Roger Serevino heads civil-rights enforcement at HHS.

But the regulation-averse Trump administration thinks it’s such a pressing problem that on Jan. 18, it announced a proposed new regulation and the creation of the Conscience and Religious Freedom Division within the civil rights office of the federal Department of Health and Human Services. The announcement was made Jan. 18, carefully choreographed for the day before the March for Life in Washington D.C., giving anti-abortion activists renewed energy.

The new section will handle complaints from health workers who feel their religious or moral beliefs are being violated, for example by having to care for transgenders or by being forced to perform or assist with procedures such as abortion, assisted death or sex reassignment surgery.

Roger Severino was a devout anti-gay, anti-abortion activist before being tapped to head civil-rights enforcement at HHS. His new conscience division is charged with investigating complaints made by health care workers. He attempted to explain the initiative on NPR’s All Things Considered on Jan. 18 saying, “The government should not be saying, you cannot have a job; you cannot be a nurse because of your views on abortion. This is about tolerance on all sides.”

What on earth is this man talking about? How can any health care worker’s freedom of religion be threatened in a health care setting? This is a free country. If abortion offends your religious beliefs, don’t work in a setting that provides them. Health care settings are not in short supply — go find another one. No one’s forcing you to work where you do.

And if it offends your religious beliefs to care for transgenders, gays or anyone else not like you, then you’re in the wrong profession. Go back and read your professional code of ethics. Every health care discipline has a code that prohibits discrimination against patients. Nursing’s, for example, reads in part, “The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person … The nurse’s primary commitment is to the patient.” If you can’t practice under those principles, go find another line of work. You are a danger to our patients.

About one such claim was made per year of the Obama administration. But 34 complaints arose during Trump’s first year. Is anyone surprised by the 34-fold increase?

After more than 50 years of policy successes to bring civil rights to discriminated-against groups of people, Trump’s election threw open the closet doors of suppressed white supremacists and other bigots. Silent no more! Ku Klux Klansmen can now throw off their hoods, stand up tall and march defiantly through the streets with torches chanting muck against Jews, blacks and browns, like they did in Charlottesville — with the support of our president.

Let’s put these 34 complaints into perspective. With more than 18 million health care workers in this country, 34 represents 0.00000189 of one percentage point of workers. That’s enough to open a new agency division?

Apparently, the meaning of “religious freedom” has evolved from the freedom to practice no religion or the religion of your choice to freedom to discriminate against others under the guise of religion. Do we want government to protect religious liberty or enforce religious dogma?

This meaningless initiative appears designed to reignite the culture wars over “conscience protections.” It won’t work, but it will cost taxpayer money, and it will harm patients by limiting their access to needed services. I guess HHS is no longer concerned with patients’ civil rights.

This and many other Republican initiatives, such as the bathroom bill from Texas’ last legislative session, are all answers to questions no one is asking. Wouldn’t it be nice if government would come up with answers to questions people are asking? Like how do we secure health care for everyone?

Senior budget officials of the esteemed Centers for Disease Control and Prevention were called to a meeting last Thursday and read a list of forbidden words and phrases — including the term “science-based” — that the Trump administration does not want to see in the agency’s official budget documents to circulate within Congress and the federal government in preparation for the upcoming presidential budget proposal.

The banned words and phrases are “fetus,” “transgender,” “science-based,” “diversity,” “evidence-based,” “entitlement” and “vulnerable.” This to the home of many of the world’s leading epidemiologists and researchers whose job it is to provide for the defense of the nation against health threats and promote the public health.

Can you imagine the atmosphere in the room? I’m envisioning a stunned silence as jaws dropped and eyes widened. It’s a good thing they were sitting down.

The officials were given alternate phrases, such as turning science- or evidence-based into the clunky “CDC bases its recommendations on science in consideration with community standards and wishes” — an outright admission of contempt of science and the triumph of politics and ideology over science. Why not use the more streamlined, “science- and politics-based” or maybe “evidence- and ideology-based?”

