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AUSTIN (AP) – Twenty five years ago, the Texas Legislature passed a sweeping set of reforms to resuscitate the state’s collapsing rural health care system.

Now, health care providers, advocates and local leaders are proposing similarly aggressive action to pull the rural maternity care system back from the brink. The Rural Texas Maternal Health Rescue Plan is a package of proposals they’re hoping lawmakers will champion in this upcoming session.

Almost half of all Texas counties offer no maternity care services, and more than a quarter of rural mothers live more than 30 minutes away from the nearest provider. Living in a “maternity care desert” contributes to delayed prenatal care, increased pregnancy complications and worse delivery outcomes. Women living in rural areas are more likely to die from pregnancy or childbirth-related causes, and infant mortality is also higher.

But despite these sobering statistics, more rural hospitals are closing their labor and delivery units, leaving patients to travel long distances or deliver in under-equipped emergency rooms. Most of those that do still deliver babies lose money in the process, due to low Medicaid payments and too few deliveries to break even on round-the-clock staffing.

“We’re reaching a tipping point where people are frequently more than an hour from routine prenatal care, and more than an hour from a delivering hospital when their water breaks,” said John Henderson, president of the Texas Organization of Rural and Community Hospitals. “There’s no way we’re going to get the kind of quality or outcomes we want as a state when that’s the reality.”

The Texas A&M Rural and Community Health Institute convened more than 40 groups, representing rural hospitals, health care providers, medical schools, advocacy groups and nonprofits, to create this rescue plan. They’ve identified steps the Legislature could take this session, including increasing Medicaid payment rates, incentivizing health care providers to work in rural areas and improving overall women’s health care access.

“I don’t think anyone thinks that we’re going to be able to restore services at the 20 or 30 rural hospitals that closed or suspended their OB programs,” Henderson said. “But if we don’t do something, we’ll see more go the same way.”

Last session, the first since the overturn of Roe v. Wade and Texas’ near-total abortion ban, lawmakers extended postpartum Medicaid to a full year and waived sales tax on diapers and menstrual products. Ahead of this session, House Speaker Dade Phelan listed improving access to rural prenatal and obstetrics care as one of his interim priorities.

Strengthening access to rural maternity care would be a bipartisan way to show up for moms and babies in Texas, said Tom Banning, CEO of the Texas Academy of Family Physicians.

“There’s not a silver bullet to this. We would have done it if there was,” Banning said. “But we just want to bring forward ideas for them to think about as possible legislation or funding strategies. That’s what this report is intended to do, to give them options.”

“Code Red” proposals

Several of the top priorities focus on Medicaid, the largest payer of maternal health services in Texas. Medicaid pays for half of births statewide, but in rural areas, covers between 60% and 90% of births. Medicaid is primarily federally funded, but states administer the program.

This plan proposes reimbursing rural hospitals based on the actual costs they incur delivering a baby, rather than a set rate, and offering doctors fixed monthly per-patient payments to cover the costs of preventive, primary and maternity care needs. They’re hoping this will make it more financially appealing for hospitals to keep delivering babies, and recruit the health care providers they need to do so.

The state should also make it easier for pregnant women to get on Medicaid, and easier for doctors to start accepting Medicaid, the report says.

“The administrative burden of being in Medicaid is substantial,” Diana Forester, the director of health policy at Texans Care for Children, a health advocacy group, is quoted as saying in the report. “I talked to one OB group outside of Sweetwater that said they’re the only birthing unit for hundreds of miles. And they couldn’t get enrolled in Medicaid so they can’t treat Medicaid patients.”

Last legislative session, lawmakers tackled the growing nursing shortage with scholarships, grants and loan repayment programs, and allocated additional funds for graduate medical education programs in rural and community health. But much more is needed, this report says. The state urgently needs to strengthen loan repayment programs for OB-GYNs, family physicians and other health care professionals who practice in rural areas, and create more opportunities for medical students and residents to train outside of major cities.

