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AUSTIN – The Texas Tribune reports themembership of the Texas House is finally set after Tuesday’s general election — but the future of the chamber’s leadership remains a mystery.

On Thursday, the jostling to hold the speaker’s gavel resumed with insurgent candidate Rep. David Cook, R-Mansfield, saying incumbent Speaker Dade Phelan does not have enough support from House Republicans to win.

“We cannot continue to govern effectively without the Republican majority selecting our Speaker,” Cook wrote in the letter. “It is clear with my list of supporters that the current speaker cannot win an endorsement of the Republican Caucus.”

The House GOP Caucus will meet in a month to endorse its nominee for speaker. The speaker presides over the processes in the House and appoints members to leadership positions. Bills often live or die on whether the speaker supports them, or the lawmaker who has authored them.

In September, Cook became the consensus candidate of House Republicans who want to oust Phelan because they believe he is too liberal. Cook published a list of 48 supporters who had pledged to vote for him in January.

It takes only 76 votes – a simple majority of the 150-member chamber – to become speaker. But the House Republican Caucus rules require that all members vote for the caucus’ endorsed candidate. To garner that endorsement, a candidate must receive three-fifths of the group’s support. Neither Cook nor Phelan have shown they have that level of public support yet.

Since initially publishing his pledge list, Cook has dropped one supporter, Steve Kinard, who lost his bid for a Collin County seat to Democratic incumbent Mihaela Plesa. That puts his pledge list at 47. But the caucus has grown to 88 members after Republican victories on election day, putting the new threshold for a group endorsement at 53.

Phelan, a Beaumont Republican, has said that he continues to have the necessary votes to win the speaker’s gavel at the beginning of the legislative session.

“Rep. Cook does not have the necessary support to become the caucus nominee, let alone the Speaker of the House,” Phelan said in a statement. “I have the votes to become Speaker of the House and look forward to leading another banner session that reflects the will of our state and its lawmakers.”

Given Cook’s pledges, however, Phelan’s presumed path to the speakership runs through a coalition of loyal Republicans and Democrats, a move that would likely bypass the GOP caucus rules. Phelan has not published a list of his supporters.

That was the situation that brought about the speakership of Joe Straus, a Republican who took the gavel in 2009 and held the position for a record five terms. Straus was considered a moderate by the GOP’s increasingly conservative base and hardline lawmakers frequently bashed him for working with Democrats, saying he was killing conservative legislation.

Cook alluded to Straus’ tenure over the House in his letter on Thursday and described his rise to power like a usurpation which “fractured the unity of the Republican Caucus and set the stage for the division that persists to this day.”

Cook said caucus members had three choices: unify behind him, speculate about a new speaker candidate and reconvene the group to hash out an endorsement or re-elect Phelan – which he said was “the worst option.”

Cook has pledged to do away with the appointment of Democrats as committee chairs – a long-standing bipartisan tradition that Phelan supports. Many of Cook’s supporters also want to replace Phelan because they believe he held up school voucher legislation last session and because he oversaw the impeachment of Attorney General Ken Paxton, a right-wing darling who is a polarizing figure in the party.

Paxton was acquitted by the Senate and school voucher legislation is a priority for Gov. Greg Abbott, who believes he now has enough votes to pass a bill.

WASHINGTON — U.S. Sen. John Cornyn has never lost an election.

On Wednesday, he’ll see if he can continue his streak, cashing in decades of political capital as he runs to become the next Senate majority leader to replace Mitch McConnell, who’s held the position for 17 years, according to the Texas Tribune.

It’ll be the highest office Cornyn has ever run for, but no Texans will cast a ballot — save for himself and Texas’ junior senator, Ted Cruz. Leadership is decided by the 53 Republican members of the next Senate in a secret ballot vote. The stakes were raised last week when Republicans won a majority in the Senate, making the party leader the agenda setter for the whole chamber and a core legislative partner for the incoming Trump administration.

Cornyn, a McConnell protégé who previously served as Republican whip and chair of the National Republican Senatorial Committee, is up against the current Minority Whip John Thune of South Dakota and former NRSC Chair Rick Scott of Florida. Like Cornyn, Thune is a decorous lawmaker who spent years close to McConnell and is well regarded throughout the conference. Scott represents a newer, more right-wing generation of the Republican conference who has openly butt heads with McConnell and appeals to the MAGA wing of the party.

Cornyn has for years signaled his desire to succeed McConnell, the longest serving party leader in Senate history. As whip, Cornyn was McConnell’s No. 2 and kept the conference on board with the leadership’s agenda by addressing each senator’s individual needs and interests. He helped elect several current senators while leading the NRSC, the party’s Senate campaign arm. He has actively campaigned and fundraised on behalf of Republicans this election cycle, raising nearly $33 million and traveling the country to help incumbents and new candidates alike. Those ties have formed a key component in his bid for leader.

“One of the things that people do expect of the leadership is to raise money for the team. You see that with Speaker [Mike] Johnson in the House. You see that with Sen. McConnell in the Senate,” Cornyn said in September. “Demonstrating my experience and my contribution to this effort, my ability, along with my team, to do it is something people are going to want to consider when it comes to the leadership election.”

