View the Texas Watchdog article The Politics of Personal Vendettas: How Kim Ogg’s Legal Circus and Lina Hidalgo’s Feuds Left Harris County in Chaos here. 

In Harris County, Texas, the lines between political ambition, personal vendettas, and the criminal justice system are blurred beyond recognition. What started as a local spat between two high-profile Democrats — District Attorney Kim Ogg and County Judge Lina Hidalgo — has turned into a full-blown political circus that threatens to undermine the credibility of the entire justice system. As Ogg’s tenure as DA comes to an ignominious end, the case she launched against Hidalgo’s staffers over a $11 million COVID-19 vaccine outreach contract is being handed off to the office of Texas Attorney General Ken Paxton. If you were looking for the perfect embodiment of political dysfunction in Texas, this is it.

This isn’t just a story of a legal battle. It’s about how personal rivalries, ideological conflicts, and political calculations can hijack public institutions. Ogg and Hidalgo are the key players, but the real victim is the public’s trust in its leaders. And the irony? Ogg, once hailed as a reformer, is leaving office under the cloud of the very kind of political maneuvering she once promised to dismantle.

To understand how things spiraled out of control, you need to know the players. Lina Hidalgo, Harris County’s top executive and a progressive darling, has quickly made a name for herself as a disruptor, advocating for aggressive reforms in criminal justice, public health, and disaster response. Hidalgo, at 32, is seen as the future of Texas politics, often compared to figures like Alexandria Ocasio-Cortez. She’s got the resume of a high-achieving millennial and the political chops to take on the old guard, which puts her in direct conflict with more moderate Democrats like Kim Ogg.

Kim Ogg was once seen as a reformer too. Elected in 2016 on a platform of criminal justice reform, she positioned herself as a pragmatist — someone who could push for change without alienating the system. But somewhere along the way, Ogg lost her progressive base. Her reversal on key issues, especially bail reform, didn’t just burn bridges; it torched them. What was once seen as a bridge between moderates and reformers became an outright feud between Ogg and Hidalgo.

The fallout between these two was inevitable. Hidalgo, backed by the Harris County Democratic Party’s more progressive elements, was diametrically opposed to Ogg’s increasingly conservative stances on criminal justice. Tensions escalated over funding disputes and criminal justice policies, with Ogg accusing Hidalgo’s administration of undermining the DA’s office by cutting funding and pushing reforms that Ogg saw as dangerous to public safety. Hidalgo, in return, saw Ogg as an obstacle to progress — a relic of a system that needed to be torn down.

The feud came to a head with a controversial $11 million COVID-19 vaccine outreach contract awarded to Elevate Strategies, a one-woman firm with little relevant experience. Hidalgo’s office was accused of steering the contract toward Elevate in a rigged bidding process. Three of her top aides — Alex Triantaphyllis, Wallis Nader, and Aaron Dunn — were indicted on felony charges of misuse of official information and tampering with government records. According to the indictments, they had allegedly shared insider information with Elevate before the contract was put out for public bidding, giving the firm an unfair advantage.

For Ogg, this case was a political goldmine. Investigating corruption in Hidalgo’s office allowed her to play the role of the watchdog — holding even her fellow Democrats accountable. But for Hidalgo, the case was a blatant act of political retribution. She and her supporters claimed the indictments were nothing more than a politically motivated attack by Ogg to weaken Hidalgo’s influence and score points with moderate and conservative voters who already disliked Hidalgo’s progressive policies.

On the surface, the Elevate Strategies scandal seems like a fairly typical case of alleged corruption in local government. But the deeper story here is about the political context in which this case unfolded. The tensions between Ogg and Hidalgo were brewing long before the contract controversy. The feud was a slow-motion train wreck, fueled by Ogg’s perceived betrayal of the progressive movement and her deteriorating relationship with the Harris County Commissioners Court, which Hidalgo leads.

The funding disputes between Ogg and Hidalgo were central to this battle. Ogg had repeatedly clashed with the Democratic-majority Commissioners Court over funding for the DA’s office. Ogg accused Hidalgo of trying to “defund” her department, framing it as part of a broader left-wing agenda to weaken law enforcement. Hidalgo’s camp, however, argued that Ogg was wasting resources on politically motivated investigations and draconian bail policies, while refusing to support reforms aimed at reducing mass incarceration.

Criminal justice reform became the flashpoint. Ogg’s office had shifted away from progressive policies, especially on bail reform, aligning more closely with conservative fears about rising crime. This put her at odds with Hidalgo, who was pushing for policies that would limit pretrial detention and offer alternatives to cash bail. Their feud represented the ideological divide within the Democratic Party itself — a microcosm of the larger battle between progressives and moderates playing out across the country.

One of the great ironies of Kim Ogg’s downfall is that she started her political career as a reformer. Elected on a platform of overhauling Harris County’s deeply flawed cash bail system, Ogg initially had the backing of progressive groups who saw her as an ally in the fight against mass incarceration. But by 2019, that relationship was already starting to sour.

In a shocking about-face, Ogg opposed a federal settlement aimed at reforming the county’s unconstitutional bail system, a move that left her progressive base stunned. Ogg’s reversal alienated many of her former supporters and fueled suspicions that she was more interested in preserving her political power than enacting real change. This was the beginning of the end for Ogg’s relationship with the Harris County Democratic Party, which would later take the extraordinary step of officially admonishing her.

Ogg’s relationship with progressive Democrats never recovered. Her office was accused of prosecuting thousands of cases without probable cause, contributing to jail overcrowding and reinforcing a system that disproportionately punishes the poor. While Ogg pointed to her office’s marijuana decriminalization efforts as proof of her reformist credentials, those accomplishments were overshadowed by her growing reputation as a DA who had lost her way.

By the time the 2024 Democratic primary rolled around, Ogg was a political pariah. Her decision to investigate Hidalgo’s staffers was seen as the final straw. The Harris County Democratic Party, already frustrated with Ogg’s perceived betrayal of reformist principles, passed a resolution condemning her, distancing the party from her leadership.

It’s rare for a political party to turn so publicly on one of its own, but Ogg had become a liability. She was out of step with the direction Harris County’s Democratic base was moving — a base that increasingly embraced progressive reforms and rejected the tough-on-crime policies Ogg was pushing.

The Democratic primary results were a referendum on Ogg’s leadership. She lost in a landslide to Sean Teare, a progressive candidate who promised to restore the DA’s office to its reformist roots. Teare won 78% of the vote, a margin that not only reflected dissatisfaction with Ogg but also a clear mandate for progressive criminal justice reform in Harris County.

The media played no small part in stoking the flames of this political feud. Local outlets like The Houston Chronicle and Texas Tribune covered every twist and turn of the case, turning the Ogg-Hidalgo saga into one of the most closely watched political battles in Texas. National media outlets also picked up on the story, framing it as a proxy war between the progressive and moderate wings of the Democratic Party.

The case against Hidalgo’s staffers became a Rorschach test for how voters interpreted the larger political dynamics at play. To progressives, Ogg was using the criminal justice system as a weapon against a rising star in their movement. To conservatives and moderates, Ogg was a hero for standing up to corruption in a county they viewed as increasingly radicalized under Hidalgo’s leadership.

Public perception was sharply divided. Local forums, like the r/houston subreddit, lit up with debates over whether Ogg was a corrupt DA clinging to power or a public servant trying to hold a corrupt administration accountable. The polarization around the case reflected the broader political tensions in Harris County — a county that has become a Democratic stronghold but is still deeply divided over what direction that party should take.

As if the case wasn’t controversial enough, Ogg’s final act as DA was to transfer the prosecution of Hidalgo’s staffers to Texas Attorney General Ken Paxton’s office. To say this decision was provocative would be an understatement. Paxton, a Republican who has been embroiled in his own legal scandals, is seen by many Democrats as the epitome of partisan corruption. For Ogg to hand the case over to Paxton was seen by Hidalgo’s supporters as an act of political sabotage — a way to keep the case alive after Ogg’s departure and ensure that it remained a thorn in Hidalgo’s side.

Ogg defended the decision as a necessary step to ensure a fair trial, arguing that her office was too politically compromised to prosecute the case. But the optics couldn’t have been worse. Critics accused her of handing the case to a known partisan who had no interest in justice and every interest in using the case to damage Hidalgo, a prominent Democrat who represents the kind of progressive leadership Paxton has spent his career fighting against.

Throughout this ordeal, Hidalgo has managed to position herself as the victim of a politically motivated attack. She has been relentless in defending her staffers, framing the indictments as part of a broader effort to undermine her administration. In doing so, she has galvanized her base, using the legal attacks against her team as a rallying cry for progressives across Texas.

Hidalgo’s ability to survive this scandal — and even turn it to her advantage — speaks to her political acumen. She’s managed to cast the entire episode as part of the broader struggle between reformers and the establishment. And in Harris County, where the progressive movement is gaining strength, that message resonates.

As Ogg leaves office, her legacy is a complicated one. On the one hand, she did implement meaningful reforms during her tenure, including decriminalizing most marijuana possession and diverting minors from the criminal justice system. But those reforms were overshadowed by her later decisions, particularly her opposition to bail reform and her high-profile investigation into Hidalgo’s office.

Ogg’s political downfall can be traced to her inability to navigate the shifting dynamics of the Democratic Party. Once a champion of reform, she found herself increasingly isolated as the party moved leftward, eventually becoming a symbol of the kind of moderate, tough-on-crime policies that progressives have come to reject.

The feud between Kim Ogg and Lina Hidalgo is more than just a personal rivalry; it’s a reflection of the larger ideological battle playing out within the Democratic Party. What began as a local power struggle has escalated into a case study in how political ambition, personal vendettas, and legal proceedings can collide with disastrous results.

In the end, it’s not just Ogg and Hidalgo who have been affected by this feud. The real losers are the people of Harris County, who have seen their leaders embroiled in a bitter, partisan fight that has distracted from the very real issues facing their community. Whether the case against Hidalgo’s staffers will ultimately lead to convictions or be dismissed as a political witch hunt remains to be seen. But one thing is clear: the fallout from this political circus will be felt for years to come.

