Lomi Kriel

By Lomi Kriel, The Texas Tribune and ProPublica July 20, 2022

While celebrating last month’s U.S. Supreme Court decision overturning the constitutional right to an abortion, Gov. Greg Abbott pointed to the millions of dollars in spending that state lawmakers approved during the 2021 legislative session to help pregnant women and new mothers.

Among the measures he touted was a law that extended Medicaid health care coverage for pregnant women until six months after they give birth or miscarry, exceeding the federal government’s requirement that states provide at least two months of the benefit.

“Texas is a pro-life state, and we have taken significant action to protect the sanctity of life,” the Republican governor said in a June 24 statement. “Texas has also prioritized supporting women’s healthcare and expectant mothers in need to give them the necessary resources so that they can choose life for their child.”

Abbott’s statement neglected to mention that Texas lags behind at least 33 states, including 11 led by Republican governors, as well as the District of Columbia, all of which have already expanded or are working with the federal government to extend postpartum Medicaid benefits for a full year after giving birth. In 2021, the Texas House passed a measure that would have lengthened that coverage to 12 months, but during the waning days of the legislative session one of the senators who co-authored the state’s restrictive abortion law halved the time period.

Texas is among a dozen states that have also declined to expand broader Medicaid coverage under the Affordable Care Act to additional people with low incomes, leaving it with some of the strictest eligibility requirements in the country. For example, single parents with one child must earn $196 or less a month to qualify.

“It is such hypocrisy,” Adrienne Lloyd, a senior health policy associate for the Children’s Defense Fund Texas, said about the contrast between state legislators’ battle against abortion access and the services they provide to pregnant people. “If you really care about that health and safety, then the pregnant person and baby will have so much better outcomes if they're covered long before and after giving birth.”

The state’s Maternal Mortality and Morbidity Review Committee recommended extending postpartum Medicaid to one year in a 2020 report that showed cardiovascular and coronary conditions, along with mental disorders, were the leading causes of deaths related to pregnancy. Nearly a third of 54 deaths determined to be directly tied to pregnancy occurred between six weeks and 12 months after birth, the committee found as part of an analysis of 2013 data, the most recent available.

Medicaid is the most comprehensive federal- and state-funded health coverage offered to pregnant people and new parents. The assistance, which is generally available to people with low incomes or with disabilities, has higher income thresholds for those who are pregnant. Medicaid covers hospital visits, specialist care and X-rays that are not provided by other Texas programs.

Extending the eligibility period is critical, said Dr. Carla Ortique, a gynecologist and vice chair of the review committee, because treatments for many of the primary causes of pregnancy-related deaths, such as postpartum depression and cardiomyopathy, take time to work.

“It makes a difference in your outcomes and has been shown to make a difference for future pregnancies,” Ortique said.

Had the state’s lawmakers heeded recommendations to extend the eligibility period beyond six months, Texas could have led the nation in expanding postpartum Medicaid for pregnant people instead of trailing behind, said Diana Forester, director of health care policy at Texans Care for Children, an advocacy group.

“Why wouldn’t we want to manage those chronic conditions for that first year postpartum so that they can focus on getting healthy and getting back to work and ensuring their kid has what they need to succeed? It just seems like a no-brainer,” Forester said.

A spokesperson for Abbott did not respond to questions about the Legislature’s decision or whether the governor supports the longer coverage period.

As it stands now, people who are eligible for Medicaid during their pregnancies are allowed to stay on the program indefinitely under federal pandemic rules. But that extended coverage could end as soon as this fall if President Joe Biden’s administration allows the emergency declaration to lapse, making states’ Medicaid eligibility decisions critical for new parents in need of health care coverage.

To qualify for pregnancy-related Medicaid, single people having their first child need to make $3,022 or less a month, compared to a $196 monthly income cap otherwise.

Connie Bunch, a single mother from Abilene, understands the consequences of losing health care coverage too soon after giving birth.

