up to the job, and now the country is waking up to the devastation he has brought about.
"Trump’s dreams of wearing that title—commander-in-chief—are both ludicrous and dangerous. Every hour of every day he is a walking, talking, tweeting threat to the national and global security of the United States," he wrote before listing off the following numbers to make his case: "Americans infected by the virus: 4,635,886. Americans dead from the virus: 155,330. Americans filing unemployment claims: 36 million. Americans collecting benefits: 25 million. Unemployment rate: 11.1 percent."
Writing, "That’s just a partial picture of the casualties the pretender-in-chief has left on the battlefield while he sulks in a parody of self-pity. The only thing he has in common with his idols like Patton and MacArthur is that both of those men were also aptly described by critics as 'media whores,'" Barnicle wrote and added that he is unaware of any time during the coronavirus pandemic where the president had offered any sincere expression of sympathy to the families of the COVID-19 victims while also noting the president's complete disregard for those who have lost their jobs and are facing possible eviction.
"He behaves as if millions of Americans, jobless with dwindling hope for a future they now measure by a clock instead of a calendar, are invisible to him. And they are because Trump is a stranger to loss, who’s never had any emotional connection to an element of life that connects all of us to its reality and inevitability," he accused before calling Trump a 'badly-damaged" individual.
The columnist then made his final case against the president.
"A fraud. A race-baiter. A loudmouth. A self-absorbed and self-deluded mini-demagogue who uses the tools of division and deception to puff himself up in front of the mirror," Barnicle wrote of the president. "And, perhaps more than anything, a coward who is afraid of eye-to-eye confrontation, a fraud who rants and pouts and pretends to be a leader as the noise of the rotor-blades of Marine One drown out his words while the lifeline of unemployment checks vanish as he golfs."
On Saturday, writing for The Washington Post, Lt. Col. Alexander Vindman, one of the key witnesses in the impeachment trial against President Donald Trump, slammed the president and stood up for his principles.
"After 21 years, six months and 10 days of active military service, I am now a civilian. I made the difficult decision to retire because a campaign of bullying, intimidation and retaliation by President Trump and his allies forever limited the progression of my military career," wrote Vindman. "At no point in my career or life have I felt our nation’s values under greater threat and in more peril than at this moment. Our national government during the past few years has been more reminiscent of the authoritarian regime my family fled more than 40 years ago than the country I have devoted my life to serving."
Since his testimony, Vindman was denied a routine promotion through the military ranks after White House officials dug up dirt on him and passed it along to the Pentagon. Vindman decided to retire from service, with his lawyer citing a culture of retaliation.
"Our citizens are being subjected to the same kinds of attacks tyrants launch against their critics and political opponents," wrote Vindman. "Those who choose loyalty to American values and allegiance to the Constitution over devotion to a mendacious president and his enablers are punished. The president recklessly downplayed the threat of the pandemic even as it swept through our country. The economic collapse that followed highlighted the growing income disparities in our society. Millions are grieving the loss of loved ones and many more have lost their livelihoods while the president publicly bemoans his approval ratings."
"Since the struggle for our nation’s independence, America has been a union of purpose: a union born from the belief that although each individual is the pilot of their own destiny, when we come together, we change the world. We are stronger as a woven rope than as unbound threads," wrote Vindman. "America has thrived because citizens have been willing to contribute their voices and shed their blood to challenge injustice and protect the nation. It is in keeping with that history of service that, at this moment, I feel the burden to advocate for my values and an enormous urgency to act."
"When I was asked why I had the confidence to tell my father not to worry about my testimony, my response was, 'Congressman, because this is America. This is the country I have served and defended, that all my brothers have served, and here, right matters,'" concluded Vindman. "To this day, despite everything that has happened, I continue to believe in the American Dream. I believe that in America, right matters. I want to help ensure that right matters for all Americans."
On Saturday, writing for Politico, Brennan Center for Justice fellow Victoria Bassetti and former House impeachment counsel Norm Eisen laid out the necessary steps to fix the problems at the Justice Department in the wake of Attorney General William Barr's political rampages.
