talkingpointsmemo--2020-08-03--Election Results Could Take Weeks—Just Look At How Long Some Primary Counts Dragged On

Having survived a crushing primary season where election infrastructure quickly had to be adapted for large-scale absentee voting , there ’ s one thing election officials are hoping for in the general election : that it ’ s not their jurisdiction that ’ s preventing the country from finding out who won the White House .
In states across the country , reporting the results from the pandemic-rocked elections in the spring and summer took days and even weeks longer than Americans are used to .
There are several different factors contributing to the delays .
But it ’ s @ @ @ @ @ @ @ reporting results moving more quickly in November , when election officials are preparing for an even larger influx of mail-voting — in some places , five or ten times greater than what they ’ ve ever faced before .
“ Even if we doubled our capacity to process and scan these ballots , then we ’ re still looking at a week , ” Lee Soltysiak , the chief clerk of Pennsylvania ’ s Montgomery County , told TPM .
“ The world is going to be waiting on the outcome , and @ @ @ @ @ @ @ to be in the way of that.
” The Philadelphia suburb presents the perfect example of many election officials ’ biggest fears about November .
Pennsylvania could be a decisive state in November , but it ’ s faced some of the steepest challenges in ramping up its capacity for mail-in voting .
Pennsylvania is not the only state where election officials are acknowledging a reality that , due to the influx of absentee voting , they could still be tabulating votes for several days after election night .
Primaries in New York @ @ @ @ @ @ @ and multifaceted the obstacles are to reporting quick election results in the current circumstances .
Recent efforts by President Trump to question the legitimacy of an election that takes more than a day to call only further illustrates the pressure election officials are under .
“ There ’ s an element of just those things that we know are going to be the case , ” Ben Hovland , a member of the U.S. Election Assistance Commission , told TPM , “ And setting the expectation and communicating that that is expected and @ @ @ @ @ @ @ year , and not necessarily something that ’ s ‘ going on ’ or some larger nefarious activity.
” Election officials in several states are trying to figure out how to adapt their mostly manual process for counting mail-in ballots — which in previous years may have made up only a very small percentage of total votes — for an election where a far greater share of voters are now turning to the option to remain safe during the COVID-19 outbreak .
Kentucky is one such state .
Before the outbreak , it @ @ @ @ @ @ @ limited reasons .
Its June 23 primary avoided the catastrophe that some were expecting .
But election officials from Kentucky ’ s two most populous counties told TPM that their infrastructure was stretched to the brink by the surge in mail ballots .
The state relaxed its absentee voting restrictions for the primary but hasn ’ t said what it will do for the general .
Even with an emergency regulation that gave election officials a several weeks head-start to begin processing absentee ballots , county clerks in Fayette and Jefferson ( home @ @ @ @ @ @ @ had to limit the non-elections services their offices offer so they could focus their staff on pitching in on running the election .
Both counties still needed the rest of the week after Election Day to finish counting .
“ I don ’ t think at this time , there ’ s really any way we can do what we did in June for the November election , simply because the numbers — it would be impossible , ” said Jordan Kelch , an official in the Jefferson County ’ s clerks office @ @ @ @ @ @ @ to be more in-person voting than what there was for the primary .
“ We don ’ t have the infrastructure , we don ’ t have the manpower , we were in total overload .
And we can ’ t continuously shut down our offices to accommodate that.
” The security measures involved in absentee voting make the system of processing those ballots work intensive — particularly in the states that don ’ t have large-scale experience with mail voting and don ’ t have the technology that experienced vote-by-mail states use @ @ @ @ @ @ @ verification — where a voter ’ s signature in the state ’ s records is matched with how she signed the ballot package — is a major timesuck , election officials said , but even the process of opening the ballots themselves was a daunting one .
“ It ’ s not rocket science , but there ’ s a lot of humanity involved in the organizing and processing and scanning of those ballots , ” Soltysiak , the Pennsylvania official said , recalling the 50 or so people who were working 12 @ @ @ @ @ @ @ results .
The volume of the counting work aside , two key policy decisions made by states about absentee voting can further slow down the process , according to Hovland , the EAC commissioner .
One is whether the election officials are allowed to start the processing of mail ballots before Election Day .
The other is whether absentee ballots that arrive within a certain period after Election Day are still counted , assuming they meet the postmark requirements .
“ If we ’ re going to allow people to postmark them by @ @ @ @ @ @ @ makes sense , you have to give it a few days to arrive .
The results can ’ t be tabulated until that occurs , ” said Fayette County Clerk Don Blevins , who estimated that a quarter of the 83,000 mail-in ballots his office received arrived the week of the primary .
New York ’ s ongoing primary debacle is an example of when those two elements combine into a perfect storm .
Election officials were not allowed to begin counting absentee ballots until a week after Election Day .
And , @ @ @ @ @ @ @ USPS operations led to thousands of ballots not being properly postmarked , and whether they ’ re being counted remains a murky question .
November ’ s presidential election is unlikely to hinge on New York .
But swing states including Michigan and Pennsylvania have similar rules restricting the amount of absentee ballot processing work that can be done before Election Day .
Election officials have been lobbying state lawmakers to let the processing begin earlier .
“ It ’ s the only way to get what everybody is going to want anywhere @ @ @ @ @ @ @ .
“ It ’ s a very solvable problem , which makes it frustrating to still be talking about it .
”

