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McALLEN, Texas (AP) — For three days, the staff of an Orlando medical clinic encouraged a woman with abdominal pain who called the triage line to go to the hospital. She resisted, scared of a 2023 Florida law that required hospitals to ask whether a patient was in the U.S. with legal permission.

The clinic had worked hard to explain the limits of the law, which was part of Gov. Ron DeSantis’ sweeping package of tighter immigration policies. The clinic posted signs and counseled patients: They could decline to answer the question and still receive care. Individual, identifying information wouldn’t be reported to the state.

“We tried to explain this again and again and again, but the fear was real,” Grace Medical Home CEO Stephanie Garris said, adding the woman finally did go to an emergency room for treatment.

Texas will be the next to try a similar law for hospitals enrolled in state health plans, Medicaid and the Children’s Health Insurance Program. It takes effect Nov. 1 — just before the end of a presidential election in which immigration is a key topic.

“Texans should not have to shoulder the burden of financially supporting medical care for illegal immigrants,” Texas Republican Gov. Greg Abbott said in a statement announcing his mandate, which differs from Florida’s in that providers don’t have to tell patients their status won’t be shared with authorities.

Both states have high numbers of immigrants, ranging from people who are in the U.S. without legal permission to people who have pending asylum cases or are part of mixed-status families. And while the medically uninsured rate in these two states — neither of which have expanded Medicaid — are higher than the national average, research has shown immigrants tend to use less and spend less on health care.

Texas and Florida have a long history of challenging the federal government’s immigration policies by passing their own. And their Republican leaders say the hospital laws counter what they see as lax enforcement at the border by the Biden administration — though Florida’s early data is, by its own admission, limited.

Florida GOP state Sen. Blaise Ingoglia, who sponsored the hospital bill, said in a written statement that the law is “the strongest, and most comprehensive state-led, anti-ILLEGAL immigration law,” but did not respond to The Associated Press’ questions about the impact of the law on the immigrant community or on hospital patients.

Luis Isea, an internal medicine doctor with patients in hospitals and clinics in central Florida, said the law “is creating that extra barrier” for patients who are already exposed to many disparities.

Immigrant advocate groups in Florida said they sent thousands of text messages and emails and held clinics to help people understand the limitations of the law — including that law enforcement agencies wouldn’t know an individual’s status because the data would be reported in aggregate.

But many outreach calls from health workers went unanswered. Some patients said they were leaving Florida, as a result of the law’s impact on getting health care and on employment; the DeSantis’ administration tied the hospital mandate to other initiatives that invalidated some driver’s licenses, criminalized transportation of migrants lacking permanent status and changed employment verification policies.

Others, advocates say, languished in pain or needed to be persuaded. Verónica Robleto, program director at the Rural Women’s Health Project in north central Florida, fielded a call before the law took effect in July 2023 from a young woman who didn’t have legal permission to be in the U.S. and was afraid she would be separated from her child if she gave birth at the hospital.

“She was very afraid (but) she did end up going after speaking with me,” Robleto said.

Whatever data Florida and Texas do collect likely will be unreliable for several reasons, researchers suggested. Health economist Paul Keckley said the report released by Florida state officials could have “incomplete or inaccurate or misleading” data.

For one, it’s self-reported. Anyone can decline to answer, an option chosen by nearly 8% of people admitted to the hospital and about 7% of people who went to the emergency room from June to December 2023, the Florida state report said. Fewer than 1% of people who went to the emergency room or were admitted to the hospital reported being in the U.S. “illegally.”

The Florida Agency for Health Care Administration acknowledged large limitations in their analysis, saying it didn’t know how much of the care provided to “illegal aliens” went unpaid. It also said it was unable to link high levels of uncompensated care with the level of “illegal aliens” coming to a hospital, saying it’s “more associated with rural county status than illegal immigration percentages.”

The agency didn’t immediately respond to requests for comment and more information. Its report noted that for much of the last decade, the amount of unpaid bills and uncollected debts held by Florida hospitals has declined.

In Florida and in Texas, people who aren’t in the U.S. legally can’t enroll in Medicaid, which provides health insurance for low-income people — except in the case of a medical emergency.

Multiple factors can affect the cost of care for people who are in the U.S. without legal permission, experts said, especially the lack of preventive care. That’s especially true for people who have progressive diseases like cancer, said Dr. James W. Castillo II, the health authority for Cameron County, Texas, which has about 22% of the population uninsured compared to the state average of 16.6%.