"Barr’s testimony demonstrated a singular blend of real pugnacity and feigned world-weariness as he defended his 18 months in office," wrote Bassetti and Eisen. "Barr has tried to muzzle Trump’s critics, protect his friends, hide information from Congress and investigate those who investigated the president. He has also — much like [Roy] Cohn and [Michael] Cohen — worked as a PR agent, spinning negative information in Trump’s favor, and even using federal agents to violently clear a path through protesters before a presidential photo op."
As a consequence of this, they wrote, "the Department of Justice is going to have to come to a larger reckoning at some point, instituting or welcoming stronger safeguards against manipulation and misuse and shoring up ethical standards."
One step, they wrote, is to make the Office of Legal Counsel — which has spent the Trump years writing partisan memos to bolster the president's legal position — truly independent. Another is to give more authority to the DOJ inspector general to investigate misconduct by the attorney general, which they note is "backed by several Republican senators," and to make the department's ethics recommendations — like their basis for recommending various officials recuse from certain cases — more transparent. Yet another is to increase congressional oversight and improve the process for confirming departmental nominees.
"In the case of Barr, Trump’s instinct for finding fixers has served his agenda well," concluded Bassetti and Eisen. "But it has devastated the once-proud Department of Justice. Restoring the department’s reputation will take sustained work long after Barr departs and Trump is once more cruising the back streets of the Tri-State area for representation."
A CNN discussion on Donald Trump's continuing obsession with mail-in voting led one contributor to claim that he is sending signals that he knows he's going to lose and he is setting the stage for multiple attempts to set aside or contest the election results.
Then he told the president to "grow up."
After "New Day" host Victor Blackwell shared clips of the president claiming the election results wouldn't be reliable and we "might never know" who actually won the election, Blackwell set the stage for CNN analyst Errol Louis.
"So Errol, anything short of a clear win for the president -- and right now there's no poll that suggests that's in the cards -- how confident are you, or is that what you're expecting we'll see from the Trump campaign, piles of litigation?" the host asked.
"Well, I don't know about litigation so much, they've already started by the way they have begun litigation trying to halt or impede or distort the implementation of mail-in ballots but we'll see the president try to throw shade, no actual facts, on the election in part because he's behind," Louis replied. "He's really laying the groundwork for a possible defeat substantively speaking with mail-in and early voting and the ways we expand people to have their voices heard, it does take about a month leading up to and following election day to get the proper count."
"We'll have early voting that starts weeks before November 3rd, we'll have absentee ballots for servicemen overseas for example, takes a while to get here. that won't begin to be counted until after November 3rd," he explained. "Then you have to total it up, so the president needs to grow up. Those who care about having every vote counted should be prepared for what's going to be about a 30-day process before we know for sure what all of the ballots are telling us about the outcome."
A global pandemic ravaging America is no time to forget the first rule of American health care: There is no set price. One out-of-network medical provider in Texas seeks permission from patients to charge fees as high as six figures to their insurance.
As she waited for the results of her rapid COVID-19 test, Rachel de Cordova sat in her car and read through a stack of documents given to her by SignatureCare Emergency Center.
Without de Cordova leaving her car, the staff at the freestanding emergency room near her home in Houston had checked her blood pressure, pulse and temperature during the July 21 appointment. She had been suffering sinus stuffiness and a headache, so she handed them her insurance card to pay for the $175 rapid-response drive-thru test. Then they stuck a swab deep into her nasal cavity to obtain a specimen.
De Cordova is an attorney who specializes in civil litigation defense and maritime law. She cringes when she’s asked to sign away her rights and scrutinizes the fine print. The documents she had been given included disclosures required by recent laws in Texas that try to rein in the billing practices of stand-alone emergency centers like SignatureCare. One said that while the facility would submit its bill to insurance plans, it doesn’t have contractual relationships with them, meaning the care would be considered out-of-network. Patients are responsible for any charges not covered by their plan, it said, as well as any copayment, deductible or coinsurance.
The more she read, the more annoyed de Cordova became. SignatureCare charges a “facility fee” for treatment, the document said, ranging “between five hundred dollars and one hundred thousand dollars.” Another charge, the “observation fee,” could range from $1,000 to $100,000.