View our sources and citations at our research document here.

View the Texas Watchdog article Bloodsport in a Broken System: How the Corpus Christi State-Supported Living Center Became a Playground for Abuse and Corruption here. 

In the spring of 2009, a Texas-sized scandal exploded out of the Corpus Christi State Supported Living Center, revealing a brutal underworld where mentally disabled residents were forced to fight for the amusement of night shift employees. This was no underground operation — it was happening within the walls of a state-run facility meant to protect the most vulnerable. Videos captured by staff — complete with laughter, cheering, and mockery — showed helpless residents being pitted against each other in brutal hand-to-hand combat. The story hit hard and fast, and the fallout was as ugly as the scandal itself.

The Corpus Christi case wasn’t just an isolated incident; it was a damning symptom of a system so rotten that employees felt emboldened to orchestrate these sickening “fights” under the state’s nose. The scandal quickly snowballed into a statewide reckoning, forcing legislators and advocacy groups to confront the catastrophic failures in Texas’s care system for the mentally disabled. What began as a grotesque glimpse into one facility revealed the systemic abuse of power within an empire of underfunded, underregulated institutions.

This is a story of abuse, corruption, and negligence in the Texas state care system — a story of how a few bad actors became the perfect storm that finally shook the system to its core.

The nightmare began to unravel in March 2009 when a lost cell phone found its way into the hands of an off-duty police officer. The phone contained videos that might as well have been pulled straight from a horror movie. They showed employees at the Corpus Christi State Supported Living Center — an institution for the mentally disabled — forcing residents to fight each other. In one particularly chilling clip, a resident tries to flee the chaos, only to be cornered by a mob of employees and fellow residents, pleading, “I will behave.” His captors, both staff and coerced participants, laugh, encouraging him to fight back against an unavoidable beating.

The residents involved were hardly fighters. These were mentally disabled adults, many unable to fully understand the violence being forced upon them. The staff — those entrusted to care for these individuals — took sadistic pleasure in their suffering. The videos, shared among employees, showed just how deep the rot ran. The “fights” were entertainment, filmed for kicks on the night shift. It wasn’t just a one-off prank; this was a systematic, ongoing form of abuse.

For over a year, according to later investigations, this fight club ran almost nightly. Residents were threatened, coerced, and intimidated into participating. One victim, Armando Hernandez, later recounted how staff threatened him with jail time if he didn’t fight. Hernandez’s story mirrored that of others, revealing the horrifying truth: employees at Corpus Christi weren’t just negligent — they were actively perpetrating violence against those under their care.

Armando Hernandez wasn’t just a victim — he was a symbol of the institutional rot festering in Corpus Christi and beyond. Hernandez, like many other residents, lived in the facility because of severe cognitive impairments that made independent living impossible. The center was supposed to offer him care, structure, and protection. Instead, he found himself trapped in a hellscape of intimidation and violence, where the very people paid to look after him became his abusers.

Hernandez spoke out after the videos were exposed, describing the deep psychological wounds inflicted by years of systemic abuse. “They said if I didn’t fight, they’d throw me in jail,” Hernandez recalled in a later testimony. The physical scars were one thing, but the emotional scars ran far deeper. Residents subjected to these beatings were left feeling dehumanized, terrified, and, worst of all, betrayed by those who should have been protecting them.

For many residents, the trauma didn’t stop when the fights ended. The constant threat of violence, the laughter of the staff, and the cheers that accompanied every blow turned their home into a battleground. The ripple effect of this abuse extended far beyond the immediate victims. Residents who didn’t participate were still traumatized by witnessing the violence, knowing it could easily be them next. The culture of fear permeated the entire institution.

The discovery of the videos led to a series of swift arrests that felt almost too easy, given how long the abuse had been allowed to fester. In March 2009, arrest warrants were issued for six employees of the facility. The charges — injury to a disabled person — were grim, but they couldn’t capture the full scope of the crimes these individuals had committed. The videos spoke for themselves, showing a level of cruelty that’s hard to reconcile with the duties of care these staff members had been entrusted with.

Among those arrested were both current and former employees, some of whom had participated directly in the fights, while others had simply stood by, complicit in their silence. Timothy Dixon, one of the accused ringleaders, faced the harshest public scrutiny. In a typical miscarriage of justice, video evidence against him was suppressed by a judge, sparking outrage among victim advocacy groups and raising questions about whether the full scope of this scandal would ever be brought to light.

The legal fallout didn’t stop at individual arrests. The state of Texas was thrust into a whirlwind of lawsuits, investigations, and political finger-pointing. Families of the victims, led by attorney Bob Hilliard, filed lawsuits against the state, seeking justice for their loved ones. Hilliard’s suits pointed out that the abuse was not merely a case of “a few bad apples.” The system itself — chronically underfunded and poorly managed — was a breeding ground for this kind of corruption and violence.

The Corpus Christi fight club scandal may have sparked outrage, arrests, and reforms, but the deeper issues it exposed are far from resolved. The abuse that took place within the walls of that facility was not just an aberration — it was a symptom of a system built on neglect, underfunding, and a dangerous lack of oversight. While the state rushed to install cameras, hire more staff, and pass legislation, these measures were little more than Band-Aids on a system that continues to fail its most vulnerable.

For the residents, the trauma inflicted by their caregivers will never truly go away. Men like Armando Hernandez were left scarred, physically and emotionally, and the families who trusted the state to protect their loved ones were betrayed in the worst way imaginable. The fight club may be gone, but the culture of abuse that allowed it to exist lingers like a toxic fog, hovering over institutions that still struggle to provide basic care without lapsing into cruelty.

This scandal was more than just a grotesque anomaly — it was a window into a broken system that routinely dehumanizes the people it’s supposed to serve. As long as these institutions remain poorly managed and insufficiently monitored, the residents inside them will continue to live on the edge of danger. Reform, real reform, demands more than superficial fixes. It requires a total rethinking of how we care for those who cannot care for themselves, and a society willing to pay attention long after the headlines have faded.

For now, the residents of Corpus Christi, and many like them across Texas, live with the fallout of a system that failed them. And unless drastic changes are made, the next fight club may not be so far off.

View our sources and citations in our research document here.

View the Texas Watchdog article Texas Medicaid Waiver System: A Cruel Joke Disguised as Care here. 

If you want to see a state government’s sociopathic side, take a look at Texas’s Medicaid Waiver system. It’s a bureaucratic mess that leaves the state’s most vulnerable citizens — individuals with severe intellectual and developmental disabilities — waiting for years, sometimes decades, just to get basic services. And for those lucky enough to finally secure help, they often step into a nightmare of abuse, neglect, and broken promises. This is more than just another story of government incompetence; this is an ongoing human tragedy on a mass scale.

Families wait 15 years or more for life-saving care, only to find that the “help” they finally receive is from an underpaid, untrained, and, too often, abusive workforce. The system is designed to make you feel like you’ve won the lottery when you’ve merely escaped the frying pan for the fire.

Imagine needing critical services for a child with severe disabilities, only to be told that the wait is — wait for it — over 15 years. That’s not just a bureaucratic inconvenience; that’s a life sentence for families. In Texas, 158,000 people are on interest lists (a more palatable way of saying waitlists) for one of six different Medicaid waiver programs. These waivers were supposed to provide a lifeline for people who want to care for their loved ones at home rather than consign them to institutional hell.

But here’s the rub: the list is so long and so slow-moving, it might as well be a gravestone. This is a system where families are stuck navigating endless red tape while their loved ones deteriorate, waiting for services that may never come. The tragic irony is that these waivers were intended to keep people out of institutions, but in many cases, the wait is so long that families are left with no choice but to give in to the very thing the system was designed to prevent: institutionalization.

The Texas Legislature, led by Republicans hell-bent on slashing government spending, has ensured that the waiver system remains a perfect storm of dysfunction. Since 2010, the number of Texans using Medicaid waivers has doubled, yet funding has increased by a laughable 17%. That’s it. Meanwhile, the state’s population is booming, and the demand for services far outweighs what little resources are available.

Caregiver wages tell you all you need to know about the state’s priorities: $8.10 an hour. That’s how much the average direct care worker in Texas earns to look after people who, without their assistance, can’t even perform basic tasks like feeding themselves or going to the bathroom.

What do you get when you pay poverty-level wages for some of the most challenging and vital work imaginable? You get a care system filled with underqualified, overworked, and, in too many cases, dangerous individuals. This isn’t a safety net for people in need; it’s a time bomb.

You don’t have to look far to see the human cost of Texas’s Medicaid Waiver system. Over the past decade, the state has opened 80,000 investigations into allegations of abuse and neglect within the system. Sexual assaults, beatings, and horrific negligence are routine. Nonverbal patients — unable to speak up for themselves — are raped by caregivers who know they’ll likely never be caught. It’s institutional sadism on a level that would make a prison warden blush.

Take the case of a woman with cerebral palsy who strangled to death in her wheelchair, the straps binding her in a death grip as she was left unattended. This wasn’t a freak accident; this was the inevitable result of a system that values cheap care over competent care. Caregivers, many of whom have little to no training, are left in charge of patients with complex medical needs. It’s a recipe for disaster.

And then there’s the aftermath: over 600 caregivers have been permanently banned from working in the Medicaid Waiver system for their role in abuse. But don’t worry, the legal system is clogged with thousands of lawsuits that likely won’t see a courtroom for years. For the victims and their families, justice is a long way off — if it ever arrives at all.

If you’re waiting for Texas state leadership to swoop in and save the day, don’t hold your breath. When the Austin American-Statesman broke the story, state officials either stonewalled reporters or issued dry, boilerplate statements that reeked of political indifference. In one especially tone-deaf moment, Texas Attorney General Ken Paxton went to war with the federal government, suing the Biden administration after it rescinded the Trump-era Medicaid waiver extension.