At that point, he said, “it’s usually much harder to treat, much more expensive to treat.”

Texas community groups, policymakers and immigration attorneys are partnering with Every Texan, a nonprofit focusing on public policy and health care access, to encourage people to not answer the status question, said Lynn Cowles with Every Texan.

And in Florida, the deportation fears are subsiding but questions about the purpose of the law remain.

“How much of this is substantive policy and good policy versus how that fared, I leave that for others to speculate,” said Garris with the Orlando clinic. “But I know the practical effect of the law was egregious and demeaning to patients who are living here, working here. It’s just insulting.”

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Salomon reported from Miami, and Shastri reported from Milwaukee.

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The Associated Press Health and Science Department receives support from the Robert Wood Johnson Foundation. The AP is solely responsible for all content.

ATLANTA (AP) — Trying to defend their narrow Senate majority with a challenging slate of contests on Republican-leaning turf, Democrats are pumping $25 million into expanded voter outreach across 10 states.

The new spending from the Democratic Senatorial Campaign Committee, first shared with The Associated Press, comes less than two months until the Nov. 5 election and as Democrats are benefiting from a fundraising surge since President Joe Biden ended his reelection bid in July and endorsed Vice President Kamala Harris as the party standard-bearer.

“A formidable ground game makes all the difference in close races,” DSCC Chairman Sen. Gary Peters of Michigan said in a statement. “We are reaching every voter we need to win.”

The latest investment will be distributed across Arizona, Florida, Maryland, Michigan, Montana, Nevada, Ohio, Pennsylvania, Texas and Wisconsin. The money will go toward efforts to defend five Democratic incumbents and open seats in Michigan, Maryland and Arizona that are currently included in Democrats’ majority, as well as efforts to unseat GOP incumbents in Florida and Texas.

Plans for the money will vary by state but will include hiring more paid field organizers and canvassers; digital organizing programs targeting specific groups of voters online; texting programs; and in-person organizing events targeting younger generations and nonwhite voters.

Democrats currently hold a 51-49 Senate advantage, a split that includes independent senators who caucus with Democrats. But of the 33 regular Senate elections this November, Democrats must defend 23 seats, counting the independents who caucus with them to make their majority. They’ve devoted few national resources to West Virginia, a Republican-leaning state where Sen. Joe Manchin, a Democrat-turned-independent, is retiring.

The playing field gives Democrats little margin for error. If they lose West Virginia and hold all other seats, they still would have to upset Florida Sen. Rick Scott or Texas Sen. Ted Cruz to win a majority or hope Harris wins the presidential election — an outcome that would allow her running mate, Tim Walz, to cast the tiebreaking vote for Democrats as vice president, as Harris did in a 50-50 Senate during the first two years of Biden’s administration.

The DSCC declined to disclose a state-by-state distribution of the $25 million. But it’s no secret that Democrats’ defense of the majority starts with tough reelection contests for Sens. Jon Tester of Montana and Sherrod Brown of Ohio. Both are relatively popular, multiterm incumbents, but they’re running in states where Donald Trump, the former president and current Republican nominee, has twice won by comfortable margins. That means Tester and Brown would need a considerable number of voters to split their tickets between Trump and their Senate choice.

Senate Democrats already have financed field offices in Montana and Ohio, since those are not presidential battleground states where the Harris campaign leads Democrats’ coordinated campaign operations. And even with the money coming from national coffers, the additional on-the-ground spending will reinforce the two Democratic senators’ strategies of distancing themselves from Harris and the national party.

Five of the 10 states getting money, meanwhile, overlap with the presidential battleground map: Arizona, Michigan, Nevada, Pennsylvania and Wisconsin. Biden won all of them four years ago, while Trump won all except Nevada in 2016. Both presidential campaigns see the states as tossups this fall.

The voter outreach spending comes alongside an ongoing $79 million advertising effort by Democrats’ Senate campaign arm and builds on staffing and infrastructure investments that the national party arm already has made.

The outlay comes after Harris, who has raised more than $500 million since taking over the Democratic presidential ticket in July, announced plans to distribute $25 million to party committees that focus on down-ballot races. Senate and House Democrats’ respective campaigns each got $10 million of that money, an acknowledgment that Democratic majorities on Capitol Hill would make a Harris presidency more successful and that Harris and down-ballot Democrats can help each other at the ballot box.

