RIO GRANDE CITY, Texas — Jake Margo Jr. stood within the triage room at Starr County Memorial Hospital explaining why an individual with persistent fever who may very well be handled with over-the-counter treatment didn’t should be admitted to the emergency room.
“We’re going to handle the sickest sufferers first,” Margo, a household drugs doctor, stated.
It’s not like there was area on that June afternoon anyway. A small monitor on the wall pulsed with the vitals of present sufferers, who crammed the ER. An ambulance idled exterior within the South Texas warmth with a affected person ready for a mattress to open up.
“All people exhibits up right here,” Margo stated. “While you’re overwhelmed and also you’re overrun, there’s solely a lot you are able to do.”
Starr County, a largely rural, Hispanic group on the southern U.S. border, made headlines in 2024 when it voted Republican in a presidential election for the primary time in additional than a century. Immigration and the financial system drove the flip on this group, the place roughly a 3rd of the inhabitants falls beneath the poverty line.
Now, latest actions by the Trump administration and the GOP-controlled Congress have triggered a brand new concern: the shortcoming of medical doctors, hospitals, and different well being suppliers to proceed to take care of uninsured sufferers. It’s a concern not solely in Starr County, which has one of many highest uninsured charges within the nation. Communities throughout the U.S. with equally excessive proportions of uninsured folks might battle as further residents lose well being protection.
About 14 million fewer Individuals are anticipated to have medical health insurance in a decade on account of President Donald Trump’s new tax-and-spending legislation, which Republicans dubbed the One Huge Lovely Invoice Act, and the pending expiration of enhanced subsidies that slashed the value of Inexpensive Care Act plans for hundreds of thousands of individuals. The brand new legislation additionally limits packages that ship billions of {dollars} to assist those that take care of uninsured folks keep afloat.
“You possibly can’t disinsure this many individuals and never have, in lots of communities, only a collapse of the well being care system,” stated Sara Rosenbaum, founding chair of the Division of Well being Coverage and Administration at George Washington College’s Milken Institute College of Public Well being.
“The long run is South Texas,” she stated.
KFF Well being Information is inspecting the influence of nationwide well being care coverage modifications on uninsured folks and their communities. Although the Trump administration informed KFF Well being Information it’s making “a historic funding in rural well being care,” individuals who deal with low-income sufferers, in addition to researchers and shopper advocates, say latest coverage selections will make it more durable for folks to remain wholesome. Docs, hospitals, and clinics that make up the well being care security internet might lose a lot cash they have to shut their doorways, a few of them warn.
“As a result of the affected person’s invoice isn’t going to receives a commission,” stated Joseph Alpert, editor-in-chief of The American Journal of Drugs and a professor of drugs on the College of Arizona. “Uninsured sufferers stress the well being care system.”
Starr County exhibits how this dynamic unfolds.
Main care medical doctors within the county serve a median of slightly below 3,900 folks every, practically 3 times the U.S. common.
Margo, the household doctor, stated as a result of so many individuals lack insurance coverage and there are so few locations to hunt care, many residents deal with the ER as their first cease after they’re sick.
In lots of circumstances, they’ve uncared for their well being, making them sicker and dearer to deal with. And federal legislation requires ERs at hospitals within the Medicare program to stabilize or switch sufferers, no matter their potential to pay.
That leaves Margo and his group to follow what he described as “catastrophe drugs.”
“They arrive in with chest ache or they cease respiration. They collapse. They’ve by no means seen a health care provider,” Margo stated. “They’re actually dying.”
Well being Techniques in ‘Survival Mode’
When individuals are uninsured or on Medicaid, they have a tendency to depend on a security internet of medical doctors, hospitals, clinics, and group well being facilities, which provide companies freed from cost or take up getting reimbursed at decrease charges than they do treating sufferers on industrial insurance coverage.
These suppliers’ monetary conditions can usually be precarious, main them to depend on myriad federal helps. The Trump administration’s cuts to well being care and Medicaid within the title of eliminating “waste, fraud, and abuse” have many involved they gained’t climate the extra monetary pressure.
Trump’s new legislation funds his priorities, like extending tax cuts that primarily profit wealthier Individuals and increasing immigration enforcement. These prices are lined partly by an almost $1 trillion discount in federal well being spending for Medicaid inside the subsequent decade and modifications to the ACA, reminiscent of requiring further paperwork and shortening the time for folks to enroll.
Many Republicans have argued Medicaid has gotten too giant and strayed from the state-federal program’s core mission of protecting these with low incomes and disabilities. And the GOP has fought to roll again the ACA since its passage.
Kush Desai, a spokesperson for the White Home, stated projections from the nonpartisan Congressional Finances Workplace about how many individuals might lose medical health insurance are an “overestimate.” He didn’t present an estimate the administration sees as extra correct.
Supporters of the “One Huge Lovely Invoice” say those that want well being protection can nonetheless get it in the event that they meet new necessities reminiscent of working in alternate for Medicaid protection.
And Michael Cannon, director of well being coverage research on the Cato Institute, a libertarian suppose tank, stated even with the laws, Medicaid spending will develop, simply not as shortly.
The price range legislation gained’t trigger “the sky to fall,” Cannon stated. “The inefficient suppliers needs to be shutting down.”