De Cordova didn’t think her fees for the test could rise into the six figures. But SignatureCare was giving itself leeway to charge almost any amount to her insurance plan — and she could be on the hook. She knew she couldn’t sign the document. But that created a problem: She still needed to get her test results.
Even in a public health emergency, what could be considered the first rule of American health care is still in effect: There is no set price. Medical providers often inflate their charges and then give discounts to insurance plans that sign contracts with them. Out-of-network insurers and their members are often left to pay the full tab or whatever discount they can negotiate after the fact.
A portion of the document given to Rachel de Cordova at SignatureCare highlighted by ProPublica describes fees for the “facility” and “observation” that could reach $100,000 each.Photo credit: Obtained by ProPublica
The CARES Act, passed by Congress in March, includes a provision that says insurers must pay for an out-of-network COVID-19 test at the price the testing facility lists on its website. But it sets no maximum for the cost of the tests. Insurance representatives told ProPublica that the charge for a COVID-19 test in Texas can range from less than $100 to thousands of dollars. Health plans are generally waiving out-of-pocket costs for all related COVID-19 treatment, insurance representatives said. Some costs may be passed on to the patient, depending on their coverage and the circumstances.
As she waited, de Cordova realized she didn’t want to play insurance roulette. She changed her mind and decided she’d pay the $175 out-of-pocket for her test. But when the SignatureCare nurse came to collect the paperwork, de Cordova said the nurse told her, “You can’t do that. It’s insurance fraud for you to pay for our services once we know you have insurance.”
Dr. Hashibul Hannan, an emergency room physician, lab director and manager at SignatureCare, told ProPublica his facility is an emergency room that offers testing, not a typical testing site. He said de Cordova should have been allowed to pay the $175 cash price. The staff members were concerned about being accused of fraud because they had already entered her insurance information into the record, he said. So they didn’t want it to appear she was being double-billed. Hannan also said he regrets that she was upset by the disclosure forms that are now required under state law.
Unable to pay cash and unwilling to take a chance on the unknown cost, de Cordova decided to leave without getting the results of her COVID-19 test.
“I would have signed anything”
Later that day, de Cordova couldn’t get past what happened. She wondered what happened to patients who didn’t read the fine print before signing the packet.
Then she realized she and her husband, Hayan Charara, could investigate it themselves. In June, the couple’s 8-year-old son had attended a baseball tryout. They thought the kids would be socially distanced and that precautions would be taken. But then the coaches had crowded the players in a dugout, with no masks or social distancing, and a couple days later the boy said he wasn’t feeling well.
So just to be safe, on June 12, Charara took their son to the same SignatureCare, the Heights location, for a COVID-19 test. The line was so long they had to wait for hours, go home, come back and wait for hours again in their car in the 100-degree heat. Charara, a poet who teaches at the University of Houston, said he didn’t take a close look at the financial disclosure paperwork. De Cordova wasn’t with them. It had been 10 hours of waiting by the time the boy was tested, so “I would have signed anything,” he said. (The child tested negative.)
Charara, de Cordova and their children are covered by the Employees Retirement System of Texas, a taxpayer-funded benefit plan that covers about half a million people. They hadn’t received any notices about the charges for their son. So they contacted the SignatureCare billing department and asked for an itemized statement. The test charge was indeed $175. But the total balance, including the physician and facility fees associated with an emergency room visit, came to $2,479.
The facility fee was $1,784 and the physician fee $486.
The couple were dumbfounded. Their son’s vital signs had been checked but there had been no physical examination, they said. The interactions took less than five minutes total, and the child stayed in the car. “You’re getting a drive-thru test, and they’re pretending like they’re giving you emergency services,” de Cordova said.
The statement for de Cordova’s son’s evaluation and $175 COVID-19 test came to $2,479 after fees added by SignatureCare. Photo credit: Obtained by ProPublica
The SignatureCare charges shocked experts who study health care costs. Charging $2,479 for a drive-thru COVID-19 test is a “nauseating” example of profiteering during a pandemic, said Niall Brennan, president and CEO of the Health Care Cost Institute, a nonprofit organization that studies health care prices. “It’s one of the most egregious examples of giving the fox the keys to the henhouse I’ve ever seen and yet another example of the absurdity of U.S. health care pricing.