This plan also lays out ways the Legislature could shore up rural women’s health care more broadly, ensuring they are healthy before and after pregnancy. As one of 10 states that hasn’t expanded Medicaid, Texas has a 21.7% uninsured rate, the highest in the nation. While lawmakers are unlikely to move on that issue anytime soon, they could allocate more money for state-run programs like Healthy Texas Women, the Family Planning Program and the Breast and Cervical Cancer Treatment Program. They could also pour more money into mobile clinics and federally qualified health centers, safety net clinics that cover un- and under-insured Texans.

In a legislative session focused on hot-button political issues like school choice, immigration and property taxes, the groups that put together the Rural Texas Maternal Health Rescue Plan are hoping to offer common-sense proposals that both parties can get behind, Henderson said. They’ll be pitching these plans to legislators in the lead up to the 2025 session.

“All these other priorities are billion dollar projects. What we’re talking about is maybe $100 million,” he said. “It’s not a showstopper budgetary impact.”

“Rural communities have figured out that if they stand together, they can stretch a dollar a long way,” Banning added. “And in this case, it can be a force multiplier for other opportunities in those communities.”

DETROIT (AP) — For a second time, a Delaware judge has nullified a pay package that Tesla had awarded its CEO, Elon Musk, that once was valued at $56 billion.

On Monday, Chancellor Kathaleen St. Jude McCormick turned aside a request from Musk’s lawyers to reverse a ruling she announced in January that had thrown out the compensation plan. The judge ruled then that Musk effectively controlled Tesla’s board and had engineered the outsize pay package during sham negotiations.

Lawyers for a Tesla shareholder who sued to block the pay package contended that shareholders who had voted for the 10-year plan in 2018 had been given misleading and incomplete information.

In their defense, Tesla’s board members asserted that the shareholders who ratified the pay plan a second time in June had done so after receiving full disclosures, thereby curing all the problems the judge had cited in her January ruling. As a result, they argued, Musk deserved the pay package for having raised Tesla’s market value by billions of dollars.

LUBBOCK (AP) — The goal of expanding broadband availability in Texas has been a long time coming.

Depending on the day, the finish line either looks closer than ever or so very far away.

Late last month, Texas won final approval to use billions of federal money to help connect every corner of the sprawling state. The news came about 17 months after the $3.3 billion was first pledged for Texas — part of the bipartisan infrastructure deal signed by President Joe Biden.

Yet two days after federal regulators OK’d the state’s plan to spend the money, Texas’ own junior U.S. Sen. Ted Cruz suggested in a letter that money might be delayed amid a presidential transition and Republicans taking control of Congress.

The most recent back and forth is emblematic of the last several years as Texas has tried to catch up with the nation in deploying reliable high-speed internet. And supporters of the effort worry it may also foreshadow hectic days ahead.

“I don’t think anyone believes there’s going to be more billions of dollars poured into this moving forward,” said Lonnie Hunt, director of Deep East Texas Council of Governments. “We’ve got one chance to get it right, we have to make wise decisions.”

The sums to expand broadband in the Lone Star state are staggering: First, there is $461.7 million from the American Rescue Plan Act in 2021, part of Biden’s response to the COVID-19 pandemic. Then in 2023, Texas voters approved $1.5 billion of state tax dollars to help the effort.

The largest chunk, however, is the $3.3 billion in federal dollars from the Broadband Equity, Access, and Deployment, or BEAD, program that is part of the Bipartisan Infrastructure Law that Biden signed into law in 2021.

For all the efforts by local government, advocacy groups and lawmakers alike, the rollout of this money has been complicated at best. It has served as a reminder of how complicated and time-consuming building infrastructure can be for the general public — even when local, state and federal governments are working together with advocacy groups and the private sector.

The foundation of the national effort to connect everyone to broadband is establishing what parts of Texas — and the rest of the country — need internet access. Maps made by the federal government identifying the places in most need have been called inaccurate by advocates.

There have also been concerns over federal regulations that limit rural internet providers from applying for project funds. And multiple rounds of funding have created a “hurry up and wait” timeline for internet service providers and the communities they serve.