Bunch received Medicaid in 2013 while pregnant with her first child at age 28, marking the first time she had health care coverage as an adult. At the time, Texas had not yet passed any legislation that exceeded the federal government’s requirement, so she lost the benefits two months after giving birth.

The new mother couldn’t manage the cost of private insurance through the Affordable Care Act. And the $600 average monthly income Bunch received from her part-time job, child support and disability assistance for her daughter’s cerebral palsy kept her from qualifying for Medicaid under Texas’ income requirements once her postpartum benefits expired.

As a result, Bunch could no longer pay for doctors’ visits and treatment related to the high blood pressure, hypertension and gestational diabetes that doctors had diagnosed her with during her pregnancy. Diabetes affects about one in 10 pregnant people across the country, and two of the top six causes of maternal mortality in Texas are related to high blood pressure.

Without medication, Bunch said, she suffered debilitating headaches, exhaustion and a loss of appetite.

Once Bunch became pregnant with her second child last year, she again qualified for Medicaid. Her extended coverage has allowed her to once more have access to hypertension and diabetes medications. She said her headaches have disappeared, she’s no longer tired all day and her blood pressure has stabilized.

Now living closer to family in Austin, Bunch said she hasn’t been able to work because she cannot afford child care. Her monthly income shrunk to $350 from the child support and disability payments she receives. But it is still too much to qualify for Medicaid coverage, except for that specifically provided to people after they give birth.

This means that as soon as the federal freeze ends, Bunch will lose coverage.

“That’s really scary,” Bunch said. “That’s something that I really worry about.”

Connie Bunch plays with her son Aiden and 9-year-old daughter Brooklyn in her Austin home. Credit: Montinique Monroe for ProPublica/The Texas Tribune

“Philosophical” resistance to Medicaid

In April 2021, Toni Rose, a Democratic state representative from Dallas, went before the 150-member Texas House to lay out her bill to expand Medicaid to a full year after pregnancy. Within three minutes, the bill passed the chamber with bipartisan support. Some lawmakers applauded its passage.

The ease with which the measure sailed through the House inspired advocates to hope that the 12 months of coverage stood a chance to become law in Texas. Of the 14 members of the public who testified on the bill during a House committee hearing, not one spoke against the measure. And not a single representative publicly raised concerns about the bill before it eventually passed by a 121-24 vote.

More than a month later, on the same day that Abbott signed into law the Texas Heartbeat Act, which banned most abortions after about six weeks of pregnancy, the state Senate took a different approach.

During a hearing that month, Lois Kolkhorst, the Senate sponsor for the postpartum Medicaid bill, ticked off a list of states that had applied to the federal government to extend coverage for new parents to 12 months or that were considering passing legislation to do so.

But she said that, at the time, only Illinois had fully enacted such coverage. Missouri, she said, had limited its extensions to substance abuse and mental health services. On the other hand, Georgia had extended full Medicaid benefits but limited them to six months, said the Republican, who represents the small Central Texas city of Brenham and chairs the Senate’s Health and Human Services Committee.

“Certainly, Texas would be on the cutting edge of this if we were to pass this bill in any form, extending past the 60 days,” Kolkhorst said.

Although her bill put forward the 12-month extension approved by the House, Kolkhorst did not indicate a preference for the full year of postpartum coverage. Instead she referenced what she characterized as a common criticism of the federal program, saying, “I think it’s a great discussion of what is the right number and some people say, well, once you get pregnant, you stay on Medicaid for forever.”

Kolkhorst suggested that Texas was already a leader, pointing to a program that she helped create in 2019 called Healthy Texas Women Plus that offers 12 months of postpartum coverage. The program aims to provide some of the benefits available through Medicaid, primarily those that would help prevent the leading causes of deaths associated with childbirth. Most eligible Texans haven’t had to use it because they still qualify for Medicaid under the federal pandemic freeze. And Kolkhorst acknowledged that Medicaid was a “more comprehensive plan.”

