Despite Trump’s win, voters widely reject school vouchers

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.)

Texas’ 90,000 DACA recipients can sign up for ACA coverage

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.”

New skating rink coming to Downtown Tyler

New skating rink coming to Downtown TylerTYLER — Looking for new winter activities in Tyler? Thanks to the Discovery Science Place, people can soon go to their new skating rink. According to our news partner KETK, the skating rink will have a grand opening event on Nov. 15 from 6 p.m. to 9 p.m. and tickets are $15 which includes, 45 minutes of skate time, dinner, a picture with Santa, holiday crafts, cookie decorating and hot cocoa.

“This exciting addition is perfect for everyone—from beginners to seasoned skaters. Enjoy public skating sessions, host unforgettable birthday parties, or book after-hour events that will leave your guests buzzing with joy,” the Discovery Science Place said. “Schools can take advantage of our special field trip packages, combining education and fun on the ice. Lace up your skates and make unforgettable memories.”

Public skating will be $7 an hour and guests are asked to arrive 15-20 minutes early to get skates. People can book public skating sessions online or purchase by the hour at the front desk.

What Trump has said about birth control, and what he could do as president

Isabel Pavia/Getty Images

The election of former President Donald Trump to a second term has put a spotlight on what his return to the White House may look like, particularly when it comes to women's health.

Online searches for topics related to women's health have spiked since the Nov. 5 election, particularly when it comes to birth control, Google data shows.

Searches for IUDs, birth control pills, and Plan B are trending higher than they have since June 2022, when Roe v. Wade was overturned, giving states the power to decide abortion access.

Since then, at least 14 states have ceased nearly all abortion services, and 21 states have put into effect restrictions on abortion.

The current abortion landscape combined with Trump's comments about birth control on the campaign trail and his first administration's efforts to roll back insurance coverage of contraceptives have led to uncertainty about what will happen in his second term.

Here are five questions answered.

1. What does the term 'birth control' include?

Birth control, also known as contraception, is the broad term for the act of preventing pregnancy.

The term includes everything from medicines and methods to devices and surgery used to prevent pregnancy, according to the National Library of Medicine.

One of the most widely-known and used types of contraception is the birth control pill, an oral, hormonal medication that commonly requires a prescription.

Around 14% of women in the United States between the ages of 15 to 49 currently use the pill, according to the Centers for Disease Control and Prevention.

2. What did Trump say about birth control on the campaign trail?

During an interview with a Pittsburgh TV station in May, Trump was asked if he supports any restrictions on a person's right to contraceptives.

"Well, we're looking at that and we're going to have a policy on that very shortly," Trump responded with. "And I think it's something you'll find interesting and it's another issue that's very interesting."

When asked to clarify if he was suggesting he was open to supporting some restrictions on contraceptives, "like the morning-after pill," Trump responded, "Things really do have a lot to do with the states -- and some states are going to have different policy than others."

The former president quickly took to social media to clarify his position, claiming that he was not advocating for restrictions on contraceptives.

"I HAVE NEVER, AND WILL NEVER ADVOCATE IMPOSING RESTRICTIONS ON BIRTH CONTROL, or other contraceptives," he wrote in a May 21 post on his social media platform.

The Trump campaign further attempted to clarify, claiming the policy Trump was referring to during the interview was mifepristone, often used in pregnancy termination. However, Trump was not asked about the abortion medication.

After winning the 2024 presidential election, Trump and the transition team have been advised on health-related appointments by Robert F. Kennedy Jr., who has also been in discussions to possibly fill a major role in the next administration, sources familiar with the matter told ABC News.

ABC News has not found public comment from RFK Jr. on the issue of birth control.

3. What happened on birth control during Trump's first administration?

During Trump's first term, the Department of Health and Human Services issued new rules allowing more employers to opt-out of the Affordable Care Act mandate guaranteeing no-cost contraceptive services for women.

The Supreme Court upheld the HHS decision in a 7-2 ruling in 2020, giving an employer or university with a religious or moral objection to opt out of covering contraceptives for employees.

4. As president, what power does Trump have over birth control?

As president, Trump would have the authority to order rollbacks of measures implemented by President Joe Biden's administration to protect birth control.

As recently as October, the Biden administration announced a plan to require insurers to fully cover over-the-counter contraceptives.

In January, the administration announced several other measures to protect contraception access, including federal agencies issuing new guidance to "clarify standards" and make sure Food and Drug Administration-approved contraceptive medications are available for free under the Affordable Care Act.

Once Trump is in office, he will also have the chance to appoint Supreme Court justices if vacancies arise. During his first term, Trump appointed three justices.

Trump could also work with Congress to enact legislation on women's reproductive rights, including birth control. Following the Nov. 5 election, control of the House of Representatives is still up in the air, while ABC News has projected that Republicans will win the Senate.