Having survived a crushing primary season where election infrastructure quickly had to be adapted for large-scale absentee voting, there’s one thing election officials are hoping for in the general election: that it’s not their jurisdiction that’s preventing the country from finding out who won the White House.
In states across the country, reporting the results from the pandemic-rocked elections in the spring and summer took days and even weeks longer than Americans are used to.
There are several different factors contributing to the delays. But it’s becoming hard to imagine the process of reporting results moving more quickly in November, when election officials are preparing for an even larger influx of mail-voting — in some places, five or ten times greater than what they’ve ever faced before.
“Even if we doubled our capacity to process and scan these ballots, then we’re still looking at a week,” Lee Soltysiak, the chief clerk of Pennsylvania’s Montgomery County, told TPM. “The world is going to be waiting on the outcome, and I don’t want our county to be in the way of that.”
The Philadelphia suburb presents the perfect example of many election officials’ biggest fears about November. Pennsylvania could be a decisive state in November, but it’s faced some of the steepest challenges in ramping up its capacity for mail-in voting.
Pennsylvania is not the only state where election officials are acknowledging a reality that, due to the influx of absentee voting, they could still be tabulating votes for several days after election night. Primaries in New York, Kentucky and elsewhere showed how widespread and multifaceted the obstacles are to reporting quick election results in the current circumstances.
Recent efforts by President Trump to question the legitimacy of an election that takes more than a day to call only further illustrates the pressure election officials are under.
“There’s an element of just those things that we know are going to be the case,” Ben Hovland, a member of the U.S. Election Assistance Commission, told TPM, “And setting the expectation and communicating that that is expected and normal and part of the process this year, and not necessarily something that’s ‘going on’ or some larger nefarious activity.”
‘There’s A Lot of Humanity Involved’
Election officials in several states are trying to figure out how to adapt their mostly manual process for counting mail-in ballots — which in previous years may have made up only a very small percentage of total votes — for an election where a far greater share of voters are now turning to the option to remain safe during the COVID-19 outbreak.
Kentucky is one such state. Before the outbreak, it only allowed absentee voting for a few limited reasons. Its June 23 primary avoided the catastrophe that some were expecting. But election officials from Kentucky’s two most populous counties told TPM that their infrastructure was stretched to the brink by the surge in mail ballots. The state relaxed its absentee voting restrictions for the primary but hasn’t said what it will do for the general.
Even with an emergency regulation that gave election officials a several weeks head-start to begin processing absentee ballots, county clerks in Fayette and Jefferson (home to Lexington and Louisville, respectively) had to limit the non-elections services their offices offer so they could focus their staff on pitching in on running the election. Both counties still needed the rest of the week after Election Day to finish counting.
“I don’t think at this time, there’s really any way we can do what we did in June for the November election, simply because the numbers — it would be impossible,” said Jordan Kelch, an official in the Jefferson County’s clerks office, who stressed that there will need to be more in-person voting than what there was for the primary. “We don’t have the infrastructure, we don’t have the manpower, we were in total overload. And we can’t continuously shut down our offices to accommodate that.”
The security measures involved in absentee voting make the system of processing those ballots work intensive — particularly in the states that don’t have large-scale experience with mail voting and don’t have the technology that experienced vote-by-mail states use to automate the process.
The signature verification — where a voter’s signature in the state’s records is matched with how she signed the ballot package — is a major timesuck, election officials said, but even the process of opening the ballots themselves was a daunting one.
“It’s not rocket science, but there’s a lot of humanity involved in the organizing and processing and scanning of those ballots,” Soltysiak, the Pennsylvania official said, recalling the 50 or so people who were working 12 hours a day to process the primary results.
‘A Very Solvable Problem’
The volume of the counting work aside, two key policy decisions made by states about absentee voting can further slow down the process, according to Hovland, the EAC commissioner. One is whether the election officials are allowed to start the processing of mail ballots before Election Day. The other is whether absentee ballots that arrive within a certain period after Election Day are still counted, assuming they meet the postmark requirements.
“If we’re going to allow people to postmark them by a particular date, then it only makes sense, you have to give it a few days to arrive. The results can’t be tabulated until that occurs,” said Fayette County Clerk Don Blevins, who estimated that a quarter of the 83,000 mail-in ballots his office received arrived the week of the primary.
New York’s ongoing primary debacle is an example of when those two elements combine into a perfect storm. Election officials were not allowed to begin counting absentee ballots until a week after Election Day. And, according to reports, a lapse in USPS operations led to thousands of ballots not being properly postmarked, and whether they’re being counted remains a murky question.
November’s presidential election is unlikely to hinge on New York. But swing states including Michigan and Pennsylvania have similar rules restricting the amount of absentee ballot processing work that can be done before Election Day.
Election officials have been lobbying state lawmakers to let the processing begin earlier.
“It’s the only way to get what everybody is going to want anywhere near election night,” Soltysiak said. “It’s a very solvable problem, which makes it frustrating to still be talking about it.”


talkingpointsmemo--2020-08-03--Pelosi Goes Off On Birx For Enabling Trump’s Bleach Fantasy On COVID

House Speaker Nancy Pelosi ( D-CA ) slammed one of President Donald Trump ’ s leading COVID-19 experts , Dr. Deborah Birx , again on Monday morning , saying that the doctor has “ enabled ” Trump ’ s disinformation crusade during the pandemic .
“ I don ’ t have confidence in anyone who stands there while the President says ‘ Swallow Lysol and it ’ s going to cure your virus , ” ’ the Democratic leader told CNN anchor Jim Sciutto , jabbing at the infamous moment when Trump claimed during a press briefing in April that @ @ @ @ @ @ @ oneself with disinfectant .
( Birx , who was present at the briefing , was seen staring utterly flabbergasted at Trump in the background ) .
“ So if the President is saying these things , who ’ s advising him that this is okay and enabling that to happen while millions of people have died ?
” Pelosi asked .
To the House speaker ’ s point about Lysol , Birx downplayed Trump ’ s astonishing remark amid the backlash and chastised the media for covering it .
“ It bothers me @ @ @ @ @ @ @ cycle , because I think we ’ re missing the bigger pieces of what we need to be doing as an American people to continue to protect one another , ” the doctor said several days after the briefing .
“ As a scientist and a public health official and a researcher , sometimes I worry that we don ’ t get the information to the American people that they need when we continue to bring up something that was from Thursday night.
” Pelosi first publicly put Birx on blast on Sunday @ @ @ @ @ @ @ if she had confidence in the health official .
“ I think the President has been spreading disinformation about the virus and she is his appointee , so I don ’ t have confidence there , no , ” Pelosi told Raddatz .
Birx pushed back against the Democratic lawmaker ’ s characterization of her on the same day in a CNN interview , stating “ I have never been called Pollyannish or non-scientific or non-data-driven ” and confirming that the virus is “ extraordinarily widespread.
” Trump attacked Birx on Monday morning @ @ @ @ @ @ @ to counter Nancy , Deborah took the bait & hit us .
Pathetic !
” he tweeted .

