Rob Robertson

Father, husband.

[Rob Robertson @RobRobertson3]

@HankFrank I’m 61. As I look back on it, if I could have done it, Europe. The PNW would have been next.

[Rob Robertson @RobRobertson3]

@STATter911 Looks like the pic is from right over the door to the People’s House exhibit

[Peter Girnus 🦅 @gothburz]

I am the Health Services Contract Administrator for U.S. Immigration and Customs Enforcement and on October 3, 2025, I stopped paying for medical care, and the system has been working better ever since.

I need to be specific about what "working better" means in this context because I am a contract administrator and specificity is my entire professional identity. It means: fewer invoices. Fewer reimbursement disputes. Fewer pharmacy reconciliations. Fewer appeals from providers who claim they provided urgent care and want to be compensated for having provided it. The workflow is cleaner. My inbox is lighter. The VA Financial Services Center, which had processed our medical claims since 2002, twenty-two years of pharmacy invoices, specialist referrals, hospital transports, dialysis authorizations, and oncology treatment plans, terminated its interagency agreement with us after a lawsuit from a nonprofit called the Center to Advance Security in America. They filed suit. The VA pulled out. Our entire claims processing pipeline vanished overnight. I posted a notice on https://t.co/AxFGsnjo6Q on November 12 describing this as an "absolute emergency" that required resolution "immediately" to "prevent any further medical complications or loss of life."

That was seven months ago. The replacement contractor, Acentra Health, had not achieved notice to proceed by the April 30 period of performance deadline. As of today, no entity is processing medical reimbursement claims for ICE detainees in the United States. When I say "no entity" I mean that structurally. A person held in a GEO Group facility in Georgia who requires dialysis three times per week is receiving dialysis from a provider who has not been paid since October. The provider continues to provide care because the alternative is that the confined person dies in their facility and the facility is then liable for a death that could have been prevented by a treatment that the facility was contractually obligated to provide. The treatment continues. The payment does not. The provider absorbs the cost. The cost is eventually written off. The write-off appears in the provider's quarterly financial statements as "uncompensated care, federal detention." It does not appear in our budget. It does not appear in any ICE financial disclosure.

The care happened. The cost was real. The payment was imaginary. The system is working better.

In fiscal year 2024, the VA processed $246.42 million in clinical reimbursement claims on our behalf. In fiscal year 2025, despite an 82.5% increase in our daily detained headcount, the VA processed only $157.2 million before the October termination. The delta between what was needed and what was processed is approximately $300 million. That $300 million represents medications not reimbursed, specialist consultations not paid for, emergency transports not covered, prenatal visits not compensated. It represents chemotherapy sessions where the drugs were administered and the oncologist submitted an invoice and the invoice entered a system that no longer exists. I have a filing cabinet in my office — three drawers, GSA-standard, beige, the kind with the lock that everyone has the same key to — that contains printed copies of the final VA-processed claims from September 2025. The bottom drawer has a jar of Tums that my predecessor left when she transferred to FEMA in August. I eat them daily. Not from stress. From the cafeteria. The cafeteria serves a chili that the facilities contractor, Aramark, describes as "Southwestern-inspired." It is inspired by the Southwest the way our medical payment system is inspired by the concept of paying for medical care.

The death rate is the number people ask about, so I will provide it with the precision my role requires. Historical baseline, 2018 through 2024: 8.9 deaths per year in ICE custody. Calendar year 2025: 33 deaths. Twelve of those occurred after October 3, after the payment freeze. January through April 2026: 17 deaths. That is one death every six days. Annualized, the current rate is 51.7 deaths per year. 5.8 times the pre-October baseline. A study published in JAMA on April 16 calculated the per-capita rate: 88.9 deaths per 100,000 person-years in partial fiscal 2026, compared to 13.0 in fiscal 2023. Nearly seven times. The JAMA authors are epidemiologists. I am a contract administrator.

We are counting the same bodies with different denominators.