The state’s response to the Medicaid Waiver crisis has been nothing short of dereliction of duty. When faced with evidence of rampant abuse and systemic neglect, the leaders of this state have chosen to deflect, stall, and, above all, avoid any real accountability. This isn’t a leadership crisis; it’s an ethical failure at the highest levels.

For the families caught in this nightmare, every day is a reminder of how broken the system truly is. The Statesman’s investigation uncovered dozens of heartbreaking stories of families waiting in the dark for help that never comes. One family described how their son, who has severe developmental disabilities, aged out of the Medically Dependent Children’s Program and was left without any services. He’s 23 years old now and waiting for the CLASS waiver — one of the most in-demand programs — with no clear end in sight.

The emotional toll on caregivers is incalculable. These families are not just fighting to keep their loved ones alive; they are waging a daily battle against a system designed to grind them into submission. Every phone call, every piece of paperwork, every bureaucratic hurdle is a reminder that, in the eyes of the state, their lives don’t matter.

You’d think federal oversight would offer some kind of relief, but the relationship between Texas and the feds is a slow-motion train wreck. The Centers for Medicare and Medicaid Services (CMS) has tried — and failed — to hold Texas accountable for years. In 2021, the Biden administration pulled the plug on a Medicaid waiver extension that the Trump administration had quietly approved in its final days. Texas Attorney General Ken Paxton, predictably, sued, claiming that the decision was politically motivated.

The truth is that Texas’s refusal to expand Medicaid under the Affordable Care Act has only deepened the crisis. The state continues to reject billions in federal aid while hospitals, caregivers, and patients suffer the consequences. Meanwhile, federal audits of the Medicaid Waiver program routinely find massive gaps in care, with the state failing to report abuse, track complaints, or even follow its own regulations.

The abysmally low wages paid to care workers have created a staffing crisis that the state refuses to address. When you pay workers $8.10 an hour, you’re not just getting underqualified employees; you’re getting desperate people who are sometimes dangerous. The turnover is so high that it’s almost impossible for patients to receive consistent care, and when staff are stretched thin, abuse and neglect become inevitable.

What’s worse, the workers who stick around are often burned out, undertrained, and overworked. That’s a combination that breeds resentment and leads to catastrophic mistakes. And who pays the price? The patients, of course, who are left in the hands of people who can barely afford to live, much less care for them.

Texas has one lifeline for families in immediate danger: the so-called “crisis diversion” system, which allows individuals at imminent risk of institutionalization to bypass the waitlist and get services immediately. But here’s the catch: this system only addresses the most extreme cases, and even then, it doesn’t solve the deeper, systemic problems.

Crisis diversion is a Band-Aid on a bullet wound. It gives the illusion that the state is doing something, but it only serves to mask the failures of a system that doesn’t work for the majority of families stuck on waitlists for years.

Texas refuses to do what’s necessary to fix the Medicaid Waiver system. For starters, expanding Medicaid under the Affordable Care Act would bring in billions of federal dollars that could be used to increase funding, pay caregivers a living wage, and eliminate the waitlist. But this is Texas, where common sense goes to die in the name of “small government.”

Other states have implemented the Tax Equity and Fiscal Responsibility Act (TEFRA) option, which allows families to access Medicaid for children with disabilities regardless of income. This would drastically reduce the pressure on Texas’s waiver system, but once again, the state’s leaders refuse to act.

For every family fighting the state for services, there’s another family fighting in court. Thousands of lawsuits have been filed against the state, clogging the legal system and delaying justice for victims of abuse and neglect. And yet, despite the growing number of cases, little has changed. Sure, 600 caregivers have been banned, but that’s just treating the symptoms. The real disease — systemic underfunding and neglect — remains unaddressed.

The path to real reform is clear, but it requires political will that Texas leaders simply don’t have. It starts with fully funding the Medicaid Waiver programs and paying caregivers a living wage. It requires comprehensive staff training that goes beyond the bare minimum and puts patient safety at the forefront.

Texas also needs a complete overhaul of its oversight and accountability systems. The state must be proactive in investigating abuse and neglect and should implement real penalties for facilities that fail to meet care standards.

For now, the only people keeping the state honest are investigative journalists and advocacy groups like Disability Rights Texas. These organizations are doing the work that the government refuses to do — holding people accountable, exposing the truth, and demanding change.

But it’s a long road ahead. The Texas Medicaid Waiver system didn’t collapse overnight, and it won’t be fixed with a few tweaks. Real change will only come when the state stops treating its most vulnerable citizens as expendable.

In Texas, the Medicaid Waiver system is less of a safety net and more of a cruel joke. For the families caught in its web, there is no punchline — only endless waiting, insurmountable hurdles, and the constant fear that their loved ones won’t survive the system that was supposed to help them. The state’s leaders may pretend to care, but their actions tell a different story: one of neglect, cruelty, and a refusal to prioritize the lives of those who need the most help.

For now, the joke is on Texas’s most vulnerable citizens. And unless real reform happens soon, the punchline will be their continued suffering.

View our sources and citations in our research document here.

View the Texas Watchdog article Texas Medicaid: A Waiting Game That’s Killing Families here. 

For families with special needs children in Texas, hope comes with an expiration date. Caught in the convoluted web of the Texas Medicaid Waiver system, thousands of families are left waiting — not just for services, but for relief from a state-run program that seems designed to fail them. With more than 158,000 individuals trapped on waitlists, some waiting over a decade for basic support, the Texas Medicaid Waiver system is less a safety net and more a bureaucratic hell. Promises of home and community-based services (HCBS) remain just that: promises that rarely come to fruition. What should be a compassionate system has instead turned into a slow, suffocating disaster for the most vulnerable.

Texas’s Medicaid Waiver system operates like a dystopian lottery. More than 158,000 people are on various interest lists for Medicaid Waiver programs, including Home and Community-Based Services (HCBS), Texas Home Living (TxHmL), Community Living Assistance and Support Services (CLASS), and the Deaf Blind with Multiple Disabilities (DBMD) program. While these programs are designed to help families avoid institutionalization, the reality is far more grim. Some families have been waiting for services for over 16 years — long enough that their children may never receive the assistance they need during their most formative years.

The Texas Health and Human Services Commission (HHSC) has recently approved the release of a meager 1,549 slots across various waiver programs for the 2022–2023 biennium. That number — 1,549 — is absurdly small when compared to the 158,000 still waiting. It’s an insult to families who are desperately hanging on, hoping their child will get one of those golden tickets. But the math is unforgiving: the chances of receiving assistance before it’s too late are slim to none. Families who don’t secure these slots are left to fend for themselves, forced into making impossible decisions — like whether to give up full-time work to care for their child, or, in the worst cases, institutionalize them.

Texas doesn’t just have a waitlist problem; it has a funding problem. The federal government mandates that Medicaid applications be processed within 45 days, but Texas has blown past that timeline for years. As of January 2024, nearly 40% of Medicaid applications in the state were taking longer than the required timeframe. These delays leave families without access to healthcare and force them to make desperate choices, like delaying critical medical treatments or paying out of pocket for care they can’t afford. For many, this backlog isn’t just an inconvenience — it’s a life-threatening crisis.

Delayed funding doesn’t just affect the families; it strangles healthcare providers too. Texas Children’s Hospital, the largest pediatric hospital in the country, has been forced to lay off employees and cut services due to delayed Medicaid reimbursements. Safety net clinics across Texas, already operating on razor-thin margins, have reported a 30% decrease in Medicaid revenue as families lose coverage or wait indefinitely for approvals. The result? Service cuts, layoffs, and an increasing number of families left without care. Clinics that serve low-income and rural communities — already some of the most vulnerable populations — are teetering on the edge of financial collapse.

At the heart of Texas’s Medicaid crisis is its stubborn refusal to expand Medicaid under the Affordable Care Act (ACA). Texas remains one of only ten states that have yet to adopt Medicaid expansion, leaving an estimated 1.4 million low-income adults without coverage. This refusal is a political choice, not a fiscal necessity. Expansion would bring billions in federal funding into the state, easing the pressure on both hospitals and families, but Texas’s Republican leadership has turned it into a political hill to die on — even if that means millions are left without healthcare.

Governor Greg Abbott and Attorney General Ken Paxton have been instrumental in fighting federal pressure to expand Medicaid. When the Biden administration rescinded a Trump-era extension of Texas’s Medicaid waiver, Paxton didn’t look for solutions — he filed a lawsuit. It’s all part of a long-standing ideological war against federal intervention, but the victims of this war aren’t bureaucrats or politicians. They’re families with disabled children who can’t get the care they need because Texas refuses to admit that Medicaid expansion is the right thing to do.

For the families waiting on the Medicaid Waiver system, life is a constant struggle against a ticking clock. Micaela Hoops, a North Texas mother, found herself buried under a $3,000 hospital bill after losing her son’s Medicaid coverage due to a procedural error. This isn’t an isolated case — it’s the everyday reality for thousands of families across Texas. Many are forced to take on massive debt to cover medical expenses or forego treatment altogether. And it’s not just about the money. The emotional toll on these families is devastating. Parents are pushed to their limits, often having to quit their jobs to provide full-time care for their children while waiting for Medicaid services that may never come.

For families who are already financially strained, these delays and denials are catastrophic. Many are one medical bill away from financial ruin. Families are choosing between paying rent and paying for their child’s medical equipment. The constant stress of navigating a broken system takes a toll on mental health as well. The emotional exhaustion of fighting for care — all while watching your child suffer — is more than most people can bear. In a state that prides itself on family values, these families are left abandoned.

Texas isn’t the only state that has struggled with Medicaid, but it’s one of the few that has refused to fix the problem. In contrast, states like Oregon, Minnesota, and Louisiana have embraced Medicaid expansion and implemented efficient systems that automatically renew coverage for eligible individuals. Louisiana, for example, uses an express lane eligibility process that pulls data from SNAP applications to automatically renew Medicaid for families. It’s a system that cuts down on paperwork, reduces wait times, and keeps families insured.