House Speaker Nancy Pelosi (D-CA) slammed one of President Donald Trump’s leading COVID-19 experts, Dr. Deborah Birx, again on Monday morning, saying that the doctor has “enabled” Trump’s disinformation crusade during the pandemic.
“I don’t have confidence in anyone who stands there while the President says ‘Swallow Lysol and it’s going to cure your virus,”’ the Democratic leader told CNN anchor Jim Sciutto, jabbing at the infamous moment when Trump claimed during a press briefing in April that the virus could be cured by injecting oneself with disinfectant. (Birx, who was present at the briefing, was seen staring utterly flabbergasted at Trump in the background).
“So if the President is saying these things, who’s advising him that this is okay and enabling that to happen while millions of people have died?” Pelosi asked.
To the House speaker’s point about Lysol, Birx downplayed Trump’s astonishing remark amid the backlash and chastised the media for covering it.
“It bothers me that this is still in the news cycle, because I think we’re missing the bigger pieces of what we need to be doing as an American people to continue to protect one another,” the doctor said several days after the briefing. “As a scientist and a public health official and a researcher, sometimes I worry that we don’t get the information to the American people that they need when we continue to bring up something that was from Thursday night.”
Pelosi first publicly put Birx on blast on Sunday when ABC News anchor Martha Raddatz asked if she had confidence in the health official.
“I think the President has been spreading disinformation about the virus and she is his appointee, so I don’t have confidence there, no,” Pelosi told Raddatz.
Birx pushed back against the Democratic lawmaker’s characterization of her on the same day in a CNN interview, stating “I have never been called Pollyannish or non-scientific or non-data-driven” and confirming that the virus is “extraordinarily widespread.”
Trump attacked Birx on Monday morning for her trouble.
“In order to counter Nancy, Deborah took the bait & hit us. Pathetic!” he tweeted.
Watch Pelosi below:


talkingpointsmemo--2020-08-03--Manhattan DA Suggests He Is Investigating Trump Org For Fraud

The Manhattan District Attorney ’ s office is probing the Trump Organization over fraud allegations , state prosecutors suggested in a Monday court filing .
The probe covers allegations of potential bank and insurance fraud , wrote Manhattan District Attorney Cyrus Vance in a motion to dismiss a federal case that President Trump filed to block a subpoena that New York prosecutors obtained for the President ’ s tax returns , which are held by a third-party accounting firm .
The Supreme Court dismissed a challenge from President Trump to the subpoena last month , but left room for him @ @ @ @ @ @ @ documents at the district court level .
Vance cited news reports and an article referencing former Trump lawyer Michael Cohen ’ s congressional testimony in the filing .
At a hearing before the House Oversight Committee last year , Cohen alleged that Trump would change the book value of his properties for lenders and insurers .
The filing does not appear to cite a specific act of alleged wrongdoing as the focus of the investigation , however , instead arguing that “ undisputed information in the public record ” invalidates Trump ’ s @ @ @ @ @ @ @ wildly overbroad.
” Rather , Vance argued , there have been “ public allegations of possible criminal activity at Plaintiff ’ s New York County-based Trump Organization dating back over a decade.
” “ Although the Office bears no affirmative burden to justify the breadth of the Mazars Subpoena , and although Plaintiff is not entitled to know the scope and nature of the grand jury investigation , publicly available information itself establishes a satisfactory predicate for the Mazars Subpoena , ” Vance argued .
Trump asked a Manhattan federal judge to throw @ @ @ @ @ @ @ re-upped the request last month after the Supreme Court rejected his argument that his status as President rendered him “ immune from criminal process ” but gave him leave to file further arguments .
Trump ’ s first round of arguments saw one of his attorneys claim that , were the President to shoot someone on Fifth Avenue , police could only investigate the crime until after the expiry of his presidential term .
Vance ’ s attorneys accused Trump of repeating the same arguments that the Supreme Court has already dismissed , @ @ @ @ @ @ @ new , despite the nearly year-long litigation leading up to the filing of the [ complaint ] .
” A New York grand jury first issued the subpoena to Trump ’ s longtime accountant Mazars USA LLP in August 2019 .
The subpoena has remained dormant for the past year as litigation progressed up to the Supreme Court .
State prosecutors had suggested at the time that their focus was on whether any New York State laws were broken when Cohen set up hush-money payments to Stormy Daniels and Karen McDougal .

The Manhattan District Attorney’s office is probing the Trump Organization over fraud allegations, state prosecutors suggested in a Monday court filing.
The probe covers allegations of potential bank and insurance fraud, wrote Manhattan District Attorney Cyrus Vance in a motion to dismiss a federal case that President Trump filed to block a subpoena that New York prosecutors obtained for the President’s tax returns, which are held by a third-party accounting firm.
The Supreme Court dismissed a challenge from President Trump to the subpoena last month, but left room for him to continue objecting to the demand for documents at the district court level.
Vance cited news reports and an article referencing former Trump lawyer Michael Cohen’s congressional testimony in the filing. At a hearing before the House Oversight Committee last year, Cohen alleged that Trump would change the book value of his properties for lenders and insurers.
The filing does not appear to cite a specific act of alleged wrongdoing as the focus of the investigation, however, instead arguing that “undisputed information in the public record” invalidates Trump’s earlier accusation that the subpoena was “wildly overbroad.”
Rather, Vance argued, there have been “public allegations of possible criminal activity at Plaintiff’s New York County-based Trump Organization dating back over a decade.”
“Although the Office bears no affirmative burden to justify the breadth of the Mazars Subpoena, and although Plaintiff is not entitled to know the scope and nature of the grand jury investigation, publicly available information itself establishes a satisfactory predicate for the Mazars Subpoena,” Vance argued.
Trump asked a Manhattan federal judge to throw out the subpoena last year, and re-upped the request last month after the Supreme Court rejected his argument that his status as President rendered him “immune from criminal process” but gave him leave to file further arguments.
Trump’s first round of arguments saw one of his attorneys claim that, were the President to shoot someone on Fifth Avenue, police could only investigate the crime until after the expiry of his presidential term.
Vance’s attorneys accused Trump of repeating the same arguments that the Supreme Court has already dismissed, saying that his complaint “alleges nothing new, despite the nearly year-long litigation leading up to the filing of the [complaint].”
A New York grand jury first issued the subpoena to Trump’s longtime accountant Mazars USA LLP in August 2019. The subpoena has remained dormant for the past year as litigation progressed up to the Supreme Court.
State prosecutors had suggested at the time that their focus was on whether any New York State laws were broken when Cohen set up hush-money payments to Stormy Daniels and Karen McDougal.
Read the filing here:


talkingpointsmemo--2020-08-03--Trump Attacks Birx After She Issues Stark New Warning On COVID-19

