In a state once considered one of the most affordable places in the country, candidates have popped up at barbershops and in voters’ homes vowing to tackle a new problem for Texas: its cost-of-living woes.

In ads, they’re holding bags of groceries as they bemoan how expensive food, healthcare and gas have become. On the campaign trail, they promise to cut taxes and give away money to help people thrive in Texas.

The word “affordability” is everywhere.

“Affordability has become the defining issue of this cycle and the voters want candidates to speak on it,” said Michael Adams, a professor and director of the Master of Public Affairs Graduate Program at Texas Southern University.

From housing to groceries and gas, Texans’ regular expenses have risen considerably in the past several years. As those costs have grown, Texans have increasingly said the higher cost of living is one of the biggest problems facing the state.

As Texans feel the pinch from the rising cost of living, candidates in this year's midterms up and down the ballot and across party lines are desperate to convince voters they have the bona fides to tackle the affordability crisis.

In the state’s marquee Senate race, Republican Ken Paxton has floated tax breaks for families to help pay for health care and housing costs, and more ideas. Among the proposals from state Rep. James Talarico, his Democratic foe from Austin: abolishing the gas tax to help Texans’ transportation costs and expanding tax benefits for parents with kids.

Gov. Greg Abbott, seeking a fourth term, wants to abolish school property taxes and make it easier to build homes. State Rep. Gina Hinojosa, the Austin Democrat running to unseat him, wants to send $1,500 to every Texas household and stop Wall Street from buying single-family homes.

For decades, Texas was considered a bastion of affordability, with its relatively low cost of living used to lure residents and employers from other, more expensive states. But Texas hasn’t proven immune from the national cost-of-living crisis that’s center stage in this year’s midterm elections. Signs abound that the state’s affordability has eroded.

Among major spending categories, energy prices saw the biggest leap in the last decade — a 65% jump — driven by gas prices, surging demand, natural disaster recovery and hardening costs and expanding transmission infrastructure. Housing grew by 44% and food rose by 41%, outpacing the state's overall inflation of 35%. Healthcare costs rose 25% from 10 years ago.

While the statewide median household income rose more than $25,000 between 2014 and 2024, it represented a 14% increase after inflation. Poverty has fallen in Texas and across the country in the past decade, but Texas still had the second-highest number of households living below the poverty line in 2024. While those higher up the income ladder are feeling the pinch from higher prices, lower income Texans have long faced difficulties making ends meet.

What’s more is higher tariffs and stricter immigration policies under the Trump administration have hit Texas harder than other states, said Ray Perryman, a longtime Texas economist, owing to the state’s bounty of international trade and reliance on immigration to fuel job growth. Those effects have been at least somewhat offset by the state’s lower cost of living and gas prices relative to the rest of the country, Perryman said.

“The whole thing is something of a perfect storm,” Perryman said.

Those higher costs have fueled unease among Texas voters. Texans’ top concern used to be immigration. But amid rising costs and slowing immigration, a plurality of Texans now view inflation and higher prices as the most important issue facing the state, according to an August poll of registered voters by the Texas Politics Project at the University of Texas at Austin. Higher prices came in as the top issue for Republicans and independents and the second most important issue for Democrats behind political corruption, the poll found.

“When you ask Texans what they think the most important problem is, a large chunk, and a large chunk across the political spectrum, say that first of all rising prices and more generally the economy are big problems facing the state and big problems for them,” said James Henson, director of the Texas Politics Project.

And while candidates in the marquee races have floated proposals to address key pain points for Texans’ budgets, some ideas might be more partisan signaling than serious proposals that would make a real difference, experts said. Some ideas, if enacted, could wind up making life more expensive, they said.

Even as voters want candidates to tackle the problem, there’s some doubt any can rein in costs.

Santiago Quinonez, a 25-year-old data analyst in Austin, said he’s had to cut back on eating out as costs rise. His younger sister now lives with him to save money on rent.

Affordability will be top of mind for Quinonez when he heads to the ballot box in November, he said, a sentiment he said was common among his family members and friends. But he’s skeptical any candidate could solve the issue.

“Instead of just telling me that they’re going to do something, have a decent, concrete plan and details about how they’re going to do it, which I don’t think anyone really has,” Quinonez said.

Santiago Quinonez, 25, refuels his car at a gas station in Austin on Aug. 26, 2026.

What’s at stake politically

Amid a national midterm environment already slated to be a difficult one for the GOP, Republicans find themselves playing defense amid a slower economy even as Texas has largely done better than the rest of the country. That poses potential peril for Republicans just as it did Democrats two years ago, when they faced bruising losses as voters felt the squeeze from inflation.