5. What has the Supreme Court said on birth control?

When the Supreme Court overturned Roe v. Wade in 2022, a solo concurring opinion by Justice Clarence Thomas included a line on birth control.

In his opinion, Justice Clarence Thomas wrote that the court "should reconsider" Griswold v. Connecticut, the Supreme Court ruling that invalidated a Connecticut law that made it illegal to use birth control devices or to advise about their use.

"We have a duty to 'correct the error' established in those precedents," Thomas wrote, citing the Griswold ruling among others.

ABC News' Lalee Ibssa, Will McDuffie, Kelsey Walsh and Soo Rin Kim contributed to this report.

Copyright © 2024, ABC Audio. All rights reserved.

Scoreboard roundup — 11/11/24

iStock

(NEW YORK) -- Here are the scores from Monday's sports events:

NATIONAL BASKETBALL ASSOCIATION
Cavaliers 119, Bulls 113
Wizards 92, Rockets 107
Nets 107, Pelicans 105
Clippers 128, Thunder 134
Kings 96, Spurs 116

NATIONAL HOCKEY LEAGUE
Kings 1, Flames 3
Predators 2, Avalanche 3
Hurricanes 5, Golden Knights 2
Canadiens 7, Sabres 5
Sharks 3, Flyers 4
Stars 7, Penguins 1

NATIONAL FOOTBALL LEAGUE
Dolphins 23, Rams 15

Copyright © 2024, ABC Audio. All rights reserved.

Amazon will build a 140,000-square foot delivery station in Tyler

Amazon will build a 140,000-square foot delivery station in TylerTYLER – The Tyler Economic Development Council said that delivery giant Amazon is planning to start construction of a new 140,000-square foot facility in Tyler soon. According to our news partner KETK, the new delivery station will sit on 30 acres at the North Tyler Commerce Park. Construction is said to start in the next couple of weeks.

Mayor Don Warren said in a release from the TEDC Monday, “On behalf of the City of Tyler, we are excited to have Amazon building a delivery station here in our city. The benefits from this project are enormous as it will add to our tax base, and provide faster service from when we make an Amazon purchase to the package showing up on our doorstep. This is a huge win for the City, County, and the Tyler Economic Development Council.”

The release also said the new facility will help to better fulfill the last mile of any deliveries coming into the area from one of Amazon’s fulfilment centers.

Air Force grapples with future of cyber war headquarters

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.

Abortion-rights groups see mixed success in races for state Supreme Court seats

(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.

A growing and aging population forcing counties to seek state EMS funding

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.”

U.S.-Mexico water agreement might bring relief

MCALLEN, Texas (AP) — The U.S. and Mexico agreed to amend a 1944 water treaty, which might bring some relief to South Texas farmers struggling with scarce water.

The International Water and Boundary Commission, a federal agency that oversees international water treaties between the U.S. and Mexico, announced Saturday that the two countries had signed a highly-anticipated agreement that will give Mexico more options to meet its water deliveries to the U.S. Mexico still needs to give the U.S. more than a million acre-feet of water.

South Texas farmers and ranchers have been devastated lately by low rainfall and Mexico falling behind on its deliveries to the region.

Under the 1944 international treaty, Mexico must deliver 1,750,000 acre-feet of water to the U.S. from six tributaries every five years, or an average of 350,000 every year. But Mexico is at a high risk of not meeting that deadline. The country still has a balance of more than 1.3 million acre-feet of water it needs to deliver by October 2025.

The new amendment will allow Mexico to meet its delivery obligations by giving up water that was allotted to the country under the treaty. It also allows Mexico to transfer water it has stored at the Falcon and Amistad international reservoirs to the U.S.

Additionally, the agreement gives Mexico the option of delivering water it doesn’t need from the San Juan and Alamo rivers, which are not part of the six tributaries.

The amendment also addresses a current offer Mexico made to give the U.S. 120,000 acre-feet of water. South Texas farmers were wary of the offer because they worried that by accepting the water, the state would later force farmers to make up for it by giving up water they have been storing for next year.

But because the amendment allows Mexico to make use of water in its reservoirs to meet its treaty obligations, the farmers hope the country will transfer enough water for the next planting season to make up for any water they might have to give up.

“What’s more important is we need water transferred at Amistad and Falcon,” said Sonny Hinojosa, a water advocate for Hidalgo County Irrigation District No. 2, which distributes water to ranchers and farmers in the region. “If water gets transferred, they’ll know they’ll have a little bit of water for next year.”

U.S. officials celebrated the signing of the amendment, which was initially meant to occur in December 2023. Mexican officials said they would not sign the agreement until after their presidential elections, which happened in June.

“The last thirty years of managing over-stretched water resources in the Rio Grande basin have produced broad agreement that the status quo was not acceptable,” IBWC commissioner Maria-Elena Giner said in a statement. “ With the signing of this (amendment), Mexico has tools for more regular water deliveries that can be applied right away.”