Women’s health advocates and physicians have criticized the Texas program as what one called a limited “package of outpatient services,” because it does not include what they said is the full range of necessary care, such as emergency room visits, specialist appointments and hospitalizations. The state initiative also has a far smaller network of providers, which experts said makes it harder to get treatment.

After the May hearing, Kolkhorst accepted an amendment by Sen. Dawn Buckingham, a Republican from Austin and an eye surgeon, that slashed the House’s proposed postpartum coverage in half.

Buckingham never publicly raised concerns about the 12 months of care during committee hearings or before the full Senate. Rose, the representative who authored the measure in the House, said when she raised questions about the cut, Kolkhorst replied that she thought six months was “progress.”

The Senate passed the amended bill just after 3 a.m. on May 27, four days before the end of the session.

Neither Kolkhorst nor Buckingham, who were among the authors of the state’s restrictive abortion bill during the same legislative session, responded to requests for comment.

Kel Seliger, a Republican senator from Amarillo who serves on the Health and Human Services Committee, said the aversion to further extending postpartum coverage stems from a fundamental opposition by some Republicans to Medicaid expansion.

“There was philosophical resistance,” he said. “Medicaid is quite removed from Obamacare. We’ve been doing Medicaid for a long time. But it got to the point where Medicaid expansion was simply a buzzword for Obamacare.”

Seliger said he thought six months of postpartum Medicaid coverage was a sufficient compromise.

“I think it’s practical to increase Medicaid by three times” the minimum required by the federal government, he said. “And let’s see what the effect is. And let’s see where the Medicaid population goes and let’s see what the cost is.”

Texas House researchers estimated in March 2021 that the cost to the state of extending postpartum Medicaid coverage to a full 12 months would be about $84 million over the first two years. The six months of care that was instead approved by the Legislature is projected to cost an average of about $40 million annually during its first four years of implementation.

The federal government pays for nearly 60% of overall Medicaid expenses in the state. It does not contribute to Healthy Texas Women Plus, although the state requested federal funding for the program in December. Approval from the federal Centers for Medicare & Medicaid Services is pending.

Dade Phelan, the Republican Texas House speaker, blamed the Senate in a statement to ProPublica and The Texas Tribune, noting his chamber voted overwhelmingly for the expanded coverage.

“The Senate refused that proposed extension for vulnerable mothers who chose life, so ultimately we landed on extending coverage to six months,” said Phelan, who is from Beaumont in southeast Texas. “The Texas House has and will continue to make certain that we support Texas women and children.”

Extending postpartum Medicaid coverage does not force states to accept the federal government’s broader Medicaid expansion.

Nearly three dozen states have opted to lengthen postpartum care to 12 months since April 2021, including seven that, like Texas, did not expand Medicaid more broadly, according to KFF, a national health care nonprofit tracking the proposals. Even Georgia, the state Kolkhorst referenced in her Senate testimony as having extended benefits for only six months, approved a full year of postpartum care in May.

If all states approved that coverage, as many as 720,000 pregnant and postpartum people in all could qualify, according to the federal government.

Many states took advantage of a streamlined process for taking such action under the 2021 American Rescue Plan Act. States must seek permission from the Centers for Medicare and Medicaid Services if they want to provide health care coverage beyond the 60 days required under the law, but the act made it easier to extend coverage to a full year.

Texas and Wisconsin, the two states so far to request approval for shorter time periods, must still go through a lengthy waiver process. If the Medicaid freeze ends before the federal government approves Texas’ proposal, people who would have been included in the state’s six-month postpartum coverage could temporarily lose that care, experts said.

The Biden administration, in a maternal mortality report released last month, called on Congress to require extending postpartum Medicaid to a full year. The report said this could eliminate “potentially deadly gaps in health insurance at a critical time for individuals.”

People are dying from pregnancy-related causes in the U.S. at a higher rate than in any other developed nation, the report said.