Making matters difficult: President Donald Trump’s trade war and the Iran war have driven up costs, adding hundreds of dollars in additional expenses to the average American family’s budget each year.

Texas Republicans have long touted the state’s robust economic growth, but those declarations might fall short if voters don’t see themselves benefitting from that growth, Henson said.

“I just think it's made it harder for Republican incumbents to make those arguments, and even harder for Republican incumbents to talk about ‘the Texas miracle,’ because in several different dimensions, it's not feeling as miraculous anymore,” Henson said.

Texas Democrats see an opportunity to paint Republicans as having presided over the state as it got more expensive while doing little if anything to stop it.

“Texas Republicans have been in office for three decades, and they got us here,” said Manny Garcia, former executive director of the Texas Democratic Party. “They've been paying attention to their billionaire, millionaire donors, lining up their pockets instead of making sure that regular Texans can have opportunities.”

That sentiment can be found among voters. Cydney Murry-Berry, a 33-year-old human resources director and mother of two, grew up in a poorer neighborhood in East Austin, she said, but has worked her way to a comfortable life in South Austin and a job in Westlake Hills. Even so, Murry-Berry said she feels limited in her ability to continue moving up the financial ladder amid higher costs. Child care in particular has strained her family’s budget, and they’ve had to sacrifice family vacations and nights out.

Growing up in a poorer neighborhood, Murry-Berry said, has made her acutely aware of income inequality around the city and the state, something she said will factor heavily into her vote in November.

“I’ve been able to see all levels of that,” Murry-Berry said. “It’s really unfortunate that we have had the same governor for this long and there hasn’t been changes, it’s only gotten worse. You can see there’s a lack of understanding for those that do not look like they look and make what they make.”

Still, Democrats face a damaged brand after stinging losses in 2024. Republicans argue that Texas is in a better position to weather tough economic times than bluer states — and that Democrats wouldn’t make it better.

“Democrats have never proposed any initiative to lower the cost of living; it has always been more taxes and more spending,” said Eduardo Leal, press secretary for the Abbott campaign. “Governor Abbott’s answer is to lower costs and cut taxes.”

Republicans haven’t completely abandoned culture war issues like immigration and abortion. While urban and suburban voters were most concerned about inflation and higher prices, immigration barely edged out higher costs as rural voters’ top concern, according to the UT poll. Nonetheless, social issues have taken a back seat to the cost-of-living crisis on the campaign trail, said Vinny Minchillo, a Plano-based Republican strategist.

“No one can worry about social issues if they're worrying about where their next meal is coming from,” Minchillo said. “So in some ways, social issues are a little bit of a luxury.”

‘Fuel to the fire?’

Candidates in the marquee races have thrown out a litany of ideas to tackle high costs in a number of areas, including housing, healthcare, child care, property insurance and higher education.

Some of those ideas could move the needle, policy experts said. Others wouldn’t — and potentially could drive up costs instead.

State Rep. Gina Hinojosa, Democratic candidate for governor, speaks during her campaign launch event in Brownsville on Oct. 15, 2025.

Gov. Greg Abbott answers questions from the media during a press conference in Austin on Aug. 10, 2026.

Hinojosa wants to tap the state’s rainy day fund — essentially Texas’ savings account, which sat at a record $24.8 billion toward the end of last year — to send each Texas household a $1,500 check as a source of one-time financial relief. Hinojosa’s campaign estimates doing so would cost the state $17 billion.

That carries the possibility of driving inflation, said John Diamond, senior director of the Center for Tax and Budget Policy at the Baker Institute for Public Policy at Rice University. That’s what happened when the federal government sent $1,400 checks to U.S. families in the wake of the COVID-19 pandemic to provide financial relief and stimulate the economy, which experienced a growth in demand while the global economy was still dealing with supply chain problems.

Given that Texas is near full employment and inflation is above 2%, injecting $17 billion into the state’s economy could fuel demand and drive up prices, Diamond said.

“You really don't want to add any fuel to the fire,” Diamond said, adding that, “$17 billion is not a massive amount, but it's still enough to create some pricing pressures.”

Abbott’s property tax plan has drawn skepticism from tax policy experts across the political spectrum — particularly a proposal to cap how fast property values can rise, which wouldn’t guarantee lower tax bills while creating other side effects like higher housing costs.

Texas Attorney General Ken Paxton, the Republican nominee for U.S. Senate, speaks at a campaign event in Amarillo on May 7, 2026.