“Imagine a vendor in any other walk of life being allowed to bill a third party for whatever amount they wanted,” Brennan said.
Insurance companies in Texas typically pay between $100 and $300 for drive-thru COVID-19 tests, said Jamie Dudensing, CEO of the Texas Association of Health Plans. But the association’s members have seen hundreds of out-of-network COVID-19 test charges come in far higher, some in the thousands of dollars.
“There’s no excuse for that, especially in a public health crisis,” said Chris Callahan, spokesperson for Blue Cross and Blue Shield of Texas, which likewise has seen high charges for COVID-19 tests from out-of-network providers.
The reimbursement rates negotiated between insurance companies and in-network providers are much lower, but they still vary, according to data provided by the nonprofit FAIR Health, which tracks spending by private insurers. For the same test billed by SignatureCare, an in-network insurer pays a median price of $23 in Utah and $75 in Wisconsin, according to FAIR Health estimates.
Texas is notorious for its high-priced out-of-network emergency bills and free-standing emergency departments. Some of the facilities appear to be using COVID-19 testing to draw in patients so their insurance plans can be charged for additional services, said Blake Hutson, associate state director for AARP Texas, the advocacy organization for older Americans. “It’s not a surprise they would be racking up the charges and adding on everything they can and billing the health plan,” he said.
In some cases, insurers do pay the exorbitant out-of-network charges, Hutson said, but they typically get reduced. In 2019, Texas lawmakers voted to ban billing patients in state-regulated insurance plans for charges not covered by their policy, Hutson said, which is known as “balance” or “surprise” billing. But consumers may still be responsible for any deductibles and other cost-sharing under their health plan. And the costs covered by the health plan get passed back to the consumers over time in the form of higher premiums, he said. “It’s all problematic for the cost of care,” Hutson said.
Hannan defended SignatureCare’s high out-of-network charges by blaming insurance companies for refusing to give what he considers to be fair in-network rates. The charges are a starting point for negotiating a fair deal from out-of-network insurance plans, he said. He described SignatureCare, which has 18 locations, as “small players. When it comes to negotiating with insurance companies, we have no luck.”
Was the statement accurate?
The medical record portrays the visit as an emergency and contains details that are not consistent with how Charara and de Cordova describe their son’s condition. The chief complaint in the record is “body fluid exposure,” and elsewhere it says “confirmed COVID exposure.”
But that’s not accurate, according to the parents. No one had coughed or sneezed on their son, and they knew of no one from the tryout who had tested positive for COVID-19, they said. The child’s temperature is registered in the record as 102.8, which is high. But Charara said that could have been caused by sitting in the Texas heat, waiting for the test.
Shelley Safian, a Florida health care coding expert who has written four books on medical billing, examined the bill and medical records of Charara and de Cordova’s son at ProPublica’s request. She said the medical records don’t justify the charges. SignatureCare billed the case as if the exam were an emergency that required an “expanded problem focused history” and “medical decision making of moderate complexity,” she said.
In order to qualify for reimbursement of an exam at that level, the encounter would need to include examining the affected organ system, Safian said. But the medical records do not document any check of the respiratory system, which would be indicated for suspected COVID-19.
Much of the medical record appeared to be cut and pasted from other electronic records, Safian said. “This is boilerplate B.S.,” she said, “and I don’t mean ‘bachelor of science.’”
Hannan, the SignatureCare doctor and manager, stands by the charges associated with the child’s COVID-19 test. The facility has to treat every case like a possible emergency, and that requires an examination, he said. He pointed out that the charges are in line with what other out-of-network providers would charge in the area, according to FAIR Health, though they are far higher than in-network prices.
A doctor’s examination may not be as hands-on during COVID-19, but, similar to a telemedicine visit, a lot can be examined visually, Hannan said. Hannan said the company he uses for coding said COVID-19 requires a higher level of care and vigilance because it’s an infectious disease.
In light of the questions raised by ProPublica and Safian, Hannan said he asked his billing company to audit the charges. Sharon Nicka, president and CEO of Nicka and Associates, the billing company used by SignatureCare, took issue with Safian’s assessment and said the billing codes used were justified by the medical record. She said the charges are high for a drive-thru test, but those are set by SignatureCare.
