As individuals lose medical insurance, strained care methods worsen : Pictures

RIO GRANDE CITY, Texas — Dr. Jake Margo Jr. stood within the triage room at Starr County Memorial Hospital explaining why an individual with persistent fever who could possibly be handled with over-the-counter treatment did not have to be admitted to the emergency room.

“We’re going to take care of the sickest patients first,” Margo, a household drugs doctor, stated.

It’s not like there was house on that June afternoon anyway. A small monitor on the wall pulsed with the vitals of present sufferers, who stuffed the ER. An ambulance idled exterior within the South Texas warmth with a affected person ready for a mattress to open up.

“Everybody shows up here,” Margo stated. “When you’re overwhelmed and you’re overrun, there’s only so much you can do.”

Trump voters and a brand new Trump legislation

Starr County, a largely rural, Hispanic neighborhood 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 economic system drove the flip on this neighborhood, the place roughly a 3rd of the inhabitants falls under the poverty line.

Now, latest actions by the Trump administration and the GOP-controlled Congress have triggered a brand new concern: the lack of docs, hospitals and different well being suppliers to proceed to take care of uninsured sufferers. It’s a worry 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 individuals may battle as further residents lose well being protection.

About 14 million fewer Americans are anticipated to have medical insurance in a decade on account of President Trump’s new tax-and-spending legislation, which Republicans dubbed the One Big, Beautiful Bill Act, or OBBBA, and the pending expiration of enhanced subsidies that slashed the value of Affordable Care Act plans for hundreds of thousands of individuals. The new legislation additionally limits programs that ship billions of {dollars} to assist those that take care of uninsured individuals keep afloat.

The security web could fail

“You can’t disinsure this many people and not have, in many communities, just a collapse of the health care system,” stated Sara Rosenbaum, founding chair of the Department of Health Policy and Management at George Washington University’s Milken Institute School of Public Health.

“The future is South Texas,” she stated.

KFF Health News is analyzing the impression of nationwide well being care coverage modifications on uninsured individuals and their communities. Though the Trump administration informed KFF Health News it’s making “a historic investment in rural health care,” individuals who deal with low-income sufferers, in addition to researchers and shopper advocates, say latest coverage selections will make it tougher for individuals to remain wholesome. Doctors, hospitals, and clinics that make up the well being care security web may lose a lot cash they have to shut their doorways, a few of them warn.

“Because the patient’s bill is not going to get paid,” stated Dr. Joseph Alpert, editor-in-chief of The American Journal of Medicine and a professor of medication on the University of Arizona. “Uninsured patients stress the health care system.”

Starr County reveals how this dynamic unfolds. Primary care docs within the county serve a median of just under 3,900 people 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 many instances, they’ve uncared for their well being, making them sicker and dearer to deal with. And federal law requires ERs at hospitals within the Medicare program to stabilize or switch sufferers, no matter their skill to pay.

That leaves Margo and his crew to follow what he described as “disaster medicine.”

“They come in with chest pain or they stop breathing. They collapse. They’ve never seen a doctor,” Margo stated. “They’re literally dying.”

Health methods in ‘survival mode’

When persons are uninsured or on Medicaid, they have a tendency to depend on a security web of docs, hospitals, clinics, and neighborhood well being facilities, which supply companies freed from cost or take in getting reimbursed at decrease charges than they do treating sufferers on industrial insurance coverage.

Those 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” has many involved they will not climate the extra monetary pressure.

Trump’s new legislation funds his priorities, like extending tax cuts that primarily profit wealthier Americans and increasing immigration enforcement. Those 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 individuals 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 House, stated projections from the nonpartisan Congressional Budget Office about how many individuals may lose medical insurance are an “overestimate.” He didn’t present an estimate the administration sees as extra correct.

Supporters of OBBBA say those that want well being protection can nonetheless get it in the event that they meet new necessities reminiscent of working in trade for Medicaid protection.