State Rep. James Talarico, the Democratic nominee for U.S. Senate, speaks at a campaign stop in Sanderson on July 13, 2026.

Paxton’s proposed income-tax deductions to help with homebuying and healthcare costs would flow to those making higher incomes and would provide little or nothing for lower-income families, who already have little tax liability to deduct from, said Andrew Lautz, senior director of federal policy at the conservative Tax Foundation’s Center for Federal Tax Policy.

Talarico has proposed expanding the federal Child Tax Credit and reinstating the Affordable Care Act’s enhanced premium tax credits to lower health insurance premiums, among other tax benefits.

There’s potential for tax breaks proposed by Paxton and Talarico to backfire, Lautz said. The ideas might ease pressure on household budgets in the short-term, he said, but if the federal government ultimately has to borrow money to pay for those breaks, that can also drive up inflation, Lautz said.

“The more our debt increases, the higher interest rates go throughout the economy, and the harder it is for folks to afford to borrow, to buy a home, or to buy a car, or go to college, or for a business to finance new investments,” Lautz said.

Hinojosa disputed the idea that her plan, which would need approval from the Texas Legislature, would drive inflation. Economists who vetted the plan, she said, believe a state-level payment wouldn’t have the same effects as the federal stimulus checks because it’s at a smaller scale.

But part of campaigning is about signaling what a candidate’s values are to voters, even if the policy proposals themselves aren’t completely solid, said Garcia, the former TDP executive director.

“It starts getting people an understanding of, ‘how would you approach the next problem?’” he said. “‘Are you going to side with the corporation? Are you going to side with me?’”

Beyond the financial relief, Hinojosa sees the checks idea as a way to rebuild trust in government at a time when distrust is high.

“We have to demonstrate to people that government can do something for the people of Texas. I mean, we pay for it,” she said.

Traffic moves around a CITGO gas station in Austin on Aug. 26, 2026.

Staff writer Kayla Guo contributed to this report.

This article first appeared on The Texas Tribune.

When the state's new fiscal year begins on Tuesday, Texas hospitals expect to lose $27 million a day in additional Medicaid funding.

The shortfall is the result of a decision by the Trump administration to withhold approval from Texas for about $9.8 billion in the next year from three programs, the bulk of which affects the Comprehensive Hospital Increase Reimbursement Program (CHIRP). This program gives hospitals additional funding to cover the difference between Medicaid rate payments and the actual costs that hospitals incur to provide services to Medicaid patients. Essentially, hospitals, which often are paid less than what they caspend on Medicaid patients due to outdated payment rates set by the state, are losing out on their additional reimbursement for 2027.

Local governmental entities collect taxes from hospitals — about $4 billion a year, according to the Texas Hospital Association — and under CHIRP, the federal government matches those funds so that Texas hospitals can then use them to cover the actual costs of providing Medicaid services. Hospitals say those CHIRP dollars are critical and if they lose that funding, they will likely have to cut services to patients.

Four million low-income Texans are enrolled in Medicaid, most of them children.

“It is impossible for a hospital to take a huge loss on a Medicaid side of their portfolio and not have that impact services across the board, regardless of what type of insurance a patient has,” said Sara González, a THA vice president of advocacy, public policy and political strategy.

In Houston alone, the impact could mean at least $258 million less for the public healthcare system there known as Harris Health and as much as $1.4 billion less for the region overall next year.

“The impacts would be catastrophic for Texas' safety-net healthcare system,” said Dr. Esmaeil Porsa, president and CEO of Harris Health. “We are carefully monitoring every dollar and would be forced to make difficult decisions about maintaining critical services if this impasse continues.”

The federal government is withholding these critical dollars because they are calling into question how local jurisdictions in Texas calculate the amount of taxes collected from hospitals.

Robert Fries, the chief financial officer for Children's Health in Dallas said in a statement that this type of funding is crucial for children's hospitals like Children's Medical Center. “Delays and uncertainty threaten access to critical pediatric specialty care, behavioral health services and the workforce needed to deliver that care," Fries said. "If these delays continue, it will become increasingly difficult to maintain the health care safety net that Texas children and families depend on every day.”

The impasse, which began quietly last December, has escalated to such an extent that Gov. Greg Abbott sent a pointed letter Aug. 7 to U.S. Health Secretary Robert F. Kennedy Jr. in which he stated that there’s nothing wrong with the way Texas hospitals’ local taxes are collected.

In it, Abbott refers to the funding holdup as an economic “gun to the head.”

