With more than 26 percent of its residents living without health insurance, Texas has the highest percentage of uninsured of any state in the country. According to federal estimates, that means more than 6 million Texans have no medical coverage.
But estimates for Brownsville reveal a situation that’s more urgent.
“We’re way beyond that,” said Dr. Joseph McCormick, regional dean at the Brownsville Regional Campus for the University of Texas Health Science Center at Houston’s School of Public Health and vice president for South Texas Programs at the UT Health Science Center of San Antonio.
The programs’ surveys have revealed that 60 to 70 percent of residents in the Brownsville area have no medical coverage, McCormick said. And the reasons should not be surprising to those who know about the challenges facing the region, he said.
“We have a lot of poverty. We have low levels of education, and we have a very high level of unemployment. The combination of those things is the explanation for this,” McCormick said.
Those factors have contributed to a number of health epidemics here that have exceeded national averages, he said, listing chronic diseases like diabetes and obesity.
The rate of diabetes in Brownsville is 31 percent of adults — one of the highest in the nation, he said. More than 50 percent of adults here are obese.
“We have a huge problem with obesity,” McCormick said.
That chronic obesity is resulting in a growing rate of liver failure, especially in an area like Brownsville, where “we have one of the highest rates of end-stage liver disease in the country.”
“Obesity is now about equal to cigarette smoking in terms of causing cancer,” McCormick said. “We also have a lot of heart disease here.”
McCormick gleans his insights, in part, through published peer-reviewed journal articles, various studies, and the health insurance surveys of about 2,600 Brownsville residents — “a robust number” — over several years. The data includes mandatory one-on-one interviews that lasted 2½ hours each, helping to provide a better snapshot of the state of health care here.
“Our survey is based on a random survey of the population,” McCormick said. “It’s a random selection rather than a convenience. We didn’t just stand out in front of H-E-B and ask people if they have health insurance.”
Locally, many people often do not receive health care coverage through their employer — nor do they often have the option.
“That’s often the issue here. You have a lot of people on hourly wages and they might have a job, but that doesn’t mean that they have a job that provides health insurance,” McCormick said.
Additionally, many employees might be part-timers who work at several places.
FILLING THE GAP
According to Healthcare.gov, Texas has been awarded $1 million in federal funds to plan an exchange system in which Texans can purchase health care coverage that is in compliance with the Patient Protection and Affordable Health Care Act.
Planning it will involve the Texas Department of Insurance and the Texas Health and Human Services Commission, funds that will examine the state’s specific circumstances and develop considerations for establishing regional exchanges in the state.
Exchanges are intended to provide options to purchase health care for people who cannot obtain coverage through their jobs. The question is whether these exchanges will reduce the number of uninsured in the Texas and Rio Grande Valley.
“I think it will have some (impact), and I think one of the ways the health system will try to help with that is to actually help people find insurance. Right now, many of the clinics and hospitals will get information from people to see if they can, in fact, enroll in an existing program, particularly in Medicaid and Medicare,” McCormick said. “People might in fact be eligible for Medicaid and Medicare and don’t know or they don’t know how to go about it. So, all the federally qualified clinics here will assist people because, obviously, it’s in their interest to help.”
People might not initially understand the exchange or the need for one, but McCormick said he thinks the medical system will have a vested interest in getting people enrolled — just as they help with Medicaid and Medicare — because then hospitals and clinics would not have to deal with uncompensated care.
“If you don’t do that, what would be the option? To keep doing what we’re doing, which is that we all pay?
“Every time someone goes to the emergency room with advanced diabetes because they didn’t have proper care initially, guess who pays for that? We already pay for that,” McCormick said. “… We pay very dearly for it because it’s exactly the same analogy as saying, ‘My car is OK, I’ll just drive it until it runs out of oil.’”
Keeping people healthy through a system that provides health maintenance checks because they have insurance improves individual lives and the entire medical system, he said.
“We either pay for some primary care that will keep people out of trouble or we wait until there is trouble and they go to the emergency room when they’re way down the road of chronic disease, and then we really pay for it,” he said.
He believes that if more people gain access to health care coverage, the region could reduce the rates of diabetes and obesity.
“With all the health disparities we’re talking about — diabetes, all the chronic disease disparities — all of those things are there because we don’t have a system that’s preventing this. It’s just that clear,” McCormick said. “It’s a big burden to the poor, because they are the least educated and have the least access to healthy foods.”
Education about health and the importance of health coverage and medical checkups are keys to improving lives here, and it will have an impact on the economy beyond doctors and clinics, he said.
“I’m an optimistic person. I don’t believe people want to be unhealthy,” McCormick said.
“But we, as health experts, have to do more than say that ‘when you get sick, come to the clinic and we’ll fix you.’ We can’t afford it. Nobody can afford to do that anymore.”