President Donald Trump lashed out at Dr. Deborah Birx , a top official on the White House Coronavirus Task Force , on Monday after she expressed a grim outlook on the virus still rocking the country .
“ So Crazy Nancy Pelosi said horrible things about Dr. Deborah Birx , going after her because she was too positive on the very good job we are doing on combatting the China Virus , including Vaccines & Therapeutics , ” Trump tweeted .
“ In order to counter Nancy , Deborah took the bait & hit us .
Pathetic !
” The @ @ @ @ @ @ @ a response to Birx ’ s interview on CNN ’ s “ State of the Union ” on Sunday , during which the doctor warned that the U.S. was in “ a new phase ” of the virus .
“ I want to be very clear : What we are seeing today is different from March and April , ” Birx told CNN anchor Dana Bash .
“ It is extraordinarily widespread.
” Though Birx ’ s comment was a plain contradiction of Trump ’ s repeated insistence that most of the country @ @ @ @ @ @ @ she did not actually criticize Trump or the administration during the interview .
The health official also denied that she was falsely spinning the pandemic in a positive light on Trump ’ s behalf after Bash mentioned that House Speaker Nancy Pelosi ( D-CA ) had said she did not have confidence in Birx .
“ I have never been called Pollyannish or non-scientific or non-data-driven , ” Birx said .
“ And I will stake my 40-year career on those fundamental principles of utilizing data to really implement better programs to save @ @ @ @ @ @ @ has “ tremendous respect for ” Pelosi and “ her long dedication to the American people .
”

President Donald Trump lashed out at Dr. Deborah Birx, a top official on the White House Coronavirus Task Force, on Monday after she expressed a grim outlook on the virus still rocking the country.
“So Crazy Nancy Pelosi said horrible things about Dr. Deborah Birx, going after her because she was too positive on the very good job we are doing on combatting the China Virus, including Vaccines & Therapeutics,” Trump tweeted. “In order to counter Nancy, Deborah took the bait & hit us. Pathetic!”
The President’s tweet seemed to be a response to Birx’s interview on CNN’s “State of the Union” on Sunday, during which the doctor warned that the U.S. was in “a new phase” of the virus.
“I want to be very clear: What we are seeing today is different from March and April,” Birx told CNN anchor Dana Bash. “It is extraordinarily widespread.”
Though Birx’s comment was a plain contradiction of Trump’s repeated insistence that most of the country is doing “very well,” she did not actually criticize Trump or the administration during the interview.
The health official also denied that she was falsely spinning the pandemic in a positive light on Trump’s behalf after Bash mentioned that House Speaker Nancy Pelosi (D-CA) had said she did not have confidence in Birx.
“I have never been called Pollyannish or non-scientific or non-data-driven,” Birx said. “And I will stake my 40-year career on those fundamental principles of utilizing data to really implement better programs to save more lives.”
Birx stated that she has “tremendous respect for” Pelosi and “her long dedication to the American people.”