All these hurdles and more have delayed the longtime goal of connecting the entire state and opening up the possibilities of telehealth, remote work, and quality broadband service to a growing population. Hunt, who carries around a paper with black spots like a Dalmatian to visualize broadband availability in Deep East Texas, worries the dark spots around the state will still exist when all is said and done.

“If we’re not careful, we run the risk of spending all this money and improving,” Hunt said, “but not really eliminating these spots.”

Texas has only just begun to spend billions

Texas has long played catch-up in broadband development.

Most other states created broadband offices in the 2010s. Texas established its broadband office in 2021. The office is run by the state comptroller, Glenn Hegar ’s office. This opened the window for Texas to receive a major injection of cash for broadband amid the COVID-19 pandemic from the American Rescue Plan Act: $461.7 million.

Local officials knew money was coming for broadband, but not when. After a long wait, the first round of funding from the program trickled out earlier this year. According to the state broadband office, 20 projects were awarded $12 million. Those projects are expected to reach 1,729 homes and businesses across Texas.

One of the winners was Poka Lambro Telecom.

For more than 75 years, Poka Lambro Telecom has served 24 small towns in and around the South Plains near Lubbock. The company has grown from providing telephone and dial-up internet services through copper phone lines to constructing fiber optic lines for up-to-date broadband needs. They have hooked up farms and oil fields in the middle of nowhere, along with solar plants.

Then in July, the state combined the remaining pandemic funds with $303 million from the state dollars approved by voters, creating a pool of $730 million to be allocated among another 24 counties chosen for the second round.

The selection came down to two factors: Location and need. To “ensure geographic distribution,” the broadband office decided that two counties would be funded in each of the 12 pre-defined economic regions used by the comptroller’s office, according to Greg Conte, the state’s broadband director.

The need was based on the percentage of homes, businesses and other locations without access to reliable broadband. Conte said in an email to the Tribune that the office relied on the most recent availability data from the federal government.

Lynn County, where Poka Lambro is headquartered, and the rest of the lower half of the region were completely passed over during the second round. Carson and Roberts, neighboring counties in the northern Panhandle, were the only two chosen from the 41-county High Plains.

“It’s good for those two counties, but that was disappointing when it came out,” said Patrick Sherrill, CEO of Poka Lambro. “I don’t know what criteria they used, but they did what they did.”

Sherrill hopes to win additional funding to help connect more of the counties he serves. He has noticed inaccuracies on the federal broadband map and has challenged them. Funding depends on where the maps show there is a need. If an area shows it is served, when it’s not, it could get passed over for federal dollars.

“It’s a huge amount of money,” Sherrill said. “It would be so sad to see our communities get passed over and not get a shot at being funded because of an inaccurate map. But I think it will happen in some cases.”

Sherrill says his challenges were accepted. He’s worried about the ones that failed. The maps produced by the federal and state governments have been an ongoing source of contention by service providers, residents, and local governments alike. After being completely bypassed for earlier funding, Rio Grande Valley leaders are urging the state not to rely on the federal maps for future grant decisions, fearing the region will be overlooked again.

Internet service providers, local governments and other officials have one more chance to challenge the maps before the $3.3 billion is allocated. That process begins Dec. 3.

Rio Grande Valley officials hope a united force will strengthen their efforts to expand broadband into the region. So they formed the Rio Grande Valley Broadband Coalition.

They argue that continued reliance on the federal maps would be a failure by the state to fulfill the requirements under the infrastructure law to support areas with high poverty rates, said Jordana Barton-Garcia, director of the broadband coalition.

“Congress directs the (government) to target persistent poverty of regions with the funding,” Barton-Garcia said. “And so if they use a faulty map, that means they will not cover this region, because it falsely shows that there is not a problem of the digital divide.”

In their requests that the state not rely on federal maps, the county judges of Hidalgo and Cameron counties noted that U.S. Census data shows only 55% of Hidalgo County residents and 43% of Cameron County residents were connected to broadband. Earlier versions of maps suggested the Valley was 100% covered.

