Texas Tribune
State rejects health plans’ protests over Medicaid contracts
by By Karen Brooks Harper, The Texas Tribune – 2024-06-06 16:13:56
SUMMARY: Texas officials have rejected proposals from major insurers to cancel a $116 billion Medicaid contract reform plan affecting nearly 2 million low-income Texans. The plan aims to reduce the number of managed care organizations (MCOs) and shift many to new insurers, impacting Medicaid STAR and CHIP programs. Critics argue the process unfairly favors national for-profit companies over established local plans like Driscoll Children's Health Plan, which may shut down. Disputes have arisen over the fairness and legality of the procurement, prompting calls from lawmakers to delay or revise the process, with potential court involvement looming.
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Texas officials on Thursday rejected attempts by several major insurers for needy families to cancel a proposal that would drop them from the state Medicaid program and shake up the coverage of nearly 2 million low-income Texans.
At issue are some $116 billion in Medicaid contracts that Texas Health and Human Services officials are attempting to award by the end of the summer, a plan announced earlier this year that has drawn wide criticism because it would eliminate three major health plans run for decades by the state's premiere nonprofit children's hospitals.
Some 1.8 million Texans who receive Medicaid coverage from six managed care organizations across the state would lose their current health plans and be shifted to new insurers next year if the decision stands.
Medicaid STAR and CHIP programs cover the cost of routine, acute and emergency medical visits. STAR is primarily for pregnant women, low-income children and their caretakers. CHIP provides health care to low-income children whose family's income is too high for Medicaid, which has some of the lowest income limits in the country.
Thursday's decision is a significant step toward finalizing the plan, which would:
* Reduce the number of managed care organizations that administer the state's Medicaid STAR and Children's Health Insurance Program
* Give contracts to more for-profit companies in most areas of the state
* Result in a smaller number of top-rated plans administering care
* Attract new national plans to replace local managed care organizations, or MCOs, that historically served some regions
The health plans are expected to appeal the decision, which puts the future of the procurement — the term for a new contract for the MCOs that run STAR and CHIP — squarely at the discretion of Texas Health and Human Services Executive Commissioner Cecile E. Young.
“We remain disappointed that the agency continues to push forward with what was shown this week … as a short-sighted, flawed and biased process,” said Craig Smith, CEO of Corpus Christi-based Driscoll Children's Health Plan, one of the three children's hospital plans that would be dropped under the proposal and which would likely shut down if it's finalized. “We appreciate the tremendous response and testimony of South Texans fighting to have their voices heard, and we will keep fighting on their behalf to serve our community.”
Young has been under mounting pressure from lawmakers, business leaders, health plans and the residents they cover to ditch it and revamp a process many describe as unfair, illegal and antiquated.
“Don't let corporate greed take away outstanding and caring care for our children,” McAllen resident Angelica Mata wrote to lawmakers earlier this week. Mata was one of about 500 people who submitted written testimony decrying the plan during a Texas House hearing.
If the protesting MCOs get their way and the contracting plan is canceled, it would be the agency's third unsuccessful attempt to finalize new contracts for STAR and CHIP managed care organizations since they were first signed a dozen years ago.
Regardless of what Young decides, the matter will likely end up in court given the uproar, division and growing uncertainty around the legitimacy of the procurement.
No deadline for a decision
Critics say the procurement process does not adhere to state laws that, over the years, have sought to favor health plans that had invested in and been well-received by their communities, or that are tailored to unique population groups like children, and that would allow the greatest continuity of care.
They also say the entire process was tainted by the early release of some competitive bid proposal information to one of the eventual winners in the procurement, an error the state acknowledged in emails to some health plans but maintains was not illegal and did not affect the outcome. Young told lawmakers under questioning earlier this week that the agency was handling the matter internally but did not elaborate.
On Tuesday, Young and other agency officials testified before the Texas House Human Services Committee that the agency complies with state law governing contract procurements. Those include requirements that the state give a fair shake to all applicants, whether new to the state or longtime contractors, and therefore cannot give any advantage to plans like the children's hospital-affiliated plans that have track records in the state.
Young did not address what she plans to do about the current procurement and has declined to discuss it publicly, saying she is limited to what she can say until the process is over.
In a letter to lawmakers earlier this week and obtained by The Texas Tribune, Young declined to address concerns about the latest STAR/CHIP contract proposal but said Medicaid recipients would not experience an interruption in care during any transition.