Meanwhile, Texas’s Medicaid renewal rate is embarrassingly low. While states like Oklahoma and Washington have ex parte renewal rates of over 75%, Texas limps along at 3.7%. The difference is stark: in states where Medicaid has been expanded and streamlined, families get the care they need without constant delays and roadblocks. In Texas, however, the system is built to fail, trapping families in a cycle of bureaucratic red tape and endless waiting.

Texas’s refusal to fix its Medicaid Waiver system comes with a price tag that extends far beyond the healthcare industry. The Perryman Group estimates that Medicaid disenrollment in Texas could result in a staggering $58.9 billion loss in gross product annually, along with the elimination of 509,200 jobs. These are numbers that should set off alarm bells, but the state’s leadership remains unmoved. The economic ripple effect is undeniable. Families who lose Medicaid coverage are forced to spend more out of pocket on medical care, which means less disposable income for everything else. Small businesses suffer, local economies stagnate, and communities fall further into poverty.

Uncompensated care costs are skyrocketing as hospitals and clinics treat patients who can’t pay for services. Many healthcare providers, especially in rural areas, are being forced to close their doors because they simply can’t survive without timely Medicaid reimbursements. For rural communities, the loss of a clinic or hospital often means losing the only accessible medical care for miles. Texas is bleeding from the inside out, and the state’s refusal to fix Medicaid is at the heart of the problem.

The long-term effects of Medicaid failures on children are the most heartbreaking aspect of this crisis. Children with severe medical needs, like those with autism, cerebral palsy, or neurodevelopmental delays, are missing out on crucial treatments because of Texas’s Medicaid disaster. Research has shown that children with continuous Medicaid coverage fare better in school, have lower mortality rates, and experience fewer health complications as adults. Texas is condemning these children to lives of struggle by denying them the services they need at critical developmental stages.

As of March 2024, more than 1.35 million children had lost Medicaid coverage due to administrative issues, not because they were ineligible. This isn’t just a healthcare problem — it’s a ticking time bomb for the state’s future. Children without healthcare are more likely to suffer academically, drop out of school, and face lifelong economic hardships. Texas is sacrificing an entire generation on the altar of political ideology, and the consequences will be felt for decades.

The Texas Medicaid Waiver system is a moral and economic failure. It’s a system designed to keep families waiting, suffocating them under layers of bureaucracy until they either give up or their needs become too urgent to ignore. For the 158,000 families on the waitlist, every day is a reminder that Texas values budget cuts over human lives. The state’s refusal to expand Medicaid or even streamline its processes is nothing short of a dereliction of duty. Until Texas confronts the reality that its Medicaid system is broken, families will continue to suffer — and the most vulnerable will continue to pay the ultimate price.

View our sources and citations in our research document here.

Visit the Texas Watchdog article Parks and Desperation: How Texas Prioritizes Trails and Trees While Neglecting Its Most Vulnerable Citizens here. 

In Texas, where political bluster about freedom and family values is as commonplace as cowboy hats, the state has quietly written a $1 billion check to expand its network of state parks. On the surface, it’s an easy win for lawmakers on both sides of the aisle. Who doesn’t love parks? Picturesque trails, rolling hills, and serene lakes make for fantastic photo ops and good press. But while politicians congratulate themselves for preserving open spaces, another group of Texans has been relegated to the margins: individuals with intellectual and developmental disabilities (IDD).

The same state that found $1 billion to throw at its state parks could only muster up a measly $75 million for services designed to support people with IDD. These are citizens — Texans — who are desperately waiting for care, stuck on Medicaid waiver waitlists that stretch over a decade long. It’s not just a funding oversight; it’s a deliberate choice, one that says loud and clear what the state prioritizes. Parks are scenic, profitable, and popular; people with disabilities are none of those things, and it shows in the budget.

The $1 billion set aside for parks is a massive windfall for Texas’s natural recreation areas. It will expand current parks, fund the creation of new ones, and help conserve historical sites. The Sporting Goods Sales Tax (SGST), a dedicated revenue stream, ensures that the state has a pot of money specifically earmarked for such projects. On paper, it sounds great — a rare example of a government program that’s well-funded and proactive.

But this is a state that still has more than 156,000 individuals waiting for crucial services through Medicaid waiver programs. These waivers, designed to help individuals with IDD live at home and avoid institutionalization, are as backed up as a traffic jam on I-35. Some people have been on the waitlist for as long as 16 years — longer than most state parks have even existed.

While the SGST ensures that parks will flourish, the funding for IDD services is cobbled together through a combination of state and federal Medicaid money. It’s an entirely different — and far less glamorous — budget conversation. While parks expansion has the potential to boost tourism and generate revenue, services for people with disabilities offer none of those economic boons. Instead, they offer something far less quantifiable: dignity and survival for thousands of people who have no other options.

Texas’s budget for IDD services is nothing short of an insult. The state allocated $75 million in the 2023–2024 budget for IDD services, a figure that’s laughably small in comparison to the need. The average wait time for IDD services in Texas is 16 years, with some families waiting as long as 19 years for help. That’s not a misprint: nearly two decades of waiting for support that can mean the difference between life at home and institutionalization.

For these families, the $75 million is a drop in the bucket, offering little hope of clearing the immense backlog of waiver applicants. The reality is that thousands of people are languishing on waitlists, stuck in limbo as they await basic services. Meanwhile, $1 billion is being spent on making sure Texans can enjoy a hike or a kayak ride on their weekends.

The truth is stark: In Texas, it’s easier to secure funding for trees and trails than it is to ensure that individuals with disabilities can live with dignity. This isn’t just an oversight in the budget; it’s a statement of values. And those values suggest that, in Texas, the needs of vulnerable individuals rank far below the desire for more parks.

To put things in perspective, let’s break down what $1 billion could do if it were redirected from parks to IDD services. With $1 billion, Texas could vastly expand the number of Medicaid waiver slots available, drastically reducing the years-long waitlists. It could provide a living wage to the state’s Direct Support Professionals (DSPs), who currently earn a paltry average of $10.60 an hour. It could help fund desperately needed respite care services for families who are stretched to the breaking point as they care for their disabled loved ones 24/7.

Instead, the $1 billion is being used to buy a feel-good project for lawmakers, something they can point to in the next election cycle as a win for Texans. The state’s parks are a priority because they’re a visible, tangible investment. People can visit a park and see where their tax dollars went. The same can’t be said for IDD services. They’re hidden away, affecting a population that doesn’t have the luxury of public visibility or political clout.

Meanwhile, $75 million for IDD services doesn’t even begin to cover the gaps in care. The state’s budget for IDD services is barely enough to maintain the status quo, let alone reduce the overwhelming waitlists. This is the grim reality for families in Texas: Parks are expanding, but for those caring for loved ones with disabilities, the future looks as bleak as ever.

So why does Texas spend more on parks than on its most vulnerable citizens? Part of the answer lies in how park funding is structured. The SGST ensures a dedicated and consistent stream of revenue for parks and historical sites. It’s politically neutral and draws bipartisan support because everyone benefits from parks — families, tourists, and businesses alike. Parks are easy to sell because they’re public-facing, aesthetically pleasing, and offer economic opportunities.

Contrast that with IDD services, which rely on a mix of state and federal Medicaid funding. This system is a political landmine, involving complex bureaucracies and requiring constant oversight. It’s easy for lawmakers to ignore or underfund these services because the people affected are often out of sight, out of mind. For most Texans, Medicaid waiver waitlists are an abstract concept. But a new park? That’s something everyone can rally around.

While lawmakers celebrate the expansion of state parks, Texas’s Medicaid waiver system is crumbling under the weight of its own failures. As of December 2022, the state had 156,000 unduplicated individuals on waitlists for Medicaid waiver programs. These programs are critical for people with IDD, offering them the services they need to live in their communities rather than in institutions.

But these services are out of reach for most. Families apply for Medicaid waivers when their children are young, knowing that it will take years — sometimes decades — before they receive any help. The waitlists are so long that many individuals age out of the services they need before they ever reach the top of the list. This isn’t just a bureaucratic failure; it’s a human tragedy that plays out in real time, year after year, as thousands of Texans with IDD go without the care they need.

One of the arguments used to justify the $1 billion park budget is that parks are good for the economy. They boost tourism, drive local development, and provide recreational spaces that contribute to a higher quality of life. And while all of this is true to some extent, the economic benefits of parks are often overstated. Yes, parks can bring in revenue, but they won’t fix the systemic issues plaguing Texas’s social services infrastructure.

In contrast, investing in IDD services would provide a long-term economic benefit that far outweighs any gains from park tourism. Families would be able to continue working if they had access to respite care. Healthcare costs would decrease as fewer people with IDD end up in emergency rooms or long-term care facilities due to lack of support. And the state’s Direct Support Professional workforce, which currently faces high turnover due to low wages, would stabilize, providing more consistent and reliable care for those in need.

But this kind of investment doesn’t come with the immediate, visible returns that parks do. It’s not something lawmakers can point to on a map or tout in campaign ads. It’s the quiet, behind-the-scenes work of taking care of the state’s most vulnerable citizens, and in Texas, that kind of work simply doesn’t get funded.

For the families caught in Texas’s Medicaid waiver nightmare, every day is a battle against a system that has forgotten them. Take the story of Juanita, a mother in Austin whose son, diagnosed with severe autism, has been on the waitlist for services for nearly 14 years. Juanita’s son is now 22, and without support, she’s been forced to quit her job to provide around-the-clock care. Her family is barely scraping by, and the emotional toll is unbearable. But for the state of Texas, Juanita and her son are just numbers on a spreadsheet.

There’s also the case of Michael, a 34-year-old man with Down syndrome who’s been waiting for services since he was a teenager. His parents, now in their 60s, are exhausted. They’ve spent years advocating, filling out paperwork, and navigating the labyrinthine Medicaid system, only to be met with endless delays and excuses. As Michael ages, the likelihood that he’ll ever receive the services he needs dwindles, leaving his parents to wonder what will happen when they’re no longer able to care for him.