“The tax structure previously enacted by the Texas Legislature, and being implemented daily by local governments, fully complies with federal law,” Abbott said in the letter. “What CMS is requesting does not.”

If the federal government insisted that Texas must restructure the way local governments tax hospitals, the federal government must first guarantee Texas would not be penalized in the future for doing so, Abbott said.

“Any voluntary change that the State makes should be understood as the product of a desire to work collaboratively with CMS and not as any kind of admission about a legal defect in Texas’ broad-based healthcare-related taxes,” Abbott wrote, adding that the state estimates the anticipated loss could be as much as $12 billion in 2027.

The Centers for Medicare and Medicaid Services, the Texas Health and Human Services Commission, which administers the Medicaid program, and the governor’s office did not offer any comment by Monday regarding the nearly $10 billion loss or if the parties are closer to resolving it. Even if a new agreement between Texas and the federal government were struck by Tuesday, the anticipated funding would be delayed for months, THA officials said.

"Even if we get an approval soon, there will be a claims backlog that takes at least 90 days to clear. And the bigger the claims backlog, the longer it takes to catch up.”
Anna Stelter, the THA's vice president of policy.

According to the THA, when H.R. 1, the One Big Beautiful Bill Act, passed a year ago, it included $900 billion in nationwide cuts to Medicaid funding by 2034. The OBBBA effectively froze Texas’ taxing structure for hospitals, a provision of the legislation that Congress implemented to allow states that did not expand Medicaid to maintain the status quo — and not to create a sudden cutoff of additional funding that hospitals, rural clinics and hospital-affiliated providers use to keep existing services, Stelter said.

Many Texas officials had believed the state was shielded from the bill’s major funding cuts and stricter regulations because it was one of the few states that did not expand Medicaid. Texas, Florida and eight others have refused to expand Medicaid health insurance coverage to more people, something the Affordable Care Act has allowed since 2013. Texas A&M’s Bush School of Government and Public Service estimates Texas loses more than $5 billion in new federal funding each year because it opted out of expanding Medicaid coverage.

Under the OBBBA, those Medicaid-expansion states face stricter work requirements for working-age Medicaid recipients that will go into effect in January.

Despite its refusal to expand, Texas, like Florida, now has questions from the federal government about how hospitals pay taxes. Florida was able to resolve its delay in additional Medicaid funding but only after 11 months. According to HHSC’s website, there’s been an exhausting 11 rounds of back and forth questions between CMS and HHSC about how locals tax hospitals.

In the latest round of questions, high on CMS’ list was assurances from Texas that none of the nearly $10 million would pay for non-citizen healthcare. “The state confirms and assures CMS that the state directed payment does not include, nor direct plans to make, payments to providers for costs or utilization for individuals who have not demonstrated satisfactory immigration status,” HHSC stated on Aug. 17.

This is not the first time Texas has fought to keep this additional funding. Before the OBBBA passed, Texas had successfully won its legal fights with CMS over the funding in 2023.

Carrie Kroll, THA's senior vice president of advocacy and public policy, noted hospitals are very aware that there’s no extra state funding to offset this federal funding hit.

“I think that we… are under no assumption that there is a large amount of money in GR (general revenue) ready to save us from the situation,” she said.

Disclosure: Texas Hospital Association has been a major financial supporter of The Texas Tribune. The Texas Tribune is a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in our journalism. Find a complete list of them and more information about our financial and disclosure policies here.

This article first appeared on The Texas Tribune.

After missing her chair and falling on the tile floor during a child’s birthday party last October, the 54-year-old Edinburg woman begged: “Don’t take me to the hospital.”

Her head was throbbing and sharp pain stretched down her back. The woman, an undocumented immigrant, told herself she'd have to brave through it. Immigration enforcement officials have detained two of her distant family members and deported another to Mexico, and she feared that going to a hospital would make her an easy next target.

“It’s not worth the risk,” said the mother of four, who would only speak on the condition of anonymity for fear of being deported.

The woman has lived in South Texas for 27 years — half of her life so far. She moved to Texas from Reynosa, her hometown, after her brother-in-law was murdered on the street. All of her children are citizens and when she fell, all she could think about was: “I don’t want to be separated from my family,” she said.

She’s one of many in Texas who have been avoiding hospitals over fear of immigration enforcement at both the state and federal level, according to public health experts. Gov. Greg Abbott ordered hospitals in November 2024 to start asking patients about their citizenship status, a question patients may decline to answer. Facilities track responses and submit that information to Texas Health and Human Services.