Cornyn is also running on his legislative record. He’s a member of three of the most coveted Senate committees: Judiciary, Finance and Intelligence. He has advised and advanced judicial confirmations under Republican and Democratic presidents. He often works across the aisle to get major legislation passed, including the CHIPS and Science Act to bolster the nation’s semiconductor industry and counter competition from Asia.

But Cornyn’s long tenure in the Senate has opened him to criticism from the right at home — some of it so rabid they’re actively rooting against Cornyn to win the leadership role. He was censured by the Collin County Republican Party and booed at the 2022 Texas Republican Party Convention after he drove the passage of the Bipartisan Safer Communities Act, the first gun safety bill to pass into law in decades, which he worked on after the Uvalde school shooting. In recent days, both the Tarrant County and Dallas County Republican Parties issued statements rejecting Cornyn as a suitable Senate leader.

“The U.S. Senate needs a Majority Leader who is fully committed to conservative principles and who will champion the policies of President [Donald] Trump,” Dallas County Republican Party Allen West wrote in an open letter to Senate Republicans. “Senators John Cornyn and John Thune have consistently aligned themselves with Democrats and voted for omnibus bills that fail to serve the interests of America and its citizens.”

Both West and Tarrant County GOP Chair Bo French are two of the state’s loudest and most far-right Republican county leaders.

Texas Attorney General Ken Paxton ridiculed Cornyn, himself a former Texas attorney general, after McConnell announced he would be stepping down. Paxton posted on social media that Cornyn shouldn’t be Senate leader because he is “anti-Trump, anti-gun,” and will be too busy fending off challengers when he’s up for reelection in 2026.

“Republicans deserve better in their next leader and Texans deserve another conservative senator,” said Paxton, who has not ruled out running against Cornyn.

In an unusual public exchange for the senator who usually shrugs off critics, Cornyn responded: “Hard to run from prison, Ken,” in reference to Paxton’s numerous legal challenges. No Senate majority leader has lost reelection since Sen. Ernest McFarland in 1952, though Thune entered the Senate in 2005 defeating then-Democratic Minority Leader Tom Daschle in South Dakota.

Several other prominent members of the MAGA movement have also rallied around Scott in the days before the leadership election. Elon Musk, Tucker Carlson and Rep. Marjorie Taylor Greene all threw their support behind Scott, criticizing both Cornyn and Thune for their work with McConnell, who has become a pariah among the most conservative flanks of the party.

But none of those outside voices will have a say in the leadership vote. The anonymity of the vote also allows senators to vote more candidly based on their own relationships with the candidates.

While his approval rating has dipped in recent years among Texas Republicans, Cornyn has maintained good standing with many prominent Republicans in Texas. He and Cruz have worked together repeatedly on legislation impacting the state and on the Senate Judiciary Committee, and both supported each other’s reelection efforts, though Cruz hasn’t said how he’s voting on the leadership election.

Texas Republican Party Chair Abraham George, who chaired the Collin County party when it censured Cornyn, met with the senator in September to coordinate efforts electing Republicans in the state.

“I truly appreciate all your efforts in what is such a pivotal election in our nation’s history,” George posted on social media after their meeting. “We are going to win Texas and we are going to win big!”

A Texan has not been a party leader in the Senate since Lyndon B. Johnson. Past leaders have used the position to benefit their home states, including Johnson, who used the perch to help secure Houston’s place as the center of the U.S. space program.
A leader in fundraising

Cornyn has been climbing the leadership ladder since his first term in Congress. He served as Republican conference vice chair from 2007 to 2009 as a first-term senator, succeeding fellow Texan Sen. Kay Bailey Hutchison.

His influence took a leap when he was elected to serve as the NRSC chair in 2009, making him the chief fundraiser and recruiter for Senate Republicans aside from the party leader himself. It’s a grueling job, but Cornyn thrived. Paired with a 2010 Tea Party wave, Republicans managed to defend all 18 of their incumbents for the first time in 16 years and gained six more seats. Cornyn’s colleagues asked him to serve a second time for the 2012 cycle.

Texas is famously home to a host of ultra-rich Republican donors who have financed campaigns for years. Cornyn proved himself an effective fundraiser as Texas attorney general from 1999 to 2002. He was one of the first members of the Republican Attorneys General Association, hosting an Austin fundraiser in 2000 for his fellow state AGs that brought in hundreds of thousands of dollars. That scale of fundraising for attorneys general was novel at the time and attracted controversy as corporate donors gave to candidates who could be involved in their cases. Democrats created their own attorneys general fundraising organization in 2002.

His fundraising reach expanded during his time at the NRSC, building relationships with major donor pools in New York, Florida and California. He courted Wall Street in 2010 to give to Republican candidates as then-President Barack Obama pursued regulatory policy to avoid a repeat of the 2008 financial crisis.

“I just don’t know how long you can expect people to contribute money to a political party whose main plank of their platform is to punish you,” Cornyn said in 2010.

During the 2022 cycle, Cornyn raised more money than any other Senate Republican, including those up for election, with the exception of McConnell himself and Scott, who was then chairing the NRSC. And unlike McConnell, whose Senate Leadership Fund is choosier in which candidates it invests in — it didn’t donated to Cruz this cycle — Cornyn gives to all of his fellow Republicans.