talkingpointsmemo--2020-08-03--How a $175 COVID-19 Test Led to $2,479 in Charges

This story first appeared at ProPublica .
ProPublica is a Pulitzer Prize-winning investigative newsroom .
Sign up for The Big Story newsletter to receive stories like this one in your inbox .
As she waited for the results of her rapid COVID-19 test , Rachel de Cordova sat in her car and read through a stack of documents given to her by SignatureCare Emergency Center .
Without de Cordova leaving her car , the staff at the freestanding emergency room near her home in Houston had checked her blood pressure , pulse and temperature during the July 21 appointment .
@ @ @ @ @ @ @ a headache , so she handed them her insurance card to pay for the $ 175 rapid-response drive-thru test .
Then they stuck a swab deep into her nasal cavity to obtain a specimen .
De Cordova is an attorney who specializes in civil litigation defense and maritime law .
She cringes when she ’ s asked to sign away her rights and scrutinizes the fine print .
The documents she had been given included disclosures required by recent laws in Texas that try to rein in the billing practices of stand-alone emergency @ @ @ @ @ @ @ while the facility would submit its bill to insurance plans , it doesn ’ t have contractual relationships with them , meaning the care would be considered out-of-network .
Patients are responsible for any charges not covered by their plan , it said , as well as any copayment , deductible or coinsurance .
The more she read , the more annoyed de Cordova became .
SignatureCare charges a “ facility fee ” for treatment , the document said , ranging “ between five hundred dollars and one hundred thousand dollars.
” Another @ @ @ @ @ @ @ ” could range from $ 1,000 to $ 100,000 .
De Cordova didn ’ t think her fees for the test could rise into the six figures .
But SignatureCare was giving itself leeway to charge almost any amount to her insurance plan — and she could be on the hook .
She knew she couldn ’ t sign the document .
But that created a problem : She still needed to get her test results .
Even in a public health emergency , what could be considered the first rule of American @ @ @ @ @ @ @ There is no set price .
Medical providers often inflate their charges and then give discounts to insurance plans that sign contracts with them .
Out-of-network insurers and their members are often left to pay the full tab or whatever discount they can negotiate after the fact .
The CARES Act , passed by Congress in March , includes a provision that says insurers must pay for an out-of-network COVID-19 test at the price the testing facility lists on its website .
But it sets no maximum for the cost of the tests @ @ @ @ @ @ @ charge for a COVID-19 test in Texas can range from less than $ 100 to thousands of dollars .
Health plans are generally waiving out-of-pocket costs for all related COVID-19 treatment , insurance representatives said .
Some costs may be passed on to the patient , depending on their coverage and the circumstances .
As she waited , de Cordova realized she didn ’ t want to play insurance roulette .
She changed her mind and decided she ’ d pay the $ 175 out-of-pocket for her test .
But when the SignatureCare @ @ @ @ @ @ @ de Cordova said the nurse told her , “ You can ’ t do that .
It ’ s insurance fraud for you to pay for our services once we know you have insurance.
” Dr. Hashibul Hannan , an emergency room physician , lab director and manager at SignatureCare , told ProPublica his facility is an emergency room that offers testing , not a typical testing site .
He said de Cordova should have been allowed to pay the $ 175 cash price .
The staff members were concerned about being accused @ @ @ @ @ @ @ her insurance information into the record , he said .
So they didn ’ t want it to appear she was being double-billed .
Hannan also said he regrets that she was upset by the disclosure forms that are now required under state law .
Unable to pay cash and unwilling to take a chance on the unknown cost , de Cordova decided to leave without getting the results of her COVID-19 test .
Later that day , de Cordova couldn ’ t get past what happened .
She wondered what happened to @ @ @ @ @ @ @ fine print before signing the packet .
Then she realized she and her husband , Hayan Charara , could investigate it themselves .
In June , the couple ’ s 8-year-old son had attended a baseball tryout .
They thought the kids would be socially distanced and that precautions would be taken .
But then the coaches had crowded the players in a dugout , with no masks or social distancing , and a couple days later the boy said he wasn ’ t feeling well .
So just to be safe , @ @ @ @ @ @ @ son to the same SignatureCare , the Heights location , for a COVID-19 test .
The line was so long they had to wait for hours , go home , come back and wait for hours again in their car in the 100-degree heat .
Charara , a poet who teaches at the University of Houston , said he didn ’ t take a close look at the financial disclosure paperwork .
De Cordova wasn ’ t with them .
It had been 10 hours of waiting by the time the boy was @ @ @ @ @ @ @ signed anything , ” he said .
( The child tested negative . )
Charara , de Cordova and their children are covered by the Employees Retirement System of Texas , a taxpayer-funded benefit plan that covers about half a million people .
They hadn ’ t received any notices about the charges for their son .
So they contacted the SignatureCare billing department and asked for an itemized statement .
The test charge was indeed $ 175 .
But the total balance , including the physician and facility fees associated with an @ @ @ @ @ @ @ 2,479 .
The facility fee was $ 1,784 and the physician fee $ 486 .
The couple were dumbfounded .
Their son ’ s vital signs had been checked but there had been no physical examination , they said .
The interactions took less than five minutes total , and the child stayed in the car .
“ You ’ re getting a drive-thru test , and they ’ re pretending like they ’ re giving you emergency services , ” de Cordova said .
The SignatureCare charges shocked experts who study health @ @ @ @ @ @ @ a drive-thru COVID-19 test is a “ nauseating ” example of profiteering during a pandemic , said Niall Brennan , president and CEO of the Health Care Cost Institute , a nonprofit organization that studies health care prices .
“ It ’ s one of the most egregious examples of giving the fox the keys to the henhouse I ’ ve ever seen and yet another example of the absurdity of U.S. health care pricing .
“ Imagine a vendor in any other walk of life being allowed to bill a third party @ @ @ @ @ @ @ Brennan said .
Insurance companies in Texas typically pay between $ 100 and $ 300 for drive-thru COVID-19 tests , said Jamie Dudensing , CEO of the Texas Association of Health Plans .
But the association ’ s members have seen hundreds of out-of-network COVID-19 test charges come in far higher , some in the thousands of dollars .
“ There ’ s no excuse for that , especially in a public health crisis , ” said Chris Callahan , spokesperson for Blue Cross and Blue Shield of Texas , which likewise has @ @ @ @ @ @ @ out-of-network providers .
The reimbursement rates negotiated between insurance companies and in-network providers are much lower , but they still vary , according to data provided by the nonprofit FAIR Health , which tracks spending by private insurers .
For the same test billed by SignatureCare , an in-network insurer pays a median price of $ 23 in Utah and $ 75 in Wisconsin , according to FAIR Health estimates .
Texas is notorious for its high-priced out-of-network emergency bills and free-standing emergency departments .
Some of the facilities appear to be using @ @ @ @ @ @ @ their insurance plans can be charged for additional services , said Blake Hutson , associate state director for AARP Texas , the advocacy organization for older Americans .