Democratic aides said the on-the-ground spending was always in the Senate committee’s plans, but Harris’ bounty certainly expands options for all party-affiliated campaign groups. Democrats believe they have a superior campaign infrastructure to Trump and the rest of the GOP in a campaign year where the White House and control of Capitol Hill could be decided by marginal turnout changes among the parties’ core supporters and a narrow band of persuadable voters.

Still, the National Republican Senatorial Committee has outraised and outspent Senate Democrats this cycle, though Democrats had more cash on hand at the end of July, the last reporting period disclosed to the Federal Election Committee.

Through July 31, the NRSC had raised $181.3 million and spent $138.5 million. Republicans reported a balance of $51 million. Democrats had raised $154 million and spent $103.3 million. They reported a balance of $59.3 million.

PITTSBURG, Kan. (AP) — A new abortion clinic has brought the debate over reproductive rights to a small college town in the southeast corner of Kansas. It’s one of the few states left in the region still allowing abortions.

A religious, Republican-leaning semi-rural location like Pittsburg, Kansas, would have been unlikely to host an abortion clinic before Roe v. Wade was overturned in 2022, but that is changing across the country.

The Associated Press reported on the new clinic and the town’s reactions. Here are key takeaways.

Border states are becoming abortion-access hubs
Over the past two years, Kansas is one of five states that people are most likely to travel to in order to get an abortion if their state doesn’t offer the procedure, said Caitlin Myers, an economics professor at Middlebury College who researches abortion policies.

Abortions have spiked by 152% in Kansas after Roe, according to a recent analysis by the Guttmacher Institute, which supports abortion rights.

Using Myers’ count, six of the clinics in Kansas, Illinois, New Mexico, North Carolina and Virginia that have opened or relocated post-Roe are in communities with fewer than 25,000 people. Two others are in communities of fewer than 50,000.

Kansas voters protected abortion rights
Five weeks after Roe was overturned, voters in Kansas had to decide whether to strip the right to an abortion from the state constitution, which could have led to an outright ban.

Pittsburg is in Crawford County, where 55% of voters were part of the 59% of voters statewide who killed the proposal. But the rural counties surrounding Pittsburg voted for the amendment.

Kansas’ statewide percentage is in line with an Associated Press-NORC poll from 2024 that showed 6 in 10 Americans think their state should generally allow a person to obtain a legal abortion if they don’t want to be pregnant for any reason.

Abortion in Kansas is generally legal up until the 22nd week of pregnancy.

Planned Parenthood has turned people away in Kansas
The new abortion clinic will be run by Planned Parenthood Great Plains. Its location is a few minutes’ drive from the Missouri border and is less than an hour away from Oklahoma.

All of Kansas’ other abortion clinics are in larger metro areas, where clinics have expanded hours — but appointments are still in short supply. About 60% to 65% of people who call Planned Parenthood clinics in Kansas for an abortion appointment are turned away because there isn’t enough capacity, said Emily Wales, president and CEO of Planned Parenthood Great Plains.

The bulk of people looking for abortions in Kansas are from out of state — mostly Texas, which is about five hours south, Wales said. She added that some come from as far away as Louisiana and even Florida, which now prohibits the procedure after six weeks.

Small towns can be welcoming — or not
Experts said smaller-sized clinics can be less overwhelming for women who are coming from rural areas, like those surrounding Pittsburg. But, often, there is little anonymity in these places where religious and family ties often run deep.

Pittsburg is home to a state university with about 7,400 students. The town is also is increasingly religious, with twice as many white evangelical Protestants as the national average, and the area is increasingly Republican.

Pittsburg State students who The Associated Press talked to are supportive of the clinic, as are many of the Democrats in town.

But churches in Pittsburg are training people on how to protest at the abortion clinic, and Vie Medical Clinic, a crisis pregnancy center, has seen an increase in donations.

AUSTIN (Nexstar) – The House of Representatives is facing an Oct. 1 deadline to pass a spending bill and avoid a government shutdown with the election only weeks away. House Speaker Mike Johnson canceled a vote Wednesday that would have combined a temporary spending bill with the Safeguard American Voter Eligibility, or SAVE, Act due to doubts on whether it could pass.