Young has no deadline for deciding whether to uphold the decision by her agency's procurement division, cancel it and start over, or officially delay it until lawmakers can respond to it when they meet in session next year.
Medicaid managed care contracts are routinely the most expensive contracts states pay for with taxes, and Texas' contracts are among the largest in the nation.
Among those who would be affected by the proposed procurement are a collective 700,000 families, pregnant women and children covered by Cook Children's Health Plan in the state's Tarrant service area, Texas Children's Health Plan in the Harris region, and Driscoll Health Plan in South Texas, all which formed when the state's CHIP program was created two decades ago.
Cook Children's and Driscoll Health plans would likely both shut down if the new plan is finalized. The hospitals themselves are not in danger, they said. In an emailed statement Thursday, officials from Cook's plan blasted the process as “flawed from the beginning” and promised to pursue “every legal option available.”
“We are confident in the strength of our case and believe we will prevail,” the statement read. “We know every child's life is sacred, and we will continue to fulfill our promise of improving the well-being of every child entrusted to our care and within our communities.”
Meanwhile, a handful of national for-profit chains would significantly expand their foothold in those markets — in one case growing from serving just one region of Texas to seven — while the others are either diminished or forced out.
The change would force nearly half of the Medicaid STAR and CHIP enrollees in the state out of their current health plan, potentially causing changes in providers, pharmacies, and mental health services.
It would also trigger a massive effort by the state to inform all those families of the change, which would take effect late next year if the plan holds.
Mounting bipartisan pressure
The Medicaid contracts outlined in the procurement were awarded based on a process that scored plans on written questions and an oral exam, after the MCOs had proved that they could effectively serve the areas for which they had applied.
When the scores were added up, the four top-scoring plans got most of the available contracts: Aetna, United, Molina and Blue Cross Blue Shield each got seven contracts, the most allowed per MCO, and expanding their foothold in Texas.
The outcome sent shockwaves throughout the Texas health care community and led to escalating calls for a closer look, both at the entire procurement process at HHS and specifically at the STAR/CHIP procurement — which was announced in March after a 15-month evaluation process.
“There are people who are genuinely concerned about this all over Texas,” state Rep. Ana-Maria Ramos, D-Richardson, said during a House committee hearing earlier this week. “Why was that decision made? People are really up in arms.”
On Tuesday, half a dozen Tarrant County state representatives signed a letter to Young, protesting the effect the plan would have on Fort Worth-based Cook Children's Health Plan and asking that she delay the procurement until lawmakers return to session in January.
“It appears that the recent award considerations have overlooked crucial factors such as track record, community investment, and overall value provided,” the letter reads.
The letter was circulated by state Rep. Nicole Collier, D-Fort Worth, whose district includes Cook Children's Hospital, and signed by four Democrats and two Republicans.
The lawmakers asked Young to remove the limit on how many managed care organizations can serve in a particular region — a limit imposed by HHS at the start of the process and blamed in part for its outcome.
The letter comes on the heels of a similar plea to delay or cancel the procurement that was sent to Young two weeks ago by state Sen. Tan Parker, R-Flower Mound, and state Sen. Charles Perry, R-Lubbock, who expressed “grave concerns” about its potential to have “long-lasting effects on community health infrastructure.”
“This drastic change comes at a time when stability and continuity in health care are more critical than ever,” the letter reads.
And earlier this year, a bipartisan group of South Texas lawmakers signed a similar letter in defense of Driscoll Children's Health Plan, which funds 75% of the women's health specialists in the region.
HHSC tells lawmakers their hands are tied
Also on Tuesday, a bipartisan group of lawmakers grilled Young and other HHSC officers during a meeting of the Texas House Committee on Human Services, charged with examining how the state runs its Medicaid managed care contracts after the STAR/CHIP procurement began garnering criticism.
State Rep. Christian Manuel, D-Beaumont, criticized the proposal, saying that changing the Medicaid plans available in his rural district would make challenges with health care access even worse if the new company doesn't understand the unique needs of communities where residents live an hour away from the nearest hospital and frequently wonder if they can get life-saving care, he said.
“Are they going to be able to understand the specific needs before they just come in and have people in a tizzy over what's going to happen?” he said. “Because there are already those fears, and this is exacerbating that.”