When I first started in neonatal intensive care almost 40 years ago, getting parents to sign consents for their baby’s immunizations was easy, no problem. But by the time I retired five years ago, it was the hardest part of my job. Using logic from the Trump administration, maybe the CDC should no longer recommend immunizations based “on science in consideration with community standards and wishes.” Right? Wrong.

In health care, you can do things because you’ve always done them that way. Or … you can do things based on scientific research. The latter is what we do in neonatal intensive care, and what the best hospitals do in all areas. It’s called evidence-based practice. In practice, we look to the CDC for published guidelines on immunizations, infection control and for all manner of health statistics and research data.

Last year, I went to the emergency room after being bitten by a strange dog with nystagmus, a condition in which the eyes make involuntary, repetitive movements. The first thing the doctor did was go to her computer to look up rabies statistics from the CDC. Only then did she give me her recommendation regarding shots.

The CDC funds Texas’ basic health functions such as HIV, sexually transmitted diseases and tuberculosis control and prevention. It supports state laboratories for new technique development.

It funds disease surveillance. For example, on Dec. 15, the CDC reported with details how widespread flu activity had spread to 12 states, up from seven states a week earlier.

Surveillance is especially critical when you need to know in a hurry where infections are popping up. Remember the case of Ebola in Dallas in 2014? Officials from the CDC were dispatched immediately to help with training and surveillance. Remember the outbreak of Zika virus in Brazil in 2015 that caused children to be born with microcephaly? Hundreds of cases were reported in South Texas, but so far this year only 45 cases. The CDC surveils the virus and funds the Texas Zika Pregnancy Registry and the Birth Defect Registry.

If the administration is saying to the CDC that they can’t use the words transgender and diversity in their budget request, you can bet that means “don’t pay attention to those issues.”

This blatant contempt for science must not stand. We need the CDC to sustain and continue to build its vast repository of science information and its culture of excellence. Politics has no place there.

In 2009, as Congress was debating the Affordable Care Act (signed into law the next year,) he was interviewed by Terry Gross on NPR’s Fresh Air. She asked him about the individual mandate to purchase health insurance, an essential ingredient of universal care.

Uwe Reinhardt speaking before Congress.

He answered that Americans have a cognitive dissonance. “Cognitive dissonance,” he said, “means that you hold two different theories that are in conflict with one another, but they’re both in your brain and in your soul …. Americans say the government doesn’t have the right to tell me to buy health insurance, but the same Americans will say if I get hit by a truck and I lie bleeding in the street, society owes it to me to send an ambulance, and the emergency room doctors owe it to me to save my life. How could both be true? Even a teenager would blush at something this ridiculous. If you believe society has a duty to save your life when you get hurt, you have a duty to chip into a fund that pays for that.”

Gross asked him if health insurance purchase were mandated, how everyone could afford it. He responded that a simpler, more helpful question would be, “What percent of a family’s discretionary income, that is, income after food, housing and clothing, should a family be expected to pay for its own health care?”

He suggested that upper-income people such as professors at Ivy League colleges like himself should be expected to pay 15 percent. Those with lower incomes such as waitresses and waiters, would reasonably be expected to pay no more than 5 percent, with government subsidizing the rest.

Reinhardt, who died of sepsis last month at the age of 80, was a plain-spoken advisor and consultant to presidents, congressional committees, countries, the media, corporations and students of health care everywhere. He taught for nearly 50 years at Princeton University, and he explained the most complex issues in health care in brilliant, bright, easy-to-understand prose in his weekly New York Times Economix Blog.

Reinhardt’s views came from personal experience. He grew up in Germany and told Gross “how good it was that when we were paupers, my family, we had health insurance like everyone else in Germany. I’ve never forgotten that. And I would like the American people to have” that.

Living close to a hospital, he saw enough of the horrors of World War II to emigrate to Canada when he was 18 to avoid the draft and to study. There again he appreciated that everyone in the country had health insurance.

After graduation, he immigrated to the United States to earn a Ph.D. in Economics from Yale University. He became bewildered to see the extent of misery, morbidity and mortality caused by a health care “system” where so many lacked insurance and put off care.