These aren’t isolated incidents — they’re emblematic of the broader crisis facing the IDD community in Texas. For these families, the state’s decision to prioritize parks over people isn’t just frustrating; it’s a betrayal.

The lack of funding for IDD services has created a workforce crisis that is spiraling out of control. Direct Support Professionals (DSPs) are the backbone of care for individuals with IDD, yet they’re paid less than most fast-food workers. The average DSP in Texas makes $10.60 an hour, a wage so low that many are forced to take on second jobs just to make ends meet. It’s no wonder, then, that turnover in this field is astronomical.

Without adequate pay, it’s impossible to retain skilled and compassionate care workers. As a result, people with IDD are often left with inconsistent or substandard care. High turnover also means that families must constantly train new caregivers, adding to their already overwhelming burden.

By refusing to invest in the DSP workforce, Texas is ensuring that the quality of care for people with IDD remains abysmal. This is the direct result of underfunding — a problem that $1 billion could have gone a long way toward solving.

The disparity between park funding and IDD services comes down to one thing: visibility. Parks are tangible, photogenic, and popular. IDD services, on the other hand, are invisible to most people. They exist in the private homes of struggling families, behind the walls of institutions, and in the paperwork of Medicaid offices.

It’s easier for lawmakers to justify a massive investment in parks because the benefits are obvious. People use parks. They see the trails, the trees, the lakes. They can point to a park and say, “This is where our tax dollars went.” But with IDD services, the benefits are harder to see. They’re hidden behind layers of bureaucracy, and the people who rely on them aren’t in a position to advocate for themselves.

The $1 billion park budget and the paltry $75 million for IDD services speak volumes about Texas’s values. The state has chosen to prioritize recreation over the basic needs of its most vulnerable citizens. It’s a moral failure on an epic scale, one that reflects a deep-seated indifference to the lives of people with disabilities.

The contrast between these two budget items raises serious questions about equity and justice in Texas. By spending more on parks than on services for people with disabilities, the state is effectively saying that some lives matter more than others. It’s a stark reminder that, in Texas, those who can’t advocate for themselves are left to fall through the cracks.

The solutions to Texas’s IDD funding crisis are not difficult to identify — they’re just difficult to enact because they require a shift in priorities. First, Texas needs to significantly increase its investment in Medicaid waiver programs. The $75 million currently allocated is nowhere near enough to meet the needs of the 156,000 people on the waitlist.

Second, the state must address the DSP wage crisis. Raising wages for care workers would not only improve the quality of care for individuals with IDD, but it would also help stabilize the workforce and reduce turnover. A living wage for DSPs would go a long way toward ensuring that people with IDD receive consistent, compassionate care.

Finally, Texas must confront its legislative and moral failures head-on. Lawmakers need to acknowledge that parks, while valuable, cannot come at the expense of human lives. It’s time for a balanced budget that reflects the state’s commitment to all of its citizens, not just the ones who enjoy a hike in the park.

Texas’s decision to allocate $1 billion to state parks while only budgeting $75 million for IDD services is more than just a budgetary oversight — it’s a reflection of the state’s values. It’s a statement that parks and recreation are more important than the dignity and well-being of individuals with intellectual and developmental disabilities.

As long as this disparity exists, families like Juanita’s and Michael’s will continue to struggle in silence, while politicians pat themselves on the back for expanding Texas’s parks. Until Texas decides to prioritize its most vulnerable citizens, the waitlists will grow, the workforce will collapse, and the state will remain a place where it’s easier to build a park than to care for a person.

View our citations and sources in our research document here. 

View the Texas Watchdog article Texas’s State-Sponsored Hell: The Corrupt, Abusive, and Politically-Protected Disaster of State Supported Living Centers here. 

In Texas, they like to say everything’s bigger. Bigger trucks, bigger steaks, bigger ego. But what they don’t talk about are the bigger scandals, the bigger failures, and the bigger, uglier bureaucratic monstrosities that exist just under the surface. Take, for example, the State Supported Living Centers (SSLCs), a chain of facilities ostensibly designed to care for people with intellectual and developmental disabilities (IDD). They should be bastions of compassionate care, but instead, they’ve become the embodiment of Texas’s worst attributes: cruelty, corruption, and cover-ups.

What Texas has built here is nothing short of a state-sponsored hell. It’s a place where the most vulnerable are subjected to unimaginable abuse, where staff members — paid by the taxpayer — are free to run their own Fight Club, and where neglect leads to death, all while the government looks the other way. And why wouldn’t they? Protecting the SSLC system is easier than reforming it, and no politician wants to risk losing votes by shutting down a local institution, no matter how rotten it is inside.

So here we are, in the great state of Texas, where oil flows and the money’s green, but if you happen to be disabled and in need of care, well, God help you. Because the Texas government sure won’t.

You’ve probably heard of Fight Club, that Brad Pitt movie where disillusioned men punch each other into oblivion for sport. Well, Texas’s SSLCs decided to make their own version — except the participants weren’t movie characters; they were real people, many of them non-verbal and severely autistic. And instead of it being a voluntary activity, it was coerced by the very people hired to care for them. The Corpus Christi SSLC Fight Club scandal in 2009 wasn’t just some isolated incident, either. It was a snapshot of the systemic abuse rotting away at these centers.

You see, staff members at Corpus Christi didn’t just take advantage of their vulnerable charges; they made a game of it. They forced residents to fight each other for their own twisted entertainment, treating human beings like pit bulls in an underground fight ring. Non-verbal individuals, incapable of reporting the abuse, were pitted against one another while staff members watched and, in some cases, filmed. It’s a scandal so grotesque that it sounds like fiction — but it’s real, and it’s just the tip of the iceberg.

Physical abuse, sexual abuse, neglect — you name it, SSLC residents have suffered it. Sean Yates, a non-verbal man with Asperger’s syndrome, died after escaping from the Corpus Christi SSLC. The staff didn’t even bother to inform his family of the abuse he endured in the Fight Club. He wasn’t the first, and he certainly won’t be the last, to meet a tragic end while under state “care.” The Lubbock SSLC saw 17 deaths in one year — 17! — under suspicious circumstances. Imagine if 17 people died mysteriously in a single high school or a corporate office. There would be public outcry, investigations, accountability. But here, in the state-run nightmare that is SSLCs, silence reigns.

So why does this system persist? Why, after multiple investigations, lawsuits, and even a $112 million settlement with the Department of Justice in 2009, do these atrocities continue? The answer lies in the Texas Legislature — those fine, upstanding politicians who love to beat their chests about “freedom” and “justice” while ignoring the rampant human rights violations happening under their noses.

You’d think the people responsible for crafting laws would have some interest in stopping the abuse, but you’d be wrong. Instead, they’ve built a system designed to protect itself. SSLCs provide jobs, and politicians — ever mindful of their reelection prospects — aren’t about to shutter a major employer in their district. That’s all that matters. Forget about the 3,000 abuse, neglect, and exploitation allegations reported annually in the SSLCs. Forget about the deaths, the beatings, the sexual assaults. No politician in Texas wants to be the one to cut jobs, especially not in rural districts where SSLCs are often the largest employer.

And then there’s the Texas Health and Human Services Commission (HHSC), the agency responsible for overseeing these institutions. HHSC has repeatedly failed to enforce any meaningful oversight. Year after year, the commission lets things slide. Instead of closing these facilities or holding staff accountable, they respond with cosmetic reforms, like increasing fines for violations — a Band-Aid on a bullet wound.

Let’s face it: the Texas government doesn’t give a damn about the disabled people suffering inside these walls. What they care about is money, power, and political expediency. It’s easier to let the SSLC system continue to rot than to fix it, easier to defend the status quo than to risk a political backlash by shutting them down.

Now, you might think the 2009 DOJ settlement would’ve fixed things. After all, $112 million and a commitment to reform sound like a pretty big deal, right? Wrong. Nearly 15 years later, SSLCs are still riddled with the same issues — understaffing, underfunding, and unrelenting abuse. In 2024, SSLCs are complying with only 42.9% of the provisions laid out in the DOJ settlement. Think about that for a second. Nearly 60% of the reforms promised haven’t even been touched.

And if you ask the politicians, they’ll say the problem is too complex to solve overnight. Complex? Really? Let’s break this down: stop the beatings, stop the sexual abuse, stop the neglect. Hire enough qualified staff, fire the abusers, and close the worst institutions. How is this complex? It’s not — it’s a choice. A choice to prioritize jobs and lobbyists over human lives, a choice to sweep abuse under the rug rather than face the political consequences of real reform.

Meanwhile, staffing shortages have reached crisis levels. SSLC employees are overworked and underpaid, forced to work shifts that stretch over 70 hours a week. It’s no wonder abuse happens; the system is designed to break people. And break them it does. At least 600 caregivers were injured between 2017 and 2022. Some were attacked by residents, but let’s be real — if you cage people in an abusive, neglectful environment, violence is inevitable.

What makes this even more infuriating is the sheer waste of taxpayer dollars. Texas spends $661.9 million a year on these institutions, with per-resident costs exceeding $120,000. That’s more than twice the cost of community-based care, which averages $50,000 per year. So not only is Texas locking people up in abusive institutions, it’s paying extra to do it. This is fiscal conservatism, Texas-style: waste more money to do a worse job.

The Texas Legislature’s answer to this mess? Keep the SSLCs open, ignore the systemic abuse, and keep funneling taxpayer dollars into a system that doesn’t work. Meanwhile, the state’s community-based care programs — which could actually provide a better, more humane solution — are woefully underfunded. The waitlist for these programs is seven years long. Seven years! That’s longer than most Texans serve in elected office. So families, left with no options, send their loved ones into SSLCs, knowing full well what could happen. It’s a devil’s bargain, forced on them by a system that treats people with disabilities as disposable.