This cycle, Cornyn raised nearly $33 million for Republican senators and candidates, including $16 million for the NRSC. That includes over $500,000 for Cruz, who came out victorious over U.S. Rep. Colin Allred, D-Dallas, one of the most expensive Senate races in Texas history.

Since joining the Senate, Cornyn’s fundraising total is over $414 million. He also traveled around the country campaigning and fundraising for fellow Republicans, including Cruz, Mike Rogers in Michigan, Sam Brown in Nevada, Jim Banks in Indiana, Bernie Moreno in Ohio and Dave McCormick in Pennsylvania. Banks, Moreno and McCormick all won their elections.

“He’s never taken his foot off the gas,” said Brian Walsh, who served as Cornyn’s communications director at the NRSC and still is in touch with his operation. “In terms of having Republican senators and candidates down to Texas, introducing them to his network, helping them raise money … I would argue there’s very few senators who are more responsible for the Republican Senate majority than he is.”

Thune is also a prolific fundraiser and crisscrossed the country this cycle attending over 200 events for Republicans or the NRSC. He has raised over $33 million across his fundraising operation this cycle and was one of the top fundraisers for the NRSC other than the current chair, Steve Daines of Montana, NBC News reported.
The Trump factor

Cornyn has shown willingness to diverge from the current leader if the rest of the party calls for it. That includes shaking up some long standing rules.

Cornyn is vowing to move heaven and earth to get Trump’s cabinet confirmed as swiftly as possible. That includes keeping senators through the weekends to get nominees confirmed (Cornyn is a vocal critic of the short working week and frequent breaks in the Senate) and even bringing back recess appointments, which allows the president to unilaterally make appointments when the Senate is not in session.

Both Republicans and Democrats have prevented presidents from making recess appointments by sending a single senator to Washington to keep sessions going while everyone else was in their home states. But Trump called for the move to get his agenda moving — a mandate all of the candidates were willing to accept.

“No weekends, no breaks,” Cornyn posted on social media Saturday. “Democrats can cooperate in the best interest of the country, or continue the resistance, which will eventually be ground down. Take your pick.”

Cornyn has also expressed an openness to term limits for the party leader — a move McConnell opposes. And he has vowed to open up the legislative process to take in more input from the rank and file through regular Senate order, including debating legislation in committee before they hit the floor. McConnell has been criticized for leading deals with strict control of his conference, with Cruz calling him a “one-man dictator.”

“I believe our members and incoming colleagues have the talent, experience, and character needed to restore the Senate to its fundamental role in our constitutional republic, inducing the critical role of Senate committees in achieving results for the American people,” Cornyn wrote in a September letter to the conference.

Scott and Thune have made similar pitches to make the chamber more participatory. Thune is the only one of the three who has chaired a standing committee, leading the Senate Commerce Committee from 2015 to 2019.

McConnell’s clashing with the right wing of the party stretches back years. He has been hostile toward the more reactionary methods of some newer members to block legislation, and several right wing members blamed McConnell for failing to take control of the Senate in 2022.

McConnell faced his first real leadership challenge in 2022 when Scott launched a bid and secured 10 votes. Cruz, who has beefed with McConnell throughout his time in the Senate, voted for Scott.

Scott has still managed to capture the support of several members of the MAGA wing of the party. He received public endorsements from senators including Tennessee’s Bill Hagerty, Kentucky’s Rand Paul and Alabama’s Tommy Tuberville.

Cruz has not endorsed in the race. He said in February: “I suspect a number of my colleagues are interested in the job, and I look forward to seeing whom the conference selects as the next leader as we hopefully enter the majority this November.” His office did not have a further update, but he recently said on Fox News: “I want to see a majority leader who changes how the Senate operates, who democratizes it more.”

Trump has also not endorsed in the race, though Scott and his allies have requested Trump do so. Trump and McConnell shared an epicly bitter relationship, particularly after Trump’s efforts to overturn the 2020 presidential election escalated into an attack on the U.S. Capitol.

Both Thune and Cornyn broke from Trump after his time in office, with Cornyn saying as recently as last year that Trump could not win in a general election and that his “time has passed him by.”

But Cornyn endorsed Trump in January after Trump won in the New Hampshire primary. He later campaigned with Trump in Texas and Nevada and attended fundraisers for the Trump campaign in Laredo, San Antonio and Houston, according to a source familiar with Cornyn’s political operation.

Cornyn has also highlighted his work advancing Trump’s policy agenda when he was whip, telling Trump “I’m interested in getting the band back together again,” Cornyn said Monday on Fox News. He advanced the conference through its ultimately unsuccessful repeal attempt of the Affordable Care Act and the Trump tax cuts that have become one of Trump’s defining pieces of legislation.

Cornyn’s and Thune’s supporters are opting to be more private, with only Sen. Josh Hawley of Missouri openly backing Cornyn and Sens. Mike Rounds of South Dakota and Markwayne Mullin of Oklahoma backing Thune. Hawley is a deeply conservative member who joined Cruz in objecting to the certification of the 2020 election.

Repeating a refrain he has said throughout the year, Cornyn said in September: “I don’t think these races are run in the press, so I’m not going to talk any length about it.”