He wondered how a country as rich, resourceful and innovative as America could have failed to develop a system to cover everyone. After all, all the other industrialized countries set up health systems where everyone was covered, their governments viewing health care as a right and a proper role and goal of government to sustain a healthy and productive society.

Without the individual mandate, Obamacare will die. As congressional Republicans contemplate the murder-suicide of getting rid of it, we remember Reinhardt’s words: “What kind of country do we want to live in? One where someone who loses their job loses their health insurance? One where kids coming out of college can’t get health insurance for the next 10 years? One where emergency rooms are packed with people who don’t have access to [primary] care? One where people who have a family member struck by cancer can become bankrupt? One where tens of millions are uninsured?”

These are questions of morality.

Covington Middle School RN Sandra Stehling teaches a school staff member how to use the EpiPen.

Austin Independent School District parents received news at the beginning of the school year that while the number of health assistants would be almost doubled, the number of registered nurses would be reduced in elementary schools. Parent testimony to school board members at the Aug. 28 meeting reflected their shock, anger and sense of betrayal. It also revealed a misconception of just who was staffing the “nurse’s room” at the schools.

But first, a little history. In the summer of 1995, new AISD Superintendent Jim Fox did what he had done in Georgia: he threw all registered nurses out of the schools. Too expensive, he said. All hell broke loose. School staff didn’t feel comfortable caring for sick or injured children. Pediatricians were up in arms that without an RN to assess problems, they would be inundated with needless calls to their offices from school staff. Parents were beside themselves.

The community came to the rescue. The Seton health system created a large stakeholder task force, on which I served, and a partnership was born between the former Children’s Hospital of Austin and AISD to provide school health services, the first such hospital/school district partnership in the country.

The model introduced student health assistants trained by school nurses. An RN and assistant were assigned to each of the schools, but with limited resources, they shared schools. Parents, teachers and school staff were greatly relieved and liked the new program.

Fast-forward 22 years to now. With a student population of almost 87,000, Seton made changes to the program.

A non-controversial change was the addition of virtual care technology, which promises to greatly increase efficiency and quality. Cameras installed on health-room computers in each of the district’s 130 schools allow assistants to instantly connect virtually with the nurse when needed and on some campuses with the child’s pediatrician’s office. Before, RNs in shared schools had to rely solely on verbal descriptions via telephone and if needed, drive through this dreadfully congested town to see the child.

The reduction of nurses, in whom parents place their full trust, is what caused the explosive reaction from parents. And it didn’t help that a public hearing wasn’t held before the changes were announced, which Seton admits was a mistake.

Seton’s Kristi Henderson, an architect of the school health program and also a nurse, was taken aback by the community’s reaction and set about to make it right. She visited schools and met with nurses, teachers, principals and parents. One thing she learned is that many parents never realized that health assistants were on staff. Just as in hospitals, assistants help RNs by performing lower-level tasks.

In response to the input she received, rather than reducing nurses, Seton is hiring 33 registered nurses. With those numbers, all of AISD’s large (greater than 700 students) schools will have an RN in the health room all day for the first time. That’s many more nurses than the program has ever had and a 33-percent increase from last year.

All school districts across the country have many students with chronic health conditions, many life-threatening, which require complex and frequent intervention. RNs write individualized protocols for each student with a condition that may become emergent, conditions such as severe food allergy, diabetes, asthma and epilepsy. RNs case-manage medically fragile students. RNs meet with parents and school staff. RNs conduct health teaching in the classrooms. RNs provide trainings for health assistants, teachers and other school staff to learn procedures such as gastrostomy feedings, urinary catheterizations, giving epinephrine and insulin and much, much more.

Parents put their trust in school nurses to be there for their children, many with special needs. Maybe some day every public-school campus will have the security of a trusted, expert registered nurse on site all day. But not today.

First, let’s take a look back to see how our health care system evolved. Every U.S. president throughout the 20th century had universal health care high on his agenda.

—  In the early 1900s, doctors organized to create the American Medical Association. Policy-makers bow to this deep-pocketed group that has a long tradition of killing legislation that changes health care. Unless the AMA is on board, health legislation is pretty much doomed.

— In 1912, Theodore Roosevelt attempted mandatory health insurance, but the effort was sidelined by World War I.