It’s easy to look at this situation from a distance and wonder why families haven’t rebelled en masse. Why, after all these years, do families still send their loved ones to SSLCs, knowing the horrors inside? The answer is brutally simple: they don’t have a choice.

Texas’s community-based services are a joke. The waitlists are longer than a Texas summer, and families are left with few alternatives. And when families do speak out — when they sue for wrongful deaths, for abuse, for the negligence that led to their loved one’s death — they run into a brick wall of bureaucratic red tape and judicial indifference.

Take the case of David Paul Taylor, whose parents sued after he died while in the care of the Richmond SSLC. They alleged that the facility refused to provide necessary care because of his disabilities, and that refusal led to his death. The case went to court, but like so many others, it was swallowed up in the endless legal wrangling that defines the SSLC system.

Even whistleblowers, people inside the system who try to expose the corruption, face retaliation. Linda Moore, a former employee of the Lubbock SSLC, filed a lawsuit under the Texas Whistleblower Act after she was fired for reporting violations. What happened? The state fought her tooth and nail in court. That’s the Texas way: protect the institution, punish the truth-teller.

When you look at the systemic abuses rampant in Texas’s State Supported Living Centers (SSLCs) — the beatings, the deaths, the criminal neglect — the question everyone asks is, why? Why do these places, which are little more than state-run warehouses for the disabled, stay open? If they cost more than community care, if they’re as dangerous as the data and lawsuits suggest, why are they still allowed to exist? The answer, like most things in Texas politics, is simple: power, money, and political survival.

Here’s the dirty secret about SSLCs: they’re not kept open for the benefit of the residents. They’re kept open for the benefit of politicians, their donors, and the local economies that rely on these institutions for jobs. If you think Texas politicians are going to risk upsetting their voters by shutting down a major employer in a rural district, you clearly don’t know how Texas works.

SSLCs are political lifelines. They’re job engines, and those jobs — however dysfunctional the work environment might be — translate into votes. In districts where these facilities are often among the largest employers, shutting them down would be political suicide. It’s not about protecting the people inside, it’s about protecting the political careers of those on the outside.

Let’s break it down: Texas’s rural economies are fragile. Many of these areas rely heavily on a few major employers — hospitals, schools, prisons, and yes, SSLCs. These institutions pump money into local economies, providing stable jobs in places where those are in short supply. In some towns, the SSLC is the only major employer, meaning that if it were to close, there’d be an economic collapse. Politicians know this, and they know that a vote to close one of these facilities is a vote to destroy jobs, alienate voters, and, ultimately, lose elections.

This is where it gets really twisted: the people fighting to keep SSLCs open aren’t the families of residents or even disability rights advocates — they’re local politicians, lobbyists, and contractors. These are the people who benefit from the status quo. They’re the ones who secure lucrative state contracts to provide services to the SSLCs, the ones who campaign on promises of keeping local jobs intact, and the ones who funnel money back into their political campaigns from grateful donors who work at these facilities.

It’s a closed loop: SSLCs employ hundreds of workers in rural districts. These workers, in turn, form the backbone of local economies. Politicians, knowing they need to maintain employment rates to stay in power, defend these institutions, even when reports of abuse and neglect surface. It’s not that they’re unaware of the problems; they’re very aware. But political expediency demands that the system remains untouched.

In fact, several Texas lawmakers have gone so far as to champion the SSLCs as essential parts of the state’s infrastructure. In public hearings, they’ll talk about how these institutions are critical for providing care to the “most severely disabled.” Behind closed doors, though, they’re protecting their political futures and keeping a steady stream of contracts flowing to local contractors.

And if you’re waiting for Governor Greg Abbott or Lieutenant Governor Dan Patrick to step in and demand reform, don’t hold your breath. Abbott has shown little interest in challenging the powerful rural interests that keep the SSLCs alive. He’s built his political career on catering to local business interests, and those interests — whether they involve prisons, oil, or state-run institutions like SSLCs — come before the residents suffering inside. Abbott isn’t a reformer; he’s a protector of the status quo, and that means SSLCs will keep operating no matter how many reports of abuse surface.

If you want to see the Texas political machine in action, look no further than the Sunset Advisory Commission’s 2020 recommendation to close six of the worst-performing SSLCs. That report should’ve been the nail in the coffin. It laid out the clear evidence: these facilities were not only abusive but also hemorrhaging money. Closing them would save taxpayer dollars and improve care for residents by shifting resources to community-based services.

What happened? Nothing. Absolutely nothing.

The proposal was shot down faster than you could say “reelection campaign.” Local politicians, bolstered by lobbyists representing the institutions and their contractors, fought tooth and nail to keep the SSLCs open. They rallied voters with scare tactics, claiming that closing the SSLCs would leave disabled residents with nowhere to go (conveniently ignoring the fact that better care options exist). They cried about job losses, about the importance of “keeping our communities strong.” And they won. The recommendation was shelved, and the SSLCs continued business as usual — abuse, neglect, and all.

This is the core of the problem: Texas politics isn’t driven by what’s best for the people; it’s driven by what’s best for the people in power. The SSLCs are allowed to remain open, despite the overwhelming evidence of their failures, because shutting them down would create short-term political pain for the lawmakers who represent the areas where they’re located. And if there’s one thing Texas politicians hate more than accountability, it’s the idea of losing power.

Every few years, someone in the Texas Legislature proposes reforming the SSLC system. They’ll suggest increasing oversight, raising pay for staff, or improving conditions for residents. These proposals are always dead on arrival. Why? Because reform threatens the entire political ecosystem that keeps SSLCs running.

Closing or reforming SSLCs would mean upending a system that benefits far too many powerful people. It would mean cutting off state contracts for private companies that provide food, medical supplies, and other services to these institutions. It would mean firing staff, many of whom are politically connected. It would mean challenging the local economies that depend on these institutions for survival. And Texas politicians simply aren’t willing to take that risk.

Instead, they choose to double down on a system that everyone knows is broken. They’ll pass some cosmetic reforms — maybe increase funding by a few million dollars here or there — but the core of the system remains untouched. The SSLCs continue to operate as little more than taxpayer-funded abuse factories, all while politicians pat themselves on the back for “addressing the problem.”

The Texas Legislature, with all its tough talk about fiscal responsibility and justice, has chosen to maintain a system that abuses the very people it’s supposed to protect, all because closing these institutions would threaten their political careers.

The real cost of Texas’s SSLC system isn’t measured in dollars — it’s measured in human lives. Lives destroyed by abuse, neglect, and systemic indifference. It’s measured in the deaths of people like Sean Yates, the broken families left behind, and the generations of disabled Texans abandoned by the state that’s supposed to protect them.

There’s no political will to fix this because there’s no political benefit to doing so. The SSLCs will continue to operate, funneling money into a corrupt system, while the Texas government pats itself on the back for being fiscally responsible. But behind that facade lies a brutal, unforgivable truth: the state of Texas is failing its most vulnerable citizens, and no one in power cares enough to stop it.

You can view our research, sources and citations at our research document here.

Read the original texas Watchdog article Silence in the Senate: The Texas Legislature’s Refusal to Address Borris Miles here.

You’d think that in a state as loud and proud as Texas, where independence and justice supposedly reign supreme, elected officials would be held to the highest standards. After all, the Lone Star State’s political brand is built on hardline accountability — tough on crime, zero tolerance for corruption, and a refusal to back down from a fight. But behind the flag-waving and chest-pounding, there’s a different story playing out in the halls of the Texas Capitol. It’s the story of Borris Miles, a state senator with a decade-long record of serious allegations, from sexual harassment to financial mismanagement, and the Texas Legislature’s cowardly refusal to do anything about it.

Instead of justice, what we’ve seen is protection — an institutional cover-up that’s left victims without recourse, as the state’s politicians prioritize party loyalty and political expediency over integrity. Miles, a walking catalog of scandal, remains in power, untouchable, shielded by a corrupt legislative system that lets him off the hook time and time again. This is Texas politics in 2024: where accusations of sexual misconduct are swept under the rug, and the accused not only evade consequences but thrive, bolstered by the very system that’s supposed to hold them accountable.

Let’s start with the facts. Over the past decade, Borris Miles has been the subject of numerous allegations, ranging from sexual harassment to legal and financial troubles. It’s not just one or two isolated incidents — it’s a pattern. The accusations against Miles first gained serious attention in 2017, when multiple women came forward with stories of sexual harassment and assault. According to The Daily Beast, the allegations included claims that Miles forcibly kissed women and made inappropriate sexual advances. Not just a one-off drunk incident — a repeated offense.

You’d think that kind of scandal would end a political career. But this is Texas, where the powerful protect their own. Instead of being investigated thoroughly and held to account, Miles carried on with his political career almost as if nothing had happened. No formal disciplinary action. No resignation. No accountability at all.

In 2024, more allegations surfaced, reported by Texas Monthly. A Houston-based political consultant, Tayhlor Coleman, accused Miles of groping her at a party. She described the senator as pulling her in for a hug, then sliding his hand down to grope her. This wasn’t the first time Miles was accused of inappropriate touching — nor would it be the last. And yet, despite mounting accusations, Miles continued to sidestep consequences.

His office has been described by staffers as a place where misogyny and inappropriate behavior were tolerated, if not encouraged. Staffers left, citing an environment they found hostile and demeaning. Meanwhile, Miles’ response to all of this has been classic deflection — calling the accusations politically motivated attacks by “powerful enemies.” It’s a strategy that’s worked because of the Texas Legislature’s deeply flawed approach to dealing with sexual misconduct among its members.

In most workplaces, if you’re accused of sexual harassment, there’s a process. There’s an investigation, disciplinary action, and, in serious cases, termination. But in the Texas Senate, there’s no such thing. Instead, senators are free to handle these allegations “internally,” meaning they can choose to deal with them as they see fit — without any oversight, transparency, or accountability. In Miles’ case, that’s meant sweeping accusations under the rug and continuing on as if nothing happened.