ProPublica identified several apparent errors and contradictions in the medical record and billing documentation. For example, the notes in the medical record alternatively refer to the boy as “symptomatic” and “asymptomatic.” The record also says the physical exam showed a skin wound that “was not red, swollen or tender,” but the child had no wound of any kind, the family said. And the billing documentation shows a charge for an antibody test when the medical record showed that the patient actually received a diagnostic test, which is something different.
In response to ProPublica’s questions, a SignatureCare medical director reviewed the record. The error about the “wound” may have been caused by a software template adding something that was not in the physician chart, the reviewer wrote. The facility now uses a different template. The charge for the antibody test is likely a billing error, as the physician had ordered the correct test, the reviewer wrote. “We will continue to update and improve our (electronic medical records),” the reviewer said.
Hannan stressed that SignatureCare is upfront with patients about the possible fees associated with its treatment, including the disclosure paperwork and explanations on its website. It’s an emergency room, he said, so patients should expect emergency room fees. Patients who do not have a medical emergency should not come, he said, though the ER allows patients to book appointments a day in advance for a COVID-19 test.
Dudensing, the chief executive of the Texas Association of Health Plans, said she’s heard Hannan’s contention before and it’s true that freestanding emergency rooms have a license that allows them to charge more. But she still believes that they handle many nonemergency cases and are forcing facility fees of thousands of dollars on them. “They’re hiding under the guise of emergency rooms when they’re really dressed-up urgent care,” she said.
Diana Kongevick, director of group benefits for the Employees Retirement System of Texas, said the health plan had only recently received the bill for the 8-year-old’s test. It hadn’t been processed, so she could not speak to it directly. But, in general, the health plan will pay 100% of the cost of the test, in this case $175, she said. The claim would be processed using out-of-network provisions, she said. So for the other charges, the patient may be responsible for paying in the range of $600, she estimated, for the out-of-network copay and deductibles. “This is a nonemergent patient self-referral to an out-of-network provider,” Kongevick said.
“Testing should be free”
Even if the Employees Retirement System of Texas determines that Charara and de Cordova should pay $600 for their son’s test, SignatureCare will not be sending the family a bill, Hannan said. He said insured patients are not being sent bills for COVID-19 treatment beyond what their insurance companies cover.
De Cordova never did get her test results, and she didn’t seek a test elsewhere. She felt better later and now believes she had just been suffering from allergies. But what if it had turned out to be COVID-19, she wondered. Might she have gone on to infect others, she’s asked herself.
From a public health perspective, the haggling about out-of-network charges and payments puts patients in the middle, and it might discourage them from getting tested for COVID-19 during the pandemic, said Stuart Craig, an economist at the University of Pennsylvania who studies health care costs. “It’s another part of the fragmentation of the health care system that makes patients’ lives miserable,” Craig said.
It’s especially frustrating, he said, because COVID-19 testing is so essential to making it safely through the pandemic. Craig said he believes there should be a nationally mandated price and government subsidies to make sure medical providers and manufacturers are motivated financially to provide tests. “Testing should be free,” Craig said. “In fact, we should probably be paying patients to get tested.”
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Disclosure: The University of Houston, the Texas Association of Health Plans, Blue Cross and Blue Shield of Texas, and AARP Texas have been financial supporters of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune's journalism. Find a complete list of them here.
The man suspected of killing anti-police brutality protester Garrett Foster in Austin on Saturday has been identified as an active U.S. Army sergeant named Daniel Perry.
Perry’s lawyer also confirmed to The Texas Tribune late Friday that his client wrote tweets that have strengthened activists’ concerns about the shooter’s frame of mind, the validity of his self-defense claim and Austin police officials’ handling of the investigation.
People across the state and the country have taken to the streets for months to protest the in-custody death of George Floyd. Floyd, a Black man, died after a white Minneapolis police officer knelt on his neck past the point when he lost consciousness in late May.
In June, when President Donald Trump tweeted that “protesters, anarchists, agitators, looters or lowlifes” protesting in Oklahoma would face “a much different scene” than protesters in New York or Minneapolis, Perry responded from a now-deleted account with the username “@knivesfromtrigu.” The tweet read, “Send them to Texas we will show them why we say don’t mess with Texas.” That account was identified as being connected to Perry by Tribune of the People, which bills itself as a “revolutionary news service.”