— First fundamental change: In the 1920s, the cost of health care increased relative to other sectors, and two hospitals began to offer health insurance to groups of employees. Enter the advent of third-party payers.

— Franklin Roosevelt tried to include health insurance in the Social Security Act of 1935, but opposition by the AMA resulted in its being dropped.

— During World War II, employers began to offer health insurance coverage to compensate for wage controls placed on employers.

— Harry Truman proposed a national health care system, but again the AMA ostracized the plan calling it the S-word: “socialized medicine.”

— Second fundamental change: During Dwight Eisenhower’s presidency, a 1954 law allowed contributions made by both employers and employees for private health insurance to be tax-free. Millions more Americans were able to gain private health coverage through their employers.

— Third fundamental change: John Kennedy proposed universal coverage, but when his presidency was tragically cut short, Lyndon Johnson picked up the torch. He was unable to get universal care, but through tenacity and legislative mastery he achieved insurance for the elderly, the very poor and the disabled. It was 1965 and they called it Medicare and Medicaid. The AMA was vehemently opposed to the legislation, but Johnson seduced them by allowing them to price their own services and procedures. This is when health care costs dramatically and momentously increased.

— In 1973, Richard Nixon signed the Health Maintenance Organization Act to help reduce costs.

— In 1994, First Lady Hillary Clinton formed a reform task force, but nothing came of the valiant effort for a variety of reasons, not the least of which were the infamous “Thelma and Louise” television ads.

— Fourth fundamental change: On March 23, 2010, Barack Obama achieved near universal coverage with the Patient Protection and Affordable Care Act, insuring tens of millions more Americans. It was the first significant reform legislation in 45 years.

Fundamental change is inherently disruptive. Fury and acrimony ensued, meaning all hell broke loose, with the passage of Medicare and Medicaid. For example, at the time, hospitals were segregated, but to receive Medicare funds, hospitals would have to become integrated. Imagine how well that went over in the overtly racist South.

But now Medicare and Medicaid are popular and well-accepted programs. Don’t believe me? Ask any senior to give up his or her Medicare and watch the reaction. For me, Medicare is far better than any employer insurance I’ve ever had.

The ACA was another disruptive fundamental change. Indeed, seven years later we are still in the eye of the storm, even though more than 20 million Americans gained insurance. The ACA needs to be improved, not scrapped. Down the road, Obamacare will be as popular and well accepted as Medicare and Medicaid.

Before we can achieve universal coverage like all the other industrialized nations, we have to decide and demand — as a society — that health care is a right for everyone, not a privilege for some, and that providing universal coverage is a legitimate role of government. And the American Medical Association must be on board.

Until that happens, we’re doomed to futilely toil like Sisyphus. Once we all come together with a shared philosophy, that stone we push will stay atop the summit.

Nurse practitioner Naomi Warren provides primary care for hundreds of devoted patients in McLennan County, one of 220 counties in Texas designated as medically underserved.

While Congress proved incompetent to improve health care, Texas legislators have a golden opportunity right now to dramatically increase access to care. How? By substantially increasing the number of primary care providers. And … it wouldn’t cost a dime.

We’ve got a real problem here. According to The Commonwealth Fund, in 2015 Texas ranked dead last regarding access to and affordability of health care, a shortage of providers being a leading cause. Thirty-five counties have no physician and of Texas’ 254 counties, 220 are considered medically underserved, according to federal data. That leaves 20 percent of Texans — 4.6 million people — without access to a primary care provider.

Bills introduced this session by Sen. Kelly Hancock (R-North Richland Hills) and Rep. Stephanie Klick (R-Fort Worth) could very well pull us out of the ditch. Senate Bill 681 and House Bill 1415 would deploy thousands more advanced practice registered nurses by removing the physician supervision requirement.

First, some context. Advanced practice registered nurses have been around since the 1960s — nurse practitioners (who provide primary care), certified registered nurse anesthetists, certified nurse midwives and clinical nurse specialists. In the 20th century, when doctors were usually men and nurses usually women, doctors staked out ownership of providing primary care, and legislatures inexplicably enabled them.