The data, limited to 10 months, suggests that undocumented immigrants may be increasingly foregoing health care.

In November 2024, Texas hospitals reported about 30,000 visits from undocumented immigrants. In a matter of months, that dropped by 32% to 20,345 visits in August.

During the same period, the number of visits by patients legally present in the U.S. increased by 14%. Self-identified undocumented patients comprised about 2% of all reported visits statewide, and dozens of hospitals reported no undocumented patients.

Experts blame the decrease in hospital visits by undocumented immigrants on the government’s strict enforcement of immigration laws.

Fulfilling his promise to carry out the country’s largest deportation program, Trump last year lifted a federal policy that limited arrests of immigrants in sensitive locations such as hospitals, along with churches and schools. Federal immigration officers have been seen staking out hospitals in other parts of the country. Although agents have not been confirmed near Texas hospitals, many immigrants are not taking the risk.

“Substantial shares of immigrants are saying they have avoided seeking medical care due to immigration related fears,” said Drishti Pillai, the director of immigrant health policy at KFF, a health policy organization that regularly surveys immigrants about policies that affect their health care access.

While undocumented immigrants have always used health care significantly less often than the general population, she said, new policies, such as Texas’ hospital citizenship question, have made it worse.

“We are seeing an exacerbation of some of these challenges,” Pillai said.

Abbott has insisted that the data produced from his executive order proves public funds are paying for the health care of undocumented immigrants. While hospital visits by undocumented immigrants dropped during the 10-month period, the average cost per visit by them increased about 50%, from $3,409 in November 2024 to $5,100 in August.

Abbott did not require hospitals to report how much visits by patients legally present in the U.S. cost taxpayers.

“For too long, Biden-Harris open-border policies forced Texas taxpayers to foot the bill for over a billion dollars in healthcare costs for individuals in the country illegally,” said Andrew Mahaleris, Abbott’s press secretary. “Texans should not have to financially support medical care for illegal immigrants.”

Abbott’s order has produced less-than-conclusive data because it depends on whether undocumented immigrants are willing to self-identify as such.

Since patients aren’t required to answer questions of their citizenship under Abbott’s order, the drop in the number of visits from patients self-identifying as undocumented immigrants could also be because fewer patients are choosing to answer the question. But, it is impossible to know that from the data.

Even so, immigrant rights groups and health care policy experts say they are seeing more Texans like the Edinburg woman who are sick and in pain but wait to seek hospital and other medical care. Undocumented immigrants are also delaying preventive care, such as cancer screenings, prenatal check-ups and vision exams. Pillai fears delay in any care could lead to worse health conditions and prognoses, and more expensive medical bills.

Dr. Ryan Padrez, an associate director at Stanford University’s Center on Early Childhood, said he’s especially concerned about the long-term impacts on children. It’s common in mixed-status families that children are citizens and parents are undocumented, and if adults are avoiding hospitals, they probably aren’t taking their children to medical clinics either, he said.

“They’re not putting themselves or their child at risk,” said Padrez. “Families are choosing to delay care for now.”

Since the Edinburg woman’s fall last year, she said “not a day goes by that I don’t experience some type of headache.” She had vision problems for a couple weeks after the incident and months later, still suffers from dizzy spells and some memory loss, she said. She’s been placing ice packs at the back of her neck daily to reduce pain, but so far, it’s only offered temporary relief.

“When state and federal governments design and implement immigration policies and enforcement to force communities into hiding, under threat of violence,” said Lynn Cowles, director of health and food justice for Every Texan, a Texas policy group, “whole communities suffer.”

Regional differences

In Texas, people have reported staying home as much as possible to avoid being targeted by police or immigration officers, and only going out for essential trips like to work or to buy groceries.

The drops in hospital visits from some undocumented patients, according to the Tribune’s analysis, were reported across the state, but some of the steepest declines were in hospitals near the Mexico border, including Edinburg.

Doctors Hospital of Laredo saw a nearly 48% decline in visits from undocumented patients, from 1,700 visits in November 2024 to 889 in August. South Texas Health System in Edinburg saw a 52% drop in visits during the same timespan by undocumented patients, from 1,127 to 538.

Declines weren’t limited to border hospitals. Dallas County Hospital District reported more than 4,000 undocumented hospital visits in November 2024, and that declined by more than a third in August.

All three hospitals declined to provide a comment for the story.

The Tribune contacted eight other hospitals across the state, including major facilities in Austin, Houston and San Antonio, asking them to explain their reported drops in visits from undocumented immigrants. Most hospitals did not respond and others declined to be interviewed. The Texas Hospital Association, which represents more than 85% of the state’s acute care hospitals, also declined to comment on the data.