AUSTIN – The Austin American-Statesman reports that Republicans netted only two new seats in the Texas House in Tuesday’s election, but of the influx of new members who either ousted incumbents in the GOP primary or won open contests means the lower chamber’s center of gravity shifted more to the right. The incoming freshmen vastly enhance Gov. Greg Abbott’s chances of getting his long-denied school voucher bill through the Legislature in 2025 while Republicans continue apace on such conservative priorities as beefing up border security and placing further restrictions on transgender Texans. And it adds a new layer of drama to the ongoing race for House speaker.

“There are a lot of things that can happen along the way. But right now, starting out, Republicans command, and they’re going to pretty much hit what they want,” said Bill Miller, a longtime lobbyist and political consultant. “The question is, how much, how much fighting will go on between leadership about various things. And that’s really the key.” House Speaker Dade Phelan, a Beaumont Republican who was first elected to the Legislature 10 years ago and took charge of the chamber in 2021, has been in the crosshairs for much of his second term. And the flak he’s been taking has come from some corners of his own party — particularly from his counterpart in the Texas Senate, Lt. Gov. Dan Patrick. The election results that showed former President Donald Trump winning back the White House and Texas Republicans winning 88 state House seats were barely tabulated when Patrick sent his latest cannon volley across the Capitol Rotunda to the speaker’s office. “(T)here’s one Republican left who still supports the Democrats’ agenda and wants to empower them. Not Liz Cheney — she’s old news,” Patrick said on social media, with a reference to the former Wyoming congresswoman who has emerged as Trump’s loudest GOP critic. “This one is right here in Texas.

AUSTIN – As Texas prepares to consider a school voucher program, ProPublica reports that in 2018, Arizona voters overwhelmingly rejected school vouchers. On the ballot that year was a measure that would have allowed all parents — even the wealthiest ones — to receive taxpayer money to send their kids to private, typically religious schools. Arizonans voted no, and it wasn’t close. Even in a right-leaning state, with powerful Republican leaders supporting the initiative, the vote against it was 65% to 35%. Coming into this week’s election, Donald Trump and Republicans had hoped to reverse that sort of popular opposition to “school choice” with new voucher ballot measures in several states. But despite Trump’s big win in the presidential race, vouchers were again soundly rejected by significant majorities of Americans. In Kentucky, a ballot initiative that would have allowed public money to go toward private schooling was defeated roughly 65% to 35% — the same margin as in Arizona in 2018 and the inverse of the margin by which Trump won Kentucky.

In Nebraska, nearly all 93 counties voted to repeal an existing voucher program; even its reddest county, where 95% of voters supported Trump, said no to vouchers. And in Colorado, voters defeated an effort to add a “right to school choice” to the state constitution, language that might have allowed parents to send their kids to private schools on the public dime. Expansions of school vouchers, despite backing from wealthy conservatives, have never won when put to voters. Instead, they lose by margins not often seen in such a polarized country. Candidates of both parties would be wise “to make strong public education a big part of their political platforms, because vouchers just aren’t popular,” said Tim Royers, president of the Nebraska State Education Association, a teachers union. Royers pointed to an emerging coalition in his state and others, including both progressive Democrats and rural Republicans, that opposes these sweeping “school choice” efforts. (Small-town Trump voters oppose such measures because their local public school is often an important community institution, and also because there aren’t that many or any private schools around.)

HOUSTON (AP) – When Victoria Elizondo first went to see a doctor about her symptoms at Legacy Community Clinic, a low-cost clinic in Houston, she didn’t know what was wrong with her but she knew something wasn’t right. Her hands would shake uncontrollably, her heart would beat fast even while resting and she suffered from insomnia.

After the appointment, she was told her immune system was attacking an overactive thyroid, a disorder called Graves’ disease, and that an endocrinologist was the only doctor who could help her. But without health insurance, the cost to see one was exorbitant — as much as $800 for a visit.

“I thought it was a joke,” said Elizondo, a 33-year-old restaurant owner.

Elizondo, who has been paying thousands of dollars a year for treatment, may soon find relief. She is now one of nearly 90,000 DACA recipients in Texas — more than 500,000 across the nation — who finally get a chance at signing up for health insurance through the Affordable Care Act. Through Jan. 15, DACA recipients — those who under the Deferred Action for Childhood Arrivals program are temporarily protected to live and work in the U.S. after being brought to the country unauthorized as children — can enroll in the federal health insurance marketplace for the first time since launching 10 years ago.

Advocacy groups say access to the marketplace will help alleviate the health disparities DACA recipients face, such as high uninsured rates and unmet medical needs after years of putting off care. However, a lawsuit threatens to take this eligibility away as Texas, along with 18 other states, argues the policy would financially harm them. Looming even larger is the uncertainty around the existence of DACA as President-elect Donald Trump has promised mass deportations and ending birthright citizenship for people born to undocumented immigrants. In 2017, he attempted to rescind DACA, arguing that it was unconstitutional. Three years later, the Supreme Court ruled that his attempt was unlawful.

With premium tax credits that help lower health insurance costs set to expire at the end of 2025, Trump also has the ability to not renew them.

These subsidies, as well as cost-sharing reductions, are also now available to DACA recipients, lowering the amount they have to pay for premiums, deductibles and co-payments. DACA recipients cannot qualify for Medicaid, the public health insurance program for low-income individuals, under federal law. It’s also unclear how many DACA recipients in Texas receive health insurance coverage through an employer or as a dependent.