“ It ’ s not a surprise they would be racking up the charges and adding on everything they can and billing the health plan , ” he said .
In some cases , insurers do pay the exorbitant out-of-network charges , Hutson said , but they typically get reduced .
In 2019 , Texas lawmakers voted to ban billing patients in state-regulated insurance plans @ @ @ @ @ @ @ , Hutson said , which is known as “ balance ” or “ surprise ” billing .
But consumers may still be responsible for any deductibles and other cost-sharing under their health plan .
And the costs covered by the health plan get passed back to the consumers over time in the form of higher premiums , he said .
“ It ’ s all problematic for the cost of care , ” Hutson said .
Hannan defended SignatureCare ’ s high out-of-network charges by blaming insurance companies for refusing to give what @ @ @ @ @ @ @ .
The charges are a starting point for negotiating a fair deal from out-of-network insurance plans , he said .
He described SignatureCare , which has 18 locations , as “ small players .
When it comes to negotiating with insurance companies , we have no luck.
” The medical record portrays the visit as an emergency and contains details that are not consistent with how Charara and de Cordova describe their son ’ s condition .
The chief complaint in the record is “ body fluid exposure , ” and elsewhere it @ @ @ @ @ @ @ that ’ s not accurate , according to the parents .
No one had coughed or sneezed on their son , and they knew of no one from the tryout who had tested positive for COVID-19 , they said .
The child ’ s temperature is registered in the record as 102.8 , which is high .
But Charara said that could have been caused by sitting in the Texas heat , waiting for the test .
Shelley Safian , a Florida health care coding expert who has written four books on medical @ @ @ @ @ @ @ records of Charara and de Cordova ’ s son at ProPublica ’ s request .
She said the medical records don ’ t justify the charges .
SignatureCare billed the case as if the exam were an emergency that required an “ expanded problem focused history ” and “ medical decision making of moderate complexity , ” she said .
In order to qualify for reimbursement of an exam at that level , the encounter would need to include examining the affected organ system , Safian said .
But the medical records do @ @ @ @ @ @ @ system , which would be indicated for suspected COVID-19 .
Much of the medical record appeared to be cut and pasted from other electronic records , Safian said .
“ This is boilerplate B.S.
, ” she said , “ and I don ’ t mean ‘ bachelor of science.
’ ” Hannan , the SignatureCare doctor and manager , stands by the charges associated with the child ’ s COVID-19 test .
The facility has to treat every case like a possible emergency , and that requires an examination , he said @ @ @ @ @ @ @ are in line with what other out-of-network providers would charge in the area , according to FAIR Health , though they are far higher than in-network prices .
A doctor ’ s examination may not be as hands-on during COVID-19 , but , similar to a telemedicine visit , a lot can be examined visually , Hannan said .
Hannan said the company he uses for coding said COVID-19 requires a higher level of care and vigilance because it ’ s an infectious disease .
In light of the questions raised by ProPublica @ @ @ @ @ @ @ his billing company to audit the charges .
Sharon Nicka , president and CEO of Nicka and Associates , the billing company used by SignatureCare , took issue with Safian ’ s assessment and said the billing codes used were justified by the medical record .
She said the charges are high for a drive-thru test , but those are set by SignatureCare .
ProPublica identified several apparent errors and contradictions in the medical record and billing documentation .
For example , the notes in the medical record alternatively refer to the boy @ @ @ @ @ @ @ ” The record also says the physical exam showed a skin wound that “ was not red , swollen or tender , ” but the child had no wound of any kind , the family said .
And the billing documentation shows a charge for an antibody test when the medical record showed that the patient actually received a diagnostic test , which is something different .
In response to ProPublica ’ s questions , a SignatureCare medical director reviewed the record .
The error about the “ wound ” may have been @ @ @ @ @ @ @ that was not in the physician chart , the reviewer wrote .
The facility now uses a different template .
The charge for the antibody test is likely a billing error , as the physician had ordered the correct test , the reviewer wrote .
“ We will continue to update and improve our ( electronic medical records ) , ” the reviewer said .
Hannan stressed that SignatureCare is upfront with patients about the possible fees associated with its treatment , including the disclosure paperwork and explanations on its website .
It @ @ @ @ @ @ @ said , so patients should expect emergency room fees .
Patients who do not have a medical emergency should not come , he said , though the ER allows patients to book appointments a day in advance for a COVID-19 test .
Dudensing , the chief executive of the Texas Association of Health Plans , said she ’ s heard Hannan ’ s contention before and it ’ s true that freestanding emergency rooms have a license that allows them to charge more .
But she still believes that they handle many nonemergency @ @ @ @ @ @ @ thousands of dollars on them .
“ They ’ re hiding under the guise of emergency rooms when they ’ re really dressed-up urgent care , ” she said .
Diana Kongevick , director of group benefits for the Employees Retirement System of Texas , said the health plan had only recently received the bill for the 8-year-old ’ s test .
It hadn ’ t been processed , so she could not speak to it directly .
But , in general , the health plan will pay 100 % of the cost @ @ @ @ @ @ @ $ 175 , she said .
The claim would be processed using out-of-network provisions , she said .
So for the other charges , the patient may be responsible for paying in the range of $ 600 , she estimated , for the out-of-network copay and deductibles .
“ This is a nonemergent patient self-referral to an out-of-network provider , ” Kongevick said .
Even if the Employees Retirement System of Texas determines that Charara and de Cordova should pay $ 600 for their son ’ s test , SignatureCare will not be @ @ @ @ @ @ @ said .
He said insured patients are not being sent bills for COVID-19 treatment beyond what their insurance companies cover .
De Cordova never did get her test results , and she didn ’ t seek a test elsewhere .
She felt better later and now believes she had just been suffering from allergies .
But what if it had turned out to be COVID-19 , she wondered .
Might she have gone on to infect others , she ’ s asked herself .
From a public health perspective , the haggling about @ @ @ @ @ @ @ the middle , and it might discourage them from getting tested for COVID-19 during the pandemic , said Stuart Craig , an economist at the University of Pennsylvania who studies health care costs .
“ It ’ s another part of the fragmentation of the health care system that makes patients ’ lives miserable , ” Craig said .
It ’ s especially frustrating , he said , because COVID-19 testing is so essential to making it safely through the pandemic .
Craig said he believes there should be a nationally mandated price @ @ @ @ @ @ @ providers and manufacturers are motivated financially to provide tests .
“ Testing should be free , ” Craig said .
“ In fact , we should probably be paying patients to get tested.
” Do you have a story to share with ProPublica about billing practices related to COVID-19 testing or treatment ?
Please complete our form to tell us about it .