Often fixtures in hospitals and clinics who help connect patients to resources, social workers are having trouble tracking down patients after an appointment, said Will Francis, executive director of the National Association of Social Workers chapters in Texas.

“Social workers will never accomplish what the client needs if they are afraid having a conversation will get them in trouble later on,” he said.

Many immigrants — not only those who are undocumented — are delaying medical care over concerns about being mistaken for an undocumented immigrant and being illegally detained, experts said.

There’s been several cases in Texas in which people lawfully in the country, such as DACA recipients, have been detained by ICE. About 1 in 7 immigrants avoided medical care over fear of immigration enforcement, according to a November KFF survey.

“Regardless of immigration status, we are seeing substantial shares of immigrants say that the current policy environment and immigration related concerns have led to negative health impacts for both immigrants and their children, the majority of whom are U.S. citizens,” Pillai said.

Immigration enforcement has blocked people from getting medical care, at hospitals and elsewhere. Last year, an 11-year-old with a brain tumor and her family were detained while traveling to Houston for a surgery. Immigration enforcement agents stopped them at a border checkpoint in Sarita, a town south of Kingsville, and the family was eventually deported.

No trust

A slow public health clinic is typically not a good sign, said Phil Huang, the director of the Dallas County Health and Human Services, especially during the back-to-school season.

By August each year, Huang said the line for back-to-school vaccines usually snakes outside the clinic’s doors and congests the waiting room. But last year, he said, “we didn’t see that.” In 2024, the county administered 16,412 vaccines, he said. Last August, Dallas County’s public health clinics administered 9,578.

In Texas, uninsured children, regardless of citizenship status, can get vaccinated at low or no cost. Because his clinics don’t ask for patients’ citizenship status, Huang suspects many of his patients are undocumented immigrants and ties the dramatic drop in county-administered vaccinations to concerns about immigration enforcement. Employees have told him that patients have been more hesitant to share routine, personal information with them, and that many have asked whether that data was being used to help ICE locate them.

The drop in vaccinations “is disheartening,” said Ann Barnes, president and CEO of Episcopal Health Foundation, a public charity based in Houston.

“The very systems that are supposed to be there to help are now not trusted,” she said.

Trump gave deportation officials access to Medicaid data last year, which public health officials say has had a chilling effect on emergency room and other hospital visits for undocumented immigrants across the country. People are now fearful that the information hospitals collect will be weaponized against them and passed along to ICE. Undocumented immigrants, however, don’t have access to federal health care coverage unless it's a medical emergency.

Barnes said one of the primary options for health care for undocumented immigrants and their families has been federally qualified health centers since they’re required to serve anyone in their service area, regardless of income or immigration status. She said it makes them a crucial safety net for the community.

Three months after her fall, the Edinburg woman said her head injury got so painful that she decided in January to go to the University of Texas Rio Grande Valley’s Health Center to get checked — a clinic she said she’s trusted for years.

But recent reinterpretations of “federal public benefits” bars undocumented immigrants from certain programs that federally qualified health centers offer, including certain mental health programs, substance abuse programs and family planning. Even though they will still have access to essential services, such as check-ups, screenings, immunizations and child visits, undocumented immigrants are opting not to come into these centers altogether.

Instead of going to federally qualified clinics, undocumented immigrants are most likely leaning on nonprofits and charity clinics with limited resources for their health care, Barnes said.

Tara Trower, deputy CEO for CommUnity Care Health Centers, which runs federally qualified clinics in Austin, said they’re offering telehealth options for those concerned about going in person, including undocumented immigrant patients. They also implemented a telehealth system that doesn’t require patients to provide information that can be used to track them down, adding an extra layer of security for undocumented patients who fear their whereabouts could be given to immigration enforcement.

“We are actually seeing a record number of patients again this year, using this method, but we also hear the concerns,” she said.

Trower said her organization is making more effort to reschedule appointments for patients and battle misinformation about these centers sending patient information to ICE. A couple years ago, Trower said a “Know Your Rights” information campaign by the organization helped patients learn about what protections they have.

“They feel safe coming in for care here because we don’t ask for anything, we deliver care regardless,” Trower said.

Long-term impact

In the Texas-Mexico border county of Hidalgo, hospitals reported a more than 40% drop in visits from undocumented patients in August compared to November 2024. Dr. Ivan Melendez, a family practice doctor serving as the county’s chief medical officer, said more patients are waiting longer before seeking treatment.