In coordination with the RGV Broadband Coalition, the counties have moved forward with their own plans to expand broadband. They each conducted feasibility studies to determine the need for the areas and formed public-private partnerships with a local internet service provider. But these efforts were done in hopes of applying for the next round of federal funds and other equity-focused grant programs that will not rely on the maps.

In Alpine, Rusty Moore similarly spent years challenging federal maps and preparing to apply for money. Moore, the general manager of Big Bend Telephone, serves customers within 18,000 square miles of the Big Bend region.

He said the company had spent four years and more than $400,000 to ensure that the federal maps are correct. Over the same period, the company filed tens of thousands of challenges. He applied for 12 of the grants and received 5, which will amount to $5.5 million.

“That’s just been a huge frustration for the industry as a whole. We’re making huge decisions with public money based on flawed data,” Moore said.

Charles Meisch, director for the National Telecommunications and Information Administration’s Office of Public Affairs, said the federal map is updated every six months with feedback from those challenges. He said the data will be the most accurate and up-to-date when the challenge process begins in Texas.

“What we’ve seen nationwide is there are local and national nonprofits who are working with individuals to submit batches of challenges for locations,” Meisch said. “To make sure everyone’s voices are heard.”

Conte, the Texas broadband director, said money from federal programs has to be distributed to eligible locations that are underserved or unserved according to the federal data, not the state’s broadband map.

“No matter how great we made our state map, it didn’t matter in the eyes of the federal government,” Conte said at a July state Senate hearing. “Because we had to tie all the federal dollars back to their map.”

Rural local governments unprepared for expansion

Local governments play a critical role in advocating for major infrastructure projects such as broadband expansion. And yet, the private sector is ultimately responsible for the projects.

For two decades, Jim O’Bryan has presided over a county that employs just over 100 people. He was a commissioner for 25 years before becoming county judge in 2019. Most of his job entails steering the frenzy of the oil fields surrounding every boundary of Reagan County and its roughly 3,100 residents.

Oil and gas, he gets. Broadband remains a mystery to him. And yet, his county is one of the 24 counties chosen for broadband funding.

“It’s just way too great of an expense of responsibility and expense for each county to handle it individually,” O’Bryan said.

O’Bryan is working with Nexlink, a Texas-based internet service provider, to provide the infrastructure his constituents desperately need.

He and the Concho Valley Council of Governments say the counties are woefully unprepared to handle that kind of money. They are not the only local government that feels overwhelmed by the firehose of broadband dollars.

“Everyone’s very interested and very eager to receive these programs, but are also very under prepared to receive them,” said Connor Sadro, regional broadband director for the Deep East Texas Council of Governments.

Building broadband on their own would be an expensive lift for most local governments to oversee, requiring projects and a workforce the counties could not afford.

It opens the door to soliciting from big companies. Hunt, with the Deep East Texas Council of Governments, said local officials are being inundated with advice from commercial internet providers, and it’s a problem. Hunt credits these companies for the broadband infrastructure that’s standing today but says national providers may not be what is needed for rural Texas.

“Our local officials are trying to wade through all these opportunities and determine what’s best for their communities,” Hunt said. “It’s a challenge for them to figure out, not just the best provider, but how to ensure the maximum coverage and most affordable rates.”

Rural counties may spend an inordinate amount of time and resources preparing just to apply for broadband money. It can be a complex process for local leaders who may not have experience in managing such a large amount of funding.

In Reagan and Irion, four internet service providers are set to receive money to build infrastructure under the Council of Governments’ jurisdiction. They had spent years preparing for the opportunity, said John Austin Stokes, executive director of the Council of Governments. Had they not, the counties would not have been prepared to spend the money.

The state broadband office created the Technical Assistance Program, which provides resources to communities that need help with broadband planning. Thirty-two counties are enrolled in the program.

HOUSTON (AP) – For decades, the Texas prison system’s guiding philosophy has shifted back and forth between punishment and rehabilitation depending on the political climate and how high crime rates are.

