Tag Archives: Medicaid

U.S. Senate Republicans to issue revised health bill to win support

Speaker of the House Paul Ryan (R-WI) speaks after Senate Republicans unveiled their version of legislation that would replace Obamacare on Capitol Hill in Washington, U.S.

By Yasmeen Abutaleb and Richard Cowan

WASHINGTON (Reuters) – U.S. Senate Republicans plan to issue a revised version of their healthcare bill on Monday, according to a Republican Senate aide, as the chamber’s leaders scrambled to get legislation passed ahead of a July 4 holiday recess starting on Friday.

The aide, who is familiar with the plan, did not provide details of changes in the works. Politico reported that a likely change to the bill would be to add a provision to encourage people, mainly those who are young and healthy, to enroll in insurance plans.

President Donald Trump and his fellow Republicans in Congress have been pushing to repeal and replace Obamacare, Democratic former President Barack Obama’s signature domestic legislation. The House of Representatives passed its version of a healthcare bill last month.

The Senate bill unveiled last week was immediately criticized by both conservatives and moderates in the party. With Republicans holding only a 52-seat majority in the 100-seat Senate, the bill was unlikely to win passage in its initial form.

At least four conservative Republicans have expressed opposition to the draft legislation, saying it does not go far enough in repealing Obamacare.

A spokesman for Senate Majority Leader Mitch McConnell would not comment on whether a vote on a bill would be held in the full Senate on Thursday, as originally anticipated.

The nonpartisan Congressional Budget Office later Monday might release its assessment of the bill’s cost and impact on future budget deficits. It was not clear whether the report will also estimate how many people might lose healthcare coverage under the legislation or whether that estimate would come later.

Meanwhile, some moderate Republicans have either withheld judgment or expressed doubts about replacing Obamacare with legislation that is similar to the House version.

They are concerned that the party’s approach to healthcare would cause too many people, and especially those with low incomes, to lose insurance. Trump touted passage of the House bill as a victory but later called it “mean.”

Republicans have targeted Obamacare since it was passed in 2010, viewing it as costly government intrusion and saying individual insurance markets are collapsing. The legislation expanded health coverage to some 20 million Americans, through provisions such as mandating that individuals obtain health insurance and expanding Medicaid, the government program for the poor.

TRUMP’S INVOLVEMENT

As he did during the House negotiations, Trump has personally pushed for a Senate bill, calling fellow Republicans to mobilize support.

In the efforts by Senate Republicans to push through a bill, the party has split over a provision in the draft bill ending federal funding of Planned Parenthood, the women’s healthcare provider, for one year.

Moderates are wary of this, while conservatives have called for an end to federal funding of Planned Parenthood because it provides abortions, even though they are not performed with taxpayer dollars.

Health insurance companies are concerned about the bill’s plan to cut Medicaid and any impact on state governments as well as the prospect of losing Obamacare’s mandate on individuals to buy insurance without creating alternative incentives for people to stay in their plans.

If the Senate passes a bill, it will either have to be approved by the House, the two chambers would have to reconcile their differences in a conference committee, or the House could pass a new version and bounce it back to the Senate.

The House is also controlled by Republicans but faced a similar balancing act between moderates and conservatives to pass its version.

A Republican leadership aide in the House said if the Senate manages to pass a healthcare bill this week, no decision has been made on when the House might schedule a vote on it or whether House Republicans might seek any changes to the Senate measure.

(Writing by Richard Cowan and Frances Kerry; Editing by Jeffrey Benkoe)

After weeks of secrecy, U.S. Senate to unveil healthcare bill

FILE PHOTO - U.S. President Donald Trump (C) acknowledges House Speaker Paul Ryan (3rdL) as he gathers with Congressional Republicans in the Rose Garden of the White House after the House of Representatives approved the American Healthcare Act, to repeal major parts of Obamacare and replace it with the Republican healthcare plan, in Washington, U.S., May 4, 2017. REUTERS/Carlos Barria

By Susan Cornwell and Richard Cowan

WASHINGTON (Reuters) – U.S. Senate Republicans plan to unveil the text of their draft healthcare bill on Thursday as senators struggle over issues such as the future of the Medicaid program for the poor and bringing down insurance costs.

Republicans in the chamber have been working for weeks behind closed doors on legislation aimed at repealing and replacing major portions of the Affordable Care Act, former Democratic President Barack Obama’s signature healthcare law, popularly known as Obamacare.

The effort has been plagued from the start by tensions between moderates and conservatives, which surfaced again on Tuesday. Democrats have also criticized the behind-the-scenes meetings, staging a protest on the Senate floor on Monday.

“Republicans are writing their healthcare bill under the cover of darkness because they are ashamed of it,” Senate Democratic leader Chuck Schumer charged.

President Donald Trump campaigned on a promise to repeal Obamacare. The 2010 law extended insurance coverage to millions of Americans through both subsidized private insurance and an expansion of Medicaid.

The Republican-controlled House of Representatives narrowly approved its version of repeal last month.

Trump has urged the Republican-led Senate to pass a more “generous” bill than that approved by the House, whose version he privately called “mean,” according to congressional sources.

An estimated 23 million people could lose their healthcare under the House plan, according to the non-partisan Congressional Budget Office. Senate Majority Leader Mitch McConnell said on Tuesday the Senate healthcare bill would be different from the House version, but he did not elaborate.

In the Senate, moderates including Senator Shelley Moore Capito have argued for a long, seven-year phase-out to the Medicaid expansion that happened under Obamacare. But Senator John Thune, a member of the Republican leadership, said on Tuesday the phase-out in the bill might just be three years.

Capito said on Tuesday she was also concerned the Senate healthcare plan might cap Medicaid spending and shift it to a lower growth rate in 2025. “That’s an issue,” she said.

CONSERVATIVES WARY

Senate conservatives also seemed wary of the emerging bill. Ted Cruz, a member of a core group of 13 Republicans who have been working on the legislation, told reporters the bill did not yet do enough to lower health insurance premiums. “If it is going to pass, the bill is going to have to make meaningful steps to reduce premiums,” he said.

Given the opposition of all Senate Democrats to repealing Obamacare, Republican leaders will need the support of at least 50 of the chamber’s 52 Republicans to ensure passage.

McConnell announced a discussion draft would be laid out on Thursday. The bill will be brought to the Senate floor once the CBO has assessed its cost and impact, “likely next week,” McConnell said.

Thune said the bill was not yet finalized, saying: “We’re trying to get definitive determinations” on a range of issues.

Vice President Mike Pence predicted that new healthcare legislation would be enacted this summer.

“I want to assure you, before this summer is over … President Donald Trump and this Congress will keep their promise to the American people, and we will repeal and replace Obamacare,” Pence told a meeting of the National Association of Manufacturers.

(Editing by Caren Bohan and Peter Cooney)

U.S. hepatitis C cases soar on spike in heroin use

FILE PHOTO - A man injects himself with heroin using a needle obtained from the People's Harm Reduction Alliance, the nation's largest needle-exchange program, in Seattle, Washington April 30, 2015. REUTERS/David Ryder/File Photo

(Reuters) – U.S. health officials said new cases of hepatitis C rose nearly 300 percent from 2010 to 2015, despite the availability of cures for the liver disease, fueled by a spike in the use of heroin and other injection drugs, according to a report released on Thursday.

In 2015, the national reported rate of hepatitis C was 0.8 per 100,000 persons with nearly 34,000 new infections, according to the report by the Centers for Disease Control and Prevention.

Access to clean syringes and a limit on Medicaid barriers to curative treatments for hepatitis C can reduce rates of death from the disease and transmission of the virus to others, the CDC said.

New treatments for hepatitis C with a cure rate of over 95 percent from Gilead Sciences <GILD.O>, AbbVie <ABBV.N> and other drugmakers have the ability to virtually wipe out the disease, which can lead to cirrhosis, cancer, the need for a liver transplant or death.