About 700 people die annually in the U.S. because of pregnancy-related complications, about one-third occuring one week to a year after they have given birth, according to the CDC. Texas ranks among the 10 worst states in the country for maternal mortality.

Growing push

Rose said the Supreme Court’s elimination of the constitutional right to an abortion is an important test to see if her Republican colleagues in the Senate are willing to provide other basic supports to pregnant people.

She plans to re-file the bill to extend Medicaid coverage to a full year on the first day of the upcoming legislative session in January.

“If you want women to have babies, then you need to make sure that they have the health care that they need in order to carry those babies and to have the comprehensive health care that they need after delivery,” Rose said.

She has support from health care advocates who have been asking for the bill to be reconsidered and from Phelan, the Republican House speaker, who told the news organizations that next session “the House will double down on prioritizing maternal health care and other resources for women, children and families in our state.”

Phelan specifically cited the one-year postpartum Medicaid extension as a priority.

A spokesperson for Lt. Gov. Dan Patrick, who sets the legislative agenda for the Senate, did not respond to questions about whether he would support the passage of such a measure. Last May, Patrick told Spectrum News that he supported the bill but “we just needed to make it less than a year.”

For Bunch, remaining on Medicaid during the federal government’s public health emergency beyond what the Texas Legislature would have allowed has meant that she could treat many of her health conditions.

She will undergo a hysterectomy in August after she said physicians told her that her health conditions mean “another baby will kill you.” She could not afford a sterilization procedure, which typically would require hospitalization not paid for by Texas programs, without her Medicaid coverage.

Last month, doctors found a small aneurysm on Bunch’s brain, which can result from high blood pressure. Bunch said they told her that her family history made treatment particularly important. Doctors said she should also see a cardiologist for abnormalities with her heart rhythm.

Several of the additional services Bunch would need are not covered by the state’s postpartum pregnancy program, leaving her fretting about how she will manage if she loses Medicaid.

The mother said she does not personally believe in abortion. But she criticized Republican lawmakers for pushing to outlaw the procedure without doing more to care for women like her after they give birth.

“On the one hand, they say, ‘No, you need to be a parent,’” Bunch said. “But then it’s like, ‘We don’t care if you’re a healthy parent.’”

She added, “It's like, ‘Have that baby, but then we're throwing you to the wolves.’”

Connie Bunch takes her hypertension and diabetes medication in her home in Austin. Credit: Montinique Monroe for ProPublica/The Texas Tribune

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This article originally appeared in The Texas Tribune at https://www.texastribune.org/2022/07/20/texas-postpartum-medicaid-abortion/.

The Texas Tribune is a member-supported, nonpartisan newsroom informing and engaging Texans on state politics and policy. Learn more at texastribune.org.

By Lomi Kriel, The Texas Tribune and ProPublica, and Uriel J. García, The Texas Tribune

Nearly four dozen migrants were found dead in an overheated tractor trailer on an industrial road in south San Antonio Monday. Many of them had been sprinkled with steak seasoning in a possible attempt by smugglers to ward off authorities, law enforcement officials said.

The sheer scale and disturbing details, including migrants who apparently tried to escape the suffocating triple-digit temperatures inside the truck by jumping to their deaths along several city blocks, were horrific.

Large numbers of fatalities along the most heavily trafficked northbound path from Mexico and Central America, for decades the route of those seeking the American dream, are not unusual or unprecedented. Still, the staggering amount Monday, more than any in recent memory, stunned law enforcement and migrant advocates alike.

The magnitude may reflect more migrants seeking increasingly dangerous pathways to come here as enforcement policies along the border — both by the Biden administration and Texas Gov. Greg Abbott — have strengthened. Biden has kept in place a pandemic-era regulation from the Trump administration that expels many migrants immediately without asylum hearings.

Immigration officials have recorded a record number of apprehensions at the southwest border under the Biden administration, with most single men and some families sent back to Mexico. People caught crossing repeatedly have also peaked under the administration’s policies, which effectively curtail many asylum-seekers.