According to Texas Monthly, under the leadership of Lt. Governor Dan Patrick, the Texas Senate has repeatedly failed to take action against senators accused of sexual misconduct. In fact, the Senate has actively buried and dismissed complaints. It’s a culture of silence and complicity, where powerful men are protected, and victims are left voiceless.

The Senate’s policy requires official complaints to be filed with the Director of Human Resources or the Secretary of the Senate to trigger an investigation. But how can you expect victims — many of whom are young staffers or interns — to feel safe filing a complaint when the system is so clearly stacked against them? The fear of retaliation is real. Miles, for example, has remained defiant throughout, denying all wrongdoing and painting himself as the victim of a smear campaign.

Even more absurd is that there’s no investigative committee in the Senate to handle these cases. Unlike the Texas House, which at least has a committee dedicated to investigating ethical violations, the Senate is operating in the dark ages. The lack of a formal investigative process means that allegations against senators like Miles can be ignored indefinitely, leaving victims without justice and the accused free to continue their behavior.

You might be wondering: why hasn’t there been more pressure from fellow Democrats to remove Miles? Why isn’t there more outrage? The truth is, Texas politics is an incestuous cesspool where loyalty to the party trumps loyalty to the truth. The Texas Democratic Party, afraid of losing political ground, has largely turned a blind eye to the allegations against Miles. There have been a few voices, like State Senator José Rodríguez, who have spoken out against the alleged behavior. But most Democrats have remained silent, unwilling to publicly condemn a fellow party member.

It’s not just about maintaining political power; it’s about maintaining political image. To push Miles out would be to admit failure — to admit that the Texas Democratic Party has a sexual harassment problem within its own ranks. And so, they’ve chosen the easy route: silence. The few calls for resignation — like those from Annie’s List, a group dedicated to electing women to office — have been easily dismissed by Miles and ignored by his colleagues.

Republicans, of course, have their own reasons for staying quiet. For them, the longer Miles remains in office, the longer they can point to him as an example of Democratic corruption. It’s a win-win for both sides: the Democrats avoid a messy internal fight, and the Republicans get a free punching bag.

Beyond the sexual harassment allegations, Miles’ record of financial mismanagement and legal troubles is staggering. In 2007, he was indicted on two counts of deadly conduct for brandishing a firearm and making threats at two separate parties. This kind of behavior would have ended most political careers, but not in Texas. Miles managed to dodge any serious consequences, and the incident was quietly swept away as just another scandal in a state that’s become desensitized to political corruption.

But the legal issues didn’t stop there. Over the years, Miles has faced multiple tax delinquency cases in Harris County, racking up unpaid taxes and financial obligations. For a senator entrusted with managing public funds, this kind of financial irresponsibility should be disqualifying. Yet, like everything else in Miles’ career, it was brushed aside.

The question is, why? Why does Miles get a pass for behavior that would sink anyone else? The answer lies in the Texas political machine — a machine that protects its own, as long as they continue to serve the interests of the party and the system. Miles’ ability to survive scandal after scandal is a testament to just how broken Texas politics has become. It’s not about serving the people. It’s about serving the system.

The allegations against Miles aren’t just an indictment of one man. They’re an indictment of the entire political culture in Texas — a culture where sexual harassment is tolerated, legal and financial misconduct is overlooked, and accountability is nonexistent.

Miles is still in office because the system allows him to be. The Texas Legislature has built an impenetrable shield around its members, protecting them from consequences, no matter how serious the allegations. This isn’t just about one man’s bad behavior — it’s about a corrupt system that enables that behavior.

The real victims here are the people — both the individuals who’ve been directly harmed by Miles and the constituents who deserve better from their elected officials. Every day that Miles remains in office is another day that the Texas Legislature proves that it cares more about protecting its own than about serving the people.

The case of Borris Miles is not just a story of one politician’s misconduct. It’s a story of systemic failure — a failure of leadership, accountability, and integrity. The Texas Legislature has allowed a culture of corruption to flourish, where powerful men can act with impunity and victims are left without recourse.

If there’s any hope for Texas politics, it lies in reform — real reform that holds elected officials accountable for their actions, protects victims of harassment, and ensures that the people of Texas are represented by individuals worthy of the office. Until then, the state’s political system will remain as corrupt and broken as ever.

You can see our sources and citations in our research document here.

View the Texas Watchdog article Waiting for a Miracle: The Cruelty of Texas’s IDD Support System here. 

Texas has always prided itself on being big. Big skies, big oil, big trucks, and a big ego when it comes to rejecting anything that smells like federal overreach. But what happens when that brash independence comes at the expense of the most vulnerable citizens? What happens when political ideologies trump the basic human need for care, compassion, and dignity? In the Lone Star State, the answer is playing out in real-time: people with intellectual and developmental disabilities (IDD) are paying the price for Texas’s political games, and it’s a price many cannot afford.

The failure of Texas to provide for its IDD population — people who require assistance with daily activities, medical care, and emotional support to lead lives with a semblance of dignity — is not a fluke or a mistake. It’s not an unintended consequence of a bureaucratic tangle. No, this is a deliberate, calculated decision made by the state’s leadership, a cynical refusal to expand Medicaid and adequately fund community-based services that leaves over 113,000 Texans stranded on an ever-growing waitlist for essential services. This isn’t just mismanagement. This is policy, and the human cost is staggering.

It’s hard to square Texas’s booming economy with the desolate landscape of its social services. The state is flush with money. In the 2024–2025 biennium, Texas boasted a surplus of $32 billion. That’s right — billion. Texas is one of the wealthiest states in the nation, with industries from technology to oil thriving. Yet for people with IDD, this wealth means nothing. They’re stuck in a system that actively chooses to leave them behind, a system where waitlists stretch for decades and services are patchy at best. It’s not because Texas can’t afford to help them — it’s because the state’s political leaders simply don’t want to.

You see, Texas isn’t interested in expanding Medicaid, which could bring in billions of federal dollars to support services for low-income residents, including those with IDD. The refusal to expand Medicaid under the Affordable Care Act (ACA) has left an estimated 1.5 million Texans without coverage, but no group feels the effects of this more than those with IDD. Medicaid expansion would have provided a lifeline — access to healthcare, housing, and community-based support for thousands who currently get nothing but a place on a waitlist.

The state’s leadership — people like Governor Greg Abbott and Lieutenant Governor Dan Patrick — have made their disdain for the ACA well known. For them, expanding Medicaid is a nonstarter. It’s seen as an affront to Texas’s independence and a violation of their anti-government principles. But this ideological crusade has very real consequences. It’s not just abstract political theater; it’s a denial of care that leaves families shattered, caregivers overwhelmed, and lives lost.

The absurdity of Texas’s IDD support system lies in the fact that it’s not even a good fiscal decision. In fact, Texas’s refusal to invest in Medicaid expansion and community-based services is costing the state more in the long run. Take the State Supported Living Centers (SSLCs), Texas’s institutions where IDD individuals are effectively warehoused. They are 13 outdated facilities that house around 3,000 people, and they cost the state around $700 million annually — $230,000 per person per year. Compare that to the cost of supporting someone in a community-based setting under a Medicaid waiver, which is around $70,000 per year, and you start to see the twisted logic of Texas’s priorities.

Why the obsession with funding institutions over community-based services? The answer, as always, is politics. The SSLCs have powerful allies — namely contractors, suppliers, and local economies that rely on these institutions to survive. They’ve got a built-in constituency of people with vested interests in keeping the SSLCs open, regardless of whether it’s in the best interests of the residents. Politicians, particularly in rural districts where these centers are often located, know better than to mess with that.

What you end up with is a system where it’s easier to institutionalize people than to support them in the community, where people with IDD are treated as problems to be warehoused rather than individuals deserving of care, dignity, and independence.

Imagine this: you’re the parent of a child with severe intellectual or developmental disabilities. Your child needs constant care — help with eating, bathing, dressing, and moving around. You can’t work because you have to be a full-time caregiver. You hear about the Medicaid waiver program, which could give you access to home care services, therapies, and equipment that would make life manageable for both you and your child.

But when you apply, you’re told there’s a 15-year waitlist. Fifteen years. In a state with an annual surplus in the tens of billions, that’s the best they can offer you. So, what do you do? You become another cog in Texas’s brutal machine of neglect. You sell your house, spend your life savings, and sacrifice your own health and well-being to provide care because the state has abandoned you.

This is the story of thousands of families across Texas. Parents who should be retiring are instead working themselves into an early grave, providing 24/7 care for adult children because there is no other option. Siblings are forced to step in as caregivers when their parents can no longer cope. And when the caregivers die, the state finally steps in — by sending their loved ones to an institution.

One particularly heartbreaking story comes from Connie Henson, whose adult son has autism. He has been on the waiver list for 16 years. Connie was told he would be eligible for services “soon,” but soon came and went long ago. Now, she’s exhausted, living off her savings, and wondering what will happen when she’s no longer able to care for him. “What happens when I die?” she asks. “Who will take care of my son?”

The state of Texas has no good answer for that.

If you think things are bad for families, wait until you hear about the people who actually provide care — the Direct Support Professionals (DSPs). These are the folks who work with IDD individuals every day, providing the care that keeps them safe, healthy, and able to live as independently as possible. DSPs do the work that most of us wouldn’t even consider — feeding, bathing, dressing, administering medication, and managing behavioral issues. And what does Texas pay them for this life-sustaining work? A whopping $10.60 an hour.

That’s right. The people doing some of the hardest, most important work in the state are being paid poverty wages. It’s no wonder the turnover rate is astronomical. Why would anyone stick around in a job that’s emotionally and physically draining, only to get paid less than they would at a fast-food joint?

But Texas isn’t interested in raising wages for DSPs. Instead, it has created a two-tiered system where SSLC workers — who are doing essentially the same job in an institutional setting — are paid up to $17.50 an hour. Why the disparity? Because SSLCs are part of the state’s budgetary priorities. Community-based care is not.