Under questioning from House members this week, Young and Molina, the agency's procurement director, said the agency hears the concerns but is hamstrung by state laws that require the agency to create a process that is fair and competitive to all applicants.
State law “basically requires us to put something out that is fair to everyone, which makes it very hard to give extra points for someone who is already in the space doing something, because then it's not fair and everyone is not judged the same way. And we struggle with that,” Molina told the lawmakers. “If there is a better way to do it, if you could put it in the law, that would make it so much easier. We're boxed into a corner using a state law that has to apply to everything.”
One way an applicant can get around that, Young told lawmakers, is by including their past performance in their written pitches and essay questions during the evaluation process. But historical performance in the market isn't a formal consideration during the process, Young said.
“Am I missing something here?” said state Rep. Candy Noble, R-Lucas. “Why would you throw out your experience, at least in some part? And I get that we do love the opportunities that Texas affords in the free market, and I'm not against that. I just think that past experience should be at least … part of the equation.”
House Health Committee Chair Stephanie Klick, R-Fort Worth, said the laws clearly need to be updated if they're setting up a no-win contracting situation for HHS. With over 40,000 contracts, procurement is one of the most important functions of HHSC and ensuring the integrity of the process is a top priority, officials there say.
“It seems to me that when you're looking at quality, and you have somebody in the space already and they're performing well, they're being put at a disadvantage, and that doesn't seem fair,” Klick said. “We need some modernization.”
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Texas Tribune
UT-Austin offers probation to students arrested in protests
by By Asad Jung, The Texas Tribune – 2024-07-05 17:44:44
SUMMARY: The University of Texas at Austin is disciplining students arrested during pro-Palestinian protests in April by offering “deferred suspension,” allowing students to avoid suspension by proving educational growth. Deferred suspension requires students to take an exam on university rules and avoid appealing the decision. Some students, like Ari Lenahan, see this as a relief compared to harsher penalties faced by peers at other universities. Over 130 protesters were arrested, but Travis County Attorney Delia Garza declined to pursue criminal trespassing charges. The university's heavy-handed response has sparked criticism from students, faculty, and free speech advocates.
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The University of Texas at Austin has begun disciplining students who were arrested in pro-Palestinian demonstrations in April, scolding them for their actions but offering them a path to avoid suspension.
In letters sent out to students this week, first reported by KUT, university officials said it would be appropriate to suspend them for their actions during the protests but would give them the option to take “deferred suspension” instead, a form of probation that would allow students to remain in class and keep the disciplinary action from appearing on their final transcripts.
“Recognizing our commitment to educational growth, we want to offer you an alternative path to avoid suspension by proving that you have learned from this experience,” reads one of the letters obtained by The Texas Tribune.
Students who choose deferred suspension must agree to take an exam testing their knowledge of the university's rules and agree not to appeal the decision. The status would be active until July 7, 2025.
Those who decline that option would be suspended, the letter says. Students may also appeal the disciplinary sanctions through a university hearing.
Ari Lenahan, a UT-Austin student set to graduate in December, said he was relieved the university offered him deferred suspension since students at other universities across the country are facing harsher punishments after participating in pro-Palestinian demonstrations. He said it may be the best choice for him since he aims to graduate this year.
“It's a lot clearer where I stand now, at least in the university's eyes,” he said.
Lenahan still has a hold on his account preventing him from registering for classes in the fall but said the letter he received Wednesday states any holds will be removed once his case is resolved.
Anne-Marie Jardine, a recent graduate, received a sanction letter concerning her involvement in an April 24 pro-Palestinian demonstration. Jardine was told she would be under deferred suspension for one year if she were to re-enroll at UT-Austin. Jardine said she hasn't received her official diploma from the university yet.
Many other students under investigation have not yet been informed about how the university plans to move forward with their cases. Sam Law, a PhD candidate who was arrested on April 29, said that he expects the university will contact him soon.
More than 130 protesters were arrested at pro-Palestinian demonstrations on UT-Austin's campus in late April. In resolute efforts to dispel the protesters, law enforcement at the time deployed pepper spray and flash-bang explosives and charged students with horses. State troopers were deployed by Gov. Greg Abbott to help quash the protests and had a hand in the arrests.
Those arrested were charged with criminal trespassing but Travis County Attorney Delia Garza declined to pursue those charges.