Perry was initially confirmed as the Austin shooter in a press release from his attorney, first posted by KXAN-TV on Friday. The statement said Perry acted in self-defense after he “reasonably perceived a threat to his life” because Foster raised a rifle at him after he unknowingly turned his car into the crowd.
Other witnesses at the scene dispute that Foster raised his weapon and said Perry seemed to use his car to instigate the violence. Vehicles have been used on numerous occasions throughout the country recently as weapons against those demonstrating against police brutality and racial injustice. And doubts over Perry’s self-defense claim have since been amplified by the discovery of his tweets.
“If he was trying to just get down Congress and get through there ... and just get out of the way of the people, he would have been going a lot slower,” Michael Capochiano, a protester at the scene, told The Texas Tribune.
Perry’s attorney, Clint Broden, said the tweets are being taken out of context. He told The Texas Tribune on Friday night that Perry was agreeing with Trump in speaking out against violent protests as a military man, but “anyone who thinks he went to Austin with an agenda” is very mistaken.
Foster, 28, was killed in downtown Austin Saturday night during a protest against police brutality. Foster, who was white, was crossing an intersection and visibly carrying an AK-47 rifle — which is legal in Texas — when Perry drove toward the crowd.
Perry, who is also white, has not been arrested, and has been cooperating and speaking with law enforcement, his lawyer said. Austin police said Friday they could not confirm Perry was the shooter and declined to provide new information about the case. A police spokesperson previously said the shooting is under investigation.
Protesters on the scene told The Texas Tribune that a group surrounded Perry’s car after it hit a traffic cone, and in video from the scene, the sound of a car horn is quickly followed by three gunshots.
Texas’ so-called “stand-your-ground” law allows people to use deadly force against someone else if they feel they are in danger. It also prohibits an individual from arguing self-defense if they provoked a threat from someone else.
“The simple fact is that Sgt. Perry reasonably perceived a threat to his life when, as has now been confirmed by independent witnesses, Mr. Foster raised his assault rifle toward Sgt. Perry who was sitting in his car,” Broden said in his release.
But Perry’s tweets added to the concerns of those who already were skeptical that he was acting in self-defense.
Capochiano and other witnesses have said Perry seemed to drive threateningly into the crowd before shots were fired, and his actions seemed intentional. Motorists hitting demonstrators with their cars has not been uncommon during this year’s anti-police brutality protests, and the incidents bear echoes of the 2017 Charlottesville white supremacist rally, during which a counter-protester was killed by a vehicle that rammed into the crowd.
Jacob Stoil, an assistant professor of military history at the U.S. Army’s School of Advanced Military Studies, said he has “without a doubt” seen the use of vehicle-ramming tactics increase during protests since Floyd’s death.
“Some researchers have identified as many as 70 to 75 attacks using this tactic,” he said.
Stoil, who emphasized that he was speaking based on his personal research and not on behalf of the Army or any institution, said there is a strong correlation between social media incitement of violence and vehicle-ramming tactics being deployed in real life. Social media can help determine whether a motorist intended to kill someone using their vehicle or saw the opportunity arise in the moment, he said.
“This is where the online environment becomes very important ... encouraging people to even have this in their thoughts and to think of it as a potential solution to their problem,” he said. “So one of the things to really look for is engagement with the online environment and encouragement that it might have provided to any individual.”
According to his attorney’s statement, Perry was driving for a ride-share company the night of Foster’s death and did not know a protest was taking place when he drove to the corner of Fourth Street and Congress Avenue. As people beat on his car, Perry said, Foster used the rifle to motion for him to roll his window down. Perry complied because he initially thought Foster was a law enforcement officer, the statement said.
Broden wrote that “several witnesses” confirmed that Foster pointed his gun toward Perry first.
“It was only then that Sgt. Perry, who carried a handgun in his car for his own protection while driving strangers in the ride share program, fired on the person to protect his own life,” the statement read. “... Perry is devastated by what happened.”