But nurse practitioners are exquisitely educated, trained and prepared to provide primary care. Dozens of studies throughout the decades demonstrate nurse practitioners provide primary care on par with physicians, having as good or better patient outcomes. They also score higher in communication.

While almost all states have evolved past physicians’ irrational oppression of nurses, Texas remains among a handful of states that restrict their practice.

As part of a legislative compromise for independent practice in 2013, advanced practice nurses were required to obtain a doctor to sign a document agreeing to supervise their work. Under these agreements, physicians don’t see nurses’ patients, audit 10 percent of their charts and don’t even have to live in the same city. The contract agreements are extremely costly, from $20,000 to more than $100,000 per year according to a Dallas Morning News editorial, effectively pricing the practitioners out of Texas.

Four years out from the pay-to-play requirement, we see advanced practice nurses — who are educated in Texas at taxpayer expense and want to stay in Texas — flocking to 21 other states that don’t restrict practice, including all that border Texas. Heck, the New Mexico Legislature recently appropriated money for an advertising campaign to recruit them!

SB 681 and HB 1415 would end the brain drain. We’ve got around 15,500 nurse practitioners practicing here, but we could have thousands more. The bills would also end the Texas Board of Medicine having any regulatory authority over nurses.

The notion of physicians supervising and regulating advanced practice nurses in any way is, in a word, outrageous. Advanced practice nurses are educated and trained by nurses, regulated by nursing, licensed by nursing and governed by nursing. Nursing and medicine are separate professions, and no other health profession is partially regulated by medicine.

Who opposes the bills? Despite the appearance of conflict of interest, the Texas Medical Association cites patient safety as the concern. Yet not a scintilla of evidence exists from states where nurses practice independently that patients are at risk. This is the same organization that produced a workforce report saying that by the year 2025, Texas would be short 10,000 doctors. You’d think they would want the help.

A broad coalition of 20 organizations has formed to support the legislation including AARP, the Texas Association of Business and think tanks that normally oppose each other — the Center for Public Policy Priorities and the Texas Public Policy Foundation.

If every single nurse practitioner and family doctor were deployed, Texas still could not meet the need for primary care, as the growing demand far outstrips the supply. If SB 681 and HB 1415 become law, Texas could keep the advanced practice nurses it educates and could recruit advanced practice nurses from other states.

On a brisk night in October of 1990, many of us had gathered for a hastily called rally for gubernatorial candidate Ann Richards. She was standing on a makeshift stage in the parking lot of the American Civil Liberties Union building on Lavaca Street, across from the Capitol.

We had watched her electric keynote address at the 1988 Democratic National Convention, where she proclaimed: “Ginger Rogers did everything Fred Astaire did. She just did it backwards in high heels,” so we were excited to see her in person. She talked about issues facing the state with clarity, charm and irreverent, quick-draw quips. But when she got to women’s reproductive rights, she became deadly serious. She told us never to take them for granted, that the day would come when those rights would be under siege.

That seemed far-fetched, but I tucked the scary thought away for a day I hoped would never come.

But here we are.

According to the Guttmacher Institute, by last year more than half the states, mostly in the South and Midwest, are deemed “hostile to abortion” based on number of restrictions.

Not to be outdone by Southern states, nor deterred by last year’s U.S. Supreme Court decision overturning Texas’ senseless and extreme abortion rules, Texas continues in its tireless, jihadist quest to oppress women by depriving them of abortion services.

It’s interesting how quick our leaders are to hurt poor women. Despite Planned Parenthood’s being indisputably the provider of choice in underserved areas — and despite abortion comprising less than five percent of its services — state health officials moved in December to oust the agency as a Medicaid health provider, a move the agency immediately filed suit to block.

Financially, the effect on the agency would be minimal since only around five percent of its revenue comes from Medicaid. But it would cut 11,000 women from receiving any of its services including birth control and life-saving screenings. Importantly, it would devastate morale, as the people who work there are deeply motivated to help low-income women.

Planned Parenthood has been around for 100 years and is deeply trusted by health care professionals and women of all income levels. My neonatal intensive care co-workers and I have referred countless mothers to the agency.

