Health Care

State of Texas: Issues that matter for Texas voters in the primary runoffs and beyond

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AUSTIN (Nexstar) – Tuesday is election day in Texas for the primary runoffs. There are pivotal races on the ballot, including the Republican race for Attorney General, pitting incumbent Ken Paxton against challenger George P. Bush. That race, like many across the state, is delivering a burst of negative campaign ads to voters both on television and social media.

But what are the issues truly important to voters, both in the runoff and beyond? Polling from the Texas Politics Project at the University of Texas gives some insight about concerns that could drive votes on Tuesday, and beyond.

Not surprisingly, inflation and the economy topped the list when the poll asked voters about the most important issue facing the country. “The majority say this is having a major impact on their household finances,” said Joshua Blank, Research Director for the Texas Politics Project.

The poll found that 55% of Texans said rising prices were having a major effect, while an additional 37% said the increases were having a minor impact on their finances.

But for Texans, the economy is still not the top concern, according to the poll.

“What leads the pack, as it really consistently does in Texas, is immigration and border security,” Blank said. The polling showed 14% of Texans citing the economy or inflation as the most important issue. Meanwhile, 34% named either immigration or border security as the top concern.

But Blank noted there is a big partisan divide.

“This is sort of a tale of two states kind of situation where about two-thirds of Republicans say that immigration or border security is the number one issue facing the state. Among Democrats 4%,” Blank said.

The leaked draft opinion showing the US Supreme Court is poised to overturn Roe vs Wade brought new attention to abortion rights. But Blank said it’s not clear yet how important that will be for voters.

“Abortion is never an issue that’s going to compete with, say, the economy in terms of sort of what’s touching everybody’s daily lives,” Blank said. “We don’t see it jump up as the big issue.”

“Having said that, I think everything that we know about abortion and abortion politics was forged, basically, in the Roe v. Wade, understanding and framework that we’ve been under for the last 50 years,” Blank added. He said there is still uncertainty without knowing exactly how the Supreme Court will rule.

“Until that opinion eventually drops, and the candidates in the campaign start to mobilize it and counter-mobilize against it, it’s hard to know whether that issue is going to rise up to the top, or whether it’s still going to be sort of behind these other issues: the economy, immigration, inflation.”

As for the primary runoff, Blank says the issues motivating the relatively small number of people expected to vote are notably different from those of voters as a whole.

“The people who tend to participate in the in the runoffs, especially the primaries, but then even moreso the runoffs are the committed partisans, the strong Democrats, the strong Republicans, and even beyond that the committed ideologues, the people who are very conservative, are very liberal,” Blank explained.

“Their issues are not necessarily reflective of I think the broader electorate. So you tend to find a lot more niche audiences in both parties and really a lot more appetite for more aggressive policy that the electorate as a whole is really supportive of.”

Electric grid is ready for summer demand, according to ERCOT report

Following a weekend of hot spring weather and a suggestion that Texans conserve energy, the state’s power grid operator, the Electric Reliability Council of Texas (ERCOT), on Monday released its outlook for the summer.

ERCOT said according to its Seasonal Assessment of Resource Adequacy (SARA) for summer 2022, the region “is expected to have sufficient installed generating capacity” to serve peak power demands from June through September.

The council said due to growth across Texas, it expects peak demand to hit 77,317 megawatts (MW), a new system-wide record.

ERCOT anticipates there will be 91,392 MW of power generation available during those peak hours, creating a buffer of roughly 14,000 MW.

“I think the summer peak estimate sounds reasonable,” said Hao Zhu who teaches power system analysis at the University of Texas at Austin.

Zhu said ERCOT’s numbers track what she has seen over the last few years.

Those estimates are based on normal system conditions. The report also examined seven risk scenarios and found the grid should be able to manage “most” of them.

Michael Jewell, managing attorney for Jewell and Associates which represents stakeholders in the ERCOT market, said the grid could run into trouble under two scenarios.

The first would be an “extraordinarily high” outage of natural gas, coal, or nuclear facilities. The second scenario would be a combination of smaller outages of those facilities coupled with low wind output.

“What ERCOT has indicated is that under normal operating conditions, the grid looks good,” Jewell told KXAN. “In many stressful situations, the grid looks good — but in high-stress situations, there are potential problems.”