Emmanuel Damas was 56 years old, Haitian, confined at an installation I am not authorized to name. He had a tooth infection. The on-call clinical staff treated the infection with ibuprofen. Ibuprofen is an anti-inflammatory. A tooth infection is a bacterial event. These are different categories of medical problem requiring different categories of intervention. The infection progressed to septic shock. Emmanuel Damas died. The ibuprofen was on our formulary. Antibiotics were on our formulary. The difference between the two was a reimbursement claim that would have been submitted to a payment processor that no longer existed. The detention center chose the treatment that did not generate a claim. I cannot tell you whether that decision was made consciously. I can tell you that it was made consistently. Across multiple facilities. Across multiple months. The ACLU reviewed deaths in ICE detention between 2017 and 2021, before the payment freeze, and determined that 95% were preventable with adequate treatment. I do not know what the percentage is now. I suspect it is also 95%. The category "preventable" has not changed. The category "payment" has.

At Fort Bliss, a military installation in El Paso repurposed as a detention facility under a $1.24 billion sole-source contract awarded to Acquisition Logistics, a firm with no prior detention management experience, three people died within 44 days. One death was ruled a homicide by the El Paso County Medical Examiner. ICE reported it as a suicide. Those are different words describing different events with different legal implications. The Medical Examiner's ruling generates an investigation. A suicide generates a compliance review. An investigation involves law enforcement. A compliance review involves my filing cabinet. I am not qualified to determine which word is correct. I am qualified to tell you that the words produce different paperwork, and the paperwork determines which systems activate, and the systems that activate determine who is accountable, and in this case, the system that activated was the compliance review, and the compliance review found that all protocols were followed, and all protocols were followed because the protocols do not include "pay for medical care."

Rodney Taylor was a double amputee detained at Stewart Detention Center, operated by CoreCivic. He was forced to crawl on floors covered in feces and mold because the center did not provide adequate mobility assistance. CoreCivic reported $2.2 billion in revenue last year, up 13%. Their profit was $116.5 million, up 70% year over year. Their ICE revenue nearly doubled between Q4 2024 and Q4 2025, from $120 million to $245 million per quarter. They received a 70% increase in profit and Rodney Taylor received a floor. CoreCivic's annual report describes their business model as "government solutions." Rodney Taylor's experience was, technically, a government solution.

GEO Group, the other major for-profit detention operator, posted $2.6 billion in revenue in 2025 and $254 million in profit, a 700% increase. They secured $520 million in new ICE task orders that year. Combined, GEO and CoreCivic spent $6.8 million on lobbying to secure access to a $75 billion funding stream from the GOP's reconciliation bill. The return on that investment is so large I had to check my calculator twice. It was not a calculator error. It was the normal functioning of a procurement system where the companies that run the facilities also fund the campaigns of the legislators who appropriate the money for the facilities.

The firm-fixed-price task orders specify a per diem rate of $187.48 per adult per day. That rate includes healthcare coverage. The rate has not changed since the disbursement freeze. We are still remitting $187.48 per day per person. The clinicians are not receiving any of it. The $187.48 goes to the facility operator. The operator is supposed to allocate a portion of it for clinical services. There is no SLA enforcement mechanism to verify that they do. There is only my filing cabinet, and the filing cabinet is for contracts, not outcomes.

Senator Ossoff's office conducted an investigation between January and August 2025 and received 85 credible reports of medical neglect, including untreated chest pain causing heart attacks and unmanaged diabetes complications. That investigation preceded the payment freeze by two months. The conditions it documented were the baseline. The baseline was already 95% preventable death. The disbursement freeze removed the financial infrastructure supporting the 5% of care that was being provided. I have a Gantt chart in my office, printed on 11x17 cardstock and laminated and pinned above the Tums drawer, that tracks the Acentra Health onboarding timeline. The original completion date was April 30, 2026. That date passed twelve days ago. The chart has a red line through it drawn in Sharpie by my deputy, who does this for every missed milestone. There are four red lines. There will be more. Each red line represents a period during which no payment processor exists. Each period without a payment processor is a period during which clinicians must choose between providing unpaid care and not providing care. The first option costs them money. The second option costs someone their life. I do not track which choice they make. I track contracts.