“More than one-third of DACA recipients currently do not have health insurance, so making them eligible to enroll in coverage will improve their health and wellbeing, and help the overall economy,” said U.S. Department of Health and Human Services Secretary Xavier Becerra in a news release.
Cost of health care

Elizondo pays about $200 for each endocrinologist visit and $100 every month for blood work. To cure Graves’ disease, she would need to undergo a thyroid gland removal surgery which can cost up to $30,000.

Having health insurance would mean she could spend less time worrying about her personal costs and physical limitations and put more focus on her growing business.

“It’s a big deal for me,” Elizondo said.

According to the Center for Medicare & Medicaid Services, DACA recipients are currently three times more likely to be uninsured than the general U.S. population, resulting in many delaying care because of high out-of-pocket costs. A 2023 survey by the National Immigration Law Center found that more than a third of DACA recipients skipped recommended medical treatments and tests, which can lead to worsening health outcomes and heftier medical costs in the future.

“Right now, people are getting sicker because of (not receiving) preventative care. More folks will have to go to the emergency room,” said Cesar Espinosa, executive director of FIEL Houston, Inc., an immigration advocacy group.

Espinosa would know. When he was an uninsured DACA recipient 16 years ago, he collapsed in front of his mother’s door and was rushed by ambulance to the emergency room. He found out there that he had Type 2 diabetes.

Without health insurance, he had to rely on the Harris Health Financial Assistance Program to cover those hospital costs. After losing access to that help, he now needs to find a way to pay for medication, which can cost about $970 without insurance.

“I’m looking forward to also being able to afford a better quality of health care,” he said.

Espinosa, now a permanent resident who also plans to enroll in federal marketplace insurance, hopes others take advantage of the new eligibility, particularly for their mental health needs. The law center report listed mental health as a top medical concern for DACA recipients, but 36% of them said costs were too high to access treatment. The uncertainty associated with the future of DACA is considered “a source of trauma, leading to increased fear, sadness, and distrust,” according to the report.

“You can never be at peace,” Espinosa said.

This distrust of public programs has motivated navigators, nonprofits that receive federal funding to help first-time enrollees sign up for Affordable Care Act coverage, to develop strategies to better help DACA recipients.

Navigators at health organization MHP Salud in Weslaco have printed flyers, brochures, and DACA-related one-pagers and messaging on their website. They cover six regions in Texas, including El Paso, Eagle Pass, San Antonio, and the Rio Grande Valley, working with community health partners and individuals they work with to spread the word.

Eight days into open enrollment, Martinez said MHP Salud had received five inquiries from DACA recipients through their online information form about coverage.

Jennifer Martinez, a program manager at MHP Salud, said the biggest challenge is trying to find where DACA recipients are located. They can be students or business owners, just graduating college or starting their own family.

In July, U.S. Rep. Joaquin Castro along with five other Texas officials wrote a letter to the U.S. Department of Health and Human Services urging them to expand their outreach and enrollment assistance efforts for DACA recipients.

“We’re going on a first date with DACA recipients,” said Stacey Thompson, a program director at Civic Heart Community Services, another health navigator organization. “We’re nervous but we’re also excited to serve them.”
Fear of taking subsidies

According to health policy research organization Kaiser Family Foundation, 43% of DACA-eligible individuals have incomes below 200% of the federal poverty level compared with 26% of U.S.-born individuals in the same age group. That’s $30,120 for one person and $62,400 for a family of four.

Since many DACA recipients are low-income and are generally barred from Medicaid, tax credits and cost-sharing reductions for marketplace plans could make the difference between having health insurance or not.

“The tax credits are huge,” said Scott Heard, senior program coordinator for the Prosper Health Coverage Program at Foundation Communities in Austin. “I don’t think some people realize just how essential that is to the program. It’s pretty much not affordable without the tax credits.”

During his previous term, Trump had led an unsuccessful effort to rid the Affordable Care Act, and although he could renew the charge in his upcoming term, a more likely action is that he could whittle away subsidies that help low-income individuals afford a marketplace plan, regardless of their citizenship.

Further complicating the issue, DACA recipients also fear using subsidies could block their paths to citizenship. During the last Trump administration, federal officials broadened rules so that certain immigrants who received Medicaid, housing assistance, child care subsidies, and other benefits for more than 12 months within any 36-month period could be deemed a public charge. Being labeled a public charge or a potential public charge carries high consequences: the inability to become lawful permanent residents.

Espinosa said DACA recipients fear using Affordable Care Act subsidies will carry the same penalty.

“We tell them the truth and that this is not a public charge,” he said. “They are not here illegally. They do have a permit to be here. We are hoping to be able to explain to people what this really means and hoping that they’ll take a chance and do it.”
An uncertain future

DACA recipients were originally excluded from the Affordable Care Act because they were not considered lawfully present. In a 2023 report, Medha Makhlouf, a Pennsylvania State University law professor, suggested that the U.S. Department of Health and Human Services’ decision to exclude DACA recipients was not based on health policy.

“It relied on a desire to not interfere with immigration policymaking,” Makhlouf wrote. “The decision to ‘carve out’ DACA beneficiaries from the category of lawfully present noncitizens was made under pressure from an administration that was concerned about appearing too lenient on immigration issues.”