‘Horrifying’ wait times for state hospital beds, official says

When State Sen. Sarah Eckhardt thinks of the state hospital waitlist, she remembers a constituent she learned about who had a mental health crisis. The man had no criminal history. His neighbors called for help expecting him to be taken to a mental health facility. Instead, he was booked in a county jail, stripped naked and put in a rubber room. There he waited, until a scarce bed in a state hospital opened, she said.

Eckhardt called that outcome “tragic.” State data show a record number of people experiencing a mental health crisis are waiting in jails for beds in state hospitals that don’t have enough staff to operate at capacity.

The state hospital waitlist problem has been building for years. In March, there were a record 2,309 people waiting in jail for a bed, another record high.

Under normal circumstances, a person charged with a crime and found mentally incompetent to stand trial would be quickly sent to a state hospital for mental competency restoration. Once stabilized, they could return to jail and proceed with their case. Without room in the state hospitals, these people now languish in jail, in many cases more than a year. That leaves their families and others waiting for closure, too.

“Every day I walk into (the Capitol), I’m confronted with yet another example of us reacting to a perpetual crisis, rather than actually governing – whether it’s the grid, whether it’s public education, and in this case, it’s mental health care and its nexus with public safety,” said Eckhardt, an Austin Democrat.

Last November, the number of individuals waiting for a state hospital bed – 1,933 – exceeded the total number of available beds – 1,510 – for the first time, according to HHSC data. That gap has since widened.

Eckhardt said there’s no “silver bullet” to fix the situation. But, solving the problem, she said, is not “rocket science.”

“We know what the solutions are: workforce, expanded Medicaid, and a diversion out of jail circumstance and into a doctor’s office,” she said. “Currently this crisis management is ineffective. It’s inefficient. It’s unfair, and it’s exceedingly intrusive on the individual who is suffering.”

EXTENDED VIDEO: KXAN’s Josh Hinkle interviews Sen. Sarah Eckhardt, D-Austin, about her plans to address mental competency challenges in Texas.

Windy Johnson, a member of the Joint Committee on Access and Forensic Services, called the waitlist situation “horrifying” at the committee’s April 20 meeting. That group monitors the waitlist, collects data and provides guidance to HHSC.

“I feel like this is a real true public health emergency, and it’s not being treated like that,” said Johnson, who represents the Texas Conference of Urban Counties. “I can’t imagine, you know, another year just hoping to get increased legislative funding to address 2,400 people sitting in jail for almost over a year.”

Not only has the state hospital system lost 4,000 workers over the past two years, but monthly job applications have also dropped significantly, HHSC Deputy Executive Commissioner Scott Schalchlin said at the April meeting. The state hospital system was averaging 15,000 applications per month, but that dropped to about 5,000, he said.

Johnson asked the committee if the National Guard had been called in to provide relief for staffing issues. Johnson’s call for military resources echoed similar remarks made in January by committee member Jim Allison, general counsel for the County Judges and Commissioners Association of Texas.

GOING IN-DEPTH

The waitlist is divided into two parts: maximum security and non-maximum. As the waitlist has grown, so has the average wait time. In March, people waited an average of 538 days for a maximum-security bed and 261 days for a non-maximum security bed.

Scott Schalchlin, an HHSC deputy executive commissioner over the state hospital system, said it is not usually the National Guard’s mission to assist with an open-ended staffing situation like the state hospital’s. Schalchlin said the workforce issues have been elevated to the highest levels of state government.  Gov. Greg Abbott’s office has been “supportive” of HHSC’s current approach, which is to increase staff by streamlining the application and hiring process and publicizing hiring bonuses of up to $5,000 for certain positions, Schalchlin said.

The changes may be helping.

The state hospital system saw a 40% jump in applications from February to March, the largest increase since the pandemic began, Schalchin said.

The hiring bonuses have been “hit or miss,” Schalchlin added. Some people have earned the bonus and left “once they hit a certain number of months with us.”

Aside from improving the workforce, Eckhardt said the state should collect better data to identify solutions and high-performing local mental health programs, she said.

