Elizabeth Davilla, relies on a Medicaid check every month to support her family and their health conditions.
The Davilla family gathers around the table for a healthy dinner that fits the dietary needs of some members diagnosed with diabetes. Credit: Scott Ball / San Antonio Report

Texas is the uninsured capital of the United States, with more than 4.5 million Texans – including 623,000 children – lacking health insurance coverage, according to the Henry J. Kaiser Family Foundation.

In his 2019 budget, President Donald Trump proposed slashing funding for public health care, including $554 billion in cuts to Medicare over 10 years, repealing the Affordable Care Act (ACA), and eliminating the health insurance mandate, which required the federal government to pay the difference for those who could not afford minimum coverage.

With 13 percent of the state’s population dependent on Medicare, including more than three million seniors and 573,000 people with disabilities, concerns over potential funding changes have municipalities throughout the state tweaking proposed 2019 budgets to ensure that their most vulnerable residents will have access to health care.

Local health care leaders and government officials have long grappled with how to close the health insurance coverage gap in Bexar County, where more than 240,000 residents are without any type of medical coverage.

CareLink has served as Bexar County’s taxpayer-subsidized health assistance program for 20 years, providing guidance on rules of eligibility for many types of health care programs and services. Since the program began, CareLink has assisted more than 430,000 Bexar County residents who were not eligible for Medicaid or other public or private funding.

“Every year there is uncertainty around [federal health care] program funding changes and we try to find ways to bolster those funds,” said Leni Kirkman, senior vice president for strategic communications and patient relations with University Health System, Bexar County’s taxpayer-supported hospital system that provides medical care to the county’s poorest residents regardless of federal funding. Revenue from property taxes, federal reimbursements, and patient payments account for University Health System’s operating budget of more than $1.5 billion.

Regardless of cuts at the federal level, Kirkman expects that tax revenue from higher property valuations and an expanding tax base spurred by San Antonio’s growth will generate an additional $20 million for the hospital system and lessen the impact locally.

The hospital district’s recommended 2019 tax rate of 27.6235 cents per $100 valuation is projected to yield $457.9 million in revenue.

People who do not have access to affordable insurance through their employers and earn200 percent less than the federal poverty level can access treatment at University Health District clinics and hospitals throughout the city through CareLink, Kirkman said. A family of four would need to be earning no more than $24,600 to qualify.

At its peak in 2010, CareLink had more than 55,000 program enrollees, but it dropped to 25,000 in 2017 due to more people utilizing the ACA.

“As the uncertainty continues over whether the [ACA] will continue, or people weren’t able to maintain eligibility, people began falling through the cracks and we are slowly started to see the CareLink population expand again,” Kirkman said. In 2017, the total cost for caring for CareLink patients was more than $83 million.

Bexar County’s 17 percent uninsured rate was higher than the state average of 16 percent, and higher than the 12 percent national average in 2016, according to U.S. Census Bureau data. Kirkman said the 2018 numbers are likely the same, as people roll on and off of the health insurance rolls.

Texas has long struggled with access to care, Texas Medical Association President Dr. Doug Curran told the Rivard Report on Saturday.  “We have this vast number of people who have no insurance, no ability to pay, and who are considered working poor who end up getting care in the emergency room unless you do something innovative like what is being done in San Antonio,” he said.

Curran runs a program similar to CareLink in the North Central Texas town of Athens, providing primary care services for a $5 fee and partnering with a local hospital to address more serious health concerns and chronic health conditions. He said that the political climate surrounding health care benefits presents “a time for concern” for health care providers in Texas.

“We have got to figure out a way to fix the health care system, because it is the right thing to do for our people,” Curran said. “We have to figure it out. And we have to keep politics out of it.

“The Texas Medical Association wants nothing more than to have really good health care for every Texan, and we will do our best to make that happen,” regardless of federal funding dollars, Curran said.

The Davilla family. Credit: Scott Ball / San Antonio Report

Medicare recipient Elizabeth Davila, 67,  is raising her three grandchildren on a $635 monthly Social Security check, in addition to working part time at a church. One of her grandchildren is on Medicaid after being diagnosed with type 1 diabetes, and Davila has type 2 diabetes.

Davila said she fears what a change in Medicare would mean to her ability to pay for medications.

“I just don’t know how I would survive [if my coverage changes]. I own my house, I pay utilities, but I won’t be able to pay for my medication with what I earn,” she said. With Medicare, medication costs Davila less than $10 a month.

“I don’t know how I will be within the next two-three years because of my condition, and it’s all very expensive,” she said.

Kirkman said that while there is understandable concern, Bexar County residents can remain confident that their health care needs will be afforded through local programs.

“If more people qualified for Medicaid, it would be a huge help, but if providing health care is about someone’s life, of course we are going to save their life when you walk into the emergency room or the doctor’s office,” Kirkman said. “We would love it if there wasn’t a crazy patchwork system of programs to provide funding for these people, but it’s too important, health is too important, for us to not take care of these people.”

Roseanna Garza

Roseanna Garza

Roseanna Garza reports on health and bioscience for the San Antonio Report.