This story first appeared at ProPublica. ProPublica is a Pulitzer Prize-winning investigative newsroom. Sign up for The Big Story newsletter to receive stories like this one in your inbox.
As she waited for the results of her rapid COVID-19 test, Rachel de Cordova sat in her car and read through a stack of documents given to her by SignatureCare Emergency Center.
Without de Cordova leaving her car, the staff at the freestanding emergency room near her home in Houston had checked her blood pressure, pulse and temperature during the July 21 appointment. She had been suffering sinus stuffiness and a headache, so she handed them her insurance card to pay for the $175 rapid-response drive-thru test. Then they stuck a swab deep into her nasal cavity to obtain a specimen.
De Cordova is an attorney who specializes in civil litigation defense and maritime law. She cringes when she’s asked to sign away her rights and scrutinizes the fine print. The documents she had been given included disclosures required by recent laws in Texas that try to rein in the billing practices of stand-alone emergency centers like SignatureCare. One said that while the facility would submit its bill to insurance plans, it doesn’t have contractual relationships with them, meaning the care would be considered out-of-network. Patients are responsible for any charges not covered by their plan, it said, as well as any copayment, deductible or coinsurance.
The more she read, the more annoyed de Cordova became. SignatureCare charges a “facility fee” for treatment, the document said, ranging “between five hundred dollars and one hundred thousand dollars.” Another charge, the “observation fee,” could range from $1,000 to $100,000.
De Cordova didn’t think her fees for the test could rise into the six figures. But SignatureCare was giving itself leeway to charge almost any amount to her insurance plan — and she could be on the hook. She knew she couldn’t sign the document. But that created a problem: She still needed to get her test results.
Even in a public health emergency, what could be considered the first rule of American health care is still in effect: There is no set price. Medical providers often inflate their charges and then give discounts to insurance plans that sign contracts with them. Out-of-network insurers and their members are often left to pay the full tab or whatever discount they can negotiate after the fact.
The CARES Act, passed by Congress in March, includes a provision that says insurers must pay for an out-of-network COVID-19 test at the price the testing facility lists on its website. But it sets no maximum for the cost of the tests. Insurance representatives told ProPublica that the charge for a COVID-19 test in Texas can range from less than $100 to thousands of dollars. Health plans are generally waiving out-of-pocket costs for all related COVID-19 treatment, insurance representatives said. Some costs may be passed on to the patient, depending on their coverage and the circumstances.
As she waited, de Cordova realized she didn’t want to play insurance roulette. She changed her mind and decided she’d pay the $175 out-of-pocket for her test. But when the SignatureCare nurse came to collect the paperwork, de Cordova said the nurse told her, “You can’t do that. It’s insurance fraud for you to pay for our services once we know you have insurance.”
Dr. Hashibul Hannan, an emergency room physician, lab director and manager at SignatureCare, told ProPublica his facility is an emergency room that offers testing, not a typical testing site. He said de Cordova should have been allowed to pay the $175 cash price. The staff members were concerned about being accused of fraud because they had already entered her insurance information into the record, he said. So they didn’t want it to appear she was being double-billed. Hannan also said he regrets that she was upset by the disclosure forms that are now required under state law.
Unable to pay cash and unwilling to take a chance on the unknown cost, de Cordova decided to leave without getting the results of her COVID-19 test.
“I Would Have Signed Anything”
Later that day, de Cordova couldn’t get past what happened. She wondered what happened to patients who didn’t read the fine print before signing the packet.
Then she realized she and her husband, Hayan Charara, could investigate it themselves. In June, the couple’s 8-year-old son had attended a baseball tryout. They thought the kids would be socially distanced and that precautions would be taken. But then the coaches had crowded the players in a dugout, with no masks or social distancing, and a couple days later the boy said he wasn’t feeling well.
So just to be safe, on June 12, Charara took their son to the same SignatureCare, the Heights location, for a COVID-19 test. The line was so long they had to wait for hours, go home, come back and wait for hours again in their car in the 100-degree heat. Charara, a poet who teaches at the University of Houston, said he didn’t take a close look at the financial disclosure paperwork. De Cordova wasn’t with them. It had been 10 hours of waiting by the time the boy was tested, so “I would have signed anything,” he said. (The child tested negative.)
Charara, de Cordova and their children are covered by the Employees Retirement System of Texas, a taxpayer-funded benefit plan that covers about half a million people. They hadn’t received any notices about the charges for their son. So they contacted the SignatureCare billing department and asked for an itemized statement. The test charge was indeed $175. But the total balance, including the physician and facility fees associated with an emergency room visit, came to $2,479.
The facility fee was $1,784 and the physician fee $486.
The couple were dumbfounded. Their son’s vital signs had been checked but there had been no physical examination, they said. The interactions took less than five minutes total, and the child stayed in the car. “You’re getting a drive-thru test, and they’re pretending like they’re giving you emergency services,” de Cordova said.
The SignatureCare charges shocked experts who study health care costs. Charging $2,479 for a drive-thru COVID-19 test is a “nauseating” example of profiteering during a pandemic, said Niall Brennan, president and CEO of the Health Care Cost Institute, a nonprofit organization that studies health care prices. “It’s one of the most egregious examples of giving the fox the keys to the henhouse I’ve ever seen and yet another example of the absurdity of U.S. health care pricing.
“Imagine a vendor in any other walk of life being allowed to bill a third party for whatever amount they wanted,” Brennan said.
Insurance companies in Texas typically pay between $100 and $300 for drive-thru COVID-19 tests, said Jamie Dudensing, CEO of the Texas Association of Health Plans. But the association’s members have seen hundreds of out-of-network COVID-19 test charges come in far higher, some in the thousands of dollars.
“There’s no excuse for that, especially in a public health crisis,” said Chris Callahan, spokesperson for Blue Cross and Blue Shield of Texas, which likewise has seen high charges for COVID-19 tests from out-of-network providers.
The reimbursement rates negotiated between insurance companies and in-network providers are much lower, but they still vary, according to data provided by the nonprofit FAIR Health, which tracks spending by private insurers. For the same test billed by SignatureCare, an in-network insurer pays a median price of $23 in Utah and $75 in Wisconsin, according to FAIR Health estimates.
Texas is notorious for its high-priced out-of-network emergency bills and free-standing emergency departments. Some of the facilities appear to be using COVID-19 testing to draw in patients so their insurance plans can be charged for additional services, said Blake Hutson, associate state director for AARP Texas, the advocacy organization for older Americans. “It’s not a surprise they would be racking up the charges and adding on everything they can and billing the health plan,” he said.
In some cases, insurers do pay the exorbitant out-of-network charges, Hutson said, but they typically get reduced. In 2019, Texas lawmakers voted to ban billing patients in state-regulated insurance plans for charges not covered by their policy, Hutson said, which is known as “balance” or “surprise” billing. But consumers may still be responsible for any deductibles and other cost-sharing under their health plan. And the costs covered by the health plan get passed back to the consumers over time in the form of higher premiums, he said. “It’s all problematic for the cost of care,” Hutson said.
Hannan defended SignatureCare’s high out-of-network charges by blaming insurance companies for refusing to give what he considers to be fair in-network rates. The charges are a starting point for negotiating a fair deal from out-of-network insurance plans, he said. He described SignatureCare, which has 18 locations, as “small players. When it comes to negotiating with insurance companies, we have no luck.”
Was the Bill Accurate?
The medical record portrays the visit as an emergency and contains details that are not consistent with how Charara and de Cordova describe their son’s condition. The chief complaint in the record is “body fluid exposure,” and elsewhere it says “confirmed COVID exposure.”
But that’s not accurate, according to the parents. No one had coughed or sneezed on their son, and they knew of no one from the tryout who had tested positive for COVID-19, they said. The child’s temperature is registered in the record as 102.8, which is high. But Charara said that could have been caused by sitting in the Texas heat, waiting for the test.
Shelley Safian, a Florida health care coding expert who has written four books on medical billing, examined the bill and medical records of Charara and de Cordova’s son at ProPublica’s request. She said the medical records don’t justify the charges. SignatureCare billed the case as if the exam were an emergency that required an “expanded problem focused history” and “medical decision making of moderate complexity,” she said.
In order to qualify for reimbursement of an exam at that level, the encounter would need to include examining the affected organ system, Safian said. But the medical records do not document any check of the respiratory system, which would be indicated for suspected COVID-19.
Much of the medical record appeared to be cut and pasted from other electronic records, Safian said. “This is boilerplate B.S.,” she said, “and I don’t mean ‘bachelor of science.’”
Hannan, the SignatureCare doctor and manager, stands by the charges associated with the child’s COVID-19 test. The facility has to treat every case like a possible emergency, and that requires an examination, he said. He pointed out that the charges are in line with what other out-of-network providers would charge in the area, according to FAIR Health, though they are far higher than in-network prices.
A doctor’s examination may not be as hands-on during COVID-19, but, similar to a telemedicine visit, a lot can be examined visually, Hannan said. Hannan said the company he uses for coding said COVID-19 requires a higher level of care and vigilance because it’s an infectious disease.
In light of the questions raised by ProPublica and Safian, Hannan said he asked his billing company to audit the charges. Sharon Nicka, president and CEO of Nicka and Associates, the billing company used by SignatureCare, took issue with Safian’s assessment and said the billing codes used were justified by the medical record. She said the charges are high for a drive-thru test, but those are set by SignatureCare.
ProPublica identified several apparent errors and contradictions in the medical record and billing documentation. For example, the notes in the medical record alternatively refer to the boy as “symptomatic” and “asymptomatic.” The record also says the physical exam showed a skin wound that “was not red, swollen or tender,” but the child had no wound of any kind, the family said. And the billing documentation shows a charge for an antibody test when the medical record showed that the patient actually received a diagnostic test, which is something different.
In response to ProPublica’s questions, a SignatureCare medical director reviewed the record. The error about the “wound” may have been caused by a software template adding something that was not in the physician chart, the reviewer wrote. The facility now uses a different template. The charge for the antibody test is likely a billing error, as the physician had ordered the correct test, the reviewer wrote. “We will continue to update and improve our (electronic medical records),” the reviewer said.
Hannan stressed that SignatureCare is upfront with patients about the possible fees associated with its treatment, including the disclosure paperwork and explanations on its website. It’s an emergency room, he said, so patients should expect emergency room fees. Patients who do not have a medical emergency should not come, he said, though the ER allows patients to book appointments a day in advance for a COVID-19 test.
Dudensing, the chief executive of the Texas Association of Health Plans, said she’s heard Hannan’s contention before and it’s true that freestanding emergency rooms have a license that allows them to charge more. But she still believes that they handle many nonemergency cases and are forcing facility fees of thousands of dollars on them. “They’re hiding under the guise of emergency rooms when they’re really dressed-up urgent care,” she said.
Diana Kongevick, director of group benefits for the Employees Retirement System of Texas, said the health plan had only recently received the bill for the 8-year-old’s test. It hadn’t been processed, so she could not speak to it directly. But, in general, the health plan will pay 100% of the cost of the test, in this case $175, she said. The claim would be processed using out-of-network provisions, she said. So for the other charges, the patient may be responsible for paying in the range of $600, she estimated, for the out-of-network copay and deductibles. “This is a nonemergent patient self-referral to an out-of-network provider,” Kongevick said.
“Testing Should Be Free”
Even if the Employees Retirement System of Texas determines that Charara and de Cordova should pay $600 for their son’s test, SignatureCare will not be sending the family a bill, Hannan said. He said insured patients are not being sent bills for COVID-19 treatment beyond what their insurance companies cover.
De Cordova never did get her test results, and she didn’t seek a test elsewhere. She felt better later and now believes she had just been suffering from allergies. But what if it had turned out to be COVID-19, she wondered. Might she have gone on to infect others, she’s asked herself.
From a public health perspective, the haggling about out-of-network charges and payments puts patients in the middle, and it might discourage them from getting tested for COVID-19 during the pandemic, said Stuart Craig, an economist at the University of Pennsylvania who studies health care costs. “It’s another part of the fragmentation of the health care system that makes patients’ lives miserable,” Craig said.
It’s especially frustrating, he said, because COVID-19 testing is so essential to making it safely through the pandemic. Craig said he believes there should be a nationally mandated price and government subsidies to make sure medical providers and manufacturers are motivated financially to provide tests. “Testing should be free,” Craig said. “In fact, we should probably be paying patients to get tested.”
Do you have a story to share with ProPublica about billing practices related to COVID-19 testing or treatment? Please complete our form to tell us about it.