“They’re coming in with a higher level of acuity, they’re sicker,” he said.

He said patients in the Rio Grande Valley, the southernmost tip of the state, more often than before are calling hospital officials ahead of time to ask whether ICE is there.

When people wait too long to flag health problems, their chances of recovering quickly or at all shortens, said Padrez. And if people are avoiding hospitals, he’s worried they’re also avoiding preventive health care services.

“We have a script for how this played out a few years ago, during the COVID-19 pandemic,” he said.

People stayed away from health clinics and children missed key routine check-ups during the height of the pandemic, Padrez said, and not too long after “we saw skyrocketing rates of under-detected or under-treated mental health needs like anxiety and depression.”

There’s an important window during a child’s early years when doctors look out for early signs of diseases or developmental delays, he said. Treatment for those conditions, such as therapy, are often more successful when children start them at a very young age.

Huang with Dallas County said Texas is ripe grounds for recurring public health crises if undocumented people continue to avoid health care. Last year, the state faced a record-breaking measles outbreak that started in West Texas and an 11-year high in whooping cough cases. This year, at least 170 cases of measles have been reported statewide, concentrated mostly in federal detention centers in West Texas.

“We are more vulnerable to outbreaks… We might see other preventable diseases further down the road,” he said.

For years, the woman in Edinburg has a work permit and has been employed as a home health aid for an elderly woman, making sure she is well fed, cleaned, and that her health is taken care of. As she now faces her own health struggles, she said she won’t stop continuing to care for someone else’s well being.

“I leave my house every day with a lot of nerves, praying and asking God to let me come back home,” she said. “To let me get to my job and let me come back home safely.”

Disclosure: Episcopal Health Foundation, Every Texan and Texas Hospital Association have been financial supporters of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune's journalism. Find a complete list of them here.

This article first appeared on The Texas Tribune.

In a state where the death penalty is as ingrained as cowboy boots and conservative politics, news of Robert Roberson’s death sentence broke through in Texas after the rarest of phenoms: a noisy, bipartisan effort that bypassed the governor’s office to save a man from lethal injection.

For years, the appeals of Roberson’s capital murder conviction for the 2002 death of his chronically ill, 2-year-old daughter had lumbered through the courts, tracing a byzantine process that often fails to register with residents of the nation’s execution capital, where 591 inmates have been put to death in the state since capital punishment was reinstated in 1976.

But while lawmakers were making historic interventions, many Texans took note of the silence by the person traditionally empowered to step in at the last minute: Gov. Greg Abbott.

“Abbott’s silence is deafening,” said Brandon Rottinghaus, a professor of political science at the University of Houston.

After all, Abbott had at his disposal the power to grant a 30-day reprieve for Roberson, whose lawyers claim was wrongfully convicted based on junk science. A U.S. Supreme Court Justice urged him to take that step. If Abbott had, there would have been no frantic and unprecedented rush by lawmakers to issue a subpoena of Roberson and then go to court to block the execution — first to a Travis County judge, then to Texas’ two high courts before Roberson’s execution was finally called off.

There’s been no public statement from Abbott about Roberson’s case before or since. If the execution had gone forward, Roberson would have been the first person in the nation to be put to death in a shaken baby syndrome case, a diagnosis that has come into question in recent years. Multiple requests for comment to the governor’s office by The Texas Tribune went unanswered.

The silence “certainly signals his willingness to go his own way against the Legislature and also reflects that, like Gov. Perry before him, the realization that being tough on crime is an essential element of muscularity for national Republicans,” Rottinghaus said.

Silence on executions, not unusual

Unlike the Hollywood image of a governor making a frantic phone call to stop an execution, the reality, especially in Texas, is far less dramatic. Texas governors can only act on a recommendation of clemency from their own appointees to the Texas Board of Pardons and Paroles. Or they can opt for the 30-day reprieve.

According to the Associated Press, the Texas parole board has recommended clemency in a death row case only six times since the state resumed executions in 1982. In three of those cases, death row inmates had their sentences commuted to life in prison. In two of the cases, Perry rejected the parole board's recommendation to commute a death sentence to life in prison, and the two prisoners were executed.

But despite that limited power, Abbott may have inadvertently raised the Texas public’s expectations of intervention last year. That’s when he was quick to jump in publicly after a jury convicted an Austin man of fatally shooting a Black Lives Matter protester. Abbott posted on social media that he would quickly seek a pardon. The parole board did recommend a pardon a year later, and Abbott made good on his promise.