As the prospect of being able to stay in the U.S. and seek that protection has become more difficult, deaths have risen. At least 650 migrants died crossing the U.S.-Mexico border in 2021, more than in any other year since the International Organization for Migration, a part of the United Nations, began tracking the data in 2014.

“The border is more closed down now than almost any time in history,” said Allison Norris, a supervising attorney for immigration legal services for the Catholic Charities of the Archdiocese of Washington. “This has led folks to increasingly seek out smugglers and engage in more dangerous ways of getting across the border.”

She said most of her clients would prefer to turn themselves into official ports of entry at the border and seek asylum rather than crossing illegally, which is usually much more dangerous and involves risky journeys through thick Texas brush or deserts and ruthless smugglers.

But under the Trump and Biden administrations’ policies of expelling migrants or keeping them in Mexico to wait for their asylum hearing, that was more difficult, she said.

Before Monday, the worst smuggling-related mass fatality in recent Texas history came in 2003, when 19 people died after being trapped in an unrefrigerated dairy truck for hundreds of miles.

Authorities later estimated that the temperature rose above 170 degrees as the desperate migrants inside tried to claw their way out of the insulated trailer. The Houston-bound truck stopped in Victoria, where the driver unhitched the trailer and drove off.

Seventeen people were found dead in the trailer, and two later died. The driver was ultimately tried on federal charges and sentenced to 34 years in prison.

San Antonio was the scene of another mass tragedy in 2017, when 39 people were found in a truck trailer in a Walmart parking lot. Eight died in the truck, and two later at a hospital. The driver of the vehicle was sentenced to life in prison without parole.

In 1987, 19 men died after being left locked in a boxcar on a railroad siding near Sierra Blanca in far West Texas in what a Border Patrol official at the time called “a tragic series of errors and misjudgments.”

The men had crossed into the United States near El Paso, and were herded by a smuggler into a heavily insulated boxcar with massive thick floors and walls. The Dallas-bound car sat on a siding for hours as the temperature inside soared.

The men tried to escape, but the floors were too thick, a lone survivor later told authorities.

The use of commercial vehicles to smuggle people into the United States from Mexico, or move undocumented individuals already in the country, is a decades-long problem. There is little evidence the problem has lessened with the enhanced presence of National Guard and Texas Department of Public Safety troopers along the Texas-Mexico border this past year as part of Abbott’s controversial border security program, Operation Lone Star.

Earlier this month in Corpus Christi, a 24-year-old Mission resident pleaded guilty to federal smuggling charges for trying to transport 73 people in a tractor-trailer. He was arrested at the Border Patrol checkpoint near Falfurrias after a search of his vehicle found dozens of people inside from Ecuador, Guatemala, Honduras, Peru, Mexico and El Salvador.

Last January, a Texas Department of Public Safety trooper found 28 migrants hidden inside a tractor-trailer’s sleeping cab. The driver has been charged with 28 counts of human smuggling and evading arrest.

DPS through the governor’s Operation Lone Star efforts has tried to highlight how its efforts are working to stop illegal immigration, even as the number of migrants crossing the border into Texas have surged nearly every month.

On the agency’s Facebook site, videos show arrests including one from March in Carrizo Springs, where 76 migrants were discovered inside a commercial truck.

Not all commercial vehicles used are large 18-wheelers. In April 2016, a Michigan man was arrested trying to illegally transport 10 undocumented individuals inside a padlocked Penske rental truck. The defendant told Border Patrol agents that he had picked up the truck in Laredo and was driving it to Corpus Christi. The driver had no key to the truck’s rear cargo area and temperatures were already in the 90s. An X-ray of the truck revealed the truck driver’s human cargo

In recent years, Mexico has stepped up its own policing of smuggling under pressure from the United States. In 2019, more than 200 migrants were discovered hidden in secret compartments in various trucks by an X-ray scanner used by Mexico border officials.