talkingpointsmemo--2020-08-03--Judge Speaks Out After Shooter Kills Son: ‘We Are Living Every Parent’s Worst Nightmare’

Esther Salas , U.S. Judge for the District of New Jersey , pleaded for the protection of judges like herself in an emotional video released on Monday , two weeks after an embittered anti-feminist lawyer fatally shot her son , Daniel , and left her husband critically injured in their home in North Brunswick , New Jersey .
“ While my husband is still in the hospital recovering from his multiple surgeries , we are living every parent ’ s worst nightmare : Making preparations to bury our only child , Daniel , ” Salas said , her voice breaking @ @ @ @ @ @ @ pain that no one should ever have to endure.
” The judge asserted that easy access to her personal information allowed the “ sick and depraved human being ” responsible for the attack , whom authorities have identified as Roy Den Hollander , to target her family as she presided over his lawsuit against the male-only military draft .
“ We know that our job requires us to make tough calls , and sometimes those calls can leave people angry and upset .
That comes with the territory , and we accept that @ @ @ @ @ @ @ what we can not accept is when we are forced to live in fear for our lives because personal information , like our home addresses , can easily be easily obtained by anyone seeking to do us or our families harm.
” She pointed to the killing of her son as a warning sign of the heightened threat against judges in the country .
“ My son ’ s death can not be in vain , which is why I am begging those empowered to do something to help my brothers and sisters @ @ @ @ @ @ @ .
“ Now , more than ever , we need to identify a solution that keeps the lives of federal judges private .
”

Esther Salas, U.S. Judge for the District of New Jersey, pleaded for the protection of judges like herself in an emotional video released on Monday, two weeks after an embittered anti-feminist lawyer fatally shot her son, Daniel, and left her husband critically injured in their home in North Brunswick, New Jersey.
“While my husband is still in the hospital recovering from his multiple surgeries, we are living every parent’s worst nightmare: Making preparations to bury our only child, Daniel,” Salas said, her voice breaking. “My family has experienced a pain that no one should ever have to endure.”
The judge asserted that easy access to her personal information allowed the “sick and depraved human being” responsible for the attack, whom authorities have identified as Roy Den Hollander, to target her family as she presided over his lawsuit against the male-only military draft.
“We know that our job requires us to make tough calls, and sometimes those calls can leave people angry and upset. That comes with the territory, and we accept that,” Salas said. “But what we cannot accept is when we are forced to live in fear for our lives because personal information, like our home addresses, can easily be easily obtained by anyone seeking to do us or our families harm.”
She pointed to the killing of her son as a warning sign of the heightened threat against judges in the country.
“My son’s death cannot be in vain, which is why I am begging those empowered to do something to help my brothers and sisters on the bench,” said Salas. “Now, more than ever, we need to identify a solution that keeps the lives of federal judges private.”
Watch Salas below: