While dozens of eligible voters are currently dispersed around the city, Bronx River Addition’s Building 11 remains a tight-knit community home to many Spanish speakers. Two ballot options promise expedited repairs, but could also require them to temporarily relocate.

Additional reporting and Spanish translation by Daniel Parra.

The lobby of Bronx River Addition’s Building 11, a mid-rise for seniors in Soundview, is plastered with information about lead and mold abatement. A caution sign sits directly beneath a hole in a ceiling that occasionally leaks, and tenants say they favor the elevator on the left, as the right one often gets stuck.  

According to resident Ana Almanzar, squatters sometimes occupy the lobby, and the fourth and 10th floors.

Other signs around the entrance have important dates on them: March 13 and April 11, the bookends of an ongoing voting period. Residents of Bronx River Addition have been tasked with picking from three distinct models to finance building repairs—the second group in the city to do so. 

Among the voters are 60 seniors who used to live a few blocks away in Building 12. But that low-rise was deemed uninhabitable in 2022 due to an issue with the heating system, and the tenants have been relocated to New York City Housing Authority complexes elsewhere in the Bronx, as well as in Manhattan and Brooklyn. 

Meanwhile, the community at Building 11 remains tight-knit, composed of many Spanish speakers, some of whom immigrated to the United States from the Dominican Republic. 

In February, two nonprofit organizations, Community Voices Heard (CVH) and the Community Service Society of New York (a City Limits funder), held a meeting in the lobby of Building 11. About 20 residents—some sitting in folding chairs, others standing—waited to hear more information about the vote. 

A majority of the residents opted for the Spanish informational booklet the organizers were distributing, along with headsets for translation to follow along. One tenant asked for a headset partway through the meeting, only to learn that there weren’t any left. 

Together, the 199 local and dispersed Bronx River Addition tenants are following in the footsteps of those at the Nostrand Houses in Sheepshead Bay, Brooklyn, who recently opted into New York’s novel Public Housing Preservation Trust, a public entity that can issue bonds to fund repairs. Under this model, NYCHA management remains in place. 

Other options on their ballots include the Permanent Affordability Commitment Together (PACT) program, which brings in outside developers and building managers, and the status quo—traditional Section 9 public housing. 

On a recent Tuesday, a handful of residents described some of the hurdles they have encountered during, and leading up to, the voting process. Some said they were unsure about the differences between the options on their ballot, and one senior described mobility challenges that made it impossible for them to attend information sessions. 

Still, everyone City Limits spoke to said they intended to vote. 

“I want to try something different to see if things change,” said Milagros Martinez, a 78-year-old resident of Building 11, in Spanish. 

Martinez moved into her studio apartment in 2008. She recalled her initial visit, thinking that the unit was “old” and “did not look good.” 

“They told me that if I didn’t take it, they wouldn’t give me one for six or seven years,” she added. 

Conditions seemed to worsen after the move. There were leaks in her apartment, the heat from the radiator seemed a bit too high and on two separate occasions, water burst out. The condensation covered her floors.

“The water was black like oil,” Martinez recalled. “I lost everything at the time… these are things you don’t want to happen.”

A member of NYCHA’s resident engagement team knocked on Martinez’s door during the first week of the vote, to explain the different options on the ballot. The next day, she filled out the bubble for the Trust and is waiting to cast her vote in person.

“Under the current conditions, you never know when the problems will be fixed,” she said. 

Milagros Tavera lives down the hall from Martinez. The 87-year-old has limited mobility and spends most of her days inside of her studio apartment. Tavera told City Limits in Spanish that she wasn’t able to attend any of the meetings NYCHA held and was feeling unwell when the most recent meeting took place in the lobby. She is still hoping NYCHA staff will visit her. 

“No one has come in [to] explain what the options are,” Tavera said in Spanish.

Above: Milagros Tavera, 87, has been a Bronx River Addition resident for 23 years. At right: peeling paint in her apartment, which she says has never been repainted in the time she has lived there. Photos by Adi Talwar.

Tavera moved into her apartment 23 years ago. She recalled that fixes used to be made within days of a request. Now, it takes months for work orders, or “tickets,” to be closed. 