Those fears that the move would cause political pushback have been validated by a lawsuit, first filed in August, that seeks to reverse DACA recipients’ eligibility for Affordable Care Act coverage. The attorney generals from 19 states, including Texas, argue that by allowing DACA recipients to benefit from subsidized health insurance and making them lawfully present in their health care system, these individuals will want to stay in the United States longer. This will in turn cause states to spend more money on education, health care, law enforcement, and other limited resources, they say. Texas spends more than $250 million each year on social services to DACA recipients, according to the lawsuit.

However, Waco-based economist Ray Perryman told the Dallas Morning News that to his knowledge there is no Texas database or study that tracks what costs the state incurs because of DACA recipients. Texas used Perryman’s estimates in the lawsuit but he said that “none of my analysis regarding immigration or the DACA recipients has identified any cost to the state imposed by DACA recipients.”

DACA advocates say that health insurance coverage helps lower costs because people do not have to wait until their health problems become more serious and more expensive, possibly putting more financial burden on health systems.

Navigators say that federally-funded clinics are the closest thing uninsured DACA recipients have to reliable quality health care.

Nicolas Espiritu, the deputy director of legal at the National Immigration Law Center, said that he does not believe that any states will be harmed if the marketplace is opened up to DACA recipients. If anything, it would be a benefit to states.

“Texas also doesn’t bear any costs for administering the program,” he said. “The health care access and quality and overall health care outcomes will only improve by ensuring that everyone has health care.”

Elizondo has been excited to sign up for Affordable Care Act insurance, listing out all the appointments she would like to make — those for regular health checkups, a gynecologist and mental health therapy. But with the results of Election Day, Elizondo fears she may never get it.

In the meantime, Elizondo, a decorated chef and owner of Houston-based Cochinita & Co., will continue to do what she has always done — push through tired and physically draining days as best she can.

“I have 17 employees, so it’s like I have 17 children,” she said. “The amount of energy it requires is high. Sometimes I feel like I’m not able to meet the demands the business requires.”

SAN ANTONIO – The San Antonio Express-News reports that nine months after the Air Force announced a sweeping reorganization that included plans to raise the stature of its cyber operations mission headquarters in San Antonio, the service still can’t say exactly what that means. The holdup has left the 16th Air Force — the unit responsible for information warfare that’s housed on Joint Base San Antonio-Lackland — wondering about the impacts on its more than 49,000 employees, including 4,850 local workers. There also are questions about what the changes will mean for the 16th’s portfolio of responsibilities, which include intelligence, surveillance, reconnaissance, electromagnetic warfare, weather, public affairs and information operations. Playing out in the background are discussions about replacing its old facilities.

The 16th’s headquarters building is 71 years old, with a hobbled HVAC system and foundation problems that cause shifting floors and cracked walls. It’s a bad look for the unit defending the nation on the digital frontier, where something as simple as an air conditioning breakdown could create big problems for the high-end technology the 16th operates. Seeing the need, Port San Antonio earlier this year submitted an unsolicited $1 billion-plus proposal to help the Air Force build a new headquarters for the unit at the Port. And, late last month, the Air Force put out a call for proposals for six projects across JBSA. Among them was a new “Cyber Security Center” for the 16th. As reorganization talks drag on, the 16th’s facilities issues continue. U.S. Rep. Tony Gonzales has warned against the Air Force’s open-ended timelines for the moves, saying “the time for waiting is over.” And Port San Antonio’s pitch has drawn bipartisan support from lawmakers who say it’s worthy of consideration. Despite such calls, the wait continues for clarity about the 16th’s future.

(AP) — A costly campaign by abortion-rights advocates for state Supreme Court seats yielded mixed results in Tuesday’s election, with Republicans expanding their majority on Ohio’s court while candidates backed by progressive groups won in Montana and Michigan.

One of the most expensive and closely watched Supreme Court races in North Carolina, where a Democratic justice campaigned heavily on abortion rights and Republicans hope to expand their majority, remained too early to call Thursday.

Groups on both the right and left spent millions in the leadup to the election hoping to reshape courts that’ll be battlegrounds for voting rights, redistricting, abortion and other issues.

Abortion-rights supporters touted victories in states that Donald Trump won, saying it’s a sign that reproductive rights will be key in judicial campaigns after the U.S. Supreme Court’s 2022 decision overturning Roe v. Wade. In states like Montana and Arizona, state courts may soon be tasked with interpreting how abortion-rights amendments voters passed this week would impact existing laws.

“State Supreme Court judges don’t really have anything to say about the economy, but they certainly do have something to say about reproductive rights and voting rights and democracy and what your life is going to be like from a right to liberty perspective in your state,” said Deirdre Schifeling, chief political and advocacy officer for the American Civil Liberties Union. “So I think we have a real opportunity to define these judges and this level of the ballot by reproductive rights.”

The ACLU spent $5.4 million on court races in Montana, Michigan, North Carolina and Ohio. Planned Parenthood and the National Democratic Redistricting Committee earlier this year announced they were collectively spending $5 million, focusing on court races in those states, as well as in Arizona and Texas.

Conservative groups also spent heavily in those states, but with ads focusing on issues other than abortion such as immigration and crime.

In Ohio, all three Democrats running for the state Supreme Court lost their race. The victory gives Republicans a 6-1 majority on the court. A county judge in October struck down the state’s six-week abortion ban and the state Supreme Court is expected to hear more cases aiming to undo regulations that, for example, require 24-hour waiting periods or in-person appointments for patients.