During the tough-on-crime era of the 1980s, Texas built more prisons and took a punitive approach to crime. But a class-action lawsuit resulted in a judge finding that the conditions of confinement violated the Eighth Amendment of the U.S. Constitution. The ruling required the state to reduce overcrowding and improve prisoner rehabilitation and recreational programs.

In 1989, the Legislature passed a comprehensive criminal justice bill that expanded the state agency’s responsibility to include administering rehabilitation programs and reintegrating former felons back into society.

The 1989 legislation created the modern-day Texas Department of Criminal Justice by merging the Department of Corrections, the Board of Pardons and Paroles and the Texas Adult Probation Commission.

In the 2006 sunset commission’s review of TDCJ, the agency found that TDCJ needed more significant investment from the state to improve recidivism rates and effectively rehabilitate former felons. The following year, the state invested $241 million on rehabilitation and diversion programs instead of spending money on additional prison beds. As a result, recidivism rates fell by more than 6%.

“You go through different cycles,” said Marc Levin, chief policy counsel on the Council on Criminal Justice. “(Gov.) Ann Richards put in all these substance abuse facilities because drug treatment was a big priority. Then there was a change in attitudes and in 2003 there was a recession, so money was cut for treatment.”

Levin said that in recent years, there has been bipartisan support for rehabilitation. And the nationwide labor shortage following the COVID-19 pandemic makes former inmates an attractive talent pool as well.

At Bartlett, employers will come in for job fairs, and inmates will also participate in job interviews through Zoom. The state partners with about 1,110 employers who are open to hiring former felons.

“The idea is to pilot these programs, see what is working, how do we fix it and expand it to other units,” Hernandez said.

Preparing for reentry

On the day of their release from Bartlett, inmates will don a new suit to mark the beginning of a new chapter in their lives. They’ll ring a liberty bell in front of their fellow inmates before they step out of the prison.

To make the transition easier, inmates will serve as peer educators, offer additional support, helping their fellow inmates learn communication skills that they will need in any workplace.

Field ministers will offer emotional and spiritual support to inmates and help them reconnect with their values.

“One of the greatest things I heard when I got here was hope,” said Michael Thorne, an inmate who also serves as a field minister. “The church here is named Chapel of Hope to help others prepare for their exit.”

Michele Deitch, a senior lecturer at University of Texas at Austin’s School of Law and LBJ School, said that creating more comfortable living conditions has been found to decrease violence and improve employee retention.

“I really hope the change in mindset will reverberate throughout the agency,” Deitch said. “It’s something that will achieve better public safety outcomes and personal outcomes for people who are incarcerated.”

TDCJ officials said they will also look to hire former inmates to work for the agency. Several inmates in Bartlett said they would like to return upon their release. Ayala said he hopes to return to prison as a case manager.

“I’ve been in here almost half my life,” Ayala said. “I know the potential that’s behind these walls. A lot of people don’t know how to reach that potential.”

DALLAS – KERA reports that Texas public health officials say they’re used to setting the record straight about vaccinations and other scientifically sound treatments – but some are bracing for even more challenges under President-elect Donald Trump’s picks for top cabinet posts. Robert F. Kennedy Jr., Trump’s nominee for Health and Human Services secretary, has raised alarms for policy experts across the country. More recently, Trump announced Dr. Mehmet Oz as his head of the Centers for Medicare and Medicaid Services. Terri Burke, who leads The Immunization Partnership, said under Kennedy, the Centers for Disease Control and Prevention and Food and Drug Administration could lose funding; health and immunization guidance for school districts could weaken; and misinformation — already widespread after the pandemic — could worsen.

“All of this could have a chilling effect on innovation and development,” she said during a Texas Vaccine Policy Symposium last month. “Will vaccine manufacturers want to produce vaccines if the market is smaller? Will academic institutions approach vaccine research and development in a challenging climate?” Much remains unclear about how Robert F. Kennedy Jr.’s plans for the Health and Human Services secretary post will play out. Kennedy, who has repeated baseless claims that vaccines cause autism and other false information, has teased a plan called “Make America Healthy Again.” The plan’s central goal is to eliminate chronic disease. He previously told NPR that federal health authorities under his leadership would not “take vaccines away from anybody.” He also expressed doubt in existing vaccine safety research.