In the aftermath of the protest, many students, faculty and free speech advocates questioned UT-Austin's heavy-handed response to the protests and criticized state GOP leaders' support of the arrests. Just a few years ago, Abbott had championed state legislation that protected free speech on college campuses, leading free speech advocates to ask who gets to enjoy free speech protections in Texas.
UT-Austin leaders, meanwhile, have vowed to carry out discipline against students who violated campus policies. Seniors in the class of 2024 were afraid their diplomas would be withheld, though they were permitted to join graduation ceremonies in the spring.
Sneha Dey contributed to this story.
Disclosure: University of Texas at Austin has been a financial supporter 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.
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The Texas Tribune is a nonprofit, nonpartisan media organization that informs Texans — and engages with them — about public policy, politics, government and statewide issues.
Texas Tribune
Hurricane Beryl likely to hit Texas coast Monday
by By Emily Foxhall, Berenice Garcia and Stephen Simpson, The Texas Tribune – 2024-07-05 16:47:07
SUMMARY: Texans are being urged to prepare for Hurricane Beryl, expected to make landfall as a Category 1 or 2 storm along the Texas coast on Monday. Currently crossing Mexico's Yucatan Peninsula, Beryl could hit anywhere from northern Mexico to the mid-Texas coast. Officials stress vigilance and preparation, especially for those along the Gulf coast, and advise stocking up on essentials like food and water. Emergency measures include distributing sandbags and readying evacuation plans. Beryl, an unusually strong early-season storm, has already caused significant Caribbean damage, with forecasters predicting a highly active hurricane season exacerbated by climate change.
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Texans need to prepare for Hurricane Beryl, which is likely to make landfall on the state's coast as a Category 1 or 2 storm on Monday, state emergency officials said.
The record-setting storm was moving across Mexico's Yucatan Peninsula on Friday, leaving forecasters still unsure exactly where along the Texas coast will see the worst rainfall and wind.
As Beryl left behind a trail of destruction across Caribbean islands, state officials urged Texans along the entire Gulf coast to pay close attention and prepare for a dangerous storm, particularly people vacationing during the July 4 holiday weekend.
“Everyone along the coast should be paying attention to this storm,” Lt. Gov. Dan Patrick said at a news conference in Austin. Patrick is serving as acting governor as Gov. Greg Abbott travels in Asia on an economic development trip.
Residents should be gassing up their vehicles and making sure they have food and water for themselves and their pets, Texas Division of Emergency Management Chief Nim Kidd said.
“A lot of people are out having fun right now, and that's a good thing, and we want them to continue to do that, but we also want them to prepare,” Kidd said. “We need a prepared community, not a panicked community.”
Boarded windows at the H-E-B Plus! grocery store in Brownsville on July 5, 2024.
Credit:
Michael Gonzalez for The Texas Tribune
Officials in the Rio Grande Valley and Corpus Christi have been distributing thousands of sandbags to help people prepare for potential flooding. South Texans have been eager for rain because the two major reservoirs on the Rio Grande have reached near or record lows in June.
Forecasters on Friday expected Beryl to make landfall anywhere from northern Mexico to the mid-Texas coast. The storm appeared likely aimed for South Texas but experts warned its path could shift north to Corpus Christi or Matagorda Bay.
Tropical storm-level winds would likely arrive Sunday night, according to the National Hurricane Center. Areas from Brownsville to Corpus Christi faced the greatest wind threat under the current forecast.
Heavy rain could begin Sunday and last through Tuesday. The National Hurricane Center predicted four to eight inches to fall along the South Texas coastline, with higher amounts in some spots, and up to six inches from Corpus Christi to Matagorda Bay. Forecasters expected the storm to slow over land, which would increase the risk of flooding.
Rip currents and high seas starting late Friday will make coastal conditions dangerous.
In the Rio Grande Valley, officials were preparing for possible flooding.
The eastern part of Hidalgo County tends to be hit the hardest during heavy rains, but the county was taking steps to mitigate flooding there, said Ricardo Saldaña, Hidalgo County's emergency management coordinator. Officials have placed water pumps near flood-prone areas and worked with contractors to prevent flooding at drainage project sites by covering up excavation holes.
Saldaña warned residents to make their own preparations by stocking up on food and water, preparing an emergency kit, and making arrangements with friends and family to relocate if necessary.