Almanzar, who has lived in the building for three years, told City Limits that she attended informational meetings ahead of the vote, hosted by NYCHA, and felt confident enough to make a selection on her ballot.

Security is a concern for her. Though she is aware of a security guard on site, she said in Spanish that she still does not feel safe.

At NYCHA’s senior properties, a security guard must be present daily for at least eight hours, according to the authority. If the tenants vote for PACT or the Trust, NYCHA said, resident input would help establish security plans going forward. 

During City Limits’ visit to Building 11, a NYCHA organizing director walked out of Apartment 3L on the third floor, where voters will be able to cast in-person ballots between April 2 and 11. 

The engagement worker, who speaks Spanish, had informed residents like Maria Gonzalez about the ongoing vote.

Gonzalez’s primary concern is a potential construction phase, if the complex chooses PACT or the Trust. 

Adi Talwar

Ana Almanzar, 70, in her friend Milagros Tavera’s apartment. Security in the building is a concern for her, she told City Limits.

“When they take out the sink, all that stuff, it hurts you, the dust,” she said in Spanish. 

Tenants may be relocated as an environmental precaution if they choose either of these options, according to NYCHA. A temporary move would be unlikely if they remain in traditional public housing, according to the authority, because comprehensive renovations would not be possible with NYCHA’s existing funding.

RELATED READING: No ‘False Promises’—NYCHA Tenants Get Preview of Trust Transition

As for the relocated residents of Building 12, NYCHA has said choosing the Trust or Pact could get them home sooner. Gonzalez, who lives directly across from 3L, is also waiting to vote in person, and is keeping her decision under wraps.

She, Almanzar and Tavera all described Building 11 as a community.

“When I cook, I call everyone to come eat and if I don’t feel good, I’ll do the same and pack the apartment with people trying to help me,” Tavera said. “I would rather stay even though the conditions are not the best… it’s better than going to a place where I don’t know anybody.”

This story was produced as part of Columbia University’s Age Boom Academy.

To reach the reporter behind this story, contact Tatyana@citylimits.org. To reach the editor, contact Emma@citylimits.org.

Want to republish this story? Find City Limits’ reprint policy here.

Three years ago, Texas House Speaker Dade Phelan unveiled a set of bills that he declared would improve the health of millions of Texans, largely by expanding access to healthcare.

The measures, authored by Republicans and Democrats, were applauded by health advocates such as the Texas Medical Association. This month, an updated version of one of the most noteworthy bills took effect, extending postpartum Medicaid coverage for new mothers from two months after giving birth to a year.

The reforms—most of which passed—fell short of full Medicaid expansion, but they cast the newly elected House speaker in a milder light: a conservative Texas GOP leader willing at times to prioritize the state’s serious healthcare gaps.

Phelan toes a conservative line, including supporting one of the country’s most restrictive abortion bans. But some advocates were hopeful that Phelan’s “Healthy Families, Healthy Texas” plan, which included bills from Republicans and Democrats, might signal openness to Medicaid expansion approval to cover more low-income adults. Texas is one of 10 states that haven’t expanded the program and has the nation’s highest rate of residents without health insurance, at nearly 19 percent for those under age 65.

But Republican leaders, including Phelan, haven’t budged. Asked in 2021 why his health reform agenda didn’t include expansion, Phelan said, “That’s a different conversation than what we’re discussing right now.” He didn’t rule it out, however. “We will have that debate,” he said.

Now, if he ever seemed like a willing listener on expansion, the prospect could soon vanish.

Phelan is fighting to keep his House seat in a primary runoff on May 28 in his far southeast Texas district. In the March primary results, Phelan trailed his Trump-endorsed challenger David Covey by three points. Another candidate, Alicia Davis, came in third and has since endorsed Covey. It was the first time Phelan had faced an opponent since he was elected to the House in 2014.

The high-profile face-off and other challenges to incumbents have spotlighted a power struggle among Texas Republicans that could push the Legislature further to the right.

Other than abortion, healthcare issues are not dominating the debates in Texas campaigns. Phelan’s office declined to talk to Public Health Watch for this story or provide a statement on Medicaid expansion.

But back home in his district—state House District 21, a vertical stretch of rural, metro, and industrial communities sandwiched between Houston and Louisiana—the needs for affordable healthcare are high.

District 21 represents all of Jasper and Orange counties and about a quarter of Jefferson County’s population, including part of Beaumont, Phelan’s hometown. Nearly 19 percent of District 21 residents younger than 65—or about 28,500 people—are uninsured, according to the Census Bureau’s 2022 five-year estimates. 

Like much of Texas, the district has a shortage of primary care providers. Hospital services are tenuous. In rural Jasper County, there’s only one hospital—Jasper Memorial, part of Christus Southeast Texas—and it no longer has a labor-and-delivery unit. The next closest is an hour northwest to Lufkin or an hour south to Beaumont. 

Bluebonnets near the Jasper County Courthouse on March 5 Kim Krisberg

Orange County, a major hub for chemical manufacturing, lost its only hospital in 2017, making it the most populous county in Texas without a hospital until Christus opened one there in January. 

The lack of access isn’t for lack of need. Federal, state and university research data show counties in District 21 are among the least healthy in the state, with high rates of cancer, diabetes, mental distress, and stroke deaths.

A handful of safety-net providers are available to the area’s thousands of uninsured, but their medical capacity is limited. And one—the Jasper Newton County Public Health District—is struggling to maintain its primary health-care program, its director said.

The health district started offering free and low-cost primary care about 30 years ago to help address the region’s access gap. Its clinic, located inside the agency’s century-old building near Jasper’s town square, sees hundreds of primary care patients a year, all of them uninsured and living on low incomes.

Services include preventive screenings, lab work, and chronic disease management, but providers can do little if patients need help beyond basic care. 

“The majority do without anything we can’t provide here,” said Patty Barthol, clinic director at Jasper Newton County Public Health District. “Most can’t afford even the discounted rate for a CT scan.” 

Transportation is also a major barrier in the rural area. “If you’re living in poverty, the disparity starts with just trying to get to the clinic,” said Diane Rashall, the health district’s administrative director.

Rashall said the area had a “[health] insurance deficiency” before COVID-19 and its related job losses made the problem worse. Nearly one-fifth of Jasper County adults younger than 65 are uninsured, according to Census Bureau data. The poverty rate is above 19 percent. 

If the health district closes its primary care program, it would leave a sizable gap in the local safety net and vulnerable patients without a medical home. But Rashall said the financial strain of keeping it open is getting too big to bear. 

The program is funded through a state grant, which means that if the funding pays for 600 primary care patients in a given fiscal year, the health district will lose money when someone needs more than a single visit. The cost of any additional clients is also unreimbursed. 

At the same time, the only way to increase the grant amount is to demonstrate  community need by accepting unfunded patients for treatment, Rashall said. It leaves the program in a chronic deficit, and it’s why many local public health departments stopped offering direct primary care, she said.

“Luckily, we have a board that has said it’s important in our county, and as long as we can pay the deficit, we’re going to do it,” she said. “But, to be honest with you … I really don’t know how long we’re going to be able to absorb that.”

Jasper resident Joycelyn Sampson Kim Krisberg

Jasper resident Joycelyn Sampson, 52, doesn’t think she would be alive today without the health district’s primary care program. Unable to afford insurance, she doesn’t know where she would turn if the clinic program were shuttered.  

Sampson, who works a part-time night shift at Walmart, has been a patient there for eight years. Last year, during a clinic visit, her blood pressure was so high that a staff member drove her straight to the emergency room.

“I thought I was just not feeling good that day,” she said. “Come to find out, I was almost about to stroke out.”

Sampson is lucky. Research shows uninsured patients are at a higher risk of experiencing and dying from a severe stroke, partly because they lack access to primary care.

Now, she’s on medication to manage her blood pressure.

“I could have really been gone if it weren’t for this place and these people,” Sampson said.

In addition to being House speaker, Dade Phelan works for his family’s fourth-generation commercial real estate and investment company.

The family is a fixture in Beaumont; its wealth traces back to the Texas oil boom of the early 1900s and a wholesale grocery business. A main thoroughfare through the city is named for the Phelan clan.

Philanthropy is part of the family’s profile. Phelan has served on the board of Catholic Charities of Southeast Texas, and his wife, Kim, a lawyer, once represented children and parents in Child Protective Services cases and is involved in charities promoting mental health services.

The area’s serious health needs have knocked repeatedly on Phelan’s door.

In 2016, Jessica Hill, then executive director of the Orange County Economic Development Corporation, was attending a Commissioners Court meeting when she got a text message: Baptist Hospital in Orange, which had been cutting its services for years, was closing its ER, citing financial strains that included the state’s failure to expand Medicaid. That left the county without a single hospital. 

“It was a shock,” she said. 

The next closest hospital was at least a 30-minute drive to Beaumont or Port Arthur, both west of the Neches River—hardly ideal. In the 2021 freeze that shut down Texas, the bridges to and from Port Arthur were too icy to safely cross. 

The hospital’s closure not only deepened the health gap and cost about 100 jobs, Hill said it also made her role—attracting new businesses and jobs to improve the economy—much harder. 

“Most young families won’t move to a community that doesn’t have those services, and most large employers won’t locate in communities that can’t offer employees that,” said Hill, who left the job in 2022.

In late January, after years of grassroots work and a 20-acre donation from a local philanthropist, Christus opened a new hospital in Orange with around-the-clock ER services. 

Phelan offered “critical” support in bringing a hospital back to Orange, Hill said, and attended the opening-day celebration.

“I think he sees [healthcare] as a very important issue,” Hill said. “I think he understands why it’s important … what it means to a community.”

Phelan’s House district cuts across a range of county-level uninsured rates. In Jefferson County, where Beaumont sits, the uninsured rate is almost 23 percent; in Orange County, it’s 16 percent, and in Jasper County nearly 19 percent. The district’s uninsured rate for children alone—those 18 and under—is in double digits, at 10.4 percent, despite Medicaid’s Children’s Health Insurance Program. One of Phelan’s “Healthy Families” priority bills, House Bill 290—which ultimately was folded into another bill signed into law in 2021—was aimed at streamlining CHIP enrollment so kids don’t churn in and out of coverage.

If Texas lawmakers passed Medicaid expansion—which extends eligibility to adults with incomes up to 138 percent of the federal poverty level, or less than $21,000 a year for a single person—researchers estimate that more than 1.2 million Texans could gain health insurance. 

Phelan hasn’t endorsed expansion, despite evidence of its positive health and financial benefits. But his healthcare work in the House—such as shepherding the Medicaid postpartum extension through two legislative sessions, benefitting 137,000 Texans—has signaled his interest in addressing systemic health issues.

It’s unclear if that focus will continue. If he loses his runoff—or even if he wins—healthcare issues could take a back seat to others dominating the campaigns.

“Well, it’s certainly not better for Medicaid expansion if Phelan loses,” said state Senator Nathan Johnson, a Democrat from Dallas, who’s filed bills to expand Medicaid during multiple sessions.  

Luis Figueroa, chief of legislative affairs at the progressive nonprofit Every Texan, said the District 21 GOP runoff could help determine if healthcare issues remain a top priority in the Texas House—“because healthcare access hasn’t been a priority in the [state] Senate.”

In Kirbyville, a small town in Jasper County, Nancy Davis will turn 65 in five years. She doesn’t plan to retire, but she said it will be a relief to qualify for Medicare and have health insurance. 

Davis, who owns a beauty salon and alterations shop, last had insurance in the early 2000s, when she briefly qualified for Texas Medicaid as a single mother raising three children.

Since losing Medicaid, she’s been a patient at the Jasper Newton County Public Health District. There, she’s been able to access a range of primary care services, such as mammograms and blood pressure checks—which she credits for keeping her healthy and out of medical debt. 

“There are lots of single women out there, working, trying to take care of their kids—they need to stay healthy, too,” Davis said. “At least if they had Medicaid, they could go to the hospital and not have to worry about debt they can never repay.”

Longtime Kirbyville resident Nancy Davis in her beauty salon on Main Street Kim Krisberg

Medicaid expansion would help many, but it won’t solve the access gap, partially because of the state’s low Medicaid reimbursement rates. Many doctors don’t accept the insurance. 

TAN Healthcare, a federally qualified health center in District 21, takes Medicaid, but its providers regularly have trouble finding nearby specialists willing to take Medicaid referrals, said Dena Hughes, TAN’s chief executive officer. Sometimes the closest available specialist is more than an hour away in Houston, which is especially difficult for people with limited incomes and transportation.  

About 40 percent of patients at TAN—which has sites in Beaumont and Orange and a mobile medical clinic that travels to Jasper and Newton counties—have no coverage, and most of its insured patients qualify for Medicaid. 

MyEisha Clifton, lead nurse practitioner and director of medical services at TAN, said the center can help people access low-cost primary care and discounted prescriptions. But if uninsured patients need higher-level care—for example, TAN has recently seen a lot of cancer cases, Clifton said—the costs can be devastating.    

“It’s hard for a provider to tell a patient that there’s nothing else that I can do for you because you don’t have health insurance,” Clifton said. 

Medicaid expansion wouldn’t plug every gap, Hughes said, but more coverage would matter for patients and providers. 

“It would still make a huge difference,” Hughes said. “Huge difference.”

The story is part of “The Holdouts,” a collaborative project led by Public Health Watch that focuses on the 10 states that have not expanded Medicaid, which the Affordable Care Act authorized in 2010.

The first round of the NCAA’s men’s basketball tournament started Thursday. But it won’t be the only college basketball competition worth watching this year. Two weeks ago, organizers of a new tournament planned for the fall at the MGM Arena in Las Vegas indicated they’d offer each participating school up to $2 million in NIL money that must be distributed to current athletes.

The Players Era tournament, as it’s known, isn’t competing against March Madness (not yet, at least). But as college athletics undergoes seismic, money-driven changes, it’s one model for the future. Others, intended to further enrich schools, athletic conferences and media partners, are also emerging.

The consequences are stark. By next season, March Madness could look very different. Within a decade, it could be obsolete. Fans, now settling into their sofas to watch some great basketball, should enjoy this year’s tournament as if it’s a last dance.

The NCAA’s first March Madness dance began in 1939. Since then, the organization has steadily grown its men’s basketball tournament — and the money earned by it.

As of 2023, more than 80% of the NCAA’s revenues come from the tournament. That money doesn’t simply stay with the NCAA; much of it is paid out in (roughly) $2 million “units” to athletic conferences based upon each team they qualify and win they earn. It adds up: The SEC took in $34 million worth of units last year.

But the process of getting in is where the problems start and what has long inspired discussions about alternatives to March Madness. Currently, 32 teams automatically qualify for the tournament by winning their conference tournaments. Most of the automatic qualifiers are from smaller leagues, and as a result, competitive teams from bigger conferences often don’t make the tournament, which ultimately also means the money.

This year, for example, the Big East, a long-time basketball power conference, saw three of its 20-win teams fail to qualify for the tournament. In response, the Big East has loudly complained about the NCAA’s selection process. And it’s not alone. On Wednesday, legendary Michigan State coach Tom Izzo (whose team qualified for this year’s tournament) pointedly noted that he wasn’t sure the process was good for the game.

Potential solutions are on the table. Last year, the NCAA proposed expanding the men’s basketball tournament to as many as 90 teams. It didn’t specify who would get those slots and how the money would be divided. But change in the tournament’s structure is imminent. The Athletic recently reported that the tournament will likely expand to 72 or 76 teams as soon as next year.

That’s unlikely to be a happy outcome for college basketball traditionalists. Among other problems, it may dilute the quality of play while marginalizing the importance of the regular season. Then there is the question of money. Unless the NCAA’s media partners are willing to pay for additional games, conferences would be dividing the revenue pie more finely as the tournament expands.

That leaves the biggest conferences with a different and arguably better possibility. Why not start their own post-season competition independent of the NCAA?

There’s plenty of interest available to make it happen. Last year, Fox Sports proposed a tournament featuring teams from the Big 12, Big East and Big Ten conferences that don’t make the NCAA tournament. Money would be a significant factor if Fox or somebody else wanted to take the next step and lure schools and conferences away altogether.

But the funds seem to be available. By one account, the NCAA undervalued its most recent sale of its men’s March Madness rights by as much as $9 billion through the early 2030s. The most recent sale of the women’s tournament may have under-valued it by nearly $50 million a year. If they wanted to do it, the major conferences would have no trouble finding sponsors, private equity and media rights partners.

There’s ample precedent that it could work, too. The College Football Playoff is owned and operated by 10 athletic conferences, plus the University of Notre Dame. CFP — not the NCAA — decides who participates and how the money is divided. On Wednesday, it completed a new, six-year agreement with ESPN that will pay it $1.3 billion annually.

It’s not just the schools and conferences that can potentially benefit from this influx of money. NCAA rules do not prevent networks and other CFP sponsors from offering athletes NIL payments. A new spring basketball tournament looking for an edge over the NCAA could be the trailblazer.

The outcome would be a different kind of event that better reflects the money-driven evolution of college athletics.

It may not have the same form as the current March Madness, but the basketball matchups will be superior, and that’s the kind of madness every fan should enjoy.

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By LEA SKENE (Associated Press)

BALTIMORE (AP) — A container ship rammed into a major bridge in Baltimore early Tuesday, causing it to snap and plunge into the river below. Several vehicles fell into the chilly waters, and rescuers were searching for survivors.

Two people were rescued from the waters under the Francis Scott Key Bridge, one in serious condition, according to Baltimore Fire Chief James Wallace. He said authorities “may be looking for upwards of seven people” but said that number could change. It was not clear if the two rescued were included in the seven.

It was not immediately clear what caused the cargo ship to crash into the bridge long before the busy morning commute in what one official called a “developing mass casualty event” in a major American city just outside of Washington.

The ship crashed into one of the bridge’s supports, causing the structure to snap and buckle at several points and tumble into the water in a matter of seconds — a shocking spectacle that was captured on video and posted on social media. The vessel caught fire, and thick, black smoke billowed out of it.

“Never would you think that you would see, physically see, the Key Bridge tumble down like that. It looked like something out of an action movie,” said Baltimore Mayor Brandon Scott, calling it “an unthinkable tragedy.”

Sonar has indicated that there are vehicles in the water, where the temperature was about 47 degrees Fahrenheit (8 degrees Celsius) in the early hours of Tuesday, according to a buoy that collects data for the National Oceanic and Atmospheric Administration.

Earlier, Kevin Cartwright, director of communications for the Baltimore Fire Department, told The Associated Press that several vehicles were on the bridge at the time of the collapse, including one the size of a tractor-trailer truck. The bridge came down in the middle of night when traffic would be lighter than during the day when thousands of cars traverse the span.

Cartwright called the collapse a “developing mass casualty event,” though he didn’t know at the time how many people were affected.

He added that some cargo appeared to be dangling from the bridge, which spans the Patapsco River at the entrance to a busy harbor. The river leads to the Port of Baltimore, a major hub for shipping on the East Coast. Opened in 1977, the bridge is named for the writer of “The Star-Spangled Banner.”

Maryland Gov. Wes Moore declared a state of emergency and said he was working to get federal resources deployed. The FBI was also on the scene.

Synergy Marine Group — which owns and manages the ship called the Dali — confirmed the vessel hit a pillar of the bridge at about 1:30 a.m. while two pilots were in control. It said all crew members, including the pilots, were accounted for and there are no reports of any injuries.

The Dali was headed from Baltimore to Colombo, Sri Lanka, and flying under a Singapore flag, according to data from Marine Traffic. The container ship is about 985 feet (300 meters) long and about 157 feet (48 meters) wide, according to the website.

In 2001, a freight train carrying hazardous materials derailed in a tunnel in downtown Baltimore and caught fire, spewing black smoke into surrounding neighborhoods and forcing officials to temporarily close all major roads into the city.

___

This story has been corrected to reflect that the ship does not appear to have sunk.