Perry said through his lawyer that he fully cooperated with law enforcement and called 911 after getting a safe distance away Saturday night to report the shooting. Police said in a statement the shooter was questioned and released while the investigation continues.
The lack of an arrest added to harsh criticism the Austin Police Department has faced in recent months. In April, police shot and killed an unarmed Black and Latino man, Mike Ramos. Officers later critically injured two protesters, ages 20 and 16, by firing “less-lethal” rounds at their heads during protests spurred by the deaths of Ramos and Floyd.
After Foster’s death, the department has again been criticized for Police Chief Brian Manley’s focus on his officers’ actions after the shooting and Austin Police Association President Ken Casaday’s tweet that Foster “was looking for confrontation.” Casaday has since deleted the tweet and apologized for it.
Perry is stationed at Fort Hood, officials confirmed to multiple news outlets Friday. The military post has been in the spotlight for the killing of and harassment claims made by soldier Vanessa Guillén. But officials did not immediately respond to questions late Friday about Perry’s military status or whether they are investigating the Austin incident.
James Sasinowski, a protester who witnessed the Foster shooting, said core disconnects — and a lack of universal compassion for fellow people — have divided the country.
"It's easy to be angry when reading ... those past tweets in the current context. We have to ask 'How did we get here? What led this person to feel this way?'" he said in a text to the Tribune. "...We can blame police and racists all day long, but until we change the system, there will be no real difference."
US federal officers will stay in the protest-wracked city of Portland until local law enforcement officials finish a "cleanup of anarchists and agitators," President Donald Trump said.
The forces -- whose deployment was seen by many as part of the president's law-and-order strategy for re-election and exacerbated tensions between authorities and anti-racism protestors -- had been scheduled to begin their phased pullout from Portland on Thursday.
Trump tweeted late Friday: "Homeland Security is not leaving Portland until local police complete cleanup of Anarchists and Agitators!"
Hundreds of demonstrators were still on the streets of downtown Portland on Saturday morning, without any federal law enforcement in sight.
Earlier, Portland police cleared parks and nearby roads around the city center on Friday in anticipation of the phased pullout by federal forces.
City mayor Ted Wheeler said the deployment was part of the agreement for federal officers to leave.
In a tweet late Friday, Wheeler thanked the peaceful protestors, and said they had "reclaimed the space that has been a staging ground for violence, to share their powerful message of reformative justice."
Earlier this month the Trump administration sent federal tactical teams, many wearing combat-like gear, to intervene in the city after weeks of protests against racism and police brutality saw windows broken and graffiti scrawled on the federal courthouse and other buildings.
But their deployment inflamed the situation, especially following footage of protesters being snatched off the street by federal agents and put into unmarked cars.
Democrats said the intervention reeked of a "police state" and that it was a political move to show Trump -- who is struggling in the polls ahead of November's presidential election -- to voters as a strict law-and-order president.
Attorney General Bill Barr has defended the use of federal officers, and rejected any suggestion of the political motivation.
"In the wake of George Floyd's death, violent rioters and anarchists have hijacked legitimate protests to wreak senseless havoc and destruction on innocent victims," Barr said in testimony to the House Judiciary Committee.
Under an agreement between Oregon officials and the Trump administration on Wednesday, the federal forces were to begin withdrawing from the city on Thursday.
However, their pullout was conditional on local law enforcement ensuring the security of the federal courthouse and other buildings that have been targeted by protesters.
Acting Homeland Security Secretary Chad Wolf, who warned earlier this week a full pullout depended on the security situation "significantly" improving.
And on Thursday Trump reiterated the need for federal intervention.
"The governor and the mayor, we've been dealing with them, and we think they don't know what they're doing, because this should not have been going on for 60 days," he told reporters.
"It's not our job to go in and clean out the cities. That's supposed to be done by local law enforcement," Trump added.
Sen. Susan Collins of Maine, a Republican facing a tough re-election race, has run numerous ads over the last three months featuring testimonials from more than 20 people who were presented as ordinary Mainers — but in fact had close ties to the state's Republican Party or to Collins herself. While such deception is not obviously illegal, it's intentionally misleading and suggests that Collins has had trouble attracting supporters outside a tight circle of Maine Republicans.
This wasn't the first time that Collins' 2020 campaign has committed an unforced video error. Last summer her campaign drew sardonic criticism after posting several minutes of B-roll of the senator meeting with Mainers in factories, a classroom, a kitchen and so on. The video was mocked as a transparent gift of content for outside groups, which could amount to a campaign finance violation.
This year, however, the campaign might catch flak for a July 30 campaign ad that features lobsterman and small business owner Wayne Parry accusing Sara Gideon, speaker of the Maine House and Collins' Democratic opponent, of "not being honest" about her criticism of the Paycheck Protection Program.
The ad informs the viewer that Parry is a lobsterman from the town of Arundel, but does not mention that Parry also served as a Republican State House representative from 2010 to 2018, and is on the ballot as a candidate again in 2020.
Back in May, the Collins campaign put out a paid social media testimonial from a GOP selectman named Ryan Lorrain, without disclosing his party affiliation. Lorrain had written a letter to the Lewiston Sun Journal in October 2018 praising Collins' "stand against the media and the political left" during Supreme Court Justice Brett Kavanaugh's confirmation hearing.
"What she did took courage that few people in politics have shown," Lorrain wrote. "I encourage others in the public eye to look to her example for handling controversy in a professional and accurate way."
The campaign ran a paid social media testimonial in May from former Maine GOP chair Mark Ellis. In 2010, Ellis worked as political director on the gubernatorial campaign of Steve Abbott, who now serves as Collins' chief of staff.
Another Collins-funded social media testimonial that month came from Bill and Jamie Logan, whose daughter, Jessie, once worked in Collins' Senate office in Bangor. Their personal connection to the candidate was not disclosed.
Collins' campaign posted in April a testimonial from Ashley Luszczki, who is currently listed as policy director on the official website for the Republican president of the Maine Senate. Luszczki's bio says she previously worked as the finance executive for the Maine Republican Party.
The testimonials have also featured a number of controversial Maine Republicans, some of whom have voiced conspiracy theories about the coronavirus pandemic.
In July, Collins' Facebook page featured a testimonial from former GOP State House member Kathleen Chase, who has recently dismissed the science behind COVID-19 safety guidelines. That same month, Chase shared a Facebook post calling on Americans to "fight back" against public health guidelines such as wearing masks and practicing social distancing, which the post claimed were put in place so the government could "rule over" citizens.
White said that Dr. Christine Blasey Ford, Kavanaugh's principal accuser, was an "emotionally unstable woman." He also called the #MeToo movement the "weaponization of victimhood" and compared it to the Salem witch trials. The Maine Beacon reported that in July 2018, White "shared a graphic criticizing women who have abortions for 'escaping the consequences of your choices by taking all choices away from another human being.'"
Another Collins testimonial this June featured Cumberland Town Council member Mike Edes. In 2014, Edes ran as the Democratic candidate for Cumberland sheriff, and was accused of illegally coordinating with a political action committee funded by a wealthy Portland real estate developer and Republican donor. No investigation was opened.
Former Maine Sen. Andre Cushing, who resigned from the State Senate in 2018 amid multiple ethics scandals, appeared in a Collins social media testimonial this May. Cushing had been accused of misusing business funds and campaign funds, and was ordered to pay a $9,000 fine to the Maine Ethics Commission for 11 campaign finance reports filed late in the two years between 2014 and 2016. The civil case is currently pending.
In May, Collins' Facebook posted a video testimonial from Dick Pickett of Dixfield, without disclosing that Pickett has represented Maine's 116th State House district as a Republican since 2014. The next month, Pickett published an op-ed in the Maine Examiner calling Democratic Gov. Janet Mills' economic shutdown orders "dictatorial."
Collins also featured a testimonial that month from Maine GOP Secretary Barbara Harvey, whose role in the Republican Party was not disclosed. Harvey published two separate op-eds on the same day in September 2018 defending Collins' vote to confirm Kavanaugh, extolling the nominee's "exemplary judiciary temperament" as something "the founding fathers would have taken great pride in."
"Stay in your own lane. Quit bitching. Mind your own business. Be thankful for what you have. Don't keep looking for the truth because you couldn't handle the truth if you found it," Hobart wrote.
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