Sandbags at a county facility in Brownsville on July 5, 2024.
Credit:
Michael Gonzalez for The Texas Tribune
Cameron County Judge Eddie Treviño, Jr. recommended that people in recreational vehicles leave county parks.
“If you don't feel safe, evacuate,” said Tom Hushen, Cameron County's emergency management coordinator.
If there is flooding, Hushen said they were prepared to mobilize fire trucks and ambulances to help people evacuate. But high winds could pose another threat. Winds of more than 90 miles per hour could cause those vehicles to topple over. In that scenario, county officials would have to deploy larger vehicles like dump trucks.
Hushen said any power outages would prompt the opening of emergency shelters. He also advised residents to tie down any loose items in their yards and to bring in all patio furniture because high winds could turn those objects into projectiles.
“Listen to the warnings,” Hushen advised residents. “Things could change at a moment's notice.”
Beryl has astounded meteorologists with its strength so early in the summer. Warmer-than-normal ocean temperatures helped Beryl rapidly strengthen into a Category 4 storm in late June — becoming the first recorded Category 4 storm to form in June, according to the National Oceanic and Atmospheric Administration.
Beryl strengthened into a Category 5 and tore across the Caribbean, causing devastation in Grenada and Jamaica. It pushed onto the Yucatan Peninsula early Friday as a Category 2 storm.
“Beryl is so out of place historically given how early in the season it is and how strong it got,” said Houston-based meteorologist Matt Lanza, who helps write a blog on tropical weather called The Eyewall. “Typically you don't see that sort of thing until August — not the end of June, beginning of July.”
Federal forecasters expect this hurricane season, which began June 1, to be a bad one. They predicted to see 17 to 25 named storms form, which was more than they had ever forecast before a season's start. They believed four to seven of those would be Category 3 storms or stronger.
Climate change driven by people burning fossil fuels is causing oceans to warm and makes hurricanes more likely to be stronger. Scientists also say climate change may make rapid intensification of storms more likely — as happened with Beryl.
“To look at a satellite on June the 30th or July the 1st and to see a storm of Beryl's magnitude is almost unbelievable,” said Michael Lowry, a hurricane expert for WPLG TV in Miami.
Reporting in the Rio Grande Valley is supported in part by the Methodist Healthcare Ministries of South Texas, Inc.
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The Texas Tribune is a nonprofit, nonpartisan media organization that informs Texans — and engages with them — about public policy, politics, government and statewide issues.
Texas Tribune
Michael McCaul seeks waiver to stay Foreign Affairs chair
by By Isaac Yu, The Texas Tribune – 2024-07-05 05:00:00
SUMMARY: U.S. Rep. Michael McCaul seeks a waiver to extend his chairmanship of the House Foreign Affairs Committee. During his term, McCaul, a Republican from Austin, led efforts to ban TikTok, supported Tibetan self-determination, and condemned the Chinese spy balloon. He also played a crucial role in passing a bipartisan Ukraine aid bill and has been active on global issues, including Ukraine and Taiwan. McCaul aims to maintain U.S. strength abroad amid growing isolationism in his party. Facing a six-year term limit, he needs special permission to continue, with several colleagues aiming for his position. His leadership's fate will be decided by the Republican Steering Committee.
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WASHINGTON — U.S. Rep. Michael McCaul isn't quite ready to give up his gavel.
In his two years as chair of the powerful House Foreign Affairs Committee, the Austin Republican has been busy; he spearheaded the charge to ban TikTok, authored one resolution on Tibetan self-determination and led another condemning the infamous Chinese spy balloon. Just last month, he helped shoulder a bipartisan Ukraine aid bill through Congress over many colleagues' loud objections. He's also traveled the globe, shaking hands with Volodymyr Zelenskyy in Ukraine, receiving a blessing from the Dalai Lama in India, and gifting Taiwan President Lai Ching Te with a cowboy hat.
To keep his leadership post on one of the most coveted committees in Washington, he'll need special permission, having hit his six-year term limit. Several colleagues are already gunning to replace him.
McCaul confirmed last week that he would indeed seek a waiver to serve another term as top Republican on his committee, which would need approval from a steering committee and then the full House Republican caucus.
“It's not time to change horses right now,” McCaul said in an interview. “It's a dangerous time where the world is on fire.”
