Why Texas is so far behind other states on virus response

But the swift-spreading coronavirus public health crisis is catching Texas unprepared. The state, which didn't expand Medicaid, has the highest uninsured rate in the country meaning millions of people don't have doctors to call if they show symptoms. And Abbott has opposed localpaid sick leave ordinances, which could encourage sick people to stay home and keep from spreading the virus, saying they hamper business growth.

"I am pleased that Governor Abbott is engaged in a way that is certainly more substantive than President Trump - but that is such a low bar," Democratic Texas Rep. Lloyd Doggett wrote in an emailed statement. "Like Trump, he has shifted responsibility for the toughest decisions to local leaders and declined to provide leadership on limitations and closures. He has provided no leadership on health care access in the state with the most uninsured."

Health providers say the state has been slow to ramp up testing, relying instead on local officials and private companies to step up efforts. About 1,200 people have been tested so far - a fifth of the number that have been tested in California and half the number that have been tested in Minnesota, according to a POLITICO analysis of state tallies.

Christopher Crow, president of Dallas-based Catalyst Health Network, said his group of clinics, which serves 1.2 million patients in the state, is ready to roll out Covid-19 testing but lackedprotective gear to keep doctors and nurses from becoming infected. On Tuesday evening the group finally got equipment from the national stockpile - enough to last for two or three days of testing.

"We haven't had to do a 180-degree turn in a moment. That is really hard," Crow said. "I wish we had more coming from our public officials than we have right now."

Texas isn't the only state to drag its feet on a response. But the state's population of 30 million people and its high uninsured rate makes the state a potential hotbed for virus spread.

"At some point the needs will overwhelm the health care system" in Texas, said James Hodge, Jr., director for Arizona State University's center for public health law and policy.

Abbott's office says the governor believes in taking a decentralized approach letting local officials take the lead in imposing restrictions and relying on private companies to help boost testing capacity.

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Several Texas cities and counties have already closed schools and limited public gatherings. That includes Austin, which issued an order Tuesday banning gatherings of more than 10 people and shutting down restaurants and bars through early May.

"County judges and mayors have done a very good job in listening to local health officials," Abbott's spokesman John Wittman said in an interview. "What is best in Dallas may not be best for Amarillo or Abilene."

Some local officials say Abbott is responding to conservative Texas voters who will chafe at what they see as overly restrictive measures.

"The biggest challenge there is still a lot of people in our communities who are trying to figure out if we are overreacting or underreacting," said Jerry Mouton, mayor of Deer Park southeast of Houston.

The outbreak is coming at the same time as a downturn in oil and gas revenue, a lifeblood for the $110 billion annual Texas budget. While the state has a rainy day fund totaling more than $11 billion, some state lawmakers worry that needs for social services will skyrocket at a moment when state coffers will be emptier.

The next session will be "frightening," said Democratic state Sen. Nathan Johnson. "We are looking at a higher demand for state services and will be less financially able to deliver them."

Johnson added that he hopes the outbreak will spark a conversation about expanding health coverage and paid sick leave policies in the state.

"If we have a stronger, better thought out system of services, I think we can avoid some of the pain the next time around," he said.