The SAVE Act would require proof of citizenship to register to vote and is backed by former President Donald Trump and opposed by Democrats. Other concerns include the length of a stopgap bill which could force the new president to focus on a spending bill quickly after taking office in January.

Rep. Michael McCaul, R-Texas, voted for the SAVE act but acknowledges that a continuing resolution with the act wouldn’t pass the Senate.
“Under federal law you have to be a legal citizen to vote and [the SAVE Act] tries to enforce that at the state level,” McCaul said. “There’s a lot of loss of faith in our elections and something like this I think would give people more confidence.”

Rep. Lloyd Doggett, D-Texas, said the SAVE Act would unnecessarily disrupt the upcoming election.

“It does not apply just to immigrants. It applies to all of us. If you don’t have your birth certificate, if you don’t have a passport, it’s not good enough to use the REAL ID that gets you through airport security, you won’t be able to vote,” Doggett said.

He believes there is no room for compromise on the act.

“Weeks before the election is supposed to begin, that will cause chaos, and maybe that’s what the objective is,” he said.
Doggett said that the House needs to pass a continuing resolution, but that that is not an ideal solution.

“The disadvantage of a continuing resolution is it’s putting in place last year’s funding without any adjustments for needs at the Defense Department or elsewhere,” Doggett explained. He blamed Republicans for failing to pass appropriations bills, setting up the need for a continuing resolution.

Doggett is hopeful that the Senate will pass a so-called clean continuing resolution, without other legislation attached and Speaker Johnson will allow the House to vote on it. Democrats have a 51 – 49 majority in the Senate.

“Some feel it’s to their advantage to threaten to shut down everything in order to get their way, and we’ve had one after another,” Doggett said. “This particular one is really ridiculous.”
McCaul also pushed back at the potential for a shutdown.

“I’ve never been a fan of that because that doesn’t accomplish anything,” he told reporters in Washington. “At the end of the day, it hurts our military more than anything,” McCaul added.
The congressman chairs the House Foreign Affairs Committee. With two decades on Capitol Hill, he’s been through several shut down standoffs before.
“I’ve been doing this for 10 terms and I’ve seen this movie before,” McCaul said.

One difference this time is the uncertainty of who will be in the White House. Some Republicans are pushing for a CR that lasts until after next year’s Presidential inauguration, with the hope that Trump wins the election. Others want the CR to expire before lawmakers leave Washington for the holidays. Which version, if any, will move forward is unclear.

“I don’t have a crystal ball,” McCaul said.

AUSTIN, Texas (AP) — A Texas jury will soon decide whether a convoy of supporters of then-President Donald Trump violently intimidated former Democratic lawmaker Wendy Davis and two others on a Biden-Harris campaign bus when a so-called “Trump Train” boxed them in for more than an hour on a Texas highway days before the 2020 election.

The trial, which began on Sept. 9, resumes Monday and is expected to last another week.

Attorneys for the plaintiffs argued that six of the Trump Train drivers violated state and federal law. Lawyers for the defendants said they did not conspire against the Democrats on the bus and that their actions are protected speech.

Here’s what else to know:
What happened on Oct. 30, 2020?

Dozens of cars and trucks organized by a local Trump Train group swarmed the bus on its way from San Antonio to Austin. It was the last day of early voting in Texas for the 2020 general election, and the bus was scheduled to make a stop in San Marcos for an event at Texas State University.

Video recorded by Davis shows pickup trucks with large Trump flags aggressively slowing down and boxing in the bus as it tried to move away from the Trump Train. One defendant hit a campaign volunteer’s car while the trucks occupied all lanes of traffic, slowing the bus and everyone around it to a 15 mph crawl.

Those on the bus — including Davis, a campaign staffer and the driver — repeatedly called 911 asking for help and a police escort through San Marcos, but when no law enforcement arrived, the campaign canceled the event and pushed forward to Austin.

San Marcos settled a separate lawsuit filed by the same three Democrats against the police, agreeing to pay $175,000 and mandate political violence training for law enforcement.

Davis testified that she felt she was being “taken hostage” and has sought treatment for anxiety.

In the days leading up to the event, Democrats were also intimidated, harassed and received death threats, the lawsuit said.

“I feel like they were enjoying making us afraid,” Davis testified. “It’s traumatic for all of us to revisit that day.”

