We have liveblogging each of the sessions from The Texas Tribune Festival's Health Care track. The track featured panel discussions on the Affordable Care Act, Medicaid, new developments coming out of Texas, and abortion and women's health.
Featured speakers included Health and Human Services Executive Commissioner Kyle Janek; U.S. Department of Health and Human Services Regional Director Marjorie McColl Petty; state Reps. Garnet Coleman, Sarah Davis, Jessica Farrar, Sylvester Turner and John Zerwas; and state Sens. Donna Campbell and Eddie Lucio Jr.
Look below for highlights of the sessions, which were held on the University of Texas at Austin campus.
With: Garnet Coleman, Kyle Janek, Marjorie McColl Petty, John Zerwas and Becca Aaronson (mod.)
Aaronson opens with the question, "It's no secret that in Texas, Gov. Perry and a lot of state leaders are not big fans of the Affordable Care Act. ... Given this intense politicization of Obamacare in Texas, how do you expect implementation to go?"
Janek says, "I expect it to go a little bit rocky at first. ... We opted for the federal exchange using federal money, federal regulations. ... We anticipate that they will not be ready for us to connect. ... They've said that."
Coleman says, "Everything brand new is bumpy. One of the things I've learned about President Obama is he'd rather have things end up right than start off wrong." Petty says there are four ways for people to enroll. One is to go to the website, a second is via phone—a bilingual line. She says, "There's help for people who are interested in accessing that as a resource." Petty mentions the navigators, who will have people on site to train people to help consumers find plans. Zerwas agrees it will be a rocky rollout, saying, "One of the most important things we need to do would be the education of the population on what you are buying. Probably most of us sitting in this room have had health insurance for most of our lives." Zerwas says he thinks plans available through an exchange is how he'd like to see any form of insurance.
Coleman responds, These are things that are not necessarily new. The challenge is the timeline. Aaronson asks about the navigator program. One group in the Rio Grande Valley has opted out of the navigator program because of increased oversight from the governor. She asks, "Is there a systematic thing going on to undermine this implementation in Texas?"
Janek says he cannot stress how sensitive the information is that's being put in by navigators. "I think the [federal requirements] need to be better." Petty responds, "The question is whether it impedes the work of the navigators, and right now the federal law requires navigators to go through 20 hours of training. The idea of the personal information is a high level worth of training. ... Navigators are prohibited from holding and collecting information." Petty says that the data is not tracked and that one of the requests from Gov. Perry's office instructs navigators to collect information, which is against the law. Petty says, "It's been a real concerted effort on the part of the federal government to meet the needs of Texans." Janek responds, "We see that happen. We have hackers from other countries pinging in, trying to get information. ... They absolutely can collect it. They're doing it on a computer. To think otherwise, I think, is a bit naive."
Coleman stresses that every state employee currently has access to sensitive information. When George Bush rolled out the navigator program for Medicare, no one complained, he says. "Perry's out there talking about it every day, all day. ... But cooperation is extremely important, and one of the ways to make something not work is to make it cumbersome," Coleman says.
Aaronson brings up Medicaid expansion, "on the subject of cooperation." What's going on with Medicaid expansion? Zerwas answers, "The Medicaid system is not working as efficiently as we need it to work. I think the whole Medicaid program does need a reform." Zerwas says that he thinks a deal should be negotiated that he put forward a bill to that effect. "The concept was, let's put insurance in the hands of these 11.5 million people, and put in those policies, the kinds of incentives you want to try to drive those healthy behaviors." From an economic perspective, he says, "It's ultimately a budget-neutral thing."
Aaronson says that, without the expansion, a lot of people are too poor to qualify for the health insurance exchange and will remain uninsured. Petty answers, when you look at the Affordable Care Act, it assumed Medicaid expansion would be a reality. Now, she says, "You end up with people with a little bit higher income, who can get tax credit for insurance. Those right below that don't qualify for anything." The amount of taxpayer money going into uncompensated care is "phenomenal," Petty says. Janek says a big part of his job is having a conversation with U.S. Health Human Services Secretary Kathleen Sebelius about what Texans can do. But, "the idea that you can go to 100 percent coverage in Texas is just not true," he says. Janek says there are a lot of people in the state who are eligible for coverage but "never get in contact." He says, "The idea that everyone just wanders into the emergency department is an old way of thinking. ... Now, what is more likely to happen ... is that we've started to build out that infrastructure program" to offer preventive services.
Coleman says, "The high-risk pool premium is double the average premium that anyone else pays. I come to the conclusion, 'Why can't those folks have the same choices I do?'" He says an indigent care system does not replace knowing that you can walk into the doctor's office at any time. Petty adds that there's a business argument to Medicaid expansion. Janek responds, "No matter how you look at it, that money is borrowed from somewhere else."
Aaronson asks how accessible the insurance plans under the ACA will be. Petty says, "All these insurance companies bid on exactly the same thing, so the consumer has the opportunity to go in and say this is what I can afford. ... Bottom line, with tax credits, it's conceivable that many people will be paying comparable to a cellphone bill for health care." She says all of us need to take responsibility for the "consumer education opportunity." Aaronson asks how this is going to impact real people. Zerwas answers, "The incentives and disincentives just don't line up to make people want to do this, whether it's a cellphone bill or otherwise." He says, "The best health care in the world is available to a lot of us in this country." He doesn't think depending on a "safety-net system" is the right answer. Janek agrees. "We need to reform the existing system in order to get our arms around that cost, which will bankrupt the country."
Aaronson brings up Perry's instruction to Janek to apply for a block grant. Zerwas says that it's unlikely that Texas would get it and that Texas has a history of being turned down for these grants under "friendlier" federal administrations. Coleman jumps in, "A block grant is not a solution to insuring." He says, "We have to agree that the government's role is to be part of the health care system." Janek answers that medical schools in Texas can be a driver of economic growth and that they're located in the high population areas. He says he'd like to give medical schools more funding to generate more primary care in the state, which will still be cost-neutral for the state. Coleman interrupts, "Wait a minute, I put that in the amendment! We do need to train providers. There's an issue, though: Once you open the door, everybody's going to want in." He says it will take a bipartisan effort to say "progress is better than nothing." He stresses, "I'm not mad at Rick Perry," and says he's been doing his job.
Aaronson asks what the measures of success will be for the ACA. Janek answers, "Outcomes. One of the measures I would use for this is how is it going to help us improve those outcomes. We need a little more flexibility to do that, but I think we're going to do a good job." Now Aaronson opens the panel up to questions to the audience. First question is for Janek. "Forgetting about the Medicaid expansion, under the existing law, is there going to be any effort made to bring in any people already eligible under the minimal criteria?" Janek responds that he's trying to push more eligibility applications out there, where people are already going, so that they don't have to take time out of their schedules to seek help. "We'll make it easier for people to get those services by making it easier for people to sign up," he says. "Better online access is already showing results, and that saves costs in the long term, because we have fewer employees," Janek says.
Second audience question is for Zerwas. "Could you go into more detail as to what kinds of behaviors you're trying to incentivize?" Zerwas says the biggest aspect is including "some kind of financial accountability," which will make people better consumers of health care. He says a more informed population will "take us in the right direction" to cutting costs. "Even the poorest of the poor have the ability to pay something when it comes to their health care," he says.
Third question from the audience is, "What do you think the prospects are for Medicaid expansion in the next legislative session?" Coleman answers, "Hope springs eternal," to laughs. But, he says, "What won't happen is that Obamacare will be repealed." Zerwas says, "I think Texas has a history of not jumping into things immediately," and says it's conceivable that eventually a bill will be passed. "I think it could come up again," he says. Coleman again stresses the importance of bipartisan cooperation. Aaronson calls it a wrap.
With: Michael Burgess, Joaquin Castro, Mike Rawlings, Sylvester Turner and Becca Aaronson (mod.)
Given the debate in Washington D.C., on the federal budget, Burgess and Castro have been replaced on the panel by John Davidson, health policy analyst at the Texas Public Policy Foundation and Tom Banning, chief executive officer at the Texas Association of Family Physicians
Aaronson opens the discussion, asking, "Can you talk about your stance on Medicaid expansion and, going forward, why this initiative failed in texas?" Davidson answers, "The reality is that we're going to have the exact same conversation in 2015 that we just had. I think that the parties that want to see Medicaid expanded are going to push again for it." He says his group, The Texas Public Policy Foundation (TPPF), worries the Medicaid program could "crowd out and overwhelm" the state budget, and will continue to push for reforms of the program before expanding it. Banning says Medicaid expansion failed because no politician wanted to vote for it, knowing Perry would veto it. Another reason, he says, is that "Republicans didn't believe that Congress or the administration would maintain its promise to fund the program."
Banning adds, "Our entire health care system, frankly, is broken in the way that it's financed. One real problem we're going to have to deal with is our demographics." Turner joins in, saying there were "some Republicans—many" who did want to expand Medicaid, but not publicly. Turner says, "The reality is, had we voted ... over the next two years, the state of Texas could have drawn down nearly $4 billion." He says Medicaid expansion will come up again in the next legislative session, but he says the federal dollars will not still be "left on the table." He adds, the "system we are operating under currently is not sustainable." He stresses that the system is not "cost-efficient or in the best interest of anyone." Applause.
Rawlings says that we can all agree that a healthy population is in the public's best interest, and that the problem is that the debate has featured too much emotion and not enough logic. "As a businessperson," he says, "I can say, Businesspeople always like leverage—free money from banks." He adds, "It is so illogical to me—There must be something in the air down here." Laughs and applause from the audience. Aaronson says she'll give Davidson, of the conservative TPPF, a chance to respond. Davidson says he's used to being the token on a panel. He says, let's forget Medicaid for a second. "How do we get people to not go to the emergency room?" he asks. He raises CareLink, in Bexar County, as an example. "The emergency room rate of use is far lower" than the average, he says.
Banning says, "The system's moving around to one that's going to emphasize preventive care, continuity and stop this completely fractured way in which our system is delivered. But that shouldn't stop us from covering those who are eligible by the Supreme Court and by Congress to health care access." Rawlings says, this is all very interesting, but it doesn't answer the question about why Texas would refuse the federal money for the taking. Turner responds, saying he is open to Medicaid expansion. "I do not want to see billions of dollars sitting around in D.C." that could provide Texans with health care, he says. "But it's not enough if you're open to it, and the other side says, we don't want to talk about it."
Aaronson asks about the approach of reforming the existing Medicaid program before expanding it. Davidson answers, saying "The state has so little flexibility. The Centers for Medicaid and Medicare Services is constrained by the kind of waivers they can issue the state, and you can't get to the real changes that are needed in the Medicaid program, without some flexibility from Washington." Turner responds, "The decision was made in the state of Texas" not to do anything to expand Medicaid. "It was dead on arrival," he says. "The leadership in the state of Texas has always been reluctant to fund health care. Period."
Turner adds, speaking to Davidson, "You cannot hurt the uninsured without also hurting those who have private health insurance." Banning makes a joke, accepting a block grant would be like giving your 16 year-old daughter a new car and a bottle of Jack Daniels. Laughter from the audience. He says, "When you look at what the Obama administration's goals are, a lot of people would argue that they've been overly flexible in arguing with the state." Rawlings adds, Sebelius has personally assured him she is open to being flexible with the state.
Rawlings speaks to the situation in Dallas. "We have a regional health plan. ... This didn't come easy." He stresses mental health care as "one of the things that cost the city so much money." Turner says the cost of Medicaid expansion would be six times less than the money spent on uncompensated care. Davidson responds, "When you look at states that did expand Medicaid, uncompensated care didn't go down." He mentions Arizona as an example. Banning challenges, citing Texas' implementation of CHIP.
Audience questions begin. The first is, "How will the change in methodology change the Medicaid enrollment"—the way of determining Medicaid eligibility—"How will that change in Texas?" Davidson responds, "HHSC is concerned about how the changes in the asset testing." He says HHSC is worried it will not be able to process applications by Jan. 1, when the insurance mandate takes effect.
The second audience question is, "What do you have to say to the people that actually have to pay for this?" Banning says, "Bend over and grab your ankles." Audience gasps and some laughter. Banning admits the joke is crass, "But you have to hold your breath as long as you can," he says.
Third audience question is, "How would you propose we expand access to health care for the poor, if not through the ACA? And, if Texas were to get a block grant, what would you do with it?"
Davidson answers, "The reason that we are against Medicaid expansion is because of the rules attached to Medicaid on the federal level." He says the rules don't incorporate co-pays on a sliding scale and penalize enrollees for inappropriate emergency access, which incentivizes health care in ways he says are needed. On the block grant, adding that he is not a speaker for Gov. Perry, is that its "point is to get flexibility with respect to the rules. It's to be able to control the long-term costs that we're seeing."
Davidson speaks again to the success of programs like Care Link in Bexar County. "Is Medicaid the best program to put these people into," or are there better alternatives, he asks. Audience member asks for other alternatives, and Davidson again brings up Care Link "as a model for all the major metro areas in Texas." A second example is called Project Access for less densely populated areas, he says, which is also designed to get people out of seeking primary care in emergency rooms.
Another audience member asks, "What happened to Republicans? Were they hatched? Did they not have mothers?" She asks, to Davidson, "What are you going to do about it?" Davidson responds that he's focused on policy, on what works and what doesn't, saying that he will not be the one who personally solves any problems with the health care system. "I'm going to keep studying the programs and recommending policies that will improve them," he says. Banning adds, "One of the best things about the ACA" is that it's finally forcing us, collectively, to talk about health care. He says, "This is the end of the beginning." Rawlings responds, citing the need for bipartisan cooperation. "I can't believe I'm saying this, but ... to paint a big brush over the Republican Party is unfair. We've got to get folks to the table in a positive spirit, because it's not going to happen if we hate each other."
Turner says he remains optimistic. He raises his prison reform bills as a model. Despite critics who accused his programs of being "hug-a-thug" in nature, he says, "many of these diversionary programs do work." He adds, "A denial today does not mean that it will not happen tomorrow. But the longer we wait, the more dollars we lose." Aaronson wraps up the panel.
With: Dorit Donoviel, George Georgiou, Eva Sevick, Jiajie Zhang and Emily Ramshaw (mod.)
Ramshaw kicks off the panel by letting everyone know it'll be like a lightning round and each panelist will have an opportunity to divulge the exciting medical work he or she is engaged in.
Donoviel starts off by saying she's going to let everyone know Texans' tax dollars are at work. She works with a small nonprofit at Baylor College of Medicine that partners with NASA.
"What our mission is is to develop health care capabilities to make sure that humans can live and work in space," she says. Three developments made for astronauts will impact everyone's lives very soon, she says.
First, Donoviel says sleep and fatigue is a major issue for all Americans, but many are very sleep-deprived. "We don't realize we're not actually performing as good as we think we are," she says. Astronauts go around the sun 16 times for each Earth day, so they get very fatigued. "When they end up having to do a very critical task like a space walk, they made mistakes," she says. They developed a simple reaction test to determine whether a person is sleep-deprived. They've made this technology accessible to the public with SleepFit, which the Department of Transportation is now testing to see whether they can use it to determine whether truck drivers aren't too fatigued to drive.
Second, Donoviel says they've been working to monitor brain pressure, which is often an issue for athletes who get knocked hard in the head.
"Right now the only way you can monitor brain pressure, which can cause some very serious effects ... is by putting a needle in somebody's spine or directly through their heads," she says. "That can have very serious implications."
Astronauts have elevations in brain pressure, says Donoviel, which may have to do with the microgravity environment — their blood isn't being pulled down to their feet. To monitor astronauts' brain pressure over time, they've developed technology to measure it through the ear and eye.
"It's going to be so much cheaper if you can do a non-invasive" test, says Donoviel.
Third, Donoviel asks if anyone has experienced kidney stones. In astronauts, the microgravity environment causes calcium to build up, and eventually, may cause the development of painful kidney stones.
"An astronaut cannot wait six weeks in excruciating pain while on a space mission, they can't have surgery to remove a kidney stone," says Donoviel. They've developed technology to target the kidney stone with ultrasound technology and pop the kidney stone — "it's almost like a video game, you're targeting the stone and moving it along."
"I hope I've convinced you some of the things we're doing with your tax dollars through the space program" are going to make health care better and cheaper, Donoviel concludes.
Georgiou says he's working on developing cancer treatments. Tumors have different metabolic needs than other cells, he says, therefore they don't need to build the building blocks of life like other cells, because they can steal them from our body. That makes them vulnerable, because if you deprive them of a particular substance, like amino acids, they will die. Regular cells can synthesize those compounds or stay alive a long time in their absence. Although scientists have known cancer cells have different metabolic needs for a long time, "the question is how do you exploit them for therapeutic purposes," he says.
Georgiou says they've created catalysts — enzymes that are based on an existing human enzyme but now have the ability to degrade cancer cells. "The proteins that we started with were mad for another purpose, but we capitalize on the fact that they are human proteins, they are not recognized as foreign," he says.
He anticipates that clinical trials for these therapeutic treatments will begin in 2014 or early 2015.
Secondly, Georgiou says they began a new way to treat cancer by producing antibodies to fight disease. Antibodies are remarkable, he says, because they can recognie toxic substances with high specificity.
"A pathogen is like a truck runing towards you, if you don't do something its going to run you over so what does the immune system do? It throws arrows at the truck, literally," he says. Although most of those arrows won't have an effect, "the one likely arrow that will hit the tire will stop the truck."
They analyze the antibodies in patients who survived a disease to figure out which antibody is effective at treating the disease, so that they can develop that antibody as a treatment for others. Right now, they're developing this type of treatment for SARS, cancer and other diseases.
Zhang opens by saying he'll be discussing big spending on health care in big Texas. He says technology – and electronic medical records — could save Texas millions of dollars a year.
As of today, 80 percent of medical records are online. Health IT has had a positive impact on the job market, says Zhang. "It has contributed to something called big data," says Zhang.
"Ninety-two percent of the world's data was created in the last two years," says Zhang. The United States has a third of the big data in the world. Examples include cellphone locations, traffic patterns, and everything else on computers. "The servers behind all of this — we use a lot of electricity," he says.
Big data could reduce health care costs by 7.6 percent, says Zhang. In 2012, there were 150 million terabytes of health care data created in the United States. "It's huge, the health care data. It's a challenge, and it's also a great opportunity for us," says Zhang.
Part of that big data is the human genome, he says, adding it would take a person 10 years to read their entire human genome online. But that information could be incredibly valuable, and costs of sequencing a genome costs roughly the same as a dental crown.
He concludes with a story of a patient receiving treatment for Alzheimer's disease who suffered a stroke. He says the patient's doctors could search 9 million patient records and identify other cases of patients who took the drug and suffered a stroke, comb their genetic data and identify whether a gene mutation could be the cause of the adverse reaction. In the future, other patients with Alzheimer's and that gene mutation could have their genes edited to repair the mutation before taking the drug for treatment.
"In Texas we know everything is big ... big data is the new oil. We are a leader in the industry, I think we can lead in the big data industry," Zhang concludes.
Sevick begins by talking about a start-up she's a part of that images the lymphatic system. The lymphatic system moves fluid through your system, and if something happens to it, you have an autoimmune disorder, she says.
"The lymphatics is where the guts absorbs all those nutrients ... and yet, we've never even seen the lymphatics before. With this technology, we're seeing the lymphatics," Sevick says.
Sevick says they use a near-infrared light to excite a dye in the lymphatic system and cause it to emit fluorescent light. They then use night-goggle technology to view the lymphatic system.
"If you have a disease, what happens is your lymph doesn't flow," says Sevick. For example, a patient may have part of her lymph system removed to treat cancer, but years later, a bug bite would cause her lymph system to stop working, and she'd become very swollen. The technology she's helped develop allows them to see those subtle and dramatic changes in the lymphatic system.
If a patient's lymphatic system is broken, there is no way to reverse the swelling of a limb other than massage therapy, says Sevick. Before, there was no proof that massage therapy worked to reverse swelling, but now, their treatment allows them to actually see how massage stimulates the lymphatic system to get the fluid inside the body moving.
Lymphatics are also involved in many blood vascular disorders, says Sevick. She tells the story of a patient whose abdomen was collecting lymphatics. They discovered this after adding the imaging dye to the patient's blood for lymphatic image testing.
Now, they're developing this fluorescent molecule for clinical use so that doctors can do these types of testing that aren't radioactive, says Sevick.
Ramshaw opens the panel up to questions, starts off by asking whether Texas is doing enough to lure medical research to Texas.
"It's not a hotbed of innovation in therapeutics, diagnostics," says Georgiou, because most of that industry is on the East and West coast. "It's quite difficult to convince experienced ... drug development people to move to Texas... They're highly sought after where they are."
He adds that the Cancer Prevention and Research Institute of Texas has made some progress in luring cancer researchers. "We need to have this infrastructure here at our institutes of higher education," says Georgiou.
Donoviel says that by working at the intersection of private and public money, they've developed products that NASA needs and that can be successfully commercialized. "We have one of the biggest health care centers in Houston... but those entrepreneurs are going to go where the money is as well, and the money in Texas is going toward oil and energy and a little bit of software, but certainly not health care," she says.
Zhang is asked if there is enough being done to protect privacy in big data.
The problem for privacy is on the human side, says Zhang, adding that password-protection isn't always secure, because a person could write that password down. "Technology side is pretty secure," he says.
In response to a question on viruses that evolve to fight diseases, Georgiou says even with HIV, there are patients with antibodies that can kill the disease. The questioner responds that it seems optimistic to think we could outpace the evolution of these viruses with "one magic cure."
"Nobody says there is one magic cure, there is a progression," says Georgiou.
With: Donna Campbell, Sarah Davis, Jessica Farrar, Eddie Lucio Jr. and Emily Ramshaw (mod.)
"I know this is a sensitive topic," Ramshaw starts with a friendly warning, "We are here to be really respectful of each others' opinions and if you can't do that we have some friendly bouncers who will escort you out."
On today's panel, we've got the only Democrat who voted for HB 2 — Lucio — and the only Republican who voted against it — Davis.
Ramshaw starts by asking what happened to the "handshake agreement" in the regular session between Democrats and Republicans to restore financing for family planning and women's health without addressing the topic of abortion. "Where did that civil discourse go? What happened? How did we get to the point where we were in the special session?" asks Ramshaw.
Davis says there was not a plan among the legislative Republicans to make an agreement to restore family-planning financing and then turn back on their agreement with Democrats by adding abortion regulations in a second special session — that's a "conspiracy theory."
Campbell adds, "We really just went forward with the intent of good legislation."
There were many issues that did not get addressed in the regular session, says Lucio, but he did not anticipate a special session, particularly a special session on abortion. "Most of the time our state leaders don't want to have special sessions. ... I wasn't surprised that we ended and then went home and then got called back," he says.
Ramshaw references the Tribune's investigation on the state inspection records of abortion facilities, and the little evidence we found that those facilities are unsafe — despite the argument by proponents of HB 2 that the new regulations were necessary to protect women.
"I don't think we need to wait for an accident to happen — death — and I think its very difficult to monitor yourself, so I do think it is reasonable," says Cambell. What harm does it do to raise the standards for abortion facilities to that of ambulatory surgical centers, she adds.
Farrar responds, "The danger lies when you overregulate facilities to the point where you have to shut down." She notes that multiple clinics have already closed. "When they can't access the care and they do desperate things in desperate times."
Davis also adds that most abortions are performed pharmacologically and it seems like a waste of medical resources to require women to receive that medication in a surgical center.
"The point is there isn't any evidence that there is harm being done to women who are having procedures at our current abortion facilities," says Davis, and it is important to note that "state law already requires any abortion that is performed at 16 weeks or later to take place at an ambulatory surgical center."
"My faith leads me to protect life and to support any measure or public policy that comes before me that I think will be healthy for the mother and for the child, regardless of the costs," says Lucio. "That's where I was this session in terms of this particular bill."
Davis says she can respect Lucio's argument, because it goes back to his views on abortion. She says she can't respect arguments that act like the legislation is not about lawmakers' views on abortion.
Abortion facilities are not required to close under the law, says Campbell, but they are required to pay money to upgrade their facilities.
"Are we really wiling to put a dollar value over the risk of women's health — the safety? Not for me as a physician," says Campbell.
It's not just the cost to the facilities, but also the added cost to women seeking abortion services, that makes it more difficult to access the procedure under the new law, says Farrar. "Abortion at an ambulatory surgical center is twice the cost," says Farrar.
Ramshaw asks about the 20-week ban on abortion that is also included in HB 2. Abortion procedures that late in a woman's pregnancy are very rare, says Farrar, and most occur because a woman finds out that there is a serious medical problem in her pregnancy. "A pregnancy that's gone wrong at that point, it's a tragedy," says Farrar.
The ban on abortion at 20 weeks is based on the premise that fetuses can feel pain at that stage of development. Although there is scientific evidence shows that fetuses cannot feel pain, Campbell says there is other research that indicates that they do feel pain and that the majority of Texans also support a ban on late-term abortions.
"We're not in the minority of what the majority of Texans agree," says Campbell.
Davis says she's in agreement that late-term abortions should not be used as a form of birth control, but that there are extenuating circumstances for some women. That's why she tried to add an amendment to create an exception for women with medical problems or in instances of rape or incest.
Lucio adds that for many people, such as him, life begins at conception, and therefore, there should never be any exceptions for abortion.
Ramshaw asks, has the abortion debate awakened as "sleeping giant" in Sen. Wendy Davis?
Lucio responds that he does believe the very public debate on abortion will engage more people in the political process. Although some people may be motivated to come out and vote for Wendy Davis, "there will be other people who will also be awakened to the fact that they too need to participate if they're truly pro-life, if they really want to keep where we stand today on the pro-life issue in Texas and elect leaders," says Lucio. "I'm not endorsing anyone, I'm just saying they're going to go out and elect their leader who is pro-life."
"I've been bombarded by people who say, 'what can I do next?'... they're very excited about this and they're not people that I typically see at our Democratic functions," says Farrar. She notes that the Capitol was so crowded with people interested in stopping this legislation that they reached capacity. "People want to win elections so much that they will put the risk of their own women at stake," says Farrar.
Davis doesn't agree. She says she does not think this issue has put the governor's office at stake for Republicans.
Because abortion is such a polarizing issue, it stirred a lot of emotions, adds Campbell. While Wendy Davis received notoriety for this issue nationwide because of the filibuster, Campbell says, "the majority of Texans don't agree with her philosophy on that issue and to win the governor's race, you've got to have the majority of Texans."
The audience laughs when Campbell states that HB 2 was not passed for political gain. She explains that the majority of lawmakers voted for the bill, and they represent the people.
"With all the legislators voting there was a big enough body to pass it, they all represent a district," says Campbell.
Although the abortion debate energized the Democratic party in way she hasn't seen before in Texas, Davis says, "I still feel very strongly that this is a conservative state."
Lucio says two years ago, Texas cut billions from health care and education spending, yet there weren't thousands of people rallying at the Capitol complaining. "I wish more people would engage themselves in other issues that are just as important when we talk about quality of life," says Lucio.
Ramshaw says, let's set the abortion issue aside for a moment and talk about family-planning financing, which was cut by two-thirds in 2011, and the state's successful efforts to oust Planned Parenthood from state programs. "Are women better off now than they were after the 2011 session or worse off?"
"There's a long way to go," says Farrar, because the cuts left lingering damage on the family-planning network in Texas. "Planned Parenthood wasn't the only provider that was knocked out."
Almost $250 million was added for women's health care this session, rebukes Campbell. She says thousands of providers, now 2,600, have signed up to give access to women's health services. "The dollars have been put out there, and the point is the facilities are actual clinics, doctor's offices, that can actually deliver care at the point of patient contact," says Campbell.
Davis explains that there's a difference between the new providers in the state's expanded primary care program for women and the providers in the Texas Women's Health Program. When Texas lost federal financing for the Medicaid Women's Health Program because it ousted Planned Parenthood and started the new Texas Women's Health Program with state funds, there were many providers listed that were not women's health providers. Davis says there is still work being done to clean up that provider list.
"It's really confusing," because we're talking about three streams of funding, she says. "It's important if we're going to criticize one that we don't lump that into all of the other strategies."
After the state fully establishes its provider network through the $100 million expansion of the primary care program for women's health, Davis says she hopes that they can streamline the multiple financing streams.
To the question of what's next for the abortion opponents' legislative agenda, Campbell says, she'd ban them all if she could. "I would like to see less abortions and more legislation that supports adoption, so that's where I would focus."
"If we save one life, that's paramount for me," says Lucio. He adds that he would like to see legislation requiring women to be counseled on adoption before having an abortion.
Davis adds that she plans to refile legislation that failed this session to remove medically inaccurate information from the "Woman's Right to Know" pamphlet that providers are required by state law to distribute to women having abortions.
Farrar says it's important to increase access to education on family planning for both women and men. "This is a dual responsibility and I think that my male colleagues need to support that as well," she says.
In defense of the provision in HB 2 that requires physicians to follow the FDA guidelines for prescription drugs that induce abortions, Campbell says, "should FDA guidelines for any prescription drugs be ignored?"
"Those are outdated, there will be new guidelines that will be issued," says Davis, explaining that standard practice is to prescribe half the dose. She says the law requires physicians to ignore clinically based practices and that is the "definition of interference with the patient-doctor relationship."
Ramshaw opens it up to the audience for questions. First person asks, "why aren't we looking at something like a humane removal?"
Farrar says, "these are medical practices ... the medical community has accepted this." Campbell counters that she does think they could consider alternative ways to remove the child.
Second question — did lawmakers consider the cost of upgrading abortion clinics or building new ambulatory surgical centers? Or how possible it would be to create those facilities by the September 2014 deadline?
Davis says she doesn't think they considered how feasible it would be to upgrade to facilities in that time, and when she asked how much this is going to cost per facility, "I was told it was really impossible to give you an answer, because it's just going to depend on the state and the age of the facility that you're talking about."
Questioner says she watched Republicans — except Davis — shut down all of the amendments to HB 2 offered by Democrats in the House. What about common ground?
"There is no common ground," says Farrar.
"It was never the intention of Republicans to accept any amendment," adds Davis, whose amendments were also rejected by the House. "I was really trying to hone in on getting rid of those admitting privileges, I even would have conceded with the ambulatory surgical center standards if we could have gotten rid of those admitting privileges."
In defense of the hospital admitting privileges rule, Campbell says that as a physician, knowing another physician has hospital privileges is confirmation that he or she has proper credentials. She also adds that it ensures continuity of care for patients who experience problems and need to be transferred to a hospital.
After a series of pointed questions directed to Campbell, she responds, "I believe that our pro-life legislation that we put forth goes further to support the safety of women who decide to have an abortion, whether I'm against it or not."
A University of Texas researcher, Dr. Joe Potter, asks whether the lawmakers would consider expanding reproductive health services for men with additional family-planning dollars, so that they could have procedures such as vasectomies.
"My colleagues act like it's all women," says Farrar.
Lucio says he has supported the distribution of condoms at our universities, but he would not support a measure for state-financed vasectomies. "It goes back to my faith, we're against contraceptives. We're against any method of keeping life from coming to existence in this natural state," says Lucio. "I don't think the state should be using tax dollars, especially when millions of people feel the way I do."