But veteran court watchers say Abbott’s silence on even a high profile death penalty case is not out of the ordinary.

“It’s typical,” said Elsa Alcala, who served for seven years as a judge on the Texas Court of Criminal Appeals, the state’s highest criminal court, before stepping down in 2018. “Usually, the governor doesn’t get involved.”

So far, more than 60 executions have been carried out while Abbott has been governor, a fraction of the more than 200 that occurred when former Gov. Rick Perry was in office. That’s the result of increased judicial scrutiny on death row cases and more prosecutors seeking life in prison instead of the death penalty.

Abbott has only commuted one death sentence. In 2018, he spared the life of Thomas “Bart” Whitaker, who masterminded a murder-for-hire scheme that resulted in the death of his mother and younger brother and injured his construction company executive father, who ultimately forgave his son. Whitaker’s case was reduced to a life sentence.

“Even going back to Ann Richards, I don’t think there’s a history of Texas governors in capital cases giving reprieves,” said Kenneth Williams, the Fred Gray Endowed Chair for Civil Rights and Constitutional Law at Texas Tech University. “They rarely do in capital cases.”

Longtime Texas political observer Cal Jillson agreed.

“Governors at least going back to George W. Bush, in the case of a mentally challenged inmate named Oliver Cruz, and Rick Perry, in the case of Cameron Todd Willingham, have been reluctant to intervene in death penalty cases for fear of appearing ‘soft on crime,’” said Jillson, a political science professor at Southern Methodist University.

The added fact that Abbott, before he was first elected governor in 2014, was the state’s longest-serving attorney general, whose office is charged with ensuring a trial court’s death sentence is carried out, could help explain why Texans don’t hear much from him regarding an individual’s case.

“He defended these cases, so that may weigh on him as governor,” said Williams, the Texas Tech University law professor, adding that Abbott’s lack of intervention in this or any other case is not out of step with governors in other states.

“Most governors are reluctant to grant any kind of clemency after there’s been conviction,” he said. “I don’t think they want the blowback in that.”.

How the case unfolded

Roberson, 57, of Palestine, was convicted of his daughter’s death in 2003 after an autopsy determined his daughter, Nikki, who had been ill with a fever, had died of shaking and blows. Investigators believed that Roberson’s emotionless demeanor was further evidence of his guilt. Roberson has since been diagnosed as having autism, which could explain Roberson’s behavior at the time. A police detective whose investigation sent the East Texas man to death row, now supports Roberson’s claims of innocence.

On Wednesday, as both the Texas parole board and the Texas Court of Criminal Appeals rejected Roberson’s last-minute appeals, the House committee members issued their subpoena, arguing that only Roberson could provide unique testimony on Texas’ pioneering 2013 junk science law — which Roberson had tried, and failed, to use to prove his innocence. Last month, 80 Texas lawmakers, including supporters of the death penalty, wrote Texas parole board members in support of Roberson’s request for clemency.

The law is designed to allow defendants an avenue to prove their innocence if they were convicted based on science that is later shown to be faulty. In fact, no Texas death row inmate has successfully used the law to obtain a new trial, leading the Texas Defender Service to conclude that the statute “is not operating as the Texas Legislature intended.”

The steps legislators took to halt the execution were unprecedented, and drew some complaints of overstepping their authority.

“I will absolutely defend what we did,” state Rep. Brian Harrison, R-Midlothian, a member of the House jurisprudence committee who began looking into Roberson’s cases a few months ago on the recommendation of a colleague. “We have to protect the integrity of the criminal justice system.”

Harrison confirmed that lawmakers contacted Abbott after their subpoena was issued but did not want to discuss specifics of those conversations, describing them only as “professional and productive.”

Many of those who tracked the Roberson saga this week were struck more by the actions of the Legislature than the inaction of Abbott.

“What is unusual in the case of Robert Roberson is not so much Abbott’s silence, as the bipartisan effort to slow this execution at least long enough to take a closer look,” Jillson said.

But Amanda Marzullo, the former executive director of the Texas Defender Service, said it was necessary for the Legislature to step in, given that the use of clemency by American governors has waned.

“We have seen a massive atrophy in the clemency power,” she said. “It was something governors did all the time.”

She pointed to how more than 200 years ago, a governor’s pardon power was used more often because death was often the punishment for far lesser crimes.

"This is how this system was designed,” Marzullo said. “So no one branch is doing all of the work in a particular sector.”

This article originally appeared in The Texas Tribune at https://www.texastribune.org/2024/10/19/greg-abbott-robert-roberson-death-penalty/.

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

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