Texas has the highest proportion of uninsured residents in nation

So much of the last two years has felt surreal for the staff at Centro De Salud Familiar La Fe, a federally qualified health center in El Paso. Apparently by nightfall, the women’s health center became a coronavirus unit. They started offering COVID-19 tests, and then, as soon as they could, fax pop-ups. They have made public service announcements and gone door to door, encouraging people to get vaccinated.

But despite the unusual nature of the pandemic, some things did not come as a surprise – such as how hard it hit its customers with low incomes and uninsured.

“This area has been hurting for a long time,” said spokeswoman Estela Reyes-L√≥pez. “We are not getting the funding we need. We do not have the medical providers we need. … The situation with the coronavirus is only exacerbating things that have already happened.

La Fe serves primarily low-income and uninsured Texans, and it has seen firsthand the various impacts the pandemic has had on the most vulnerable communities. Many work hours, public jobs that do not allow them to wait in line for COVID-19 tests – or take time for quarantine. Others have chronic, untreated health conditions that make them more susceptible to severe cases of the disease. Nationally, uninsured people are lagging behind in vaccination rates.

Dr.  Manjul Shukla delivers Pfizer COVID-19 vaccine in a syringe on Dec. 2 at a mobile vaccination clinic in Worcester, Mass.  with a delta variant that sends record numbers of people to hospitals in New England and the Midwest.

Dr. Manjul Shukla delivers Pfizer COVID-19 vaccine in a syringe on Dec. 2 at a mobile vaccination clinic in Worcester, Mass. with a delta variant that sends record numbers of people to hospitals in New England and the Midwest.

And now, with a new COVID-19 wave threatening to crash on the shores of Texas, La Fe’s staff are preparing to hit these same communities hardest.

“The biggest crisis we’re currently having among the uninsured is confusion over the cost of testing and where they can get the tests,” said La Fe community health manager Jorge Salazar. “And then the vaccines, which come for free, but when people are not used to it, they still hesitate.”

Medical vulnerability

Many questions remain about omicron, the highly contagious new variant of coronavirus, but health care experts say that preparation has proved the key to how a community destroys the disease. And many uninsured and low-income Texans may be on a preparation deficit after decades of medical education.

In 2019, more than 18% of Texans were without health insurance, the highest rate in the country and more than double the national average. Texas is one of only 12 states that have opted to extend Medicaid access under the Affordable Care Act.

In El Paso County, where La Fe is based, about a quarter of adults under the age of 65 do not have health insurance. Salazar said this means the area was already behind the ball when the pandemic hit.

“The problem is the historic lack of health insurance, not just the lack of health insurance now,” Salazar said. “They have not been able to attend preventive care or maintain their health.”

Salazar said health center clients often face chronic or untreated health conditions that compromise their immune system and make them vulnerable to getting a severe case of COVID-19. This undertreatment may have intensified during the pandemic, he said, because many people were prevented or unable to get treatment in emergency rooms, which could be a starting point for the health care system for uninsured patients.

It’s a similar story in the Rio Grande Valley, which, like El Paso, has among the lowest rates of health insurance in the state.

“There are a lot of individuals here who have comorbidities like undiagnosed or untreated diabetes, for example,” said Michael Dobbs, vice president of clinical affairs and chief medical officer at the University of Texas Health Rio Grande Valley . “Their immune system may not be working as well. They are more susceptible to infections. And sitting on a ventilator for so long in hospital is very dangerous for those patients.

“The perfect storm”

With the holidays over and omicron on the rise, many Texans are scrambling to get their hands on COVID-19 tests. But that will also be more difficult for low-income and uninsured Texans, many of whom cannot afford expensive kits at home or wait in long lines for free test sites.

“In the beginning, there was much more access to publicly accessible test centers, for free,” said Brian Sasser, chief communications officer at the Episcopal Health Foundation. “Obviously, that was beneficial for everyone, especially those without insurance.”

But if testing requires paying out of pocket or seeing a doctor, Sasser said, many people without insurance will simply not be tested. This is especially true for people who work in jobs that do not offer them paid time or insurance.

“It’s one of those reinforcing loops where it’s harder to take a test, and it’s less of an incentive to take a test, because if you find that you’re positive, you’re not paid for work, he said. “The end result is that people are in danger … and can put other people in danger. It’s all going to be the perfect storm.”

Sasser hopes the pandemic has underscored the vulnerability of a health insurance system that is tied to employment and, perhaps, only full-time professional work. By May 2020, just two months after the pandemic, it was estimated that more than 650,000 Texans would lose their employer-sponsored health insurance.

Lagging vaccination rates

Among the most pressing questions for healthcare professionals at the moment is how effective COVID-19 vaccines are against the omicron strain – and how you can get more vaccines and boosters into the community. In El Paso County, 65% of the population is fully vaccinated, about 10 percentage points higher than in the state. Salazar, with La Fe, said getting these shots into the arms required a lot of work.

“The most important part is the outreach: knocking on doors, letting people know we’re there, letting people know we do not need insurance and do not even need paperwork other than identification so we can get everyone immunized,” he said.

Vaccinations for coronavirus and boostershots are free, regardless of whether a patient has insurance. Texas does not track the insurance status of vaccinated individuals, but a nationwide survey by the Kaiser Family Foundation in September found that uninsured adults are significantly behind on vaccination.

Healthcare professionals who serve uninsured patients say they hear concerns about hidden costs, such as side effects that require medical care. Or, they worry, people without insurance may not have trusted medical professionals to turn to for advice.

And in border communities like El Paso, Salazar said, they are fighting an increasing tide of government mistrust. He said Governor Greg Abbott and former President Donald Trump have raised concerns about maintaining immigration in heavy Latino communities.

“Then they suddenly say we need to be immunized, and we start to see some of these ghosts emerge from earlier lack of confidence,” he said.

“Put on the shoes of the immigrant, who is a frontline worker who cannot speak the language, who lives in a colony, who has to work to survive, and at the same time someone in her house can have those who have all the good paperwork, “he said.

Salazar said these personal circumstances, plus increasing anti-immigration rhetoric and enforcement, are a “fleeting combination” of forces that discourage people in the area from seeking public services, including faxing.

This fear is not limited to the border. In other parts of the state, black leaders have mobilized to tackle vaccination hesitation arising from government mistrust and health care systems that are often against black patients. There were also early concerns that Black and Hispanic communities would not have equal access to vaccination sites.

While Hispanic people are now being vaccinated at somewhat higher rates than whites in Texas, Black people remain the lowest vaccination rates in the state.

This article originally appeared on Amarillo Globe-News: Texas Has the Highest Share of Unsecured Residents in Nation

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