HOUSTON – The :Houston Chronicle reports that twenty-three years after Enron declared bankruptcy, the infamous Houston-based energy company appears to be making a return. A group representing itself as Enron, which became the center of a corporate scandal Dec. 2, 2001, following revelations of gross financial misconduct, has recently emerged in the Houston area. The company erected a billboard heralding Enron’s supposed return, took out a full-page ad in Monday’s print edition of the Houston Chronicle and has posted a statement on X promising a new leaf and a bright future for the company.

“Enron Corporation today announced its relaunch as a company dedicated to solving the global energy crisis,” the statement read. “With a bold new vision, Enron will leverage cutting-edge technology, human ingenuity and the spirit of adaptation to address the critical challenges of energy sustainability, accessibility and affordability.” Reconciliation is a major focus of Enron’s alleged revamp — so much so, the “R” in Enron now stands for “repentant,” according to the company’s newly-launched website. Enron Corporation denied the Chronicle’s request for an interview, but documents filed with the U.S. Patents and Trademark Office indicate the College Company, an Arkansas-based LLC that described itself on LinkedIn as “a multi-facet parent company which creates and operates clothing brands in the United States,” currently holds the rights to the multi-colored “E Enron” trademark seen on the billboard and Monday news release. According to trademark documents, in June the company granted the rights to the “E Enron” trademark to the Enron Corporation for $1. An individual named Charles Gaydos, who identified as the owner of the College Company and the CEO of Enron Corporation, signed on behalf of both entities. The College Company did not respond to the Chronicle’s request for comment. The College Company also owns several trademarks related to a popular gag-conspiracy theory called Birds Aren’t Real. The gag became popular among Gen Z users on social media around 2020, and claimed birds are not animals but government-controlled drones sent to spy on U.S. citizens. Trademark documents indicate the College Company owns the rights to the Birds Aren’t Real brand for use on stickers, apparel and “promoting public awareness.” What kind of business is the new Enron? Although the company’s messaging appears to allude to a return to the energy sector, the exact nature of Enron’s new business remains unclear. The company’s Monday news release and website are loaded with vague promises including “solving the energy crisis,” but little has been made public regarding the operational nuts and bolts.

HOUSTON – Houston Public Media report that President-elect Donald Trump has pledged to slap 25% tariffs on all imports from Mexico and Canada as soon as he takes office, as well as an extra 10% fee on all imports from China – the latter coming on top of tariffs Trump instituted on China in his first term and which were maintained by President Joe Biden. Those tariffs could have serious consequences for the Texas economy and for the Houston area specifically. “The impact would be quick, sudden, and sure, with inflation raging across the economy over the first several months,” said economist Ed Hirs, energy fellow at the University of Houston. Hirs said the prices of Mexican imports would spiral everywhere from the produce departments of grocery stores to automobile dealerships. Then, there’s the 4 million barrels of crude oil per day imported from Canada.

“Generally, we count on that to run many of our refineries in the United States,” Hirs said, “and that would lead to an immediate increase in the price of gasoline and diesel. It would also lead to a price increase in crude oil in West Texas as well.” Mexico, Canada and China collectively accounted for more than 43% of Texas’ total exports of goods last year, or roughly $192 billion. Even that understates the dependence of Texas on those three countries, because it doesn’t include exports of services or foreign direct investment. Hirs said if Mexico, Canada and China respond with tariffs of their own, or by reducing their purchases of U.S. imports, it would send the U.S. into a deep recession. He pointed to how China responded to the first round of Trump tariffs. “We saw China retaliate in the first Trump years by refusing to buy U.S. grains, and as a result, it was devastation across the farm belt,” Hirs said. “Farmers lost their homes, lost their fields, lost their properties. Some lost their lives.” Much of that agricultural trade with China moves through the Port of Houston.