Krishnaveni Gundu, co-founder and executive director of the nonprofit Texas Jail Project, said funding and state beds aren’t the only solutions. More work should be done by counties to provide “community-based healthcare, housing, crisis respite units, rehab and other evidence-based solutions that can  address the problem at the front door.”

“Most county budgets are heavily skewed toward carceral solutions. We get what we pay for,” said Gundu.

Last year, KXAN investigated HHSC’s data collection effort and found gaps in the state’s work. Many details that experts say are critical aren’t tracked. For example, the state doesn’t keep data on the number of people on the waitlist who are experiencing homelessness or can’t afford an attorney. The state also doesn’t keep track of people that die while waiting for a state hospital bed. HHSC said it still isn’t tracking that information.

In January, for the first time, HHSC publicly displayed a racial breakdown of people on the waitlist. HHSC released a second batch of racial data in April. Both datasets showed a disparity between Black and white people’s wait times for maximum-security beds.

White people wait a shorter amount of time, on average, than Hispanic or black people for a state hospital bed, according to fiscal-year-to-date state data.
White people wait a shorter amount of time, on average, than Hispanic or Black people for a state hospital bed, according to fiscal-year-to-date state data.

Data released in January showed Black people were waiting, on average, 110 days longer than white people for a maximum-security bed. 

When KXAN asked HHSC why that disparity existed and what the agency was doing to better understand it, a HHSC spokesperson said it was “an anomaly.”

“Although the data show that during this time, Black or African-American people had a longer average wait time, this appears to be an anomaly as race/ethnicity data outside of this time period suggests there is no consistent pattern of any particular race/ethnic group waiting longer for admission over others,” HHSC chief press officer Christine Mann said in an email.

Three months later, the trend continued.

Fiscal-year-to-date data from April shows Black people waited an average of 73 days longer for a maximum-security bed than whites.

HHSC said the wait times in the public data are a snapshot of the fiscal year to date, which began in September 2021. Examining the data by month shows more variation in average wait times, including some individual months with average waits for white people being longer than Black people.

A number of variables could affect how long a person waits for a state hospital bed. For example, a person could be on a medical hold for a condition that cannot be treated in a state hospital, or they could have specialized programming needs. There are also state laws that require certain people be admitted within certain timeframes, according to HHSC.

The agency said it “will continue to monitor our waitlist data to ensure that any racial or other disparities are identified and addressed as soon as possible.”

State Senator Sarah Eckhardt, an Austin Democrat, sits in her office during an interview with KXAN investigator Josh Hinkle about the worsening state hospital waitlist.
Sen. Sarah Eckhardt sits in her Capitol office for an interview with KXAN’s Josh Hinkle about the waitlist.

Eckhardt, a former county judge who has studied the waitlist issue and proposed legislation in 2021 to improve state oversight, said the racial disparity was “unfortunately unsurprising when you look at the incarceration data on through racial demography.”

“African Americans are much more likely to be taken to jail for a mental health crisis than a person of another race,” Eckhardt said. “It is laughable to think that that is an anomaly, when you look at the statistics in criminal justice over decades.”

Moving forward, Joint Committee on Access and Forensic Services member Stephen Glazier said he and other members are working to provide the committee with waitlist and wait time data sorted by every county in the state.

“Our goal for this committee right now is to keep analyzing the data to see what it tells us in terms of hopefully we will be able to have some data-driven recommendations for policy actions or legislative action,” Glazier said in April.

The story is part of the KXAN investigation, “Mental Competency Consequences,” a project supported by the USC Annenberg Center for Health Journalism.

CTRMA: No ‘confidence’ in data to bill TxTag users

The Central Texas Regional Mobility Authority has not billed TxTag customers for the past six months because it doesn’t “have confidence in the data” it gets from the Texas Department of Transportation, according to CTRMA’s top official.

The revelation comes following a series of technical problems that continue to plague TxDOT, which operates TxTag. In recent weeks and months, KXAN has heard from dozens of viewers who have complained about issues related to TxTag’s billing. It’s an issue KXAN has investigated for years.

It’s such a concern to CTRMA that the toll authority decided last November to temporarily stop billing TxTag customers, for the second time in less than a year, according to CTRMA Director of Operations Tracie Brown.