If his quest is successful, McCaul pledges to keep supporting key allies around the globe and stay aggressive on adversaries like Russia and China. If not, defense hawks in Washington could lose a powerful voice in charge just as the GOP prepares to redefine its approach to foreign policy under a potential second Trump administration.
Closing out his twentieth year in Congress, McCaul is well-connected and one of the most experienced members of the Texas delegation, having chaired the Homeland Security Committee from 2013 to 2019. The Foreign Affairs Committee under his leadership has been the most productive House committee this term, his office said, with 67 measures and 18 bills passed by the full chamber.
McCaul is making the case that his relationships on the Hill — including a friendship with Speaker Mike Johnson that helped push Ukraine aid over the finish line — justify him staying on an extra term.
Johnson had voted against sending aid to Ukraine before becoming speaker, part of a growing wing of conservatives who believed foreign aid came at the expense of funding for border security. McCaul, a steadfast supporter of Ukraine, helped sway Johnson's thinking and the speaker ultimately threw his support behind a package to send $60 billion in aid to boost Ukraine's arsenal against Russia.
The decision was opposed by a majority of Republicans and drew the ire of hardline conservatives, including Rep. Marjorie Taylor Green of Georgia, who filed a motion to vacate the speaker, which failed.
“I think I feel compelled to do it not for myself, but I don't think anyone would be able to do what I do or shepherd the [Ukraine] supplemental the way I was able to,” McCaul said.
McCaul has also been a leading China antagonist this term, leading an effort to force the sale of TikTok to an American company. His visits with Taiwanese leaders and the Dalai Lama, who China views as a separatist threat, have drawn strong condemnation and sanctions from Beijing.
His efforts on Ukraine, Taiwan and elsewhere are linked by a desire to project U.S. strength abroad, even as the isolationist wing of his party grows.
“If we abandoned Ukraine and allowed [Vladimir] Putin to take over Ukraine and threaten Eastern Europe, that would be a big mistake, and it would send a message to Chairman Xi [Jinping] that Taiwan's fair game,” McCaul said.
House Republicans set six-year term limits for committee chairs, including years spent as ranking member when the party is the minority. The GOP last voted to keep the term limits at the beginning of the current term.
Waivers are rare. Only one was granted last session, to Rep. Virginia Foxx, R-North Carolina, who stayed an extra term chairing the House Education and Workforce Committee. Before Foxx, the last waiver was granted in 2012, to former Speaker Paul Ryan, R-Wisconsin.
McCaul's fight comes as Texan influence in the House is on the decline. The state delegation, which includes more Republicans than any other state, will see the retirements of Rep. Kay Granger, R-Fort Worth, who stepped down from her powerful perch as Appropriations chair, and Rep. Michael Burgess, R-Denton, who will give up the Rules Committee gavel less than a year after gaining it.
Rep. Jodey Arrington, R-Lubbock, will remain the top Republican on the Budget Committee. And Rep. Brian Babin, R-Woodville, is currently the only Republican running for the top spot on the Science, Space and Technology Committee.
Committee assignments are determined by the Republican Steering Committee, made up of party leadership and regional representatives, and then approved by the full conference. The 36-member Steering Committee, which always includes at least two Texans, has been stingy with waivers in the past, even when considering chairs like McCaul who have spent most of their time in the minority.
The decision could depend in part on how McCaul's committee feels about his leadership. Foxx had the support of every Republican on her committee in seeking a waiver, including from the next-highest ranking Republican who would have replaced her.
None of McCaul's 26 Republican colleagues on Foreign Affairs have made endorsements yet, but at least three members — Ann Wagner of Missouri, the committee's vice chair, Darrell Issa of California and Joe Wilson of South Carolina — have already confirmed they are running against McCaul for the top spot. The committee includes three fellow Texans: Reps. Nathaniel Moran of Tyler, Keith Self of McKinney and Ronny Jackson of Amarillo, none of whom responded to requests for comment.
It's not immediately clear whether any of McCaul's announced rivals would diverge greatly from his policy positions, and all three supported foreign aid packages for Ukraine, Israel and Taiwan earlier this year.
Matthew Choi contributed to this report.
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The Texas Tribune is a nonprofit, nonpartisan media organization that informs Texans — and engages with them — about public policy, politics, government and statewide issues.
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