This session, priority bills are being introduced by the lieutenant governor to prohibit third trimester abortion, ban insurance coverage of abortion and ban abortion providers from donating fetal tissue for medical research. Really? That makes about as much sense as outlawing organ donation.

Another bill would eliminate an exception that allows for third-trimester abortions for fetuses with “severe and irreversible abnormalities” that are incompatible with life outside the womb. And Sen. Bob Hall, R-Edgewood, has proposed a constitutional amendment “guaranteeing the right to life of unborn children and prohibiting abortion to the extent authorized under federal constitutional law.” I guess the senator hasn’t heard which way Roe v. Wade went.

Facts, science and reason — endangered concepts — do not support legislators’ assault on abortion. According to the Centers for Disease Control and Prevention, the abortion rate has fallen to well below the 1973 rate when abortion was illegal and Roe v. Wade decided. So, what’s the point?

On Jan. 20, a confidence man who bragged about assaulting women will be inaugurated as the U.S. president. The day after, tens of thousands of us will gather on the south grounds of the Capitol at noon to demonstrate that the right of women to freely decide whether and when to have children is important. As Ann Richards said, we’ve got to fight to keep our rights from being taken away.

Dr. Mary Lou Adams

I met Professor Adams as a nursing student in the ’70s at the University of Texas at Austin School of Nursing. Being in the presence of Adams and the other wonderful faculty inspired us to be the best nurses that we could possibly be, something that stuck with us throughout our careers.

She combined rigorous academics with unwavering compassion for students and patients. Troubled by seeing low-income African-American women die needlessly of breast cancer for lack of screening, she set her sights on changing that. She and Professor Sue Grobe developed a culturally sensitive screening model and obtained funding from the state, the feds and multiple foundations to open the school of nursing’s Breast Cancer Screening Project in 1990, which served primarily women from East Austin.

In 1991, the pilot project became the Women’s Wellness Clinic. From 1990 to 2007, more than 14,000 women were screened for breast cancer. What to do for the women who tested positive? The intrepid pair signed eligible women up for Medicare or Medicaid; recruited surgeons with the help of the late Dr. Robert Askew Sr.; and enticed St. David’s and Seton to perform 10 free surgeries per year. In 2007, the clinic was renamed the Family Wellness Clinic when the nursing school expanded clinic services to family practice.

Over the years, Adams and Grobe refined the model and helped the state acquire a huge grant from the then-named Centers for Disease Control to adopt the model statewide, saving thousands of lives. Their blueprint for comprehensive cancer care, prevention and control has been disseminated to 18 communities across Texas and Kansas.

Through Adams long volunteer service on so many community boards of directors as well as national and state panels including the National Cancer Institute scientific review panels, her considerable influence on clinical practice and health policy will endure.

To funders, policymakers and community stakeholders, Adams’ no-nonsense-but-fun attitude, conspicuous goodwill and focused goals were as irresistible as the twinkle in her eye and her hearty laugh.

Succumbing to pneumonia while in the end stage of rheumatoid arthritis, Adams died this month at the age of 74. Among the 20 or so awards she received were the President’s Volunteer Service Award and induction into the prestigious American Academy of Nursing. She leaves quite a legacy, and she made us all — her patients, students and co-workers — better.

Trish Young Brown

Another most influential woman in health care is Trish Young Brown, 56, who is retiring at the end of the year after 12 years as the founding president and chief executive officer of Central Health. After compassionate Austinites voted to create a taxing authority to pay for indigent health care, its inaugural board needed a leader who could get the district up and running.

They selected Young Brown, who between 2000 and 2005, as the indefatigable CEO of Austin’s CommUnity Care, she ran the federally qualified health centers and Medical Access Program; managed Seton’s lease of Brackenridge; established the women’s hospital within Brackenridge to continue reproductive services while conforming with Catholic directives; and helped establish the health care district.

Young Brown vastly improved health services and access to them. Importantly, she saw to it that women’s reproductive services would continue despite state funding cuts. And she established a lasting framework to better meet mental health needs.