Seventy-one percent of ICE deaths in 2025 and 2026 occurred in privately operated detention sites. Half of 2026's deaths occurred in CoreCivic or GEO Group facilities. The Office of Detention Oversight, the COR entity responsible for facility inspections, conducted 36.25% fewer compliance audits in 2025 than the previous year. Fewer audits, more deaths, higher profits. The three trend lines move in coordinated directions. I do not draw conclusions from correlated trend lines. I am a contract administrator. I process contracts. The contracts are technically valid. The facilities are technically operational. The reimbursement apparatus is technically being replaced. The deaths are technically being counted. The word "technically" is doing more work in this paragraph than any clinician in the ICE detention system has been compensated for in seven months.

My internal memo from November 12 used the phrase "absolute emergency." It recommended resolution "immediately" to "prevent any further medical complications or loss of life." That memo was written on government letterhead, classified as internal correspondence, distributed to eleven recipients, and filed in the correspondence tracking system under routing symbol HSA-OAQ, which requires a FOIA request to access.

Seventeen people have died since I wrote it.

The memo was technically effective. It generated a procurement action. The procurement action generated a bridge contract. The bridge contract generated an onboarding timeline. The onboarding timeline generated a Gantt chart. The Gantt chart generated four red Sharpie lines. The red Sharpie lines generated nothing. They are decorative. Like the per diem rate that includes medical care nobody is billing for. Like the 95% preventable death rate that is not being prevented. Like the word "emergency" in a seven-month-old memo that is technically still active, technically still urgent, technically still describing a situation that requires immediate resolution.

I am technically still the person responsible for resolving it. The system is technically still working. The people are technically still dying. The filing cabinet is technically still organized. The contracts are technically still valid.

The word "technically" has appeared so many times in this document that it has lost all meaning. That is exactly what it was designed to do.

[Scott Greenfield @ScottGreenfield]

Disbar AUSA Kevin Bolan
https://t.co/mctCznOyv1

[Dave Levinthal @davelevinthal]

What happened in Buffalo this evening when the singer’s mic fritzed out during the Canadian National Anthem.

[Rob Robertson @RobRobertson3]

@ScottGreenfield Not yet, they were just starting painting it yesterday

[Rob Robertson @RobRobertson3]

@waltersbardc @mattyglesias Now you know that only God gets a break from the height restrictions. (National Cathedral and the Basilica).

[Rob Robertson @RobRobertson3]

Thinking about the ODU ROTC students and wondering if this is appropriate: https://t.co/YwWO786iKK

[Rob Robertson @RobRobertson3]

@TheDMVLive Wouldn’t a large drone program be more flexible and less impactful (re: airspace issues)? It should cost less as well. Train a group of officers (or supervisors) to operate drones that they have in their cars for rapid deployment when needed?

[Subi-doo 🐸 @suzamaroo]

This should be played through every speaker across the country! 👊

[Rob Robertson @RobRobertson3]

@RichKelsey KHAAAAAAN!!!!!!

[Rob Robertson @RobRobertson3]

@drdave1999 I was going for “Epstein Ballroom”!

[Rob Robertson @RobRobertson3]

@gtconway3d The WW1 Memorial last week. No reason, I just like the picture.

[Rob Robertson @RobRobertson3]

@gtconway3d That’s at the FDR Memorial.

[Rob Robertson @RobRobertson3]

Can we talk about the stupidity of engaging in duel when your wife is pregnant (with an ex just waiting for you to die)? #poldark

[Rob Robertson @RobRobertson3]

Verity deserved a better outcome than this

[Rob Robertson @RobRobertson3]

Somehow, I kind of noticed that Francis was not long for this show. #poldark

[Rob Robertson @RobRobertson3]

Another probably inane observation on Poldark. The actor who played Delmaza should have been casted as Elizabeth, and vice versa.

[Rob Robertson @RobRobertson3]

Though Ross seems a pretty good guy for the most part right now. Elizabeth, not so much

[Rob Robertson @RobRobertson3]

I’m watching the first two (and maybe the third episode) of Poldark on Netflix. So far, I think my favorite character is Verity, followed by the “still feral” Delmeza. Don’t know what to make of it yet….