A latest survey from AMGA, previously the American Medical Group Affiliation, which represents well being methods throughout the nation, discovered practically half of rural services might shut or restructure on account of Medicaid cuts. Almost three-quarters of respondents stated they anticipated layoffs or furloughs, together with of front-line clinicians.
Public well being departments, which regularly fill gaps in care, additionally face federal funding cuts which have diminished their capability. In South Texas’ Cameron County, the well being division has eradicated practically a dozen positions, stated company head Esmer Guajardo. In neighboring Hidalgo County, the well being division has laid off greater than 30 folks, stated Ivan Melendez, who helps oversee its operations.
In July, the Texas Division of State Well being Providers canceled Operation Border Well being, a large annual occasion that final yr supplied free well being companies to just about 6,000 South Texas residents.
Gateway Group Well being Heart in Laredo, a border metropolis north of the Rio Grande Valley, is in “survival mode,” with a few third of sufferers already missing insurance coverage and much more who will battle to afford well being care if the ACA subsides aren’t renewed, stated David Vasquez, its director of communications and public affairs. The middle is searching for different types of funding to keep away from layoffs or cuts to companies, and its growth and hiring plans are on maintain, Vasquez stated.
That downsizing is going on as extra folks lose medical health insurance and want free or reduced-cost care.
Esther Rodriguez, 39, of McAllen has been out of labor for 2 years and her husband makes $600 per week working in development. Neither of them has medical health insurance.
Medicaid lined the payments for the births of her 5 youngsters. Now, she relies on a cell well being clinic run by an area medical college, the place she will pay out-of-pocket for routine checkups and medicines to manage her Kind 2 diabetes. If she wanted extra care, Rodriguez stated, she would go to the ER.
“It’s a must to adapt,” she stated in Spanish.
‘Loss of life by a Thousand Cuts’
Individuals’s incapacity to pay ends in uncompensated care, or companies that hospitals, medical doctors, and clinics don’t receives a commission for, which, beneath an earlier model of the megabill, was projected to extend by $204 billion over the following decade, in keeping with the City Institute, a nonprofit suppose tank.
However the Trump administration can be slicing different assist that helped offset the price of take care of individuals who can’t pay. The brand new legislation caps federal packages that many well being suppliers for low-income folks have come to depend upon, particularly in rural areas, to shore up their budgets. These embody taxes on hospitals, well being plans, and different suppliers that states use to assist fund their Medicaid packages. Such supplier taxes are a “monetary gimmick,” Desai stated.
Whereas the legislation creates a short lived $50 billion fund to assist rural medical doctors and hospitals, that’s slightly over a 3rd of estimated Medicaid funding losses in rural areas, in keeping with KFF, a well being data nonprofit that features KFF Well being Information. Desai referred to as the evaluation “flawed.”
Any loss in income might spell monetary smash, particularly for small rural hospitals, stated Quang Ngo, president of the Texas Group of Rural & Group Hospitals Basis.
“It’s sort of like demise by a thousand cuts,” he stated. “Some will in all probability not make it.”
And the hits might preserve coming. The Trump administration’s price range request for the approaching fiscal yr requires cuts to a number of rural well being packages operated by means of the Well being Sources and Providers Administration. Desai stated the spending legislation’s funding in rural well being “dwarfs” the cuts.
In February, the Trump administration introduced funding cuts of 90% to the ACA navigator program, which helps folks discover medical health insurance. That program has been “traditionally inefficient,” Desai stated.
In December 2023, practically 3 million of Texas’ uninsured have been eligible for ACA subsidies, Medicaid, or the Youngsters’s Well being Insurance coverage Program, in keeping with Texas 2036, a public coverage suppose tank.
Maria Salgado spends her workdays tabling at group occasions, dropping off flyers at medical doctors’ places of work, and holding one-on-one conferences with purchasers of MHP Salud, a nonprofit that connects residents to Medicaid and ACA protection.
She anxious funding cuts would actually set the group’s efforts again: “A whole lot of group members right here, they’re going to be left behind,” stated Salgado, a group well being employee, or promotora.
Chris Casso, a main care doctor who grew up in McAllen and now practices there, held again tears as she described treating sufferers who’ve postpone seeing a health care provider due to an incapacity to pay, solely to have their preventable circumstances deteriorate.
She worries about the way forward for her group as doctor shortages worsen, probably leaving few suppliers to deal with uninsured folks.
“It’s heartbreaking,” she stated, sitting in a small again room in her workplace in a suburban strip mall, wedged between a Kohl’s and a Shoe Carnival. “These are hardworking folks,” she stated. “They fight their greatest to handle themselves.”
Casso stated her personal sister, who labored as a medical biller in a doctor’s workplace, couldn’t afford medical health insurance. She delayed care and died at age 45 of problems from diabetes and coronary heart illness. Casso worries the long run will discover extra folks in related conditions.
“Our inhabitants goes to endure,” she stated. “It’s going to be devastating.”
KFF Well being Information is a nationwide newsroom that produces in-depth journalism about well being points and is among the core working packages at KFF—an impartial supply of well being coverage analysis, polling, and journalism. Study extra about KFF.
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