This pay gap has real consequences. As more DSPs leave the profession, community-based care providers are left understaffed, overworked, and unable to meet the needs of the people they’re supposed to serve. This creates a vicious cycle: understaffed facilities provide lower-quality care, leading to more people being institutionalized, which in turn strengthens the argument for funding SSLCs over community services.

At the root of all this suffering is a political system that has no interest in addressing the needs of the most vulnerable Texans. The state’s leadership views people with intellectual and developmental disabilities as little more than a line item on a budget spreadsheet — an expense to be minimized rather than a population to be cared for.

Governor Greg Abbott, a man who rarely misses an opportunity to trumpet Texas’s booming economy and low taxes, has steadfastly refused to expand Medicaid, even though doing so would bring billions of dollars in federal funding into the state. His rationale? Expanding Medicaid would “grow a broken system.” But the real reason is simple: Texas Republicans have built their brand on resisting anything that smacks of “big government,” and they’d rather let people suffer than be seen as giving in to Washington.

The refusal to expand Medicaid is the purest distillation of the state’s priorities. It’s not about saving money; it’s about political theater. Texas has the resources to provide care for everyone on the waiver list, to raise DSP wages, to ensure that every person with IDD gets the support they need. But it won’t, because that would require acknowledging that the current system is broken and that the state has a moral obligation to fix it.

In Texas, that kind of acknowledgment is seen as weakness. And so, the suffering continues.

For people with intellectual and developmental disabilities in Texas, there is no “Lone Star miracle.” There is only waiting, neglect, and abandonment. Families are left to fend for themselves, caregivers are paid starvation wages, and the most vulnerable Texans are shuffled off to institutions where they are forgotten.

This is not an accident. It is a deliberate choice, made by politicians who value ideology over human life. Until Texas’s leaders stop treating IDD services as a political pawn and start recognizing the basic humanity of the people they’ve abandoned, nothing will change.

And in the meantime, more Texans will suffer, more families will break under the strain, and more lives will be lost to a system that’s as broken as the politicians who created it.

You can view our sources and citations in our research document found here.

View the Texas Watchdog article Death by Ideology: How Texas’s Refusal to Expand Medicaid Is Killing Rural Texans and Destroying Healthcare here. 

The refusal to expand Medicaid in Texas has left hundreds of thousands of low-income Texans, particularly in rural areas, without access to affordable healthcare. This decision, led by the state's conservative political leadership, has had catastrophic consequences for healthcare facilities, patients, and communities across the state. With Texas leading the nation in the number of uninsured residents, the absence of Medicaid expansion has worsened the already precarious situation for rural hospitals, working-class families, and healthcare providers. Rural Texans, who are disproportionately affected by this policy, find themselves trapped in a broken system that seems to care more about ideology than human lives.

This investigation examines the impact of Texas's Medicaid non-expansion policy on rural communities, based on the reporting by KERA News, Texas Tribune, and ruralhealthinfo.org, and will delve into the political motivations behind this decision, the devastating economic and health outcomes, and the preventable deaths that have resulted from this ongoing healthcare crisis.

The heart of this crisis lies in the refusal of Texas’s political leaders, spearheaded by Governor Greg Abbott and Lieutenant Governor Dan Patrick, to expand Medicaid under the Affordable Care Act (ACA). Despite overwhelming evidence of the benefits Medicaid expansion could provide—including a $5.4 billion influx of federal funds annually—Texas Republicans have doubled down on their ideological opposition to the ACA, often branding it as “Obamacare” to stoke political resentment among their conservative base.

Abbott has called Medicaid expansion a “massive expansion of an already broken and bloated Medicaid program,” choosing instead to stick with the status quo. This rhetoric may play well with conservative voters who fear government overreach, but it leaves nearly 800,000 Texans in a coverage gap—earning too much to qualify for Medicaid but too little to afford private insurance. This ideological grandstanding leaves rural Texans, who often don’t have access to the same wealth of healthcare options as urban areas, struggling to access even basic medical care.

The irony here is palpable. Texas, with its reputation for self-reliance and independence, is sacrificing the health and well-being of its residents, especially in rural areas, on the altar of political ideology. And it’s not just a few people suffering—nearly 15% of Texas’s population lives in rural areas, and many of them are uninsured.

If there’s one visible consequence of Texas’s refusal to expand Medicaid, it’s the closure of rural hospitals. In the last decade, 21 rural hospitals in Texas have closed, and another 26% are at risk of closure, according to a 2022 report from Kaufman Hall. These hospitals serve as lifelines for communities spread out over large distances, often with no other healthcare options for miles. Without them, routine medical care, emergency services, and life-saving treatments are out of reach for many rural Texans.

This isn't just a healthcare problem; it's an economic disaster. Rural hospitals are often some of the largest employers in their communities. When a hospital closes, the economic ripple effects are devastating. Jobs are lost, families leave, and local businesses that relied on the hospital’s staff and patients for revenue also suffer. It’s a downward spiral that pushes already struggling rural economies even closer to collapse.

But why are these hospitals closing? One of the biggest reasons is the amount of uncompensated care they provide. Without Medicaid expansion, many rural Texans remain uninsured and cannot afford to pay for medical services. As a result, hospitals are forced to provide care for free, but they still have to cover the costs of staff, equipment, and supplies. In 2019, rural hospitals in Texas faced uncompensated care costs of 3.81% of their operating expenses, compared to 3.12% for urban hospitals. In Medicaid expansion states, this figure is even lower—2.55%—which highlights just how much Texas is losing out on by refusing to expand coverage.

Texas hospitals are hemorrhaging money because the state refuses to take federal funds that would help cover these uninsured patients. It’s as simple as that. And as these hospitals continue to close, more rural Texans are left without access to the care they desperately need.

Texas’s Medicaid eligibility criteria are among the most restrictive in the nation. To qualify for Medicaid as a parent in Texas, your income must be less than 17% of the federal poverty level—around $3,733 annually for a family of three. Childless adults, regardless of income, don’t qualify for Medicaid at all. This leaves a huge number of working Texans—people in low-wage jobs, many of whom are essential workers—without access to affordable healthcare.

In industries like construction, food services, and home healthcare, workers often make too much to qualify for Medicaid but not enough to afford private insurance. These are people who are vital to Texas’s economy, yet they are being left behind. Around 77% of those in the coverage gap are in families where at least one person works, and 42% are women of reproductive age.

Without Medicaid expansion, these workers are less likely to have a regular source of healthcare, more likely to delay or avoid necessary treatment, and at higher risk of medical debt and bankruptcy. For them, an unexpected illness or injury can be financially ruinous, pushing them further into poverty.

The fact that Texas’s leaders continue to deny these people healthcare while they work for low wages is not just a policy failure—it’s a moral one. These are the people who keep Texas’s economy running, and they are being abandoned by a state government that values ideological purity over human lives.

With rural hospitals closing and Medicaid expansion off the table, Federally Qualified Health Centers (FQHCs) have become the safety net for many uninsured Texans. These centers provide care for underserved populations, but they are also stretched to their limits. About a third of patients at FQHCs in Texas have Medicaid, while nearly a quarter are uninsured. The demand for services far exceeds the capacity, and with limited resources, these health centers are struggling to keep up.

For uninsured patients, the cost of care is often prohibitive. A visit to an FQHC might cost $350, but an uninsured patient might only be able to pay $30-$40, leaving the center to absorb the rest. This means fewer resources for expanding services, fewer staff to handle the growing number of patients, and longer wait times for care. As a result, uninsured Texans often don’t seek care until their condition becomes severe, which leads to more expensive and complicated treatments down the line.

The lack of Medicaid expansion also impacts the ability of these centers to recruit healthcare providers. Working in a community health center can be financially unstable, and providers may prefer to work in urban settings where salaries are higher and there are more opportunities for career advancement. This staffing shortage exacerbates the already limited access to care in rural areas.

The consequences of Texas’s refusal to expand Medicaid are not just financial—they are fatal. Between 2014 and 2017, an estimated 2,920 Texans aged 55-64 died prematurely because the state refused to expand Medicaid. These are deaths that could have been prevented if these individuals had access to regular healthcare.

Chronic conditions like diabetes, hypertension, and heart disease go untreated or poorly managed when people don’t have access to care. Without insurance, people are less likely to take medications regularly, less likely to see a doctor for check-ups, and more likely to end up in the emergency room when their condition worsens. The result is a healthcare system that spends far more on emergency care and hospitalizations than it would on preventive care, but with far worse outcomes for patients.

Maternal and infant health in Texas is also a significant concern. The state has one of the highest maternal mortality rates in the country, and uninsured women are at significantly higher risk. Expanding Medicaid would provide prenatal care and reduce the risk of complications for both mothers and babies. Yet, Texas’s leaders continue to deny this coverage, putting the lives of women and children at risk.

The refusal to expand Medicaid is costing Texas billions of dollars in federal funding—money that could be used to improve healthcare access, keep rural hospitals open, and provide insurance for hundreds of thousands of Texans. Expanding Medicaid would bring in an estimated $5.4 billion per year in federal funds, money that could cover the cost of care for low-income Texans and reduce the financial strain on healthcare providers.

The economic benefits of Medicaid expansion are clear. It would create jobs, strengthen rural economies, and ensure that more Texans have access to the care they need. States that have expanded Medicaid have seen significant improvements in health outcomes, including lower mortality rates, earlier detection of cancer, and better management of chronic diseases. Yet, Texas continues to reject these benefits, leaving its most vulnerable residents to fend for themselves.

At the heart of Texas’s Medicaid crisis is a simple truth: the state’s leaders care more about maintaining their ideological opposition to “Obamacare” than they do about the lives of rural Texans. The decision not to expand Medicaid is not based on sound economic reasoning or concern for the state’s healthcare system—it is a political stance that sacrifices the well-being of millions of Texans for the sake of partisan purity.

Rural Texans, the backbone of the state’s economy, are the ones paying the price. They are losing their hospitals, their access to care, and, in many cases, their lives. Until Texas’s leaders put people over politics, this crisis will only continue to worsen.