And Michael Cannon, director of well being coverage research on the Cato Institute, a libertarian assume tank, stated even with the laws, Medicaid spending will develop, simply not as rapidly.

The funds legislation will not trigger “the sky to fall,” Cannon stated. “The inefficient providers should be shutting down.”

Layoffs beginning, extra anticipated

A recent survey from AMGA, previously the American Medical Group Association, which represents well being methods throughout the nation, discovered practically half of rural amenities may shut or restructure on account of Medicaid cuts. Nearly 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 lowered 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 individuals, stated Dr. Ivan Melendez, who helps oversee its operations.

In July, the Texas Department of State Health Services canceled Operation Border Health, an enormous annual occasion that final 12 months offered free well being companies to almost 6,000 South Texas residents.

Gateway Community Health Center 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 heart is in search of 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 occurring as extra individuals lose medical 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 every week working in development. Neither of them has medical insurance.

Medicaid lined the payments for the births of her 5 kids. Now, she will depend on a cellular well being clinic run by a neighborhood medical faculty, the place she will be able to pay out-of-pocket for routine checkups and medicines to manage her Type 2 diabetes. If she wanted extra care, Rodriguez stated, she would go to the ER.

“You have to adapt,” she stated in Spanish.

“Death by a thousand cuts”

People’s lack of ability to pay ends in uncompensated care, or companies that hospitals, docs, and clinics do not receives a commission for, which, beneath an earlier model of the megabill, was projected to extend by $204 billion over the following decade, according to the Urban Institute, a nonprofit assume tank.

But the Trump administration can also be slicing different help that helped offset the price of take care of individuals who cannot pay. The new legislation caps federal programs that many well being suppliers for low-income individuals have come to depend upon, particularly in rural areas, to shore up their budgets. These include taxes on hospitals, well being plans, and different suppliers that states use to assist fund their Medicaid applications. Such supplier taxes are a “financial gimmick,” Desai stated.

While the legislation creates a brief $50 billion fund to help rural docs and hospitals, that is somewhat over a 3rd of estimated Medicaid funding losses in rural areas, according to KFF, a well being data nonprofit that features KFF Health News. Desai known as the evaluation “flawed.”

Any loss in income may spell monetary damage, particularly for small rural hospitals, stated Quang Ngo, president of the Texas Organization of Rural & Community Hospitals Foundation.

“It’s kind of like death by a thousand cuts,” he stated. “Some will probably not make it.”

Additional cuts to rural well being

And extra cuts may hold coming. The Trump administration’s funds request for the approaching fiscal 12 months requires cuts to a number of rural well being applications operated by the Health Resources and Services 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 individuals discover medical insurance. That program has been “historically inefficient,” Desai stated.

In December 2023, practically 3 million of Texas’ uninsured have been eligible for ACA subsidies, Medicaid, or the Children’s Health Insurance Program, according to Texas 2036, a public coverage assume tank.

Maria Salgado spends her workdays tabling at neighborhood occasions, dropping off flyers at docs’ workplaces, and holding one-on-one conferences with shoppers of MHP Salud, a nonprofit that connects residents to Medicaid and ACA protection.

She nervous funding cuts would actually set the group’s efforts again: “A lot of community members here, they’re going to be left behind,” stated Salgado, a neighborhood well being employee, or promotora.

Dr. 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 physician due to an lack of ability to pay, solely to have their preventable circumstances deteriorate.
She worries about the way forward for her neighborhood as physician shortages worsen, doubtlessly leaving few suppliers to deal with uninsured individuals.

“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 people,” she stated. “They try their best to take care of themselves.”

Casso stated her personal sister, who labored as a medical biller in a doctor’s workplace, could not afford medical insurance. She delayed care and died at age 45 of problems from diabetes and coronary heart illness. Casso worries the longer term will discover extra individuals in related conditions.
“Our population is going to suffer,” she stated. “It’s going to be devastating.”

KFF Health News is a nationwide newsroom that produces in-depth journalism about well being points and is among the core working applications at KFF .