The amendment’s provisions that address current water delivery shortfalls expire in five years unless extended. The amendment also establishes longer-term measures such as an environmental working group to explore other sources of water. It also formalized the Lower Rio Grande Water Quality Initiative to address water quality concerns, including salinity.

Hinojosa said he’s concerned that by allowing Mexico to deliver water from the San Juan River, which is downstream from the reservoirs, the country won’t feel as obligated to deliver water from the six tributaries managed by the treaty and still end up delivering less water to the Big Bend region. But he said he expects the agreement will bring some immediate relief.

“It’s going to get us some water, for now,” Hinojosa said. “Hopefully.”

Texas secession advocates celebrate state House wins

SAN ANTONIO – The San Antonio Express-News reports that group that advocates for Texas to declare independence from the United States celebrated the election of several Republicans to the state House this week. The Texas Nationalist Movement said 190 leaders have signed its “Texas First Pledge,” including 65 current officeholders. The group said the Nov. 5 election “isn’t just a victory – it’s a revolution in Texas politics,” according to a Facebook post. “The political establishment tried to paint the Texas First Pledge as extreme. These results prove what we’ve known all along – when Texans understand their right to self-government is on the line, they’ll fight back,” said TNM President Daniel Miller in the post, which had received 75 likes three days after being posted.

In 2023, the group submitted a petition with 140,000 signatures to the state Republican Party to put an advisory vote on the 2024 GOP primary asking voters whether they think Texas should “reassert its status as an independent nation.” But the GOP rejected the petition, saying it was not delivered in time and the vast majority of the signatures were invalid. The “TEXIT” proponents fought the rejection, but the state Supreme Court declined to take up a case and also rejected the petition.

Musk endorses Scott over Cornyn

WASHINGTON – Reuters reports businessman Elon Musk, an ally of President-elect Donald Trump, endorsed Republican Senator Rick Scott for U.S. Senate majority leader on Sunday as the race to fill the influential post heats up after the party won control of the chamber. Republicans are expected to hold at least 52 seats in the 100-member Senate after capturing three previously held by Democrats in West Virginia, Ohio and Montana in last Tuesday’s election. Current Senate Republican Leader Mitch McConnell, who has led his party in the chamber since 2007, has said he will step down from leadership after the election. “Rick Scott for Senate Majority Leader!” Musk, a tech billionaire who has emerged as a major backer of Trump in recent months, wrote in a social media post on Sunday.

Musk is the world’s wealthiest person. Scott, who represents Florida in the Senate, is a former healthcare executive and the wealthiest sitting senator. Musk endorsed Trump on July 13, the day the former president was shot in the ear in a Pennsylvania assassination attempt. In an interview on Fox News on Sunday, Scott said that the Senate needs to implement real change. “We can’t keep doing what we’re doing,” Scott said. “That’s what Donald Trump got elected to do, to be the change.” Trump campaigned on promises, among other things, to deport immigrants who are in the United States illegally, cut taxes, impose tariffs on international trading partners and loosen fiscal policy. Scott has the backing of several hard-right Republican senators, but it remains whether he can bring Republican moderates to his side.

Round 2 in the Trump-vs-Mexico matchup

TEXAS BORDER (AP) – Mexico is facing a second Donald Trump presidency, and few countries can match its experience as a target of Trump’s rhetoric: There have been threats to close the border, impose tariffs and even send U.S. forces to fight Mexican drug cartels if the country doesn’t do more to stem the flow of migrants and drugs. That’s not to mention what mass deportations of migrants who are in the U.S. illegally could do to remittances — the money sent home by migrants — that have become one of Mexico’s main sources of income. But as much as this second round looks like the first round — when Mexico pacified Trump by quietly ceding to his immigration demands — circumstances have changed, and not necessarily for the better. Today, Mexico has in Claudia Sheinbaum a somewhat stern leftist ideologue as president, and Trump is not known for handling such relations well.

Back in 2019, Mexico’s then-President Andrés Manuel Lopez Obrador was a charismatic, plain-spoken, folksy leader who seemed to understand Trump, because both had a transactional view of politics: You give me what I want, I’ll give you what you want. The two went on to form a chummy relationship. But while López Obrador was forged in the give-and-take politics of the often-corrupt former ruling party, the Institutional Revolutionary Party, or PRI, Sheinbaum grew up in a family of leftist activists and got her political experience in radical university student movements. “Claudia is more ideological than López Obrador, and so the problem is that I see her potentially responding to Trumpian policies, whether it’s, you know, organized crime or immigration or tariffs with a much more nationalistic, jingoistic view of the relationship,” said Arturo Sarukhan, Mexico’s former ambassador to the U.S. from 2007 to 2013. Sheinbaum made a point of being one of the first world leaders to call Trump on Thursday to congratulate him after the election, but during the call Trump did two things that may say a lot about how things will go.