Valley delegation backs health care reform

The chronic back pain finally hit Maria Sanchez so bad last April that she was unable to get out of bed one morning.

With no health insurance and no money to pay her own way to the doctor, Sanchez had spent the previous seven months gritting through intense pain in her lower back as she worked jobs in the kitchen of a restaurant and as a home health provider.

Unable to endure the pain any longer, she went to the doctor who treats her son, who has government-sponsored insurance, and asked him to diagnose her own ailment.

The kidney stones the doctor saw on the X-ray —whose symptoms Sanchez ignored for months — were so bad he scheduled her for surgery to remove her badly damaged kidney at a reduced cost.

But Sanchez could be among as many as 574,000 residents in the Valley’s three congressional districts who are uninsured now but would be extended coverage under a health care bill the House passed Saturday by a vote of 220-215.

Valley representatives touted their support of the bill because of expanded insurance coverage for South Texans, changes to employer-based coverage and tax credits for small businesses and individuals to help pay for health coverage.

The legislation’s passage marks a major step forward in changing the overall health care experience of not just Sanchez but virtually all U.S. residents.

The 49-year-old has received follow-up care at Hope Family Health Center, where staff watch for complications from the surgery and monitor her high blood pressure, diabetes and other health issues.

She’s among 600 patients that a tiny team of therapists, doctors and a case manager see each month at Hope, a free clinic subsisting on monetary donations and the volunteer work of health care providers.

As debate over sweeping reforms to the nation’s health care system culminated this weekend in the U.S. House, Hope Family Health Center is serving the uninsured as it always has, and one doctor there says he sees no end to the clinic’s list of waiting patients.

But in an area placed in the spotlight this summer when President Barack Obama pointed to McAllen as an example of what he wanted to fix in health care, the results of the reform effort are certain to have a dramatic impact on how the clinic operates.

Various assessments have repeatedly singled out the Rio Grande Valley for having the nation’s highest rate of uninsured, the highest percentage of the population dependent on Medicaid and Medicare and the highest costs for medical care — that last of which came to light June 1 in a New Yorker magazine article that was required reading for Obama’s staff.

TROUBLED SYSTEM

The House committee that prepared the final health care bill pegged the uninsured rate for non-senior citizens at 36 percent in Rep. Henry Cuellar’s district, which extends from western Hidalgo County to Webb County, and 37 percent in Rep. Rubén Hinojosa’s district stretching from McAllen to Harlingen.

But in the 18-64 age group — those who don’t qualify for the Children’s Health Insurance Program or Medicare — the uninsured rate is 54 percent in Hidalgo County and 49 percent in Cameron County, according to the U.S. Census Bureau. In both counties, people who get their health coverage through public aid programs like Medicaid are close to outnumbering those who are covered through private insurers.

The high cost for health care was also referenced in the New Yorker article, which noted annual Medicare spending per enrollee in McAllen was higher than the average income per capita.

The article’s author concluded the high cost for care here was due to an “across-the-board overuse of medicine” when compared to similar border towns like El Paso.

Local doctors and hospitals criticized the piece for failing to account for the realities of practicing medicine along the border, including the high uninsured rate, lack of access to preventive care and the number of undocumented immigrants who flood area emergency rooms.

Nevertheless, the article thrust McAllen to the center of the debate for those who supported an overhaul of the country’s health care system.

Five months later, a bill that makes broad changes to that system has passed the House with support from the Valley’s delegation.

The debate now moves to the U.S. Senate, where majority leader Harry Reid, D.-Nev., will try to shepherd his own version of the bill to passage. The versions will then be hammered out in a conference committee and voted on by both chambers before being sent to the president for signing.

Rep. Solomon Ortiz, D-Corpus Christi, who said he grew up in a migrant family whose idea of insurance was to kneel down and pray, argues the legislation is needed to help those without resources to pay for health coverage.

“We see South Texas is expanding but we have poverty that is growing,” Ortiz said. “We need to address it so we can have a healthy community. There’s no question we need health care reform.”

BETTER ACCESS

At Hope Family Health Center and other medical facilities that are inundated by the uninsured in South Texas, the Affordable Health Care for America Act will expand the number of insured patients who step through their doors.