U.S. transportation officials have long waged a public relations campaign against human smuggling via commercial ground vehicles. The Federal Motor Carrier Safety Administration offers training on how to spot smugglers.

The more than a dozen migrants, including children, who remain hospitalized from Monday’s tragedy in San Antonio might qualify for a visa providing legal residency in the United States for migrants who are crime victims or cooperating witnesses, said Norris, the attorney with Catholic Charities of the Archdiocese of Washington.

But some qualifying migrants could have a harder time tapping this immigration benefit because of Title 42, the pandemic health order the Trump and Biden administrations have used more than 2 million times since March 2020 to immediately expel a majority of recent border crossers, including asylum-seekers.

Taylor Levy, an immigration attorney in California, said it’s likely that the surviving migrants could be held in federal custody during the investigation and ultimately kicked out of the country.

“Unfortunately, we have seen in the past that being victimized by one’s smugglers is oftentimes insufficient to protect from being deported,” Levy said.

Terri Langford contributed to this report.

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When Guy Schwartz heard about the shooting at an elementary school that killed 19 children and two teachers in Uvalde this week, his heart sank, both as a father of two and a lifelong member of the National Rifle Association who for months had eagerly awaited this year’s convention in Houston, the first after the pandemic canceled it for two years.

“It is just unimaginable,” said Schwartz, a 67-year-old insurance broker in Las Vegas, Nev. “I couldn’t imagine sending my kids to school and then not coming home.”

But as he admired the display of new assault rifles at a booth in the sprawling George R. Brown Convention Center downtown, Schwartz said he knew the shooting would once again inflame the tense debate about gun control in the U.S., which he said always seems to vilify responsible gun owners like himself who simply want to protect the Second Amendment.

“Every time we have a whack job that shoots up people, it puts us under stress,” he said.

Thousands of devoted NRA members descended to Houston on Friday, 250 miles east of the site where the children, all 10 years old or younger, were gunned down by an 18-year-old with two legally purchased assault rifles. They attended the event, which was headlined by former President Donald Trump — just 72 hours after the massacre — despite other speakers and musical performers canceling out of respect for the victims and as Democrats and gun control advocates called for the event to be canceled or moved.

In interviews with The Texas Tribune, a dozen NRA convention attendees were horrified by the Uvalde shooting. But they were also unified in their belief that the shooter’s access to guns was not to blame.

Instead, they attributed this attack and others to a broader breakdown in society wrought by the removal of God from public schools, the decline of two-parent households, a perceived leniency toward criminals, social media and an increase in mental illness.

They described feeling ostracized for their beliefs, and not just those on guns. For their refusal to get the COVID-19 vaccine. For their objections to gay people serving as teachers. For their belief in disciplining children through spanking.

“Society is going downhill and the problems are getting bigger and bigger,” said Lyndon Boff, a 67-year-old retiree from Florida. “I hate that so many people got killed in this shooting. But the first thing you have is a president that says ‘we got to do something about it, because it’s guns that killed the people.’ No. It’s their programs teaching children in school that our country is a bunch of crap.”

For many, conversations about gun rights quickly slipped into other cultural topics as they framed any attempt at curtailing gun rights as chipping away at their freedoms, preventing their ability to defend themselves and changing America’s culture as a whole.

“It’s not a gun problem, it’s a society problem,” said Bill Forcht, a 71-year-old retired management executive at the Coca-Cola company who lives in Magnolia, just outside of Houston. “They want to demonize us because we like shooting guns and believe in defending ourselves.”

Their sense of a culture under siege was underscored by more than 1,000 protesters across the street, chanting furiously and waving signs such as “their blood is on your hands” and asking attendees at the convention to “honor the sacrifice of our brave school children who lay down their lives to protect our right to use AR-15s.”

Watching the protests on the sidewalk outside the convention center, a 53-year-old Tennessee woman who would only identify herself by her first name, Anna, said the obvious response to Uvalde would be to arm classroom teachers.