“Ohioans made a strong statement tonight that will keep the court under Republican control for years to come,” said Dee Duncan, president of the Republican State Leadership Committee’s Judicial Fairness Initiative, which spent nearly $1 million on the race.

Michigan Democrats won two seats on the state’s Supreme Court, expanding their majority to 5-2. While the elections are nonpartisan, parties nominate the candidates.

“With the liberal majority protected, Michigan Dems’ hard work past and future will not be threatened by the MAGA fanatics that threaten our values here in Michigan,” Chair of the Michigan Democratic Party Lavora Barnes said in a statement.

In North Carolina, Justice Allison Riggs trailed narrowly Court of Appeals Judge Jefferson Griffin in their race for an eight-year term on the state’s highest court. The Associated Press has not called the race, for which nearly 5.5 million ballots have been counted. Tens of thousands of additional provisional and absentee ballots still had to be reviewed by county election officials, and the trailing candidate could seek a recount if the final margin is narrow enough.

Riggs’ campaign focused on reproductive rights, running ads that said Griffin could be a deciding vote on the 5-2 majority Republican court for further abortion restrictions. Griffin had said it was inappropriate for Riggs to talk about an issue that could come before the court.

Heated bids for a pair of seats on Montana’s court were a split decision, with county attorney Cory Swanson defeating former U.S. Magistrate Judge Jerry Lynch for chief justice. State judge Katherine Bidegaray defeated state judge Dan Wilson for another open seat on the court.

Progressive groups backed Lynch and Bidegaray, casting the races as key to protecting abortion rights in a state where Republicans control the Legislature and the governor’s office. Republicans who complained about the court’s rulings against laws that would have restricted abortion access or made it more difficult to vote supported Swanson and Wilson.

A longshot effort by abortion-rights advocates to unseat three justices on Texas’ all-Republican Supreme Court fell short, with Jimmy Blacklock, John Devine and Jane Bland winning reelection. The three were part of unanimous rulings rejecting challenges to the state’s abortion ban.

In Arizona, two justices won retention elections despite efforts to oust them over the court decision that cleared way for a long-dormant 1864 law banning nearly all abortions to be enforced. The state Legislature swiftly repealed it, and voters on Tuesday approved a constitutional amendment guaranteeing abortion access up to fetal viability, typically after 21 weeks.

Conservatives also won in Oklahoma, where voters removed one of three Supreme Court justices appointed by a former Democratic governor who were up for retention. A 5-4 ruling by the court last year overturned a portion of the state’s near total ban on abortion. It was the first time any Oklahoma appellate judge had been removed through a retention election.

An Arkansas justice who wrote a blistering dissent when the court’s Republican-backed majority blocked an abortion rights measure from the ballot was elected chief justice. That race, however, won’t change the court’s majority.

The next big battleground comes next year in Wisconsin, where a race will determine whether liberals maintain their 4-3 majority on the court. The open race for retiring Justice Ann Walsh Bradley’s seat comes after the court flipped from conservative control in a 2023 election marked by record-breaking spending.

“It doesn’t seem like state Supreme Court elections are going to go back to the way they were 10 years ago anytime soon,” said Douglas Keith, senior counsel in the judiciary program at the Brennan Center, which has tracked spending on state court races.

JOHNSON COUNTY (AP) – County Commissioner Rick Bailey knows immediately when one of his Johnson County constituents has suffered a health scare. That’s typically when the calls and texts roll in from residents wanting to know more about ambulance service for those living outside the city limits of Cleburne or Burleson.

“I do get complaints if there has been an accident or a heart attack, saying ‘Hey, why did it take so long?’” Bailey said.

His county, about 15 miles south of Fort Worth, is in the midst of an unprecedented boom. More Dallas and Fort Worth retirees are either cashing in on their homes and relocating, or younger, working adults, unfazed by a longer commute, are opting for a more affordable lifestyle, choosing among the hundreds of new homes being built there.

In the past three years, Johnson County has added 25,000 more people, and by 2030, another 60,000 are expected to relocate here, Bailey said. Right now, the county, which at 734 square miles is a little larger than the size of Houston, has 17 proposed municipal utility districts, the first signal from developers that they want to raise funds to pay for new infrastructure for new housing construction.

Factor in highway expansions and roads at capacity, counties like Johnson will see a rise in traffic accidents that will need a more immediate medical response than smaller towns, with their combined fire and EMS services, can offer.

In 2023, more than 152,000 crashes happened in rural areas across the state.

“We’ve exploded with growth, and with so many vehicles on the road, the roads were not designed for this much traffic or this much delay,” Bailey said. “It’s only going to increase.”

Adding to the need for more ambulances, Johnson County has a shortage of health care options. The county has only one hospital — Texas Health Harris Methodist Hospital Cleburne — within its boundaries that can admit patients overnight, Bailey said. This summer, t he hospital also shut down its maternity department, because of a decrease in the number of deliveries there. Now, residents here can expect that when a medical emergency happens, they will be transported to hospitals in neighboring Tarrant and Dallas counties, which can take anywhere from 40 minutes to an hour, depending on the type of care needed. In those situations, county officials know they must have multiple ambulances at their disposal in case one is in use transporting a patient miles away.