The Congressional Budget Office — a nonpartisan agency that reviews congressional budgets and other legislative initiatives with budgetary implications — estimates 96 percent of U.S. residents across the nation will have insurance when the law takes effect.

The bill insures more people in four ways:

>> Extending Medicaid to more people.

>> Establishing a health insurance exchange that allows people — including illegal immigrants — who don’t receive health care coverage through employers to purchase coverage at group insurance rates.

>> Creating affordability credits that are subsidies to help low- and middle-income families pay for insurance premiums.

>> Establishing a “public option” — the government-run plan that was fiercely debated in the run-up to a vote but will only cover 2 percent of Americans.

By expanding coverage of Medicaid to 150 percent of the poverty line — set this year at $22,050 for a family of four — it makes coverage available to the poorest, Rep. Hinojosa said. But in an area where much of the population lives just above that line, it goes further by giving the families a subsidy to help with costs.

Hinojosa was disappointed a robust public option was abandoned to get the votes needed to pass the bill, he said. But even with a watered-down public option, “we are still better off than what we have,” he said.

“Our region is in dire need of reform,” Hinojosa said. “It certainly has a lot to gain that we’re going to get 40 percent of the (uninsured) people in my district insured.”

FULL SUPPORT

Other reforms in the 2,000-page bill are numerous.

Those with employer-based insurance can keep the coverage they have, there will be no co-pays or deductibles for preventive care, and pre-existing medical conditions can’t be used to deny coverage.

The bill caps annual out-of-pocket costs at $5,000 for individuals and $10,000 for families, provides tax credits to small businesses that offer insurance and closes the Medicare doughnut hole that results in seniors paying full cost for drugs.

Rep. Cuellar, who secured two provisions in the bill to protect state medical malpractice laws and require new federal agencies to undergo annual performance assessments, said the bill is stronger than the one introduced in the House in July.

Calling it one of the most important votes Congress will ever take, Cuellar said the bill responds to the needs in his district by giving the uninsured access to health care and protecting the insured from rising premiums.

“It’s a historic, unprecedented plan to better the lives of all Americans,” he said. “This vote was a once-in-a-lifetime opportunity to build upon the premise that all Americans are created equal and would ensure that every American is worthy of access to quality affordable health care.”

MORE HOPE

The list of new patients seeking care at Hope Family Health Center is always expanding.

Each month, the three volunteer doctors see more than 200 new patients — a fraction of the waiting list that constantly has more than 600 names — and almost 400 patients for follow-up visits.

Most patients at the center are employed in jobs without insurance benefits, said Rebecca Ramirez, Hope’s executive director. Patients usually don’t show up at the clinic until their symptoms have taken a turn for the worse.

Doctors regularly see patients with blood sugar levels or blood pressure that is through the roof.

Some patients ignore problems like gangrene or tumors until the doctors — with no lab and limited resources — can only try to refer them somewhere else.

Poverty-stricken patients at the clinic are concerned more with paying their own bills than worrying about their health, Ramirez said. Many tell doctors they don’t visit the center because they don’t have insurance.

“The same problems come in every day,” Ramirez said. “Something needs to be done so people don’t put off their health because they can’t afford it.”

For Sanchez, the 49-year-old woman who had a kidney removed, the current health care bill would undoubtedly give her insurance for the first time.

She barely missed qualifying for Medicaid before because her husband receives a disability check that puts their income $50 above the eligibility threshold.

The Mission resident still owes her first doctor more than $2,000 for the kidney removal.

She hasn’t worked any jobs since the debilitating pain from the kidney stones put her on her back, and she doesn’t bother with trips to the pharmacy to find prices on prescription medications she knows she can’t afford.

Health insurance would have kept her from ignoring the kidney stones for seven months, she said Thursday at the center. But even now, with no insurance, she’s putting off another surgery to remove gallstones because she can’t afford it.

“She knows it isn’t possible for her to get insurance right now,” said Sanchez’s case manager, Cynthia Anguiano, translating from Spanish for the woman. “Now she needs it more than before because her problems won’t go away.”

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Jared Janes covers Hidalgo County government, Edinburg and general assignments for The Monitor. He can be reached at (956) 683-4424.