“When we send out a bill in error, customers call us trying to understand why that happened, and that calls into question CTRMA’s billing processes,” said Brown. “We obviously don’t want to send out bills in error, so we just made a decision, let’s not do this until we can work with TxTag, and have some more confidence in the data that they’re sending us.”

The TxTag troubles are taking a toll on Danny Snyder, a longtime customer, who reached out to KXAN. He carries a folder of frustrations.

“I received no statements, no indication that anything was wrong with the account,” said Snyder.

In late 2020, Snyder said his account suddenly stopped auto-billing. That resulted in multiple pay-by-mail invoices from CTRMA, including overdue notices for hundreds of dollars, he said. Instead of tolls deducting from his TxTag account, he began receiving paper statements from CTRMA, without the 33% discount that TxTag account holders should receive.

“I’ve opened multiple tickets online with TxTag and they keep telling me they’re working on it,” Snyder said in his email to KXAN. “In the meantime, I’m having to manually check my account and add money when my prepaid funds are used up.”

Danny Snyder, a TxTag customer, holds a stack of CTRMA paper bills. (KXAN Photo/Matt Grant)

TxTag’s “solution” was for him to “manually pay the bills” to CTRMA and submit the invoices to TxTag. This way he could be reimbursed for the amount he should have been charged if the discount had been correctly applied, Synder said.

To add to the confusion, CTRMA’s billing statements say he could have “saved” money if he had a TxTag — even though he is already a current account holder — a standard message for anyone not recognized as having a TxTag. Snyder’s emails to TxTag, dating back over a year, show his mounting anger as the agency blamed an unspecified system “update.”

“Our system has been in the process of an update to improve billing for our customers,” TxTag told him in an email dated Aug. 11, 2021. “Several of our customers have reported they are not able to access their monthly statements. We are in the process of correcting the issue.”

The same line — “[o]ur system has been in the process of an update to improve billing for our customers” — was used, again, on Nov. 29, 2021, in response to another complaint made by Synder.

“What’s going on with this entire system?” Snyder asked. “It’s been a lot of controversy since it started. And this seemed like one more thing to add fuel to that fire.”

CTRMA blames TxTag. Last November, the toll authority said it stopped billing TxTag customers due to a lack of confidence with TxDOT’s account-holder data. CTRMA said it attempts to post bills on a TxTag account four times before sending out pay-by-mail notices.

Danny Snyder, a TxTag customer, holds up overdue CTRMA bills. (KXAN Photo/Matt Grant)
Danny Snyder, a TxTag customer, holds up overdue CTRMA bills. (KXAN Photo/Matt Grant)

“We had some assurances from TxTag last summer, late last summer, that the data was good and we could go ahead and start reacting to the data that they were sending us,” said Brown. “We started that in August and we noticed issues almost immediately in September.”

“We had conversations with them and decided to stop reacting to that data in November of 2021,” said Brown. “So, we have not sent out any new bills related to TxTag customers.”

When CTRMA does begin billing again, tolls older than 60 days will be waived, said Brown.

A TxDOT spokesperson did not respond to questions about CTRMA’s response. On its website, TxTag says it has taken “longer than anticipated” to generate toll statements. The agency said the issues began when it migrated 2.6 million accounts to a new operating system in late 2020.

“While we have resolved many of these issues there are still remaining areas we are working through,” TxDOT spokesperson Veronica Beyer said in a statement. “TxTag staff and our new replacement back-office vendor are making progress to address these outstanding issues caused by the transition and migration.”

The agency fired its previous vendor last summer due to a botched upgrade that was bogged down with technical problems.

TxTag says it will continue communicating issues directly with customers and online. The agency says it also improved its call center operations to “better handle these concerns.”

“We understand that billing issues are time-consuming and frustrating for customers,” said Beyer. “We appreciate your patience and apologize for the inconvenience.”

As for Snyder, he eventually found a workaround to his situation. It took deleting his account and starting a new one, he said.

“As someone who works in [information technology], it’s befuddling to me that they couldn’t just fix whatever the problem is on the back-end,” he said. “And just make this work.”

Customers experiencing issues with their account are urged to call (888) 468-9824 or submit an inquiry online.

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