What’s the plaintiffs’ argument?

In opening statements, an attorney for the plaintiffs said convoy organizers targeted the bus in a calculated attack to intimidate the Democrats in violation of the “Ku Klux Klan Act,” an 1871 federal law that bans political violence and intimidation.

“We’re here because of actions that put people’s lives in danger,” said Samuel Hall, an attorney with the law firm Willkie Farr & Gallagher. The plaintiffs, he said, were “literally driven out of town by a swarm of trucks.”

The six Trump Train drivers succeeded in making the campaign cancel its remaining events in Texas in a war they believed was “between good and evil,” Hall said.

Two nonprofit advocacy groups, Texas Civil Rights Project and Protect Democracy, also are representing the three plaintiffs.

What’s the defense’s argument?

Attorneys for the defendants, who are accused of driving and organizing the convoy, said they did not conspire to swarm the Democrats on the bus, which could have exited the highway at any point.

“This was a political rally. This was not some conspiracy to intimidate people,” said attorney Jason Greaves, who is representing two of the drivers.

The defense also argued that their clients’ actions were protected speech and that the trial is a concerted effort to “drain conservatives of their money,” according to Francisco Canseco, a lawyer for three of the defendants.

“It was a rah-rah group that sought to support and advocate for a candidate of their choice in a very loud way,” Canseco said during opening statements.

The defense lost a bid last month to have the case ruled in their favor without a trial. The judge wrote that “assaulting, intimidating, or imminently threatening others with force is not protected expression.”

BISMARCK, N.D. (AP) — A federal judge in North Dakota has temporarily blocked a new Biden administration rule aimed at reducing the venting and flaring of natural gas at oil wells.

“At this preliminary stage, the plaintiffs have shown they are likely to succeed on the merits of their claim the 2024 Rule is arbitrary and capricious,” U.S. District Judge Daniel Traynor ruled Friday, the Bismarck Tribune reported.

North Dakota, along with Montana, Texas, Wyoming and Utah, challenged the rule in federal court earlier this year, arguing that it would hinder oil and gas production and that the Interior Department’s Bureau of Land Management is overstepping its regulatory authority on non-federal minerals and air pollution.

The bureau says the rule is intended to reduce the waste of gas and that royalty owners would see over $50 million in additional payments if it was enforced.

But Traynor wrote that the rules “add nothing more than a layer of federal regulation on top of existing federal regulation.”

When pumping for oil, natural gas often comes up as a byproduct. Gas isn’t as profitable as oil, so it is vented or flared unless the right equipment is in place to capture.

Methane, the main component of natural gas, is a climate “super pollutant” that is many times more potent in the short term than carbon dioxide.

Well operators have reduced flaring rates in North Dakota significantly over the past few years, but they still hover around 5%, the Tribune reported. Reductions require infrastructure to capture, transport and use that gas.

North Dakota politicians praised the ruling.

“The Biden-Harris administration continuously attempts to overregulate and ultimately debilitate North Dakota’s energy production capabilities,” state Attorney General Drew Wrigley said in a statement.

The Bureau of Land Management declined comment.

WASHINGTON (AP) — Walgreens has agreed to pay $106 million to settle lawsuits that alleged the pharmacy chain submitted false payment claims with government health care programs for prescriptions that were never dispensed.

The settlement announced on Friday resolves lawsuits filed in New Mexico, Texas and Florida on behalf of three people who had worked in Walgreens’ pharmacy operation. The lawsuits were filed under a whistleblower provision of the False Claims Act that lets private parties file case on behalf of the United States government and share in the recovery of money, the U.S. Justice Department said. The pharmacy chain was accused of submitting false payment claims to Medicare, Medicaid and other federal health care programs between 2009 and 2020 for prescriptions that were processed but never picked up.

Settlement documents say Walgreens cooperated in the investigation and has improved its electronic management system to prevent such problems from occurring again.
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In a statement, Walgreens said that because of a software error, the chain inadvertently billed some government programs for a relatively small number of prescriptions that patients submitted but never picked up.

“We corrected the error, reported the issue to the government and voluntarily refunded all overpayments,” the statement by Walgreens said.

In reaching the settlement, the chain didn’t acknowledge legal liability in the cases. ____ This story has been corrected to say the lawsuits were filed by private parties, not by the U.S. Justice Department.