But the opioid addiction epidemic appears to be creating tens of thousands of new cases, with unclean needles the leading cause of infections. Some experts say that one reason heroin use has soared is because the illegal drug has become much cheaper than prescription opioid painkillers and due to new limits on dispensing of the addictive legal pain medicines.

The CDC conducted a state-by-state analysis of reported cases of the hepatitis C virus (HCV), as well as a review of laws related to access to clean needles for individuals who inject drugs, and levels of restriction on Medicaid access to treatments.

In 2015, it found HCV rates in 17 states exceeded the national average.

The analysis found only Massachusetts, New Mexico and Washington had both a comprehensive set of laws and a permissive Medicaid treatment policy that could help prevent the spread of HCV and provide treatment services for those who inject drugs.

Twenty-four states had policies that require some period of sobriety to receive HCV treatment through Medicaid, potentially limiting access to cures, compared with 16 states without such restrictions.

Among the best ways of preventing spread of the virus are public health laws that allow access to clean syringes for drug users, such as needle exchange programs, decriminalization of the possession of syringes, and allowing the retail sale of syringes without a prescription.

Eighteen states had no such programs, the report found, while Maine, Nevada and Utah had the most comprehensive laws related to prevention, including syringe exchange without limitations.

(Reporting by Bill Berkrot; Editing by Leslie Adler)

Republicans to press ahead with plan to dismantle Obamacare health plan

File photo: Information cards are stacked on a table during an Affordable Care Act outreach event for the Latino community in Los Angeles, California September 28, 2013. REUTERS/Jonathan Alcorn

WASHINGTON (Reuters) – U.S. President Donald Trump and his Republicans were set to press ahead in Congress on Thursday with a plan to dismantle Obamacare, negotiating changes as they go, with their bill slated to move to the budget committee on its way to a crucial vote soon by the full House of Representatives.

Conservatives have demanded a quicker end to the expansion of the Medicaid program put in place under the Affordable Care Act, the healthcare overhaul approved under former Democratic President Barack Obama.

They also want to add work requirements for some recipients of Medicaid, the government health insurance program for the poor.

The White House said it was discussing such tweaks with House Republican leaders, including Speaker Paul Ryan.

“There’s no perfect piece of legislation. There’s gonna be this framework that’s going to be added to or subtracted to during the process, and eventually it’s going to pass the House and it’s going to pass the Senate,” White House budget director Mick Mulvaney told Fox News in an interview on Thursday.

Mulvaney acknowledged the difficulty the draft legislation could face in the Senate, where Republicans hold a slimmer majority and several of them have already voiced doubts.

On Wednesday, Trump held a campaign-like rally in Tennessee as he tried to build momentum for his first legislative initiative to make good on his campaign promise to repeal and replace Obamacare.

Trump administration officials and House Republican leaders have not given a timetable for a vote on the legislation, although Ryan has said he wants to pass it by lawmakers’ mid-April recess.

Two House committees approved the bill’s provisions with no changes last week. On Thursday, the Budget Committee will try to unify the plan into a single bill for consideration on the House floor.

Signs have emerged that the White House was winning over reluctant conservatives who initially questioned the legislation on the grounds that it too closely resembled Obamacare. But Republican moderates have raised concerns that tax credits in the bill will not be enough to help people buy health insurance.

Senate Republicans have also voiced dissatisfaction with the bill.

“As written, the House bill would not pass the Senate. But I believe we can fix it,” Senator Ted Cruz said on Wednesday.

Republican Senator Rand Paul, a fierce critic of the House plan, also said the White House has been more open to negotiation than House leaders.

(Writing by Susan Heavey; Editing by Bernadette Baum)

Republican healthcare plan clears first hurdle as concerns loom

A copy of Obamacare repeal and replace recommendations (L) produced by Republicans in the U.S. House of Representatives sit next to a copy of the Affordable Care Act known as Obamacare as U.S. Health and Human Services Secretary Tom Price addresses the daily press briefing at the White House in Washington, U.S. March 7, 2017. REUTERS/Carlos Barria

By Susan Cornwell and Yasmeen Abutaleb

WASHINGTON (Reuters) – U.S. Republicans cleared the first hurdle in their plan for the massive healthcare system overhaul backed by President Donald Trump, despite concerns among Democratic lawmakers, hospitals and insurers about its unknown costs and impact on coverage.

The House of Representatives Ways and Means Committee approved the bill along party lines on Thursday morning after debating the draft legislation for nearly 18 hours.

The chamber’s Energy and Commerce committee continued its own marathon session after Republican leaders earlier this week unveiled the plan, which would undo much of the 2010 Affordable Care Act, popularly known as Obamacare.

Republicans, who control the House and the Senate, are eyeing mid-April for passage of the bill.

“This is an historic step, an important step in the repeal of Obamacare,” said Republican Representative Kevin Brady, chairman of the House Ways and Means committee after it voted 23-16 for the measure.

The legislation would end the financial penalty for not owning health insurance, reverse most Obamacare taxes, introduce a smaller system of tax credits based on age rather than income, and overhaul Medicaid, the government health insurance program for the poor.

The American Hospital Association, the American Medical Association and other hospital groups have come out against the bill. The proposed changes to Medicaid have weighed on shares of hospitals, particularly Community Health Systems and Tenet Healthcare Corp, as investors worry about less government reimbursement.

Obamacare also enabled 20 million previously uninsured people to obtain coverage. About half came from a Medicaid expansion that the new bill would end.

America’s Health Insurance Plans, which represents Anthem Inc and other insurers, said tax credits for the individual insurance market did not go far enough.

The House Ways and Means committee, which was looking at the tax-related provisions of the bill, made no changes, despite dozens of attempts by Democrats to introduce amendments.

The fast-emerging disorder around the bill, Trump’s first legislative test, follows the chaos triggered by his travel ban on citizens from several Muslim-majority nations that was later revised.

Trump and fellow Republicans campaigned last year on a pledge to dismantle Obamacare, the signature domestic policy achievement of Democratic former president Barack Obama. They have called it government overreach that had ruined the more than $3 trillion U.S. healthcare system.

RESISTANCE

But Republican lawmakers face resistance from conservatives within their own ranks who say the bill, which would create a system of tax credits to coax people to buy private insurance on the open market, is not radical enough.

Health and Human Services Secretary Tom Price has tried to allay those concerns, saying the bill is part of a three-phase plan. But he told Fox News: “The message might not have been absolutely piercing to folks.”

In a series of tweets early on Thursday, Republican Senator Tom Cotton urged his House colleagues to pull back, saying their measure could not pass the Senate without major changes. “What matters in long run is better, more affordable health care for Americans, NOT House leaders’ arbitrary legislative calendar,” he wrote.

Representative Steve King said on CNN that his fellow Republicans must act now. “If nothing gets done here in this Congress, we are stuck with Obamacare,” he said.

Democrats denounce the bill as a gift to the rich and say informed debate on it is impossible without knowing its cost.

“The millionaires and billionaires, they’re going to do just great,” Democratic Senator Chris Van Hollen, a member of the Senate Budget Committee told MSNBC. But for working Americans, “this makes that squeeze much tighter and provides windfall tax breaks to the wealthy.”

House Democratic leader Nancy Pelosi cited the lack of analysis of the bill by the nonpartisan Congressional Budget Office. “This is decision-making without the facts,” she told reporters on Wednesday.

Republicans said they had asked the CBO to provide a preliminary estimate of the cost of the bill and expect to have that analysis by the time it hits the House floor.

“CONSTRUCTIVE IMPROVEMENTS”

Dan Holler, spokesman for the powerful conservative group Heritage Action, also sought more information. “Americans deserve full transparency, which includes the full budget score,” he said.

But some Republicans have cast doubt on the accuracy of CBO estimates, suggesting the agency’s initial assessment of the cost of Obamacare had proved far wide of the mark.

“If you’re looking at the CBO for accuracy, you’re looking in the wrong place,” White House spokesman Sean Spicer said on Wednesday.

Trump and Vice President Mike Pence met with leaders of conservative groups who have concerns about the bill on Wednesday. A White House official later said they were open to “constructive improvements.”

Once the two committees have approved their parts of the legislation, both will go to the House Budget Committee, which is expected to merge them into one bill that will then be voted on by the full chamber.

House Speaker Paul Ryan wants that vote to happen this month so the bill can move to the Senate for consideration.

Medicaid Chief Medical Officer Andrey Ostrovsky said on Twitter that he was aligned with experts who oppose the bill, breaking with the administration.

(Additional reporting by David Morgan, Brendan O’Brien, Susan Heavey and Doina Chiacu; Writing by Nick Tattersall; Editing by Lisa Von Ahn)

Overhaul of Medicaid expansion could cost states $32 billion: report

A woman picks up a leaflet at a health insurance enrollment event in Cudahy, California March 27, 2014. REUTERS/Lucy Nicholson

By Hilary Russ

NEW YORK (Reuters) – Proposals in Congress that would effectively end Medicaid expansion in 31 U.S. states would cost those states at least $32 billion altogether in 2019, according to a report released on Friday.

“Few, if any, states could absorb such new costs,” the Center on Budget and Policy Priorities, a Washington-based, left-leaning think tank, said in its report.

Republican President Donald Trump has pushed to fulfill a campaign promise to replace Obamacare, his Democratic predecessor’s signature healthcare plan, with the help of a Republican-controlled Congress.

More details of potential replacements by U.S. House Republicans for former President Barack Obama’s Affordable Care Act emerged on Friday, though they have yet to agree on a single detailed policy proposal to repeal and replace the healthcare law.

One scenario to phase out enhanced federal funding would convert the current system, in which states share the cost of Medicaid enrollees with the federal government, into fixed payments, or block grants, sent to the states.

But that would dramatically affect the 31 states and the District of Columbia that chose to expand Medicaid, the government health insurance program for low-income Americans, and collect extra dollars that came with expansion.

Those states would have to find the extra $32 billion themselves to maintain their expansions, the center said in its report.

The block grant conversion would “shrink federal Medicaid funding over time, result in even deeper funding cuts when needs increase, and ultimately place coverage for tens of millions more Americans at risk,” the center said in its report.

The reduced federal funding would cause the automatic end of the expansion in seven states. Other expansion states would “almost certainly drop or substantially scale back their expansions,” the report said.

Medicaid sits at the heart of the federal-state fiscal relationship. Over $330 billion in federal Medicaid dollars flowed to states in fiscal year 2016, accounting for more than half of all federal grants sent to state and local governments and the largest individual program, according to Standard & Poor’s.

(Reporting by Hilary Russ; Editing by Jonathan Oatis)

U.S. judge blocks Texas plan to cut Planned Parenthood Medicaid funds

FILE PHOTO - Planned Parenthood South Austin Health Center is seen in Austin, Texas, U.S. on June 27, 2016. REUTERS/Ilana Panich-Linsman/File Photo

By Jon Herskovitz

AUSTIN, Texas (Reuters) – A U.S. judge in Austin issued a preliminary injunction on Tuesday halting Texas’ plan to cut Medicaid funding for Planned Parenthood, saying the state did not present evidence of a program violation that would warrant termination.

U.S. District Judge Sam Sparks said state health officials “likely acted to disenroll qualified health care providers from Medicaid without cause.” He said the preliminary injunction will preserve the court’s ability to render a meaningful decision on the case’s merits.

“Such action would deprive Medicaid patients of their statutory right to obtain health care from their chosen qualified provider,” wrote the judge who was appointed by Republican former President George H.W. Bush.

The reproductive healthcare group has said the threatened funding cut, by terminating Planned Parenthood’s enrollment in the state-funded healthcare system for the poor, could affect nearly 11,000 patients across Texas as they try to access services such as HIV and cancer screenings.

Texas and several other Republican-controlled states have pushed to cut the organization’s funding since an anti-abortion group released videos it said showed Planned Parenthood officials negotiating prices for fetal tissue collected from abortions.

Texas investigated Planned Parenthood over the videos and a grand jury last January cleared it of any wrongdoing. The grand jury indicted two anti-abortion activists who made the videos for document fraud but the charges were dismissed.

The state took no further criminal action against Planned Parenthood after that but has repeated its accusations that the abortion provider may have violated state law.

Planned Parenthood has denied any wrongdoing and sued the anti-abortion activists who made the videos.

Texas Republican Attorney General Ken Paxton said his office would appeal.

“Today’s decision is disappointing and flies in the face of basic human decency,” he said in a statement.

In fiscal 2015, Planned Parenthood affiliates across Texas received about $4.2 million in Medicaid funding, the state’s Health and Human Services Commission said. Planned Parenthood said the amount for 2016 was estimated at around $3 million.

None of the money that the group received went for abortions, plaintiffs in a lawsuit against Texas and the Medicaid defunding plan have said.

Planned Parenthood has 34 health centers in Texas, serving more than 120,000 patients, 11,000 of whom are Medicaid patients, it said.

(Reporting by Jon Herskovitz; Editing by Grant McCool and James Dalgleish)

U.S. healthcare costs to escalate over next decade: government agency

doctor holds hand of patient

WASHINGTON (Reuters) – The cost of medical care in the United States is expected to grow at a faster clip over the next decade and overall health spending growth will outpace that of the gross domestic product, a U.S. government health agency said on Wednesday.

A report by the U.S. Centers for Medicare and Medicaid Services (CMS) cited the aging of the enormous baby boom generation and overall economic inflation as prime contributors to the projected increase in healthcare spending.

Overall healthcare spending will comprise 19.9 percent of the economy in 2025, up from 17.8 percent in 2015, the report forecast. The pace of growth in U.S. spending on health is expected to pick up in 2017, increasing 5.4 percent over 2016. That compares with an estimated 4.8 percent spending uptick in 2016. Spending for 2016 was estimated at $3.4 trillion.

When the final numbers are in, the growth in prescription drug spending for 2016 is expected to have slowed to 5 percent from 9 percent in 2015. However, CMS has forecast growth of 6.4 percent per year between 2017 and 2025, in part because of spending on expensive newer specialty drugs, such as for cancer and multiple sclerosis.

The projections for 2016 to 2025 were made assuming that the Affordable Care Act (ACA), former President Barack Obama’s signature healthcare law widely known as Obamacare, would remain intact. It does not take into account likely changes to the law.

The Republican-led Congress and President Donald Trump have vowed to repeal and replace the ACA, but a viable replacement plan has yet to emerge.

Trump signed an executive order on his first day in office last month to freeze regulations and enable government agencies to take other steps to weaken Obamacare.

The ACA expanded Medicaid, the government health insurance program for the poor, in more than 30 states and set up private healthcare exchanges that enabled previously uninsured people to buy health insurance. After high enrollment between 2014 and 2015, Medicaid and private health insurance spending were expected to have slowed in 2016.

But spending on Medicare, the government health insurance program for the elderly, is expected to grow between 2017 and 2025 as a larger elderly population requires more medical services.

The overall insured rate of the population is expected to reach 91.5 percent in 2025, up from 90.9 percent in 2015, the report said.

(Reporting By Yasmeen Abutaleb; Editing by Tom Brown)

Iowa moves to cut Medicaid funding for Planned Parenthood

Planned Parenthood in Texas

By Timothy Mclaughlin

(Reuters) – The Republican-controlled Iowa state senate voted on Thursday to cut Medicaid funding for family planning services to abortion providers including Planned Parenthood.

State senators passed the bill 30-20, advancing it to the Republican-controlled House. The vote was along party lines, with one independent voting in favor of the measure.

Republican Governor Terry Branstad has said he supports the bill.

Planned Parenthood draws the ire of many Republicans because it provides abortions, and Republican President Donald Trump has pledged to defund the organization.

“This change will allow Iowa to restrict government funding to family planning services away from organizations that perform abortions that are not medically necessary,” Republican Senator Amy Sinclair, one of the bill’s sponsors, said on Thursday before the vote.

Planned Parenthood denounced the vote.

“The Republican lawmakers who continue to advance this bill should be ashamed of themselves. They are playing political games, with the lives of low-income Iowans at stake,” Planned Parenthood of the Heartland said in a statement.

“This bill does nothing to advance their extremist agenda to limit access to abortion. Instead, it blocks access to crucial family planning services for thousands of Iowans – the very services that most effectively prevent abortion. It’s a self-serving, misleading and dangerous political game.”

The bill directs the Iowa Department of Human Services to discontinue the Medicaid family planning network waiver on July 1 and replace it with a state family planning services program.

Eligibility requirements for the new network would remain the same, but no funding would be provided to organizations that provide abortions or maintain facilities where abortions are carried out.

Planned Parenthood is Iowa’s largest abortion provider with 12 clinics in the state, but no public money is used for abortions, according to the Des Moines Register.

Branstad has proposed paying for the new state-run program by shifting $2.8 million in funds from services for vulnerable adults, families and children, the newspaper reported.

Planned Parenthood is also facing a funding cut in Texas, where a judge is considering the move, which the organization has challenged in court.

(Reporting by Timothy Mclaughlin in Chicago; Editing by Cynthia Osterman)

Texas Planned Parenthood asks judge to block Medicaid funding cut

Planned Parenthood in Austin, Texas

By Jon Herskovitz

AUSTIN, Texas (Reuters) – The leaders of Texas Planned Parenthood asked a federal judge on Tuesday to block the state’s bid to halt Medicaid funding for the healthcare group, which has long been targeted by Republicans for providing abortions.

Planned Parenthood has said the threatened funding cut, by terminating Planned Parenthood’s enrollment in the state-funded healthcare system for the poor, could affect nearly 11,000 patients across Texas.

It is seeking an injunction from Judge Sam Sparks in federal court in Austin to stop the cutoff, part of a protracted legal and political fight.

Texas and several other Republican-controlled states have pushed to cut the organization’s funding since an anti-abortion group released videos it said showed Planned Parenthood officials negotiating prices for fetal tissue collected from abortions.

The defunding efforts could gain traction now that Republicans, who already control the U.S. House and Senate, are expanding their powers with this week’s inauguration of President-elect Donald Trump.

Ken Lambrecht, chief executive of Planned Parenthood of Greater Texas and a plaintiff, testified his group does not participate in fetal tissue donation for medical research.

Planned Parenthood has denied wrongdoing nationally, saying the videos were heavily edited and misleading.

The Medicaid cut was “unconscionable,” Lambrecht testified, adding it would make it more difficult for some of the state’s poorest people to access services his affiliate provides, such as cancer screenings and HIV testing.

Texas has said other medical facilities could provide similar services as Planned Parenthood.

Planned Parenthood affiliates across Texas received about $4.2 million in Medicaid funding during the 2015 fiscal year, the state’s Health and Human Services Commission said.

None of that money went to abortions, plaintiffs in the lawsuit against Texas and the Medicaid defunding plan have said.

Sparks said he does not see the videos as a central to the hearing, which opened Tuesday and is scheduled to run through Thursday. He called on the state to present evidence to back up its allegations that Planned Parenthood violated the law.

Texas investigated Planned Parenthood over the videos and a grand jury last January cleared it of any wrongdoing. The grand jury indicted two people who made the videos for document fraud but the charges were later dismissed.

The state took no further criminal action against Planned Parenthood after that but has repeated its accusations that the abortion provider may have violated state law.

Planned Parenthood gets about $500 million annually in federal funds across the United States, largely in reimbursements through Medicaid.

(Reporting by Jon Herskovitz; Editing by Tom Brown and Lisa Shumaker)