“If you allow somebody to defend themselves the way our Second Amendment was intended… you’ll stop a lot of this,” she said. “Stop pussy-footing with these poeple.”

Her husband Paul, 68, struck a more conspiratorial tone, suggesting without evidence that gun control advocates planned the Uvalde attack to gin up public support for their cause.

Inside the cavernous downtown Houston event space, the convention proceeded as if the type of AR-15 rifle on display in dozens of booths had not been used to kill 21 people just days earlier. Thousands of attendees, who skewed older and whiter than the average demographics of Texas, perused exhibits, attended seminars and voted in a NRA leadership election.

Some of the vendors reflected the gun organization’s roots representing the interests of hunters and sport shooters. Others showcased historic firearms with little modern application. A significant number of vendors and classes promoted guns for self-defense, reflecting the modern NRA’s hardline stance opposing almost any regulation of gun ownership. One seminar offered tips on how to draw a pistol as quickly as possible; a video advertising a vendor’s short-barreled semiautomatic rifle depicted a man using the weapon against a home invader.

The rhetoric of the event’s speakers and attendees conceded a troubling theory: That no government intervention or policy can stop gunmen intent on slaughter from assaulting our schools, offices and other public spaces. They posited that the best society can hope for is to stop them from entering by improving armed security and physical barriers. And if those fail, the responsibility to stop a rampage and triage wounded falls on average citizens with personal weapons.

At an active threats seminar Friday morning, presenter Kris Sacra said training average citizens on how to stop blood loss from gunshot wounds can minimize deaths during mass shootings. He added this is especially important when — as was in the case in Uvalde — first responders cannot or will not intervene quickly.

“Each one of my girls has a ballistic plate in their backpack,” Sacra said. “Each one of my girls knows how to put a tourniquet on.”

The afternoon speakers at the main event echoed those points. Each condemned the Uvalde attack but none of their proposed reforms to prevent future shootings involved restrictions on guns. Gov. Greg Abbott, who canceled his planned in-person speech in favor of a taped one, said new laws would not have stopped the Uvalde shooter because he didn’t bother to follow existing ones — first by bringing a gun onto school grounds and then by committing murder.

Republican Sen. Ted Cruz spoke about “evil” that caused the shooting in Uvalde and has happened “too many damn times.” He said the Second Amendment has “never been more necessary” during a period when he said there were practices of “defunding the police,” increasing homelessness and district attorneys who “refuse to prosecute violent crime.”

He said attempts to restrict access to guns would not work, but offered few ideas for what would. Most notably, he said schools should have single entry points much like federal buildings and suggested installing bulletproof doors and locking classrooms.

“At that single point of entry, we should have multiple armed police officers,” Cruz said. “Or if need be, military veterans trained to provide security and keep our children safe.”

Former President Donald Trump, who criticized Abbott for his absence, made similar suggestions for improving physical security at schools.

Such a lack of any substantive recommendations filled Paul Castro with rage as he stood across the convention center in Discovery Green park, holding a giant photo of his 17-year-old son, David. The teen was shot and killed last year after the family left an Astros baseball game in downtown Houston.

Police have said a twice-convicted felon who should never have had a gun followed Castro onto Interstate 10 after he didn’t let him merge during snarled post-game traffic. He shot into the truck, killing the teen. Castro held David as he died.

“It makes me mad at the same politicians saying the same thing that they have been saying since Columbine,” said Castro, a superintendent at A +UP Charter School in Houston.

Limiting school entrances and arming teachers are laughable, he said, if the topic wasn’t so critical. He noted that police in Uvalde didn’t enter the elementary school for almost an hour, according to authorities. DPS Chief Col. Steve McCraw on Friday blamed a supervising officer who wanted to wait for backup officers and equipment.

“Armed police were on the premises and didn't go in and now you want Miss Smith in elementary school to take a shot?” the superintendent asked. “It’s disingenuous and a lie and it stops politicians from taking responsibility. It is hypocrisy at its worst.”