“I got a call for a woman who was in her second trimester,” Bailey recalled. “She said, ‘What are we going to do? I was depending on the hospital out here.’”

To help shore up the ambulance service outside Johnson County’s largest cities’ fire departments, commissioners this year approved a $1.5 million contract with Grand Prairie-based CareFlite, which adds five full-time ambulances and another one part-time to cover unincorporated areas. To save money, the county paid the contract in full, up front. That’s a lot for a county that has a total general fund budget of about $102 million, Bailey said.

In 2019, Gov. Greg Abbott signed into law a measure that puts a cap on property tax hikes. Cities and counties cannot raise property taxes beyond that 3.5% cap without taking the issue to local voters. Bailey said the need for better EMS service, something counties are not required to provide, is making working within that cap tougher, especially as rural hospitals close or reduce beds because of rampant health care workforce shortages.

“As the population grows, so will the need for more ambulances,” he said.
The pressing EMS need statewide

The complaints from counties about how to pay for emergency medical services are not new, says Rick Thompson, program director for the County Judges and Commissioners Association of Texas. As the demand for EMS service grows, the old volunteer fire department model for smaller towns concentrated in one or two areas of a sprawling county is forcing counties to explore hiring paid county staff members and buying ambulances or contracting with private ambulance companies.

“It is a huge issue,” Thompson said. “I’ve been working with counties for 25 years and as I’ve traveled the state, it’s always been an issue.”

But it’s become a more pressing one as the rise in housing prices has pushed more people into metro-adjacent counties where homes are more affordable and as the number of older residents who have more medical needs and emergencies grow. The coronavirus pandemic also made workers more mobile and less location dependent, able to work anywhere there’s internet access.

This summer a survey was sent to 236 of the state’s 254 counties about their EMS services. Of the 81 counties that completed the survey, about 48% reported having open EMS positions and about half indicated they had zero volunteer staff, Thompson said. Also, about 55% reported EMS round trip times of an hour, 38% reported round trips of two hours and 26% reported three-hour round trips. The nearest trauma center for counties ranged from less than 5 miles to 200 miles away.

And even though counties are not required to provide ambulance services, they do it to keep from dying out completely and becoming ghost regions.

Last month, Grayson County’s district attorney put the question squarely before the state attorney general’s office after EMS contractors notified the county they would not provide ambulance service to planned housing developments being built in unincorporated areas.

Does the county have a legal obligation to provide fire and ambulance service to residents living in unincorporated areas?

“There is a problem on the horizon wherein Grayson County residents living in higher density subdivisions will not have emergency services,” the Grayson County request to the attorney general stated.

Calls for comment were not immediately returned from Grayson County officials.

About 40 minutes northwest of Lubbock, Lamb County Judge James “Mike” DeLoach can recall how rural ambulance service was a “load and go” type of operation, where residents were placed in the beds of pickup trucks and driven dozens of miles to the nearest hospital.

Today, DeLoach, a paramedic for the past 38 years, says the job is more sophisticated, with competition for trained emergency personnel that has reached a critical juncture. While his county is not seeing the growth spurt Johnson County is experiencing, Lubbock’s growth has translated to more health care personnel working there, where salaries are higher. And the need is growing for emergency medical transport as his residents get older.

“We’re not necessarily seeing the influx of people,” DeLoach said. “But we’re seeing an aging population that needs EMS more.”

Texas is aging at a rapid clip. According to Texas Health and Human Services, the state has the third largest population of people 50 years of age and older. That population is expected to grow 82% to 16.4 million by 2050 and a lot of the over 50 demographic choose to live where it’s more affordable: in rural and metro-adjacent counties.

Among those aging are the volunteers who now staff EMS positions at small town fire departments. Current volunteers are retiring and finding their replacements is getting tougher as rises in the cost of living deter people from working for free. Counties that pay EMTs or paramedics often lose them after a few years to larger counties that can pay them more.

DeLoach said it’s tough to recruit EMTs and paramedics to his county when they can work in Lubbock and make $57,000.

Then there’s the overall operational cost associated with a private ambulance service forced to travel long distances to hospitals. Even when there is a local hospital, not every hospital in a rural county can treat every injury or illness in their ER. That means taking patients to more specialized care elsewhere.

The cost is rising because of both the specialized training and equipment needed on board.

“It’s going up because in theory there are more requirements. They have to have all sorts of equipment. It’s very expensive,” said Fannin County Judge Newt Cunningham.
More dedicated state funding

When the Texas Legislature convenes in January, county leaders like Bailey and DeLoach will be asking lawmakers for a better, dedicated way to fund emergency medical care that would help counties from raising property taxes.

They have their eyes on a successful remedy secured by rural law enforcement agencies. A year ago, a new $330 million grant program was approved for rural policing needs. Counties would like to see such a grant program to help counties pay for rural ambulance services.

“Counties are working with the state to find foundational funding to support rural EMS,” said Thompson, of the county judge and commissioners association. “Nobody wants to be that person on the side of the road and nobody’s coming.”

And as Thompson notes, the days of the pancake breakfasts and other fundraising to help pay for volunteer ambulance services is over.

“You can’t have enough bake sales to afford a $400,000 ambulance and then equip it and man it,” Thompson said. “It’s not realistic.”