Adams and Young Brown had similar tactics to achieve their lofty goals. Both were focused and goal-directed. Both convened stakeholders making everyone feel welcome, always respectful, yet could hold people’s feet to the fire. Both could run a meeting and work with diversity like nobody’s business.

The seeds Adams and Young Brown planted took root and blossomed. The indelible impact these influential women made on health care will be felt for many years to come.

For background, when the federal government refused to allow — and the courts blocked — Texas’ attempt to exclude Planned Parenthood from the Women’s Health Program in 2011, Texas created its very own, nearly identical program. To do that, Texas turned down $30 million in federal money and replaced it with $30 million of our scarce tax dollars with the express purpose of excluding clinics affiliated with an abortion provider — Planned Parenthood.

That was a major policy shift and a blow to poor women of childbearing age, as many of Planned Parenthood’s 35 clinics were the only source of specialized family planning services in many rural and medically underserved areas. The move cut out an organization that provided 40 percent of the women’s health services in the state while promising access would be improved.

Sen. Jane Nelson, R-Flower Mound

Naturally, researchers at the University of Texas Population Research Center were curious as to what impact the exclusion would have.

Collaborating with researchers at the Texas Health and Human Services Commission, which is required to keep comprehensive Medicaid data, a study was designed to measure the rates of use of the most effective contraceptives and rates of Medicaid-funded childbirth. Data were retrieved for two-year periods before and after the exclusion from counties that had a Planned Parenthood affiliated clinic and counties that did not.

The study found that excluding Planned Parenthood affiliates led to a 35 percent reduction in claims for long-acting contraceptives, such as intrauterine devices, as well as a 27 percent increase in childbirths paid by Medicaid among users of injectable contraception.

Sen. Jane Nelson, an architect of the Texas Women’s Health Program and Republican from Flower Mound, immediately cried foul. “Invalid,” “flawed,” “biased” were among the adjectives she used to describe the study almost immediately after publication.

Time out. We’re talking about The New England Journal of Medicine here, for Pete’s sake. Like other scholarly journals, manuscripts are reviewed by several outside experts in a process called peer review. First delivered by horseback 204 years ago when bloodletting was a common treatment, it’s the oldest continuously published and arguably the most prestigious medical journal in the world. My money is on the New England journal, not the Texas senator, to determine the validity of a research study.

Apparently confusing the study as an indictment of the Texas program as a whole, Nelson further complained that the study sampled only a narrow population of the health program. The study clearly states it never set out to evaluate the entire set of family planning programs in effect in Texas at the present time.

But the senator went even further, writing Health Commissioner Chris Traylor to demand an explanation of how two commission researchers’ names appeared as co-authors on a study she viewed as political.

Traylor responded back to Nelson in a letter dated Feb. 26 that “there is no record of authorization from anyone at HHSC for the two employees to co-author this study.” Neither their immediate supervisor nor anyone in HHSC leadership knew, he claimed. He further proclaimed that his agency demanded that the New England journal and UT immediately remove the two HHSC names from the study.

What’s worse, co-author Rick Allgeyer, a quiet, erudite and revered director of research with more than 20 years tenure with the state, found himself without a job, officially in retirement but clearly ousted from the agency over the controversy.

I’m guessing the senator and the commissioner are unaware of the industry standard — the three guidelines for authorship established in 1979 by the International Committee of Medical Journal Editors. They include substantial contributions to study design or acquisition of data or analysis and interpretation of data; drafting or revising the article critically for important intellectual content; and final approval of the version to be published. It was on the basis of those very criteria that the two commission researchers were invited as authors, according to corresponding author Joe Potter, who heads the Texas Policy Evaluation Project at the UT Population Research Center.

Nelson may also not be aware that the state invests considerable resources for researchers with the capability and freedom to analyze findings so that policy impact can be evaluated. Sharing such research via publications is essential and expected to improve policy and health.

Faced with hard data showing their policy shift has failed poor women living in underserved area, the only Republican response is to call foul? What’s foul are cover-ups, scapegoating and policy based on religion rather than the public interest.

Texas politicians have a nasty habit of interfering with medical board investigations. They need to butt out.